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Ananth P, Lindsay M, Mun S, McCollum S, Shabanova V, de Oliveira S, Pitafi S, Kirch R, Ma X, Gross CP, Boyden JY, Feudtner C, Wolfe J. Parent Priorities in End-of-Life Care for Children With Cancer. JAMA Netw Open 2023; 6:e2313503. [PMID: 37184834 PMCID: PMC10878399 DOI: 10.1001/jamanetworkopen.2023.13503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Importance Robust quality measures to benchmark end-of-life care for children with cancer do not currently exist; 28 candidate patient-centered quality measures were previously developed. Objective To prioritize quality measures among parents who lost a child to cancer. Design, Setting, and Participants This survey study was conducted using an electronic, cross-sectional discrete choice experiment (DCE) with maximum difference scaling from January to June 2021 in the US. In each of 21 questions in the DCE, participants were presented with a set of 4 quality measures and were asked to select the most and least important measures within each set. All 28 quality measures were presented an equal number of times in different permutations. In the volunteer sample, 69 eligible bereaved parents enrolled in the study; 61 parents completed the DCE (participation rate, 88.4%). Main Outcomes and Measures Using choices participants made, a hierarchical bayesian multinomial logistic regression was fit to derive mean importance scores with 95% credible intervals (95% Crs) for each quality measure, representing the overall probability of a quality measure being selected as most important. Importance scores were rescaled proportionally from 0 to 100, with the sum of scores for all quality measures adding up to 100. This enabled interpretation of scores as the relative importance of quality measures. Results Participants included 61 bereaved parents (median [range] age, 48 [24-74] years; 55 individuals self-identified as women [90.2%]; 1 American Indian or Alaska Native [1.6%], 1 Asian [1.6%], 2 Black or African American [3.3%], 1 Native Hawaiian or Pacific Islander, and 58 White [91.8%]; 58 not Hispanic or Latinx [95.1%]). Highest-priority quality measures by mean importance score included having a child's symptoms treated well (9.25 [95% Cr, 9.06-9.45]), feeling that a child's needs were heard by the health care team (8.39 [95% Cr, 8.05-8.73]), and having a goal-concordant end-of-life experience (7.45 [95% Cr, 6.84-8.05]). Lowest-priority quality measures included avoiding chemotherapy (0.33 [95% Cr, 0.21-0.45]), provision of psychosocial support for parents (1.01 [95% Cr, 0.57-1.45]), and avoiding the intensive care unit (1.09 [95% Cr, 0.74-1.43]). Rank-ordering measures by mean importance revealed that symptom management was 9 times more important to parents than psychosocial support for themselves. Conclusions and Relevance This study found that bereaved parents prioritized end-of-life quality measures focused on symptom management and goal-concordant care while characterizing quality measures assessing their own psychosocial support and their child's hospital resource use as substantially less important. These findings suggest that future research should explore innovative strategies to measure care attributes that matter most to families of children with advanced cancer.
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Affiliation(s)
- Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, Connecticut
| | - Meghan Lindsay
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, Connecticut
| | - Sophia Mun
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Sarah McCollum
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Sarah Pitafi
- University College London, London, United Kingdom
| | - Rebecca Kirch
- National Patient Advocate Foundation, Washington, District of Columbia
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Cary P Gross
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jackelyn Y Boyden
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia
- Justin Michael Ingerman Center for Palliative Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Justin Michael Ingerman Center for Palliative Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Departments of Pediatrics, Medical Ethics, and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Joanne Wolfe
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston
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Pettit SD, Kirch R. Do current approaches to assessing therapy related adverse events align with the needs of long-term cancer patients and survivors? Cardiooncology 2018; 4:5. [PMID: 32154005 PMCID: PMC7048033 DOI: 10.1186/s40959-018-0031-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/30/2018] [Indexed: 01/29/2023]
Abstract
The increasing efficacy of cancer therapeutics means that the timespan of cancer therapy administration is undergoing a transition to increasingly long-term settings. Unfortunately, chronic therapy-related adverse health events are an unintended, but not infrequent, outcome of these life-saving therapies. Historically, the cardio-oncology field has evolved as retrospective effort to understand the scope, mechanisms, and impact of treatment-related toxicities that were already impacting patients. This review explores whether current systemic approaches to detecting, reporting, tracking, and communicating AEs are better positioned to provide more proactive or concurrent information to mitigate the impact of AE's on patient health and quality of life. Because the existing tools and frameworks for capturing these effects are not specific to cardiology, this study looks broadly at the landscape of approaches and assumptions. This review finds evidence of increasing focus on the provision of actionable information to support long-term health and quality of life for survivors and those on chronic therapy. However, the current means to assess and support the impact of this burden on patients and the healthcare system are often of limited relevance for an increasingly long-lived survivor and patient population.
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Affiliation(s)
- Syril D. Pettit
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
- Health and Environmental Sciences Institute, Washington DC, USA
| | - Rebecca Kirch
- National Patient Advocate Foundation, Washington DC, USA
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Kirch R, Reaman G, Feudtner C, Wiener L, Schwartz LA, Sung L, Wolfe J. Advancing a comprehensive cancer care agenda for children and their families: Institute of Medicine Workshop highlights and next steps. CA Cancer J Clin 2016; 66:398-407. [PMID: 27145249 DOI: 10.3322/caac.21347] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 03/29/2016] [Accepted: 03/31/2016] [Indexed: 12/20/2022] Open
Abstract
This article highlights key findings from the "Comprehensive Cancer Care for Children and Their Families" March 2015 joint workshop by the Institute of Medicine (IOM) and the American Cancer Society. This initiative convened more than 100 family members, clinician investigators, advocates, and members of the public to discuss emerging evidence and care models and to determine the next steps for optimizing quality-of-life outcomes and well-being for children and families during pediatric cancer treatment, after treatment completion, and across the life spectrum. Participants affirmed the triple aim of pediatric oncology that strives for every child with cancer to be cured; provides high-quality palliative and psychosocial supportive, restorative, and rehabilitative care to children and families throughout the illness course and survivorship; and assures receipt of high-quality end-of-life care for patients with advancing disease. Workshop outcomes emphasized the need for new pediatric cancer drug development and identified critical opportunities to prioritize palliative care and psychosocial support as an integral part of pediatric cancer research and treatment, including the necessity for adequately resourcing these supportive services to minimize suffering and distress, effectively address quality-of-life needs for children and families at all stages of illness, and mitigate the long-term health risks associated with childhood cancer and its treatment. Next steps include dismantling existing silos and enhancing collaboration between clinical investigators, disease-directed specialists, and supportive care services; expanding the use of patient-reported and parent-reported outcomes; effectively integrating palliative and psychosocial care; and clinical communication skills development. CA Cancer J Clin 2016;66:398-407. © 2016 American Cancer Society.
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Affiliation(s)
- Rebecca Kirch
- Consultant, The Center to Advance Palliative Care, New York, NY
- Consultant, Cameron and Hayden Lord Foundation, New York, NY
| | - Gregory Reaman
- Associate Director, Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Chris Feudtner
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Lori Wiener
- Behavioral Health Core, and Head of the Psychosocial Support and Research Program, National Cancer Institute, Bethesda, MD
| | - Lisa A Schwartz
- Psychologist, Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
- Assistant Professor, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Lillian Sung
- Pediatric Oncologist, Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joanne Wolfe
- Pediatric Palliative Care Service, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Director, Pediatric Palliative Care, Boston Children's Hospital, Boston, MA
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Twillman RK, Kirch R, Gilson A. Efforts to control prescription drug abuse: Why clinicians should be concerned and take action as essential advocates for rational policy. CA Cancer J Clin 2014; 64:369-76. [PMID: 25044063 DOI: 10.3322/caac.21243] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 06/18/2014] [Indexed: 11/18/2022] Open
Affiliation(s)
- Robert K Twillman
- Deputy Executive Director, Director of Policy and Advocacy, American Academy of Pain Management, Clinical Associate Professor, Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Kansas City, KS
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McCorkle R, Kirch R, Thiboldeaux K, Taylor J, Gorman M. TheAlliance for Quality Psychosocial Cancer Care: an innovative model for disseminating and improving implementation of national quality care recommendations. J Natl Compr Canc Netw 2014; 12:947-51. [PMID: 24925203 DOI: 10.6004/jnccn.2014.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, Cooper D, Gansler T, Lerro C, Fedewa S, Lin C, Leach C, Cannady RS, Cho H, Scoppa S, Hachey M, Kirch R, Jemal A, Ward E. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 2012; 62:220-41. [PMID: 22700443 DOI: 10.3322/caac.21149] [Citation(s) in RCA: 2026] [Impact Index Per Article: 168.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although there has been considerable progress in reducing cancer incidence in the United States, the number of cancer survivors continues to increase due to the aging and growth of the population and improvements in survival rates. As a result, it is increasingly important to understand the unique medical and psychosocial needs of survivors and be aware of resources that can assist patients, caregivers, and health care providers in navigating the various phases of cancer survivorship. To highlight the challenges and opportunities to serve these survivors, the American Cancer Society and the National Cancer Institute estimated the prevalence of cancer survivors on January 1, 2012 and January 1, 2022, by cancer site. Data from Surveillance, Epidemiology, and End Results (SEER) registries were used to describe median age and stage at diagnosis and survival; data from the National Cancer Data Base and the SEER-Medicare Database were used to describe patterns of cancer treatment. An estimated 13.7 million Americans with a history of cancer were alive on January 1, 2012, and by January 1, 2022, that number will increase to nearly 18 million. The 3 most prevalent cancers among males are prostate (43%), colorectal (9%), and melanoma of the skin (7%), and those among females are breast (41%), uterine corpus (8%), and colorectal (8%). This article summarizes common cancer treatments, survival rates, and posttreatment concerns and introduces the new National Cancer Survivorship Resource Center, which has engaged more than 100 volunteer survivorship experts nationwide to develop tools for cancer survivors, caregivers, health care professionals, advocates, and policy makers.
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Affiliation(s)
- Rebecca Siegel
- Surveillance Information, Surveillance Research, American Cancer Society, Atlanta, GA 30303, USA.
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Yates JW, Kirch R. Regulatory barriers for adequate pain control. Asian Pac J Cancer Prev 2010; 11 Suppl 1:17-21. [PMID: 20590343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
In 1961 the "Single Convention on Narcotic Drugs" was adopted by the United Nations to explicitly address the need for narcotic drugs to curtail suffering and keep the distribution of these drugs in the control of health professionals. Fifty years later, neither goal has been reached for a variety of reasons. Governments have avoided putting in place systems to assure adequate supplies to relieve the suffering of those with severe pain, drug enforcement agencies maintain restrictive regulations and physicians are intimidated by threats of legal action if their prescribing patterns do not conform to arbitrary standards. There is a shortage of pain control consultants and the training for most health care providers is deficient when it comes to the management of chronic pain. Some of the regulatory barriers have been successfully addressed through advocacy efforts and the expertise deficiencies improved through targeted educational programs.
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Mikelsaar M, Türi M, Lencner H, Kolts K, Kirch R, Lencner A. Interrelations between mucosal and luminal microflora of gastrointestine. Nahrung 1987; 31:449-56, 637-8. [PMID: 3657920 DOI: 10.1002/food.19870310533] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The quantitative relations of various groups of microbes, the biological properties of lactobacilli in the luminal and mucosal microfloras of the gastrointestine of rats after having received kanamycin and after starvation, of conventional and germfree mice after irradiation and of piglets of different ages were compared. It was revealed that there exists a positive correlation between the mucosal and the lumenal microfloras which remains considerably stable under different conditions. Nevertheless, in case of irradiation or starvation influencing the gastrointestine microflora, the mucosal microflora gets more changed and the translocation of microbes through the mucosa into blood circulation takes place. The mucosal lactoflora of piglets is formed during the first (1-5) days of life on account of microbes with well-expressed antagonistic activity and lysozyme resistance.
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Affiliation(s)
- M Mikelsaar
- Tartu State University, Institute of General and Molecular Pathology, USSR
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Abstract
On the assumption that both the lobular and intraductal atypical lesions of the breast are precancerous in nature, a group of 572 such patients have been closely followed during the past 12 years. Thirty-four patients eventually developed cancer during this period. The cumulative incidence of breast cancer was 7.74% at 10 years in the group of patients with atypical lesions only and 16.15% at 10 years in the patients with atypical lesions in one breast and cancer in the contralateral breast. The transformation of this probable precancerous state into cancer apparently takes a long interval of time.
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Kirch R. Ein Beitrag zur Kasuistik der akuten Strychninvergiftung. Dtsch Med Wochenschr 1902. [DOI: 10.1055/s-0029-1203370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kirch R. Ein Fall von acuter Magendilatation mit tödtlichem Ausgang. Dtsch Med Wochenschr 1899. [DOI: 10.1055/s-0029-1200423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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