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Bach Y, Panov E, Espin‐Garcia O, Chen E, Krzyzanowska M, O'Kane G, Moore M, Prince RM, Knox J, Grant R, Ma LX, Allen MJ, Eng L, Kosyachkova E, Megid TBC, Barron C, Wang X, Saltiel M, Farooq ARR, Jang RW, Elimova E. First impressions: A prospective evaluation of patient-physician concordance and satisfaction following the initial medical oncology consultation. Cancer Med 2023; 12:22293-22303. [PMID: 38063318 PMCID: PMC10757128 DOI: 10.1002/cam4.6758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/14/2023] [Accepted: 09/30/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND An especially significant event in the patient-oncologist relationship is the initial consultation, where many complex topics-diagnosis, treatment intent, and often, prognosis-are discussed in a relatively short period of time. This study aimed to measure patients' understanding of the information discussed during their first medical oncology visit and their satisfaction with the communication from medical oncologists. METHODS Between January and August 2021, patients without prior systemic treatment of their gastrointestinal malignancy (GI) attending the Princess Margaret Cancer Centre (PMCC) were approached within 24 h of their initial consultation to complete a paper-based questionnaire assessing understanding of their disease (diagnosis, treatment plan/intent, and prognosis) and satisfaction with the consultation. Medical oncology physicians simultaneously completed a similar questionnaire about the information discussed at the initial visit. Matched patient-physician responses were compared to assess the degree of concordance. RESULTS A total of 184 matched patient-physician surveys were completed. The concordance rates for understanding of diagnosis, treatment plan, treatment intent, and prognosis were 92.9%, 59.2%, 66.8%, and 59.8%, respectively. After adjusting for patient and physician variables, patients who reported treatment intent to be unclear at the time of the consultation were independently associated with lower satisfaction scores (global p = 0.014). There was no statistically significant association between patient satisfaction and whether prognosis was disclosed (p = 0.08). CONCLUSION An in-depth conversation as to what treatment intent and prognosis means is reasonable during the initial medical oncology consultation to ensure patients and caregivers have a better understanding about their cancer.
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Affiliation(s)
- Yvonne Bach
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | - Elan Panov
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | | | - Eric Chen
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | | | | | | | | | | | - Robert Grant
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | - Lucy X. Ma
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | | | - Lawson Eng
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | | | | | - Carly Barron
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | - Xin Wang
- Princess Margaret Cancer CentreTorontoOntarioCanada
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Ribeiro T, Mahar A, Jerath A, Bondzi-Simpson A, Barabash V, Barr AA, Wright FC, Kosyachkova E, Deleemans J, Coburn NG, Hallet J. Novel patient-centred outcome in cancer care, days at home: a scoping review protocol. BMJ Open 2023; 13:e071201. [PMID: 36931670 PMCID: PMC10030791 DOI: 10.1136/bmjopen-2022-071201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION Patient-centred care is valued by patients and providers. As management of cancer becomes increasingly complex, the value of providing care that incorporates an individual's values and preferences along with demographic and tumour factors is increasingly important. To improve care, patients with cancer need easily accessible information on the outcomes important to them. The patient-centred outcome, days at home (DAH), is based on a construct that measures the time a patient spends alive and out of hospitals and healthcare institutions. DAH is accurately measured from various data sources and has shown construct validity with many patient-centred outcomes. There is significant heterogeneity in terms used and definitions for DAH in cancer care. This scoping review aims to consolidate information on the outcome DAH in cancer care and to review definitions and terms used to date to guide future use of DAH as a patient-centred care, research and policy tool. METHODS AND ANALYSIS This scoping review protocol has been designed with joint guidance from the JBI Manual for Evidence Synthesis and the expanded framework from Arksey and O'Malley. We will systematically search MEDLINE, Embase and Scopus for studies measuring DAH, or equivalent, in the context of active adult cancer care. Broad inclusion criteria have been developed, given the recent introduction of DAH into cancer literature. Editorials, opinion pieces, case reports, abstracts, dissertations, protocols, reviews, narrative studies and grey literature will be excluded. Two authors will independently perform full-text selection. Data will be extracted, charted and summarised both qualitatively and quantitively. ETHICS AND DISSEMINATION No ethics approval is required for this scoping review. Results will be disseminated through scientific publication and presentation at relevant conferences.
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Affiliation(s)
- Tiago Ribeiro
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Alyson Mahar
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Angela Jerath
- Institute of Health Policy Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Adom Bondzi-Simpson
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Victoria Barabash
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Austin A Barr
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Frances C Wright
- Institute of Health Policy Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario, Canada
| | | | - Julie Deleemans
- Department of Oncology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Natalie G Coburn
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario, Canada
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Yang J, Barabash T, Rajendran L, Mahar AL, Hsu AT, James PD, Gotlib Conn L, Wright FC, Ludwig C, Kosyachkova E, Deleemans J, Coburn NG, Hallet J. Patient-centered outcomes for gastrointestinal cancer care: a scoping review protocol. BMJ Open 2022; 12:e061309. [PMID: 35701055 PMCID: PMC9198790 DOI: 10.1136/bmjopen-2022-061309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Following a cancer diagnosis, patients and their caregivers face crucial decisions regarding goals of care and treatment, which have consequences that can persist throughout their cancer journey. To foster informed and value-driven treatment choices, evidence-based information on outcomes relevant to patients is needed. Traditionally, clinical studies have largely focused on a few concrete and easily measurable outcomes such as survival, disease progression and immediate treatment toxicities. These outcomes do not capture other important factors that patients consider when making treatment decisions. Patient-centred outcomes (PCOs) reflect the patients' individual values, preferences, needs and circumstances that are essential to directing meaningful and informed healthcare discussions. Often, however, these outcomes are not included in research protocols in a standardised and practical fashion. This scoping review will summarise the existing literature on PCOs in gastrointestinal (GI) cancer care as well as the tools used to assess these outcomes. A comprehensive list of these PCOs will be generated for future efforts to develop a core outcome set. METHODS AND ANALYSIS This scoping review will follow Arksey and O'Malley's expanded framework for scoping reviews. We will systematically search Medline, Embase, CINAHL, Cochrane Library and APA PsycINFO databases for studies examining PCOs in the context of GI cancer. We will include studies published in or after the year 2000 up to the date of the final searches, with no language restrictions. Studies involving adult patients with GI cancers and discussion of any PCOs will be included. Opinion pieces, protocols, case reports and abstracts will be excluded. Two authors will independently perform two rounds of screening to select studies for inclusion. The data from full texts will be extracted, charted and summarised both quantitatively and qualitatively. ETHICS AND DISSEMINATION No ethics approval is required for this scoping review. Results will be disseminated through scientific publication and presentation at relevant conferences.
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Affiliation(s)
- Joanna Yang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tori Barabash
- Cancer Program, Sunnybrook Research Institute, Evaluative Clinical Sciences Platform, Toronto, Ontario, Canada
| | - Luckshi Rajendran
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alyson L Mahar
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy T Hsu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Paul D James
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Lesley Gotlib Conn
- Tory Trauma Research Program, Sunnybrook Research Institute Evaluative Clinical Sciences Platform, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Frances C Wright
- Cancer Program, Sunnybrook Research Institute, Evaluative Clinical Sciences Platform, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Claire Ludwig
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Julie Deleemans
- Division of Psychosocial Oncology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Natalie G Coburn
- Cancer Program, Sunnybrook Research Institute, Evaluative Clinical Sciences Platform, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Cancer Program, Sunnybrook Research Institute, Evaluative Clinical Sciences Platform, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
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