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van de Weerd C, Geurts SME, Vercoulen RJMT, van Veggel IHF, Brands MT, Marres HAM, Hermens RPMG, van Tol-Geerdink JJ, Kaanders JHAM, Takes RP. Value of routine follow-up for recurrence detection after treatment with curative intent for laryngeal squamous cell carcinoma. Eur J Surg Oncol 2024; 50:107304. [PMID: 38043360 DOI: 10.1016/j.ejso.2023.107304] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/30/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION The benefits of routine follow-up after treatment of primary laryngeal squamous cell carcinoma (LSCC) remain disputed. Guidelines worldwide are consensus-based, and evidence for specific subgroups is lacking. This study evaluates routine LSCC follow-up including flexible endoscopy for detecting locoregional recurrence (LRR). METHODS A retrospective cohort of 413 LSCC patients treated between 2006 and 2012 was analysed. The cumulative risk of LRR was calculated. Routine follow-up was evaluated by follow-up visit (routine or interval) at which LRR was detected, LRR treatment intent, and overall survival (OS). Analyses were stratified by early (I-II) and advanced (III-IV) TNM-stage. RESULTS There were 263 (64 %) patients with early-stage and 132 (32 %) patients with advanced-stage LSCC. One-, two- and five-year cumulative risks for LRR after early-stage LSCC were 8 %, 18 %, and 26 %. For advanced-stage LSCC, cumulative risks of LRR were 20 %, 30 %, and 35 %. Of all 69 LRRs after early-stage LSCC, 72 % were routine-detected, 81 % were symptomatic, and 90 % received curative-intent treatment. Of all 45 LRRs following advanced-stage LSCC, 42 % were routine-detected, 84 % were symptomatic, and 62 % received curative-intent treatment. Five-year OS of early-stage LSCC with routine-detected LRR was 70 %, and 72 % for interval-detection (log-rank-p = 0.91). Five-year OS of advanced-stage LSCC with routine-detected LRR was 37 %, and 18 % for interval-detection (log-rank-p = 0.06). CONCLUSIONS Routine follow-up for detecting asymptomatic recurrences seems redundant for early-stage LSCC. After advanced-stage LSCC, no asymptomatic recurrences were detected beyond one year posttreatment despite regular follow-up. Emphasis should be on other follow-up aspects, such as psychosocial support, especially after one year posttreatment.
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Affiliation(s)
- Cecile van de Weerd
- Radboud University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands.
| | - Sandra M E Geurts
- Maastricht University Medical Center, Department of Medical Oncology, GROW School for Oncology and Reproduction, Maastricht, the Netherlands
| | - Richard J M T Vercoulen
- Radboud University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands
| | - Inge H F van Veggel
- Radboud University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands
| | - Maria T Brands
- Hospital Network Antwerp, Middelheim Medical Center, Department of Oral and Maxillofacial Surgery, Antwerp, Belgium
| | - Henri A M Marres
- Radboud University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- Radboud University Medical Center, Department of IQ Healthcare, Nijmegen, the Netherlands
| | | | - Johannes H A M Kaanders
- Radboud University Medical Center, Department of Radiation Oncology, Nijmegen, the Netherlands
| | - Robert P Takes
- Radboud University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands
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Deuning-Smit E, Custers JAE, Braam CIW, Hermens RPMG, Prins JB. Toward implementation of an evidence-based intervention for fear of cancer recurrence: Feasibility in real-world psycho-oncology practice. Psychooncology 2024; 33:e6297. [PMID: 38282226 DOI: 10.1002/pon.6297] [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: 09/27/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Few evidence-based interventions addressing high levels of fear of cancer recurrence (FCR) have been implemented. Understanding how these might be implemented is crucial to bridge the research-practice gap. This study investigated the feasibility of implementing the blended Survivors' Worries of Recurrent Disease (SWORD) intervention in real-world psycho-oncology practice. METHODS SWORD was offered for 15 months (2021-2022) as the standard care for clinical FCR in a university hospital, a general hospital, and psycho-oncological center. We evaluated using a mixed-methods design six feasibility outcomes based on Bowen's framework: demand, limited effectiveness, degree of execution, acceptability, practicality, and integration. Anonymous data were collected for all oncology patients on referral. Study participants completed questionnaires before and after treatment, including the Cancer Worry Scale (CWS-6) as the primary measure of effectiveness. Qualitative data included interviews with patients and psychologists, and field notes. RESULTS Regarding demand, 81 of 644 patients referred (13%) were eligible for SWORD. The uptake of SWORD was 79% (n = 63/80) and the completion rate 73% (n = 46/63). SWORD was effective in reducing FCR (p < 0.001, ηp2 = 0.694). Regarding execution, a variability in the length, planning and number of treatment sessions was found between different settings. Adherence to the treatment manual's content was high (89%). Regarding acceptability, most patients were satisfied with SWORD (average 8.2/10) and psychologists valued the blended format. Psychologists reported SWORD was practical to deliver given their knowledge and skills. Although differences between settings were found, SWORD integrated well into practice. Referral for FCR and a reluctance to contract new eHealth providers were barriers for implementation. CONCLUSIONS Despite differences between healthcare settings, the implementation of SWORD was evaluated well. The feasibility of SWORD in different settings should inform a national implementation strategy.
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Affiliation(s)
- Esther Deuning-Smit
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José A E Custers
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cheyenne I W Braam
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Department of IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
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Westerdijk K, Steeghs N, Tacke CSJ, van der Graaf WTA, van Erp NP, van Oortmerssen G, Hermens RPMG, Desar IME. Therapeutic drug monitoring to personalize dosing of imatinib, sunitinib, and pazopanib: A mixed methods study on barriers and facilitators. Cancer Med 2023; 12:21041-21056. [PMID: 37902257 PMCID: PMC10709747 DOI: 10.1002/cam4.6663] [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: 03/28/2023] [Revised: 08/20/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Personalized dosing based on measurement of individual drug levels and adjusting the dose accordingly can improve efficacy and decrease unnecessary toxicity of oncological treatment. For imatinib, sunitinib, and pazopanib, this therapeutic drug monitoring (TDM)-guided dosing is, however, not routinely used, despite accumulating evidence favoring individualized dosing. Therefore, we aimed to identify and quantify (potential) barriers and facilitators in TDM-guided dosing for imatinib, sunitinib, and pazopanib. METHODS We performed a mixed methods study among all stakeholders involved: patients, healthcare professionals (HCPs), pharmaceutical companies, and health insurance companies. During the first qualitative part of this study, we performed semi-structured individual interviews and one focus group interview to identify all (potential) barriers and facilitators, and during the second quantitative part of this study, we used a web-based survey to quantify these findings. The interviews addressed the six domains of the implementation of change model of Grol and Wensing: (1) the innovation itself; (2) the HCP; (3) the patient; (4) social context; (5) organizational context; and (6) finances, law, and governance. RESULTS In the qualitative study, we interviewed 20 patients, 18 HCPs and 10 representatives of pharmaceutical and health insurance companies and identified 72 barriers and 90 facilitators. In the quantitative study, the survey was responded by 66 HCPs and 58 patients. Important barriers were on the domain of the HCP, such as a lack of experience with TDM (36.4%), on the domain of the patient, such as lack of awareness of TDM (39.7%), and the processing time for measurement and interpretation of the TDM result (40.9%) (organizational domain). Important facilitators were education of HCPs (95.5%), education of patients (87.9%) and facilitating an overview of when and where TDM measurements are being performed (86.4%). CONCLUSION We identified and quantified important barriers and facilitators for the implementation of TDM-guided dosing for imatinib, sunitinib, and pazopanib. Based on our results, the implementation strategy should mainly focus on educating both HCPs and patients and on the organizational aspect of TDM.
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Affiliation(s)
- Kim Westerdijk
- Department of Medical OncologyResearch Institute for Medical Innovation, Radboud University Medical CenterNijmegenThe Netherlands
| | - Neeltje Steeghs
- Department of Medical OncologyNetherlands Cancer Institute, Antoni van LeeuwenhoekAmsterdamThe Netherlands
| | - Casper S. J. Tacke
- Department of Medical OncologyResearch Institute for Medical Innovation, Radboud University Medical CenterNijmegenThe Netherlands
| | - Winette T. A. van der Graaf
- Department of Medical OncologyNetherlands Cancer Institute, Antoni van LeeuwenhoekAmsterdamThe Netherlands
- Department of Medical OncologyErasmus MC Cancer Institute, Erasmus Medical Center RotterdamRotterdamThe Netherlands
| | - Nielka P. van Erp
- Department of PharmacyResearch Institute for Medical Innovation, Radboud University Medical CenterNijmegenThe Netherlands
| | | | | | - Ingrid M. E. Desar
- Department of Medical OncologyResearch Institute for Medical Innovation, Radboud University Medical CenterNijmegenThe Netherlands
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Smit Y, Metsemakers SJJPM, Janssen JJWM, Posthuma EFM, Walraven I, Hermens RPMG, Blijlevens NMA. Measuring chronic myeloid leukaemia TKI-related toxic effects in the real world: a systematic review and critical assessment of content validity of patient-reported outcome measures. Lancet Haematol 2023; 10:e849-e859. [PMID: 37604177 DOI: 10.1016/s2352-3026(23)00173-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 08/23/2023]
Abstract
Insight into real-world treatment-related toxic effects reported by patients has the potential to improve care, benchmark trials, and fill knowledge gaps, especially in patients with chronic myeloid leukaemia, which is treated in the majority of patients continually with tyrosine-kinase inhibitors (TKIs). The aim of our systematic review was to investigate the content validity of instruments that elicit TKI-related toxic effects reported by patients with chronic myeloid leukaemia in the real world. We searched PubMed and Embase from Jan 1, 2017 to Oct 21, 2022. Studies on instruments used in or developed for patients with chronic myeloid leukaemia that assess a patient's symptoms were eligible. Content validity was assessed according to the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN): none of the six identified instruments were rated as sufficient. Five instruments (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire for chronic myeloid leukaemia with 24 items [EORTC QLQ-CML24], EORTC symptom set, Functional Assessment of Cancer Therapy-Leukaemia [FACT-LEU], haematological malignancies patient-reported outcomes [HM-PRO], and MD Anderson Symptom Inventory for chronic myeloid leukaemia [MDASI-CML]) were rated as inconsistent due to not being evaluated by professionals post-development, having very few patients with chronic myeloid leukaemia involved, or missing key symptoms. Moderate-quality to very low-quality evidence underpinned these ratings. The two EORTC instruments were the only ones not to miss key toxic effects (eg, muscle cramps). However, their relevance was rated as inconsistent: the QLQ-CML24 includes questions on health-related quality-of-life, whereas the symptom set includes items sourced from solid cancer treatments. This Review shows the need for an instrument with sufficient content validity to measure toxic effects from TKI treatment in patients with chronic myeloid leukaemia. Until then, stakeholders can make an informed choice from currently used instruments with our assessment.
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Affiliation(s)
- Yolba Smit
- Department of Haematology, Radboud University Medical Center, Nijmegen, Netherlands.
| | | | - Jeroen J W M Janssen
- Department of Haematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eduardus F M Posthuma
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, Netherlands; Department of Haematology, Leiden University Medical Center, Leiden, Netherlands
| | - Iris Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
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Verweij L, Metsemakers SJJPM, Ector GICG, Rademaker P, Bekker CL, van Vlijmen B, van der Reijden BA, Blijlevens NMA, Hermens RPMG. Improvement, Implementation, and Evaluation of the CMyLife Digital Care Platform: Participatory Action Research Approach. J Med Internet Res 2023; 25:e45259. [PMID: 37713242 PMCID: PMC10541637 DOI: 10.2196/45259] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/16/2023] [Accepted: 07/21/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The evaluation of a continuously evolving eHealth tool in terms of improvement and implementation in daily practice is unclear. The CMyLife digital care platform provides patient-centered care by empowering patients with chronic myeloid leukemia, with a focus on making medication compliance insightful, discussable, and optimal, and achieving optimal control of the biomarker BCR-ABL1. OBJECTIVE The aim of this study was to investigate to what extent the participatory action research approach is suitable for the improvement and scientific evaluation of eHealth innovations in daily clinical practice (measured by user experiences) combined with the promotion of patient empowerment. METHODS The study used iterative cycles of planning, action, and reflection, whereby participants' experiences (patients, health care providers, the CMyLife team, and app suppliers) with the platform determined next actions. Co-design workshops were the foundation of this cyclic process. Moreover, patients filled in 2 sets of questionnaires for assessing experiences with CMyLife, the actual use of the platform, and the influence of the platform after 3 and at least 6 months. Data collected during the workshops were analyzed using content analysis, which is often used for making a practical guide to action. Descriptive statistics were used to characterize the study population in terms of information related to chronic myeloid leukemia and sociodemographics, and to describe experiences with the CMyLife digital care platform and the actual use of this platform. RESULTS The co-design workshops provided insights that contributed to the improvement, implementation, and evaluation of CMyLife and empowered patients with chronic myeloid leukemia (for example, simplification of language, and improvement of the user friendliness of functionalities). The results of the questionnaires indicated that (1) the platform improved information provision on chronic myeloid leukemia in 67% (33/49) of patients, (2) the use of the medication app improved medication compliance in 42% (16/38) of patients, (3) the use of the guideline app improved guideline adherence in 44% (11/25) of patients, and (4) the use of the platform caused patients to feel more empowered. CONCLUSIONS A participatory action research approach is suited to scientifically evaluate digital care platforms in daily clinical practice in terms of improvement, implementation, and patient empowerment. Systematic iterative evaluation of users' needs and wishes is needed to keep care centered on patients and keep the innovation up-to-date and valuable for users.
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Affiliation(s)
- Lynn Verweij
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Peter Rademaker
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bas van Vlijmen
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bert A van der Reijden
- Laboratory of Hematology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
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Swillens JEM, Nagtegaal ID, Engels S, Lugli A, Hermens RPMG, van der Laak JAWM. Pathologists' first opinions on barriers and facilitators of computational pathology adoption in oncological pathology: an international study. Oncogene 2023; 42:2816-2827. [PMID: 37587332 PMCID: PMC10504072 DOI: 10.1038/s41388-023-02797-1] [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: 11/17/2022] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
Computational pathology (CPath) algorithms detect, segment or classify cancer in whole slide images, approaching or even exceeding the accuracy of pathologists. Challenges have to be overcome before these algorithms can be used in practice. We therefore aim to explore international perspectives on the future role of CPath in oncological pathology by focusing on opinions and first experiences regarding barriers and facilitators. We conducted an international explorative eSurvey and semi-structured interviews with pathologists utilizing an implementation framework to classify potential influencing factors. The eSurvey results showed remarkable variation in opinions regarding attitude, understandability and validation of CPath. Interview results showed that barriers focused on the quality of available evidence, while most facilitators concerned strengths of CPath. A lack of consensus was present for multiple factors, such as the determination of sufficient validation using CPath, the preferred function of CPath within the digital workflow and the timing of CPath introduction in pathology education. The diversity in opinions illustrates variety in influencing factors in CPath adoption. A next step would be to quantitatively determine important factors for adoption and initiate validation studies. Both should include clear case descriptions and be conducted among a more homogenous panel of pathologists based on sub specialization.
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Affiliation(s)
- Julie E M Swillens
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Iris D Nagtegaal
- Department of Pathology, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sam Engels
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Rosella P M G Hermens
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, The Netherlands
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van de Weerd C, Ebbers T, Smilde DEM, van Tol‐Geerdink JJ, Takes RP, van den Broek GB, Hermens RPMG, Kool RB. Evaluation of a remote monitoring app in head and neck cancer follow-up care. Cancer Med 2023; 12:15552-15566. [PMID: 37293944 PMCID: PMC10417106 DOI: 10.1002/cam4.6202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/01/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND A remote monitoring app was developed for head and neck cancer (HNC) follow-up during the SARS-CoV-2 pandemic. This mixed-methods study provides insight in the usability and patients' experiences with the app to develop recommendations for future use. METHODS Patients were invited to participate if they were treated for HNC, used the app at least once and were in clinical follow-up. A subset was selected for semi-structured interviews through purposive sampling considering gender and age. This study was conducted between September 2021-May 2022 at a Dutch university medical center. RESULTS 135 of the 216 invited patients completed the questionnaire, resulting in a total mHealth usability score of 4.72 (± 1.13) out of 7. Thirteen semi-structured interviews revealed 12 barriers and 11 facilitators. Most of them occurred at the level of the app itself. For example, patients received no feedback when all their answers were normal. The app made patients feel more responsible over their follow-up, but could not fulfill the need for personal contact with the attending physician. Patients felt that the app could replace some of the outpatient follow-up visits. CONCLUSIONS Our app is user-friendly, makes patients feel more in control and remote monitoring can reduce the frequency of outpatient follow-up visits. The barriers that emerged must be resolved before the app can be used in regular HNC follow-up. Future studies should investigate the appropriate ratio of remote monitoring to outpatient follow-up visits and the cost-effectiveness of remote monitoring in oncology care on a larger scale.
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Affiliation(s)
- Cecile van de Weerd
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Tom Ebbers
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Donna E. M. Smilde
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | | | - Robert P. Takes
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Guido B. van den Broek
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | | | - Rudolf B. Kool
- Department of IQ HealthcareRadboud University Medical CenterNijmegenthe Netherlands
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Steenbeek MP, van Bommel MHD, intHout J, Peterson CB, Simons M, Roes KCB, Kets M, Norquist BM, Swisher EM, Hermens RPMG, Lu KH, de Hullu JA. TUBectomy with delayed oophorectomy as an alternative to risk-reducing salpingo-oophorectomy in high-risk women to assess the safety of prevention: the TUBA-WISP II study protocol. Int J Gynecol Cancer 2023:ijgc-2023-004377. [PMID: 37045546 DOI: 10.1136/ijgc-2023-004377] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Risk-reducing salpingectomy with delayed oophorectomy has gained interest for individuals at high risk for tubo-ovarian cancer as there is compelling evidence that especially high-grade serous carcinoma originates in the fallopian tubes. Two studies have demonstrated a positive effect of salpingectomy on menopause-related quality of life and sexual health compared with standard risk-reducing salpingo-oophorectomy. PRIMARY OBJECTIVE To investigate whether salpingectomy with delayed oophorectomy is non-inferior to the current standard salpingo-oophorectomy for the prevention of tubo-ovarian cancer among individuals at high inherited risk. STUDY HYPOTHESIS We hypothesize that postponement of oophorectomy after salpingectomy, to the age of 40-45 (BRCA1) or 45-50 (BRCA2) years, compared with the current standard salpingo-oophorectomy at age 35-40 (BRCA1) or 40-45 (BRCA2) years, is non-inferior in regard to tubo-ovarian cancer risk. TRIAL DESIGN In this international prospective preference trial, participants will choose between the novel salpingectomy with delayed oophorectomy and the current standard salpingo-oophorectomy. Salpingectomy can be performed after the completion of childbearing and between the age of 25 and 40 (BRCA1), 25 and 45 (BRCA2), or 25 and 50 (BRIP1, RAD51C, and RAD51D pathogenic variant carriers) years. Subsequent oophorectomy is recommended at a maximum delay of 5 years beyond the upper limit of the current guideline age for salpingo-oophorectomy. The current National Comprehensive Cancer Network (NCCN) guideline age, which is also the recommended age for salpingo-oophorectomy within the study, is 35-40 years for BRCA1, 40-45 years for BRCA2, and 45-50 years for BRIP1, RAD51C, and RAD51D pathogenic variant carriers. MAJOR INCLUSION/EXCLUSION CRITERIA Premenopausal individuals with a documented class IV or V germline pathogenic variant in the BRCA1, BRCA2, BRIP1, RAD51C, or RAD51D gene who have completed childbearing are eligible for participation. Participants may have a personal history of a non-ovarian malignancy. PRIMARY ENDPOINT The primary outcome is the cumulative tubo-ovarian cancer incidence at the target age: 46 years for BRCA1 and 51 years for BRCA2 pathogenic variant carriers. SAMPLE SIZE The sample size to ensure sufficient power to test non-inferiority of salpingectomy with delayed oophorectomy compared with salpingo-oophorectomy requires 1500 BRCA1 and 1500 BRCA2 pathogenic variant carriers. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS Participant recruitment is expected to be completed at the end of 2026 (total recruitment period of 5 years). The primary outcome is expected to be available in 2036 (minimal follow-up period of 10 years). TRIAL REGISTRATION NUMBER NCT04294927.
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Affiliation(s)
| | | | - Joanna intHout
- Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Christine B Peterson
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Kit C B Roes
- Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Marleen Kets
- Human Genetics, Radboudumc, Nijmegen, The Netherlands
| | - Barbara M Norquist
- Obstetrics & Gynecology, University of Washington, Seattle, Washington, USA
| | | | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboudumc, Nijmegen, The Netherlands
| | - Karen H Lu
- Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Bouwman E, Pluijm SMF, Stollman I, Araujo-Soares V, Blijlevens NMA, Follin C, Winther JF, Hjorth L, Kepak T, Kepakova K, Kremer LCM, Muraca M, van der Pal HJH, Schneider C, Uyttebroeck A, Vercruysse G, Skinner R, Brown MC, Hermens RPMG, Loonen JJ. Perceived barriers and facilitators to health behaviors in European childhood cancer survivors: A qualitative PanCareFollowUp study. Cancer Med 2023. [PMID: 37029537 DOI: 10.1002/cam4.5911] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/20/2023] [Accepted: 03/26/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Healthy behaviors, that is, engaging in regular physical activities, maintaining a healthy diet, limiting alcohol consumption, and avoiding tobacco and drug use, decrease the risk of developing late adverse health conditions in childhood cancer survivors. However, childhood cancer survivors may experience barriers to adopting and maintaining healthy behaviors. This study aimed to assess these barriers and facilitators to health behavior adoption and maintenance in childhood cancer survivors. METHODS A focus group ( n = 12) and semi-structured telephone interviews ( n = 20) were conducted with a selected sample of European and Dutch childhood cancer survivors, respectively. The Theoretical Domains Framework (TDF) was used to inform the topic guide and analysis. Inductive thematic analysis was applied to identify categories relating to barriers and facilitators of health behavior adoption and maintenance, after which they were deductively mapped onto the TDF. RESULTS Ten TDF domains were identified in the data of which "Knowledge," "Beliefs about consequences," "Environmental context and resources," and "Social influences" were most commonly reported. Childhood cancer survivors expressed a need for knowledge on the importance of healthy behaviors, possibly provided by healthcare professionals. They indicated physical and long-term benefits of healthy behaviors, available professional support, and a supporting and health-consciously minded work and social environment to be facilitators. Barriers were mostly related to a lack of available time and an unhealthy environment. Lastly, (social) media was perceived as both a barrier and a facilitator to healthy behaviors. CONCLUSION This study has identified education and available professional support in health behaviors and the relevance of healthy behaviors for childhood cancer survivors as key opportunities for stimulating health behavior adoption in childhood cancer survivors. Incorporating health behavior support and interventions for this population should therefore be a high priority.
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Affiliation(s)
- Eline Bouwman
- Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - Iridi Stollman
- Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Vera Araujo-Soares
- Center for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, Heidelberg University, Röntgenstraße 7, D-68167, Mannheim, Germany
| | - Nicole M A Blijlevens
- Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Cecilia Follin
- Oncology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lasarettsgatan 40, 221 85, Lund, Sweden
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
| | - Lars Hjorth
- Pediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lasarettsgatan 40, 221 85, Lund, Sweden
| | - Tomas Kepak
- International Clinical Research Center (FNUSA-ICRC) at St. Anne's University Hospital, Masaryk University, Pekařská 53, Brno, 656 91, Czech Republic
| | - Katerina Kepakova
- International Clinical Research Center (FNUSA-ICRC) at St. Anne's University Hospital, Masaryk University, Pekařská 53, Brno, 656 91, Czech Republic
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Faculty of Medicine, Utrecht University and Utrecht Medical Center, Universiteitsweg 98, 3584 CG, Utrecht, the Netherlands
| | - Monica Muraca
- DOPO Clinic, Division of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Via G. Gaslini, 5, 16147, Genoa, Italy
| | - Helena J H van der Pal
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
- PanCare, Jacobus Bellamylaan 16, 1401 AZ, Bussum, the Netherlands
| | - Carina Schneider
- Childhood Cancer International - Europe, Servitengasse 5/16, 1090, Vienna, Austria
| | - Anne Uyttebroeck
- Department of Oncology, Pediatric Oncology, KU Leuven, Leuven, Belgium
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Gertrui Vercruysse
- Department of Oncology, Pediatric Oncology, KU Leuven, Leuven, Belgium
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Rod Skinner
- Wolfson Childhood Cancer Research Center, Newcastle University Center for Cancer, Newcastle University, NE1 7RU, Newcastle upon Tyne, Herschel Building, Brewery Lane, UK
- Great North Children's Hospital, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
- Wolfson Childhood Cancer Research Center, Translational and Clinical Research Institute, Newcastle University, Herschel Building, Brewery Lane, Newcastle upon Tyne, NE1 7RU, UK
| | - Morven C Brown
- Wolfson Childhood Cancer Research Center, Newcastle University Center for Cancer, Newcastle University, NE1 7RU, Newcastle upon Tyne, Herschel Building, Brewery Lane, UK
- Population Health Sciences Institute, Newcastle University, Ridley Building 1, Queen Victoria Road, Newcastle upon Tyne, NE1 7RU, UK
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Geert Grooteplein 21, 6525 EZ, Nijmegen, the Netherlands
| | - Jacqueline J Loonen
- Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
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10
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Bogaerts JMA, van Bommel MHD, Hermens RPMG, Steenbeek MP, de Hullu JA, van der Laak JAWM, Simons M. Consensus based recommendations for the diagnosis of serous tubal intraepithelial carcinoma: an international Delphi study. Histopathology 2023. [PMID: 36939551 DOI: 10.1111/his.14902] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/10/2023] [Accepted: 02/25/2023] [Indexed: 03/21/2023]
Abstract
AIM Reliably diagnosing or safely excluding serous tubal intraepithelial carcinoma (STIC), a precursor lesion of tubo-ovarian high-grade serous carcinoma (HGSC), is crucial for individual patient care, for better understanding the oncogenesis of HGSC, and for safely investigating novel strategies to prevent tubo-ovarian carcinoma. To optimize STIC diagnosis and increase its reproducibility, we set up a three-round Delphi study. METHODS AND RESULTS In round 1, an international expert panel of 34 gynecologic pathologists, from 11 countries, was assembled to provide input regarding STIC diagnosis, which was used to develop a set of statements. In round 2, the panel rated their level of agreement with those statements on a 9-point Likert scale. In round 3, statements without previous consensus were rated again by the panel while anonymously disclosing the responses of the other panel members. Finally, each expert was asked to approve or disapprove the complete set of consensus statements. The panel indicated their level of agreement with 64 statements. A total of 27 statements (42%) reached consensus after three rounds. These statements reflect the entire diagnostic work-up for pathologists, regarding processing and macroscopy (three statements); microscopy (eight statements); immunohistochemistry (nine statements); interpretation and reporting (four statements); and miscellaneous (three statements). The final set of consensus statements was approved by 85%. CONCLUSION This study provides an overview of current clinical practice regarding STIC diagnosis amongst expert gynecopathologists. The experts' consensus statements form the basis for a set of recommendations, which may help towards more consistent STIC diagnosis.
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Affiliation(s)
- Joep M A Bogaerts
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Majke H D van Bommel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- IQ Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Miranda P Steenbeek
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jeroen A W M van der Laak
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | | | - Michiel Simons
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
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11
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Verweij L, Ector GICG, Smit Y, van Vlijmen B, van der Reijden BA, Hermens RPMG, Blijlevens NMA. Effectiveness of digital care platform CMyLife for patients with chronic myeloid leukemia: results of a patient-preference trial. BMC Health Serv Res 2023; 23:228. [PMID: 36890512 PMCID: PMC9994406 DOI: 10.1186/s12913-023-09153-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/06/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Two most important factors determining treatment success in chronic myeloid leukemia (CML) are adequate medication compliance and molecular monitoring albeit still being suboptimal. The CMyLife platform is an eHealth innovation, co-created with and for CML patients, aiming to improve their care, leading to an increased quality of life and the opportunity of hospital-free care. OBJECTIVE To explore the effectiveness of CMyLife in terms of information provision, patient empowerment, medication compliance, molecular monitoring, and quality of life. METHODS Effectiveness of CMyLife was explored using a patient-preference trial. Upon completion of the baseline questionnaire, participants actively used (intervention group) or did not actively use (questionnaire group) the CMyLife platform for at least 6 months, after which they completed the post-intervention questionnaire. Scores between the intervention group and the questionnaire group were compared with regard to the within-subject change between baseline and post-measurement using Generalized Estimating Equation models. RESULTS At baseline, 33 patients were enrolled in the questionnaire group and 75 in the intervention group. Online health information knowledge improved significantly when actively using CMyLife and patients felt more empowered. No significant improvements were found regarding medication compliance and molecular monitoring, which were already outstanding. Self-reported effectiveness showed that patients experienced that using CMyLife improved their medication compliance and helped them to oversee their molecular monitoring. Patients using CMyLife reported more symptoms but were better able to manage these. CONCLUSIONS Since hospital-free care has shown to be feasible in time of the COVID-19 pandemic, eHealth-based innovations such as CMyLife could be a solution to maintain the quality of care and make current oncological health care services more sustainable. TRIAL REGISTRATION ClinicalTrials.gov NCT04595955 , 22/10/2020.
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Affiliation(s)
- Lynn Verweij
- Department of Hematology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Geneviève I C G Ector
- Department of Hematology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Yolba Smit
- Department of Hematology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bas van Vlijmen
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bert A van der Reijden
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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12
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Vrinzen CEJ, Bloemendal HJ, Stuart E, Makady A, van Agthoven M, Koster M, Merkx MAW, Hermens RPMG, Jeurissen PPT. Cancer treatments touch a wide range of values that count for patients and other stakeholders: What are the implications for decision-making? Cancer Med 2023; 12:6105-6116. [PMID: 36373590 PMCID: PMC10028089 DOI: 10.1002/cam4.5336] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/02/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cancer rates and expenditures are increasing, resulting in debates on the exact value of this care. Perspectives on what exactly constitutes worthwhile values differ. This study aims to explore all values-elements regarding new oncological treatments for patients with cancer and all stakeholders involved and to assess their implications in different decision-making procedures. METHOD Thirty-one individual in-depth interviews were conducted with different stakeholders to identify values within oncology. A focus group with seven experts was performed to explore its possible implications in decision-making procedures. RESULTS The overarching themes of values identified were impact on daily life and future, costs for patients and loved ones, quality of life, impact on loved ones, societal impact and quality of treatments. The expert panel revealed that the extended exploration of values that matter to patients is deemed useful in patient-level decision-making, information provision, patient empowerment and support during and after treatment. For national reimbursement decisions, implications for the broad range of values seems less clear. CONCLUSION Clinical values are not the only ones that matter to oncological patients and the stakeholders in the field. We found a much broader range of values. Proper recognition of values that count might add to patient-level decision-making, but implications for reimbursement decisions are less clear. The results could be useful to guide clinicians and policymakers when it comes to decision-making in oncology. Making more explicit which values counts for whom guarantees a more systematic approach to decision-making on all levels.
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Affiliation(s)
- Cilla E J Vrinzen
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute of Health Sciences (RIHS), Radboudumc, Nijmegen, The Netherlands
- Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands
| | - Haiko J Bloemendal
- Department of Oncology, Radboud Institute of Health Sciences (RIHS), Radboudumc, Nijmegen, The Netherlands
| | - Esra Stuart
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute of Health Sciences (RIHS), Radboudumc, Nijmegen, The Netherlands
| | - Amr Makady
- Janssen-Cilag B.V., Pharmaceutical Companies of Johnson & Johnson, Breda, The Netherlands
| | - Michel van Agthoven
- Janssen-Cilag B.V., Pharmaceutical Companies of Johnson & Johnson, Breda, The Netherlands
| | - Mariska Koster
- Janssen-Cilag B.V., Pharmaceutical Companies of Johnson & Johnson, Breda, The Netherlands
| | - Matthias A W Merkx
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute of Health Sciences (RIHS), Radboudumc, Nijmegen, The Netherlands
- Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute of Health Sciences (RIHS), Radboudumc, Nijmegen, The Netherlands
| | - Patrick P T Jeurissen
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute of Health Sciences (RIHS), Radboudumc, Nijmegen, The Netherlands
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13
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Bouwman E, Pluijm SMF, Stollman I, Araujo‐Soares V, Blijlevens NMA, Follin C, Falck Winther J, Hjorth L, Kepak T, Kepakova K, Kremer LCM, Muraca M, van der Pal HJH, Schneider C, Uyttebroeck A, Vercruysse G, Skinner R, Brown MC, Hermens RPMG, Loonen JJ. Healthcare professionals' perceived barriers and facilitators of health behavior support provision: A qualitative study. Cancer Med 2023; 12:7414-7426. [PMID: 36397667 PMCID: PMC10067039 DOI: 10.1002/cam4.5445] [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: 05/16/2022] [Revised: 10/27/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Childhood cancer survivors (CCSs) have an increased risk of developing chronic health conditions. Evidence suggests that poor health behaviors further increase health risks. Healthcare professionals (HCPs) involved in survivorship care have a key role in providing health behavior support (HBS) but can feel limited in their ability to do so. This study aims to explore European HCPs perceived facilitators and barriers to providing HBS to CCSs. METHODS Five focus groups with 30 HCPs from survivorship care clinics across Europe were conducted. Topic guides were informed by the Theoretical Domains Framework (TDF) to capture domains that may influence provision of HBS. Focus groups were analyzed with thematic analysis. Transcripts were inductively coded, after which axial coding was applied to organize codes into categories. Finally, categories were mapped onto the TDF domains. RESULTS Nine TDF domains were identified in the data. The most commonly reported TDF domains were "Knowledge", "Skills", and "Environmental context and resources". HCPs indicated that their lack of knowledge of the association between late effects and health behaviors, besides time restrictions, were barriers to HBS. Facilitators for HBS included possession of skills needed to pass on health behavior information, good clinic organization, and an established network of HCPs. CONCLUSIONS This study identified education and training of HCPs as key opportunities to improve HBS. Survivorship care clinics should work towards establishing well-integrated structured care with internal and external networks including HBS being part of routine care. Proper understanding of facilitators and barriers should lead to better survivorship care for CCSs.
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Affiliation(s)
- Eline Bouwman
- Department of Hematology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Iridi Stollman
- Department of Hematology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Vera Araujo‐Soares
- Department of Health Technology & Services Research, Technical Medical CenterUniversity of TwenteEnschedeThe Netherlands
| | - Nicole M. A. Blijlevens
- Department of Hematology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Cecilia Follin
- Oncology, Department of Clinical Sciences LundLund University, Skåne University HospitalLundSweden
| | - Jeanette Falck Winther
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
- Department of Clinical MedicineAarhus University and Aarhus University HospitalAarhusDenmark
| | - Lars Hjorth
- Pediatrics, Department of Clinical Sciences LundLund University, Skåne University HospitalLundSweden
| | - Tomas Kepak
- International Clinical Research Center (FNUSA‐ICRC) at St. Anne's University HospitalMasaryk UniversityBrnoCzech Republic
| | - Katerina Kepakova
- International Clinical Research Center (FNUSA‐ICRC) at St. Anne's University HospitalMasaryk UniversityBrnoCzech Republic
| | - Leontien C. M. Kremer
- Princess Máxima Centre for Pediatric OncologyUtrechtThe Netherlands
- Department of Pediatrics, Emma Children's HospitalAmsterdam UMCAmsterdamThe Netherlands
- Faculty of MedicineUtrecht University and Utrecht Medical CenterUtrechtthe Netherlands
| | - Monica Muraca
- DOPO Clinic, Division of Pediatric Hematology and OncologyIRCCS Istituto Giannina GasliniGenoaItaly
| | | | | | - Anne Uyttebroeck
- Department of Oncology, Pediatric Oncology, KU Leuven, Department of Pediatric Hematology and OncologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Gertrui Vercruysse
- Department of Oncology, Pediatric Oncology, KU Leuven, Department of Pediatric Hematology and OncologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Roderick Skinner
- Wolfson Childhood Cancer Research Center, Newcastle University Centre for CancerNewcastle UniversityNewcastle upon TyneUK
- Great North Children's HospitalRoyal Victoria InfirmaryNewcastle upon TyneUK
- Wolfson Childhood Cancer Research Center, Translational and Clinical Research InstituteNewcastle UniverstiyNewcastle upon TyneUK
| | - Morven C. Brown
- Wolfson Childhood Cancer Research Center, Newcastle University Centre for CancerNewcastle UniversityNewcastle upon TyneUK
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Rosella P. M. G. Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Jacqueline J. Loonen
- Department of Hematology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
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14
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Vrinzen CEJ, Delfgou L, Stadhouders N, Hermens RPMG, Merkx MAW, Bloemendal HJ, Jeurissen PPT. A systematic review and multilevel regression analysis reveals the comorbidity prevalence in cancer. Cancer Res 2023; 83:1147-1157. [PMID: 36779863 PMCID: PMC10071818 DOI: 10.1158/0008-5472.can-22-1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/13/2022] [Accepted: 01/30/2023] [Indexed: 02/14/2023]
Abstract
Comorbidities can have major implications for cancer care, as they might impact the timing of cancer diagnosis, compromise optimal care, affect treatment outcomes, and increase healthcare costs. Thus, it is important to comprehensively evaluate cancer comorbidities and examine trends over time. Here, we performed a systematic literature review on the prevalence and types of comorbidities for the five most common forms of cancer. Observational studies from Organisation for Economic Co-operation and Development (OECD) countries published between 1990 and 2020 in English or Dutch that used routinely collected data from a representative population were included. The search yielded 3,070 articles of which 161 were eligible for data analyses. Multilevel analyses were performed to evaluate determinants of variation in comorbidity prevalence and trends over time. The weighted average comorbidity prevalence was 33.4%, and comorbidities were the most common in lung cancer (46.7%) and colorectal cancer (40.0%), followed by prostate (28.5%), melanoma (28.3%), and breast (22.4%). The most common types of comorbidities were hypertension (29.7%), pulmonary diseases (15.9%), and diabetes (13.5%). After adjusting for gender, type of comorbidity index, age, data source (patient records versus claims), and country, a significant increase in comorbidities of 0.54% per year was observed. Overall, a large and increasing proportion of the oncological population is dealing with comorbidities, which could be used to inform and adapt treatment options to improve health outcomes and reduce healthcare costs.
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15
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Deuning-Smit E, Custers JAE, Kwakkenbos L, Hermens RPMG, Prins JB. Evaluating the capacity of the distress thermometer to detect high fear of cancer recurrence. Psychooncology 2023; 32:266-274. [PMID: 36385563 PMCID: PMC10099705 DOI: 10.1002/pon.6066] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/31/2022] [Accepted: 11/06/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Fear of cancer recurrence (FCR) is common and burdensome to patients, but often remains undetected. Oncology professionals report need for tools to improve FCR detection in routine care. Oncology care guidelines recommend the Distress Thermometer (DT) for distress screening, but it has not been validated for FCR. This study evaluated the capacity of the DT and accompanying problem list to detect FCR. METHODS Amalgamated data of two studies with 149 breast cancer and 74 colorectal cancer survivors were used. We evaluated the Dutch DT including the DT score, problem list fears item and emotional domain score using Receiver Operating Characteristic analyses. The Dutch Cancer Worry Scale-6 (CWS-6) was used as reference measure, with validated cut-off scores ≥10 and ≥12 for high FCR. Sensitivity, specificity, negative and positive predictive values were calculated. RESULTS The DT score showed poor performance in discriminating between low and high FCR. The recommended cut-off ≥4 had low sensitivity (65% for CWS-6≥10; 72% for CWS-6 ≥12) and specificity (67% and 58%). No other cut-off had an acceptable combination of sensitivity and specificity. The fears item had low sensitivity (29% and 44.9%) and high specificity (95% and 94%). The emotional domain score had fair performance in discriminating between low and high FCR but there was no cut-off with acceptable sensitivity and specificity. CONCLUSION The DT as currently recommended in oncology care guidelines is not suitable to effectively detect FCR in routine care. To improve patients access to psychosocial care, it should be investigated how FCR-specific measures can be integrated in oncology practice.
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Affiliation(s)
- Esther Deuning-Smit
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José A E Custers
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Kwakkenbos
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Clinical Psychology, Radboud University, Nijmegen, The Netherlands.,Department of Psychiatry, Radboudumc Center for Mindfulness, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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16
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Ector GICG, Geelen IGP, Dinmohamed AG, Hoogendoorn M, Westerweel PE, Hermens RPMG, Blijlevens NMA. Adherence to quality indicators in chronic myeloid leukemia care: results from a population-based study in The Netherlands. Leuk Lymphoma 2023; 64:424-432. [PMID: 36369821 DOI: 10.1080/10428194.2022.2142055] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Suboptimal guideline adherence in chronic myeloid leukemia (CML) care is associated with worse treatment outcomes. Current study focused on adherence to seven quality indicators (QIs) based on the European Leukemia Network guideline (one diagnostic, one therapeutic, and five monitoring indicators). Data were obtained from population-based registries in the Netherlands of 405 newly diagnosed chronic phase CML patients between January 2008 and April 2013. Compliance rates regarding diagnostic and therapeutic indicator were 83% and 78%, respectively. Monitoring indicators rates were lower: 21-27% for indicators concerning the first year and 58% and 62% for the second and third year, respectively. Noncompliance occurred mostly due to non-timely monitoring. Twenty cases did not comply with any indicator, 6% complied with all indicators. After adjustment for age, overall survival rates did not differ significantly between the groups. Adherence to guideline-based QIs was suboptimal. This demonstrates the evidence-practice gap, shows room for improvement and underscores the need for real-world data.
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Affiliation(s)
| | - Inge G P Geelen
- Department of Hematology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Avinash G Dinmohamed
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mels Hoogendoorn
- Department of Hematology, Medical Center Leeuwarden, on behalf of the HemoBase Population Registry Consortium, Leeuwarden, Netherlands
| | - Peter E Westerweel
- Department of Hematology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud Institute for Healthcare Sciences (RIHS), Radboud University Medical Center, Nijmegen, Netherlands
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17
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Gelderblom ME, Jaspers V, Akkermans RP, Slangen B, Oei ALM, van Ginkel AA, Ngo H, IntHout J, Hermens RPMG, de Hullu JA, Piek JMJ. First step in implementation of opportunistic salpingectomy for prevention of ovarian cancer: Current care and its determinants. Acta Obstet Gynecol Scand 2023; 102:257-269. [PMID: 36661074 PMCID: PMC9951340 DOI: 10.1111/aogs.14507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/20/2022] [Accepted: 12/25/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Opportunistic salpingectomy (OS) refers to additional removal of the fallopian tubes during abdominal surgery performed for another medical indication, as prevention for ovarian cancer. As OS has been inconsistently implemented, its clinical practice varies worldwide. To reduce this variation, insight is required into current clinical practice and its determinants. Therefore, the study aim was to determine the implementation of counseling and performance of OS between 2015 and 2018, and its patient, surgical, physician, and hospital characteristics. MATERIAL AND METHODS Retrospective study using electronic medical records from six different Dutch hospitals: two academic, two large teaching, and two non-teaching hospitals. Patients were considered eligible for OS if they underwent elective non-obstetric abdominal surgery for a gynecological indication from January 2015 through December 2018. Primary outcomes were uptake of counseling and performance of OS. Multilevel multivariable logistic regression analyses were conducted to identify characteristics associated with OS. RESULTS A total of 3214 patients underwent elective non-obstetric abdominal surgery for a gynecological indication and were eligible for OS. Counseling on OS increased significantly from 2.9% in 2015 to 29.4% in 2018. In this period, 440 patients were counseled on OS, of which 95.9% chose OS. Performance of OS increased significantly from 6.9% in 2015 to 44.5% in 2018. Counseling for and performance of OS were more likely in patients who had surgery by laparoscopic approach, were counseled by a gynecological resident, or had more than three contact moments before surgery. Additionally, OS was less likely in patients who had vaginal surgery. CONCLUSIONS Although the uptake of OS increased from 2015 to 2018, the majority of patients who were eligible for OS were not counseled and did not undergo OS. Its clinical practice varies on patient, surgery, and physician characteristics. Therefore, an implementation strategy tailored to associated determinants is recommended.
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Affiliation(s)
- Malou E. Gelderblom
- Department of Obstetrics and Gynecology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Veerle Jaspers
- Department of Obstetrics and Gynecology and Catharina Cancer InstituteCatharina HospitalEindhovenThe Netherlands
| | - Reinier P. Akkermans
- Radboud Institute for Health Sciences, Department of IQ health careRadboud University Medical CenterNijmegenThe Netherlands,Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - Brigitte Slangen
- Department of Obstetrics and GynecologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Angele L. M. Oei
- Department of Obstetrics and GynecologyBernhoven HospitalUdenThe Netherlands
| | | | - Huy Ngo
- Department of Obstetrics and GynecologyElkerliek HospitalHelmondThe Netherlands
| | - Joanna IntHout
- Department for Health Evidence, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Rosella P. M. G. Hermens
- Radboud Institute for Health Sciences, Department of IQ health careRadboud University Medical CenterNijmegenThe Netherlands
| | - Joanne A. de Hullu
- Department of Obstetrics and Gynecology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Jurgen M. J. Piek
- Department of Obstetrics and Gynecology and Catharina Cancer InstituteCatharina HospitalEindhovenThe Netherlands
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van de Weerd C, van Tol-Geerdink JJ, van den Broek GB, Kaanders JHAM, Marres HAM, Hermens RPMG, Takes RP. Individualised follow-up for head and neck cancer-design of a prospective cohort study to assess its feasibility. BMJ Open 2022; 12:e068750. [PMID: 36581428 PMCID: PMC9806091 DOI: 10.1136/bmjopen-2022-068750] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION It is a common practice for many cancer types to monitor patients after treatment to detect new disease manifestations early. For head and neck cancer (HNC), however, long-term routine follow-up is up for debate for several reasons. The benefits of prolonged routine follow-up on survival have not been proven. Also, cancer follow-up is putting increasing pressure on healthcare resources due to rising incidence and survival rates. Therefore, this study investigates a novel follow-up approach among HNC patients, giving them the opportunity to choose their own follow-up programme. METHODS AND ANALYSIS HNC patients are offered a decision-aided choice between standardised or individualised follow-up after 1.5 years of uncomplicated guideline-prescribed follow-up. Standardised follow-up entails continuing the 5-year guideline-prescribed schedule. Individualised follow-up means the patient only attends the outpatient clinic on their own initiative in case of physical symptoms or supportive care needs. Patients are educated on self-examination and when a control visit is necessary. The primary outcome measure is the feasibility of offering patients this choice. Secondary outcome measures are quality of life, costs, productivity loss and detection of new disease. ETHICS AND DISSEMINATION We believe that it is essential to let patients determine their follow-up programme based on their own values and preferences. If this choice is feasible, it can be implemented and investigated in other HNC care centres. TRIAL REGISTRATION NUMBER NCT05386225.
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Affiliation(s)
- Cecile van de Weerd
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | | | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | | | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | | | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
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Bouwman E, Hermens RPMG, Brown MC, Araújo-Soares V, Blijlevens NMA, Kepak T, Kepakova K, Kremer LCM, van den Oever SR, van der Pal HJH, Skinner R, Pluijm SMF, Loonen JJ. Person-centred online lifestyle coaching in childhood, adolescent, and young adult cancer survivors: protocol of the multicentre PanCareFollowUp lifestyle intervention feasibility study. Pilot Feasibility Stud 2022; 8:260. [PMID: 36527164 PMCID: PMC9756491 DOI: 10.1186/s40814-022-01221-x] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Physical inactivity and unhealthy dietary habits are known to be disadvantageous for the development of late adverse effects in survivors of childhood, adolescent, and young adult cancer. To make interventions, aimed at improving lifestyle, fit into the daily life of survivors, interventions should be designed and delivered in a person-centred way with a limited time burden. As part of the European PanCareFollowUp project, an eHealth intervention was developed to support sustainable changes to physical activity levels and/or diet of childhood, adolescent, and young adult cancer survivors. This feasibility study aims to gain insight into the feasibility and potential effect sizes of the PanCareFollowUp lifestyle intervention. METHODS The PanCareFollowUp lifestyle intervention consists of person-centred 3-6 screen-to-screen sessions with a certified lifestyle coach. The intervention will be evaluated with a single-arm pre-post feasibility study conducted at two survivorship care clinics in the Netherlands. A total of 60 participants who are (i) diagnosed with cancer <25 years, (ii) ≥ 5 years post-treatment, (iii) aged 16-55 years, and (iv) have a low physical activity level and/or unhealthy dietary intake manifested by overweight will be recruited. Using reports, hospital records, and questionnaires for survivors, coaches, and late effect doctors, feasibility will be based on (i) adherence to intervention, (ii) acceptability, (iii) practicality, (iv) integration/implementation, (v) demand, and (vi) attrition. The potential effect sizes of the intervention will be explored by determining the percentage of survivors that reach the personalized lifestyle goals that were set with the coach. Physical activity level, dietary intake, BMI, general self-efficacy, self-management, and motivation level will be assessed at three time points with questionnaires, reports, and/or an accelerometer. DISCUSSION Data of this study will be gathered to assess the feasibility and potential effect sizes. This will allow for further intervention refinement as needed as well as to inform a future large-scale intervention study and a manual for implementation at other centres. TRIAL REGISTRATION International Clinical Trial Registry Platform (ICTRP) number: NL8932 (ICTRP Search Portal (who.int)). Registered on September 29, 2020.
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Affiliation(s)
- Eline Bouwman
- grid.10417.330000 0004 0444 9382Centre of Expertise for Cancer Survivorship, Radboud Institute for Health Sciences, Radboud University Medical Centre, Reinier Postlaan 4, 6500 HB Nijmegen, the Netherlands
| | - Rosella P. M. G. Hermens
- grid.10417.330000 0004 0444 9382 Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Morven C. Brown
- grid.1006.70000 0001 0462 7212Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle University, Herschel Building, Brewery Lane, Newcastle upon Tyne, NE1 7RU UK ,grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Ridley Building 1, Queen Victoria Road, Newcastle upon Tyne, NE1 7RU4 UK
| | - Vera Araújo-Soares
- grid.6214.10000 0004 0399 8953Department of Health Technology & Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
| | - Nicole M. A. Blijlevens
- grid.10417.330000 0004 0444 9382 Department of Haematology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10 , 6525 GA Nijmegen, Nederland
| | - Tomas Kepak
- International Clinical Research Centre (FNUSA-ICRC), St. Anne’s University Hospital, Masaryk University, Pekařská 53, 656 91 Brno, Czech Republic
| | - Katerina Kepakova
- International Clinical Research Centre (FNUSA-ICRC), St. Anne’s University Hospital, Masaryk University, Pekařská 53, 656 91 Brno, Czech Republic
| | - Leontien C. M. Kremer
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands ,grid.414503.70000 0004 0529 2508Department of Paediatrics, Emma Children’s Hospital, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University and Utrecht Medical Centre, Universiteitsweg 98, 3584 CG Utrecht, the Netherlands
| | - Selina R. van den Oever
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands
| | - Helena J. H. van der Pal
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands ,PanCare, Jacobus Bellamylaan 16, 1401 AZ Bussum, the Netherlands
| | - Roderick Skinner
- grid.1006.70000 0001 0462 7212Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle University, Herschel Building, Brewery Lane, Newcastle upon Tyne, NE1 7RU UK ,grid.419334.80000 0004 0641 3236Great North Children’s Hospital, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK ,Translational and Clinical Research Institute, Wolfson Childhood Cancer Research Centre, Herschel Building, Brewery Lane, Newcastle upon Tyne, NE1 7RU UK
| | - Saskia M. F. Pluijm
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands
| | - Jacqueline J. Loonen
- grid.10417.330000 0004 0444 9382Centre of Expertise for Cancer Survivorship, Radboud Institute for Health Sciences, Radboud University Medical Centre, Reinier Postlaan 4, 6500 HB Nijmegen, the Netherlands
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Gelderblom ME, IntHout J, Dagovic L, Hermens RPMG, Piek JMJ, de Hullu JA. The effect of opportunistic salpingectomy for primary prevention of ovarian cancer on ovarian reserve: a systematic review and meta-analysis. Maturitas 2022; 166:21-34. [PMID: 36030627 DOI: 10.1016/j.maturitas.2022.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Opportunistic salpingectomy (OS) is an attractive method for primary prevention of ovarian cancer. Although OS has not been associated with a higher complication rate, it may be associated with earlier onset of menopause. OBJECTIVE To provide a systematic review and meta-analysis of the effect of OS on both age at menopause and ovarian reserve. METHODS A search was conducted in the Cochrane Library, Embase and MEDLINE databases from inception until March 2022. We included randomized clinical trials and cohort studies investigating the effect of OS on onset of menopause and/or ovarian reserve through change in anti-Müllerian hormone (AMH), antral follicle count (AFC), estradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH). Data was extracted independently by two researchers. Random-effects meta-analyses were conducted to estimate the pooled effect of OS on ovarian reserve. RESULTS The initial search yielded 1047 studies. No studies were found investigating the effect of OS on age of menopause. Fifteen studies were included in the meta-analysis on ovarian reserve. Meta-analyses did not result in statistically significant differences in mean change in AMH (MD -0.07 ng/ml, 95%CI -0.18;0.05), AFC (MD 0.20 n, 95 % CI -4.91;5.30), E2 (MD 3.97 pg/ml, 95%CI -0.92;8.86), FSH (MD 0.33mIU/ml, 95%CI -0.15;0.81) and LH (MD 0.03mIU/ml; 95%CI -0.47;0.53). CONCLUSION Our study shows that OS does not result in a significant reduction of ovarian reserve in the short term. Further research is essential to confirm the absence of major effects of OS on menopausal onset since clear evidence on this subject is lacking. Registration number PROSPERO CRD42021260966.
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Affiliation(s)
- M E Gelderblom
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - J IntHout
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L Dagovic
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R P M G Hermens
- Radboud Institute for Health Sciences, Department of IQ Health Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J M J Piek
- Department of Obstetrics and Gynecology and Catharina Cancer Institute, Catharina Hospital, Eindhoven, The Netherlands
| | - J A de Hullu
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands
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van Kalsbeek RJ, Korevaar JC, Rijken M, Haupt R, Muraca M, Kepák T, Kepakova K, Blondeel A, Boes S, Frederiksen LE, Essiaf S, Winther JF, Hermens RPMG, Kienesberger A, Loonen JJ, Michel G, Mulder RL, O'Brien KB, van der Pal HJH, Pluijm SMF, Roser K, Skinner R, Renard M, Uyttebroeck A, Follin C, Hjorth L, Kremer LCM. Evaluating the feasibility, effectiveness and costs of implementing person-centred follow-up care for childhood cancer survivors in four European countries: the PanCareFollowUp Care prospective cohort study protocol. BMJ Open 2022; 12:e063134. [PMID: 36396317 PMCID: PMC9677022 DOI: 10.1136/bmjopen-2022-063134] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Long-term survival after childhood cancer often comes at the expense of late, adverse health conditions. However, survivorship care is frequently not available for adult survivors in Europe. The PanCareFollowUp Consortium therefore developed the PanCareFollowUp Care Intervention, an innovative person-centred survivorship care model based on experiences in the Netherlands. This paper describes the protocol of the prospective cohort study (Care Study) to evaluate the feasibility and the health economic, clinical and patient-reported outcomes of implementing PanCareFollowUp Care as usual care in four European countries. METHODS AND ANALYSIS In this prospective, longitudinal cohort study with at least 6 months of follow-up, 800 childhood cancer survivors will receive the PanCareFollowUp Care Intervention across four study sites in Belgium, Czech Republic, Italy and Sweden, representing different healthcare systems. The PanCareFollowUp Care Intervention will be evaluated according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Clinical and research data are collected through questionnaires, a clinic visit for multiple medical assessments and a follow-up call. The primary outcome is empowerment, assessed with the Health Education Impact Questionnaire. A central data centre will perform quality checks, data cleaning and data validation, and provide support in data analysis. Multilevel models will be used for repeated outcome measures, with subgroup analysis, for example, by study site, attained age, sex or diagnosis. ETHICS AND DISSEMINATION This study will be conducted in accordance with the guidelines of Good Clinical Practice and the Declaration of Helsinki. The study protocol has been reviewed and approved by all relevant ethics committees. The evidence and insights gained by this study will be summarised in a Replication Manual, also including the tools required to implement the PanCareFollowUp Care Intervention in other countries. This Replication Manual will become freely available through PanCare and will be disseminated through policy and press releases. TRIAL REGISTRATION NUMBER Netherlands Trial Register (NL8918; https://www.trialregister.nl/trial/8918).
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Affiliation(s)
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Mieke Rijken
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Health and Social Care Management, University of Eastern Finland-Kuopio Campus, Kuopio, Finland
| | - Riccardo Haupt
- DOPO Clinic, Department of Hematology/Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Monica Muraca
- DOPO Clinic, Department of Hematology/Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Tomáš Kepák
- International Clinical Research Centre (FNUSA-ICRC) at St Anne's University Hospital, Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - Katerina Kepakova
- International Clinical Research Centre (FNUSA-ICRC) at St Anne's University Hospital, Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - Anne Blondeel
- European Society for Pediatric Oncology (SIOP Europe), Brussels, Belgium
| | - Stefan Boes
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Line E Frederiksen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Samira Essiaf
- European Society for Pediatric Oncology (SIOP Europe), Brussels, Belgium
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine and Faculty of Health, Aarhus Universitet, Aarhus, Denmark
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboudumc, Nijmegen, The Netherlands
| | | | | | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Renée L Mulder
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Helena J H van der Pal
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- PanCare, Bussum, The Netherlands
| | - Saskia M F Pluijm
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Roderick Skinner
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
- Royal Victoria Infirmary, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Marleen Renard
- Department of Paediatric Haematology and Oncology, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Paediatric Haematology and Oncology, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Cecilia Follin
- Department of Clinical Sciences Lund, Oncology, Lund University, Skane University Hospital, Lund, Sweden
| | - Lars Hjorth
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skane University Hospital, Lund, Sweden
| | - Leontien C M Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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22
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Deuning-Smit E, Kolsteren EEM, Kwakkenbos L, Custers JAE, Hermens RPMG, Prins JB. Barriers and facilitators for implementation of the SWORD evidence-based psychological intervention for fear of cancer recurrence in three different healthcare settings. J Cancer Surviv 2022:10.1007/s11764-022-01285-x. [DOI: 10.1007/s11764-022-01285-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Abstract
Purpose
Fear of cancer recurrence (FCR) interventions are effective, but few are implemented. This study aimed to identify barriers and facilitators for implementing the evidence-based blended SWORD intervention in routine psycho-oncological care.
Methods
Semi-structured interviews with 19 cancer survivors and 18 professionals from three healthcare settings assessed barriers and facilitators in six domains as described by the determinant frameworks of Grol and Flottorp: (1) innovation, (2) professionals, (3) patients, (4) social context, (5) organization, and (6) economic and political context.
Results
In the innovation domain, there were few barriers. Facilitators included high reliability, accessibility, and relevance of SWORD. In the professional domain, physicians and nurses barriers were lack of self-efficacy, knowledge, and skills to address FCR whereas psychologists had sufficient knowledge and skills, but some were critical towards protocolized treatments, cognitive behavioral therapy, or eHealth. Patient domain barriers included lack of FCR awareness, negative expectations of psychotherapy, and unwillingness/inability to actively engage in treatment. A social context domain barrier was poor communication between different healthcare professionals. Organization domain barriers included inadequate referral structures to psychological services, limited capacity, and complex legal procedures. Economic and political context domain barriers included lack of a national implementation structure for evidence-based psycho-oncological interventions and eHealth platform costs.
Conclusions
Implementation strategies should be targeted at patient, professional, organizational and economic and political domains. Identified barriers and facilitators are relevant to other researchers in psycho-oncology that aim to bridge the research-practice gap.
Implications for cancer survivors
This study contributes to the implementation of evidence-based psychological interventions for cancer survivors, who can benefit from these services.
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Myren BJ, de Hullu JA, Koksma JJ, Gelderblom ME, Hermens RPMG, Zusterzeel PLM. Cyclic workflow to improve implementation of learning points from morbidity and mortality meetings. BMC Health Serv Res 2022; 22:1282. [PMID: 36284295 DOI: 10.1186/s12913-022-08639-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Morbidity and mortality meetings (M&MMs) are organized in most hospital departments with an educational purpose to learn from adverse events (AEs) to improve patient care. M&MMs often lack effectiveness due to unsuccessful systematic follow-up of areas of improvement. This can have an effect on improving patient safety and care. Therefore, a new strategy that focuses on implementing areas of improvement into daily practice is necessary. The study aim is to see if we could improve the implementation of meeting outcomes from the M&MM by using a cyclic workflow, and which factors are important to achieve its implementation. METHODS This prospective study took place at the department of gynecologic oncology of a university hospital. Research was conducted with a participatory action research (PAR) approach using 10 consecutive M&MMs in 2019 and 2020. The cyclical workflow consisted of an action list based on the PDCA-cycle, a check of the implementation of areas for improvement at the next M&MM and regular monitoring of tasks. Each M&MM was observed and each professional with an assigned task was interviewed and gave their informed consent. Thematic content analysis was performed with the program Atlas.ti 8.4.20. RESULTS Out of the 39 tasks that resulted from 10 M&MMs, 37 (94.8%) followed all the steps in the PDCA-cycle and were implemented. In total, 16 interviews were conducted with consultants, nurses, registrars and residents. Five main factors were important to achieve follow-up of areas for improvement: organizational culture, motivation, commitment, communication to mobilize employees and skills. Repetition of the cyclic workflow at the M&MM and an external person who reminded professionals of their assigned task(s) was important to change habits and motivate professionals. CONCLUSION Cyclical tools can support the implementation of areas for improvement to optimize the M&MM. A M&MM with an organizational culture where attendees can discuss openly and freely may motivate attendees to take on tasks successfully. A positive stimulant to reach commitment of professionals is team participation. Integrating new habits of reflection may lead to a deeper level of learning from the PDCA-cycle and of the M&MM. Creating a learning environment outside of the M&MM may support professionals to take on actions and engage in improvement practices. Future research may focus on including a comparative analysis to show a success rate of the implementation of learning points from the M&MM more clearly.
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Affiliation(s)
- B J Myren
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands.
| | - J A de Hullu
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - J J Koksma
- Health Academy, Radboudumc, Nijmegen, The Netherlands
| | - M E Gelderblom
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | | | - P L M Zusterzeel
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
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24
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van den Berg M, Kaal SEJ, Schuurman TN, Braat DDM, Mandigers CMPW, Tol J, Tromp JM, van der Vorst MJDL, Beerendonk CCM, Hermens RPMG. Quality of integrated female oncofertility care is suboptimal: A patient-reported measurement. Cancer Med 2022; 12:2691-2701. [PMID: 36031940 PMCID: PMC9939180 DOI: 10.1002/cam4.5149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical practice guidelines recommend to inform female cancer patients about their infertility risks due to cancer treatment. Unfortunately, it seems that guideline adherence is suboptimal. In order to improve quality of integrated female oncofertility care, a systematic assessment of current practice is necessary. METHODS A multicenter cross-sectional survey study in which a set of systematically developed quality indicators was processed, was conducted among female cancer patients (diagnosed in 2016/2017). These indicators represented all domains in oncofertility care; risk communication, referral, counseling, and decision-making. Indicator scores were calculated, and determinants were assessed by multilevel multivariate analyses. RESULTS One hundred twenty-one out of 344 female cancer patients participated. Eight out of 11 indicators scored below 90% adherence. Of all patients, 72.7% was informed about their infertility, 51.2% was offered a referral, with 18.8% all aspects were discussed in counseling, and 35.5% received written and/or digital information. Patient's age, strength of wish to conceive, time before cancer treatment, and type of healthcare provider significantly influenced the scores of three indicators. CONCLUSIONS Current quality of female oncofertility care is far from optimal. Therefore, improvement is needed. To achieve this, improvement strategies that are tailored to the identified determinants and to guideline-specific barriers should be developed.
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Affiliation(s)
- Michelle van den Berg
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Suzanne E. J. Kaal
- Department of Medical OncologyRadboud University Medical CenterNijmegenthe Netherlands,Dutch AYA ‘Young and Cancer’ Care NetworkIKNLUtrechtthe Netherlands
| | - Teska N. Schuurman
- Center for Gynecologic Oncology AmsterdamThe Netherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | - Didi D. M. Braat
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | | | - Jolien Tol
- Department of Medical Oncology, Jeroen Bosch HospitalDen BoschThe Netherlands
| | - Jacqueline M. Tromp
- Dutch AYA ‘Young and Cancer’ Care NetworkIKNLUtrechtthe Netherlands,Department of Medical OncologyAmsterdam University Medical CenterAmsterdamThe Netherlands
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Swillens JEM, Voorham QJM, Akkermans RP, Nagtegaal ID, Hermens RPMG. Nationwide implementation of a multifaceted tailored strategy to improve uptake of standardized structured reporting in pathology: an effect and process evaluation. Implement Sci 2022; 17:52. [PMID: 35907877 PMCID: PMC9338618 DOI: 10.1186/s13012-022-01224-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Implementation strategies are aimed at improving guideline adherence. Both effect and process evaluations are conducted to provide insights into the success or failure of these strategies. In our study, we evaluate the nationwide implementation of standardized structured reporting (SSR) in pathology. Methods An interrupted time series analysis was conducted to evaluate the effect of a previously developed implementation strategy, which consisted of various digitally available elements, on SSR in pathology laboratories. A segmented regression analysis was performed to analyze the change in mean SSR percentages directly after the strategy introduction for pathology reporting and specific subcategories. In addition, we analyzed the change in trend in the weekly percentages after strategy introduction, also for subgroups of tumor groups, retrieval methods, and type of laboratory. The change in SSR use after the strategy introduction was determined for all pathology laboratories. We further conducted a process evaluation in which the exposure to the strategy elements was determined. Experiences of the users with all strategy elements and the remaining barriers and potential strategy elements were evaluated through an eSurvey. We also tested whether exposure to a specific element and a combination of elements resulted in a higher uptake of SSR after strategy introduction. Results There was a significant increase in an average use of SSR after the strategy introduction for reporting of gastrointestinal (p=.018) and urological (p=.003) oncological diagnoses. A significant increase was present for all oncological resections as a group (p=.007). Thirty-three out of 42 pathology laboratories increased SSR use after the strategy introduction. The “Feedback button”, an option within the templates for SSR to provide feedback to the provider and one of the elements of the implementation strategy, was most frequently used by the SSR users, and effectiveness results showed that it increased average SSR use after the strategy introduction. Barriers were still present for SSR implementation. Conclusions Nationwide SSR implementation improved for specific tumor groups and retrieval methods. The next step will be to further improve the use of SSR and, simultaneously, to further develop potential benefits of high SSR use, focusing on re-using discrete pathology data. In this way, we can facilitate proper treatment decisions in oncology. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01224-5.
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Affiliation(s)
- Julie E M Swillens
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, Kapittelweg 54 (route 160), Nijmegen, The Netherlands.
| | | | - Reinier P Akkermans
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, Kapittelweg 54 (route 160), Nijmegen, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, Kapittelweg 54 (route 160), Nijmegen, The Netherlands
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Steenbeek MP, van Bommel MHD, Bulten J, Hermens RPMG, IntHout J, de Hullu JA. Reply to J. Zhang et al. J Clin Oncol 2022; 40:3783-3784. [PMID: 35820084 DOI: 10.1200/jco.22.01266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Miranda P Steenbeek
- Miranda P. Steenbeek, MD, PhD, and Majke H.D. van Bommel, MD, Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands; Johan Bulten, MD, PhD, Radboud University Medical Center, Department of Pathology, Nijmegen, the Netherlands; Rosella P.M.G. Hermens, PhD, Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen, the Netherlands; Joanna IntHout, PhD, Radboud University Medical Center, Department for Health Evidence, Nijmegen, the Netherlands; and Joanne A. de Hullu, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Majke H D van Bommel
- Miranda P. Steenbeek, MD, PhD, and Majke H.D. van Bommel, MD, Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands; Johan Bulten, MD, PhD, Radboud University Medical Center, Department of Pathology, Nijmegen, the Netherlands; Rosella P.M.G. Hermens, PhD, Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen, the Netherlands; Joanna IntHout, PhD, Radboud University Medical Center, Department for Health Evidence, Nijmegen, the Netherlands; and Joanne A. de Hullu, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Johan Bulten
- Miranda P. Steenbeek, MD, PhD, and Majke H.D. van Bommel, MD, Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands; Johan Bulten, MD, PhD, Radboud University Medical Center, Department of Pathology, Nijmegen, the Netherlands; Rosella P.M.G. Hermens, PhD, Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen, the Netherlands; Joanna IntHout, PhD, Radboud University Medical Center, Department for Health Evidence, Nijmegen, the Netherlands; and Joanne A. de Hullu, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- Miranda P. Steenbeek, MD, PhD, and Majke H.D. van Bommel, MD, Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands; Johan Bulten, MD, PhD, Radboud University Medical Center, Department of Pathology, Nijmegen, the Netherlands; Rosella P.M.G. Hermens, PhD, Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen, the Netherlands; Joanna IntHout, PhD, Radboud University Medical Center, Department for Health Evidence, Nijmegen, the Netherlands; and Joanne A. de Hullu, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Joanna IntHout
- Miranda P. Steenbeek, MD, PhD, and Majke H.D. van Bommel, MD, Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands; Johan Bulten, MD, PhD, Radboud University Medical Center, Department of Pathology, Nijmegen, the Netherlands; Rosella P.M.G. Hermens, PhD, Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen, the Netherlands; Joanna IntHout, PhD, Radboud University Medical Center, Department for Health Evidence, Nijmegen, the Netherlands; and Joanne A. de Hullu, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Joanne A de Hullu
- Miranda P. Steenbeek, MD, PhD, and Majke H.D. van Bommel, MD, Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands; Johan Bulten, MD, PhD, Radboud University Medical Center, Department of Pathology, Nijmegen, the Netherlands; Rosella P.M.G. Hermens, PhD, Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen, the Netherlands; Joanna IntHout, PhD, Radboud University Medical Center, Department for Health Evidence, Nijmegen, the Netherlands; and Joanne A. de Hullu, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
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Swillens JEM, Voorham QJM, Nagtegaal ID, Hermens RPMG. Evidence-Based Selection, Development, and Testing of a Tailored Strategy to Improve Standardized Structured Reporting in Pathology. Arch Pathol Lab Med 2022; 146:1496-1507. [PMID: 35417541 DOI: 10.5858/arpa.2021-0236-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Standardized structured reporting (SSR) among pathologists results in more complete diagnoses and, subsequently, improved treatment decisions and patient outcomes. Therefore, SSR templates' usage is advocated in oncology guidelines. However, actual SSR usage varies widely. Previous studies have shown multiple impeding and facilitating factors regarding SSR implementation. OBJECTIVE.— To select, develop, and test an evidence-based multifaceted strategy, tailored to the impeding and facilitating factors to improve SSR implementation in oncologic pathology. DESIGN.— Six strategy elements to increase the use of SSR were selected on the basis of a barrier and facilitator analysis, literature review, and consecutive discussions with a nationwide expert panel and project team. In collaboration with a professional organization for developing SSR templates (PALGA), we developed elements and combined them in 1 multifaceted strategy and subsequently tested effectiveness and feasibility. RESULTS.— The 6 strategy elements were as follows: (1) renewed Web site including SSR information; (2) e-learning including SSR instructions; (3) communication manual describing communication about SSR; (4) improved feedback process, including use of the "Feedback Button" within SSR templates and "Frequently Asked Questions" on the Web site; (5) information sheet on SSR updates within SSR templates; and (6) monthly telephone conversations to discuss audit and feedback information regarding local SSR usage. A significant change (12.4%) in SSR usage among test laboratories was noticed. After the first test, e-learning and the "Feedback Button" were deemed most feasible and effective. However, awareness of all elements could be increased. CONCLUSIONS.— Next step will be to optimize the tailored strategy, to distribute it to all Dutch pathology laboratories, and to evaluate effectiveness and feasibility in a nationwide setting.
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Affiliation(s)
- Julie E M Swillens
- From the Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences (Swillens, Hermens)
| | - Quirinus J M Voorham
- The Radboud University Medical Center, Nijmegen, the Netherlands; and PALGA Foundation, Houten, the Netherlands (Voorham)
| | - Iris D Nagtegaal
- The Department of Pathology, Radboud Institute for Molecular Life Sciences (Nagtegaal)
| | - Rosella P M G Hermens
- From the Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences (Swillens, Hermens)
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28
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Abma IL, Roelofs LCG, van der Kolk MB, Mulder SF, Schers HJ, Hermens RPMG, van der Wees PJ. Roles of general practitioners in shared decision-making for patients with cancer: A qualitative study. Eur J Cancer Care (Engl) 2022; 31:e13594. [PMID: 35416333 PMCID: PMC9539996 DOI: 10.1111/ecc.13594] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 12/12/2021] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The shared decision-making (SDM) process for the treatment of pancreatic and oesophageal cancer primarily takes place with healthcare professionals (HCPs) in the hospital setting. This study aims to explore the perspectives of general practitioners (GPs) on their possible roles during this SDM process, their added value and their requirements for involvement in SDM. METHODS Semi-structured interviews were conducted with 12 GPs about their views on SDM for patients with cancer. The interviews were analysed by two researchers using an inductive open coding approach. RESULTS Five potential roles in SDM were described by the interviewed GPs, of which the role as 'coach' of the patient was mentioned by all. GPs see their main added value as their long-standing relationship with the patient. To be able to participate optimally in SDM, GPs indicated that they need to be kept up to date during the patient's care process and should receive enough medical information about treatment options and contextual information. CONCLUSION GPs see different potential roles for themselves when involved in SDM. Hospital HCPs that want to facilitate GP involvement should take the initiative, provide the GPs with enough and timely information and must be easy to consult.
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Affiliation(s)
- Inger L Abma
- IQ healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lianne C G Roelofs
- IQ healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Sasja F Mulder
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Henk J Schers
- Department of Primary Care Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rosella P M G Hermens
- IQ healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Philip J van der Wees
- IQ healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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29
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Myren BJ, de Hullu JA, Hermens RPMG, Koksma JJ, Zusterzeel PLM. Patient involvement via videoconference at the morbidity and mortality (M&M) meeting during COVID-19. BMJ Open Qual 2022; 11:bmjoq-2021-001691. [PMID: 35121576 PMCID: PMC8819547 DOI: 10.1136/bmjoq-2021-001691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/13/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Britt Jose Myren
- Department of Gynaecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
| | - Joanne A de Hullu
- Department of Gynaecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboudumc, Nijmegen, The Netherlands
| | - Jur J Koksma
- Health Academy, Radboudumc, Nijmegen, The Netherlands
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30
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Myren BJ, de Hullu JA, Bastiaans S, Koksma JJ, Hermens RPMG, Zusterzeel PLM. Disclosing Adverse Events in Clinical Practice: The Delicate Act of Being Open. Health Commun 2022; 37:191-201. [PMID: 33045852 DOI: 10.1080/10410236.2020.1830550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Practicing a "safe" disclosure of adverse events remains challenging for healthcare professionals. In addition, knowledge on how to deliver a disclosure is still limited. This review focuses on how disclosure communication may be practiced based on the perspectives of patients and healthcare professionals. Empirical studies conducted between September 2008 and October 2019 were included from the databases PubMed, Web of Science and Psychinfo. After full text analysis and quality appraisal this scoping review included a total of 23 studies out of 2537 studies. As a first step, the needs of patients and the challenges of healthcare professionals with the practice of providing an effective disclosure were extracted from the empirical literature. Based on these findings, the review demonstrates that specific disclosure communication strategies on the level of interpersonal skills, organization, and supportive factors may facilitate healthcare professionals to provide optimal disclosure of adverse events. These may be relevant to provide patients with a tailored approach that accompanies their preferences for information and recognition. In conclusion, healthcare professionals may need training in interpersonal (verbal and nonverbal) communication skills. Furthermore, it is important to develop an open (organizational) culture that supports the communication of adverse events and disclosure as a standard practice.
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Affiliation(s)
- B J Myren
- Department of Gynaecology, Radboud University Medical Center
| | - J A de Hullu
- Department of Gynaecology, Radboud University Medical Center
| | - S Bastiaans
- Department of Gynaecology, Radboud University Medical Center
| | - J J Koksma
- Health Academy, Radboud University Medical Center
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van Kalsbeek RJ, Mulder RL, Haupt R, Muraca M, Hjorth L, Follin C, Kepak T, Kepakova K, Uyttebroeck A, Mangelschots M, Winther JF, Loonen JJ, Michel G, Bardi E, Elmerdahl Frederiksen L, den Hartogh J, Mader L, Roser K, Schneider C, Brown MC, Brunhofer M, Göttgens I, Hermens RPMG, Kienesberger A, Korevaar JC, Skinner R, van der Pal HJH, Kremer LCM. The PanCareFollowUp Care Intervention: A European harmonised approach to person-centred guideline-based survivorship care after childhood, adolescent and young adult cancer. Eur J Cancer 2022; 162:34-44. [PMID: 34953441 DOI: 10.1016/j.ejca.2021.10.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Long-term follow-up (LTFU) care, although endorsed, is not available for the majority of adult survivors of childhood, adolescence and young adult (CAYA) cancer. Barriers to implementation include lack of time, knowledge, personnel and funding. Sustainable solutions are urgently needed to address the needs of CAYA cancer survivors to improve the quality of life and reduce the burden of late effects on survivors, health care systems and society. The European Union-funded PanCareFollowUp project, initiated by the Pan-European Network for Care of Survivors after Childhood and Adolescent Cancer, was established to facilitate the implementation of person-centred survivorship care across Europe. PATIENTS AND METHODS The PanCareFollowUp Care Intervention was co-developed with survivors as part of the PanCareFollowUp project. It is a person-centred approach to survivorship care, supported by guidelines and with flexibility to adapt to local health care settings. The Care Intervention consists of three steps: (1) previsit completion of a Survivor Questionnaire (by the survivor) and Treatment Summary (by the health care provider [HCP]), (2) a clinic visit including shared decision-making, and (3) a follow-up call to finalise the individualised Survivorship Care Plan. RESULTS We developed the key components of the PanCareFollowUp Care Intervention: a PanCareFollowUp Survivor Questionnaire, Treatment Summary template, Survivorship Care Plan template, and educational materials for HCPs and survivors. Wide implementation of the PanCareFollowUp Care Intervention will be supported with a freely distributed Replication Manual on completion of the PanCareFollowUp project. CONCLUSIONS The PanCareFollowUp Care Intervention will support the implementation of person-centred, guideline-based LTFU care in different health care settings across Europe to improve survivors' health and well-being.
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Affiliation(s)
| | - Renée L Mulder
- Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Monica Muraca
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Paediatrics, Lund, Sweden
| | - Cecilia Follin
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Oncology, Lund, Sweden
| | - Tomas Kepak
- International Clinical Research Centre (FNUSA-ICRC), St. Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Katerina Kepakova
- International Clinical Research Centre (FNUSA-ICRC), St. Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Anne Uyttebroeck
- Department of Oncology, Paediatric Oncology, KU Leuven, Department of Paediatric Haematology and Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Marlies Mangelschots
- Department of Oncology, Paediatric Oncology, KU Leuven, Department of Paediatric Haematology and Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Centre, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Jacqueline J Loonen
- Department of Haematology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Edit Bardi
- PanCare, Bussum, the Netherlands; St Anna Children's Hospital, Vienna, Austria; Department of Pediatric and Adolescent Medicine, Kepler University Clinic, Linz, Austria
| | | | - Jaap den Hartogh
- PanCare, Bussum, the Netherlands; Childhood Cancer International Europe, Vienna, Austria
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Centre, Copenhagen, Denmark; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Morven C Brown
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Herschel Building, Newcastle Upon Tyne, United Kingdom
| | | | - Irene Göttgens
- Department of Primary and Community Care, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
| | | | - Joke C Korevaar
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| | - Roderick Skinner
- Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Herschel Building, Newcastle Upon Tyne, United Kingdom; Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; Translational and Clinical Research Institute, Wolfson Childhood Cancer Research Centre, Herschel Building, Newcastle Upon Tyne, United Kingdom
| | - Helena J H van der Pal
- Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands; PanCare, Bussum, the Netherlands.
| | - Leontine C M Kremer
- Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands; Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands; Faculty of Medicine, Utrecht University and Utrecht Medical Centre, Utrecht, the Netherlands
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32
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van Bommel MHD, Steenbeek MP, IntHout J, Hermens RPMG, Hoogerbrugge N, Harmsen MG, van Doorn HC, Mourits MJE, van Beurden M, Zweemer RP, Gaarenstroom KN, Slangen BFM, Brood-van Zanten MMA, Vos MC, Piek JM, van Lonkhuijzen LRCW, Apperloo MJA, Coppus SFPJ, Prins JB, Custers JAE, de Hullu JA. Cancer worry among BRCA1/2 pathogenic variant carriers choosing surgery to prevent tubal/ovarian cancer: course over time and associated factors. Support Care Cancer 2022; 30:3409-3418. [PMID: 34997316 PMCID: PMC8857097 DOI: 10.1007/s00520-021-06726-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/26/2021] [Indexed: 11/03/2022]
Abstract
Objective High cancer risks, as applicable to BRCA1 and BRCA2 pathogenic variant (PV) carriers, can induce significant cancer concerns. We examined the degree of cancer worry and the course of this worry among BRCA1/2-PV carriers undergoing surgery to prevent ovarian cancer, and identified factors associated with high cancer worry. Methods Cancer worry was evaluated as part of the multicentre, prospective TUBA-study (NCT02321228) in which BRCA1/2-PV carriers choose either novel risk-reducing salpingectomy with delayed oophorectomy or standard risk-reducing salpingo-oophorectomy. The Cancer Worry Scale was obtained before and 3 and 12 months after surgery. Cancer worry patterns were analysed using latent class growth analysis and associated factors were identified with regression analysis. Results Of all 577 BRCA1/2-PV carriers, 320 (57%) had high (≥ 14) cancer worry pre-surgery, and 54% had lower worry 12 months post-surgery than pre-surgery. Based on patterns over time, BRCA1/2-PV carriers could be classified into three groups: persistently low cancer worry (56%), persistently high cancer worry (6%), and fluctuating, mostly declining, cancer worry (37%). Factors associated with persistently high cancer concerns were age below 35 (BRCA1) or 40 (BRCA2), unemployment, previous breast cancer, lower education and a more recent BRCA1/2-PV diagnosis. Conclusions Some degree of cancer worry is considered normal, and most BRCA1/2-PV carriers have declining cancer worry after gynaecological risk-reducing surgery. However, a subset of these BRCA1/2-PV carriers has persisting major cancer concerns up to 1 year after surgery. They should be identified and potentially offered additional support. Clinical trial registration The TUBA-study is registered at ClinicalTrials.gov since December 11th, 2014. Registration number: NCT02321228. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06726-4.
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Affiliation(s)
- Majke H D van Bommel
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Miranda P Steenbeek
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Joanna IntHout
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marline G Harmsen
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Helena C van Doorn
- Department of Gynaecology, Erasmus MC Cancer Clinic, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Marian J E Mourits
- Department of Gynaecologic Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Marc van Beurden
- Center for Gynaecological Oncology Amsterdam (CGOA), Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Ronald P Zweemer
- Department of Gynaecological Oncology, UMC Utrecht Cancer Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Katja N Gaarenstroom
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, GROW-School for Oncology and Developmental Biology, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Monique M A Brood-van Zanten
- Center for Gynaecological Oncology Amsterdam (CGOA), Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Center for Gynaecological Oncology Amsterdam (CGOA), AmsterdamUMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M Caroline Vos
- Gynaecologic Oncologic Center South Location Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5000 LC, Tilburg, The Netherlands
| | - Jurgen M Piek
- Gynaecologic Oncologic Center South Location Catharina Hospital, Department of Obstetrics and Gynaecology and Catharina Cancer Institute, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Luc R C W van Lonkhuijzen
- Center for Gynaecological Oncology Amsterdam (CGOA), AmsterdamUMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mirjam J A Apperloo
- Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - Sjors F P J Coppus
- Department of Obstetrics and Gynaecology, Maxima Medical Center, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud Institute F Or Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - José A E Custers
- Department of Medical Psychology, Radboud Institute F Or Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Swillens JEM, Voorham QJM, Nagtegaal ID, Hermens RPMG. Improving Interdisciplinary Communication: Barriers and Facilitators for Implementation of Standardized Structured Reporting in Oncology. J Natl Compr Canc Netw 2021; 19:1-11. [PMID: 34653965 DOI: 10.6004/jnccn.2021.7002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 01/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Standardized structured reporting (SSR) improves quality of diagnostic cancer reporting and interdisciplinary communication in multidisciplinary team (MDT) meetings, resulting in more adequate treatment decisions and better health outcomes. However, use of SSR varies widely among pathologists, but might be encouraged by MDT members (MDTMs). Our objectives were to identify barriers and facilitators (influencing factors) for SSR implementation in oncologic pathology from the perspective of MDTMs and their determinants. METHODS In a multimethod design, we identified influencing factors for SSR implementation related to MDT meetings, using 5 domains: (1) innovation factors, (2) individual professional factors, (3) social setting factors, (4) organizational factors, and (5) political and legal factors. Four focus groups with MDTMs in urologic, gynecologic, and gastroenterologic oncology were conducted. We used an eSurvey among MDTMs to quantify the qualitative findings and to analyze determinants affecting these influencing factors. RESULTS Twenty-three MDTMs practicing in 9 oncology-related disciplines participated in the focus groups and yielded 28 barriers and 28 facilitators in all domains. The eSurvey yielded 211 responses. Main barriers related to lack of readability of SSR: difficulties with capturing nuances (66%) and formulation of the conclusion (43%); lack of transparency in the development (50%) and feedback processes of SSR templates (38%); and lack of information exchange about SSR between pathologists and other MDTMs (45%). Main facilitators were encouragement of pathologists' SSR use by MDTMs (90%) and expanding the recommendation of SSR use in national guidelines (80%). Oncology-related medical discipline and MDT type were the most relevant determinants for SSR implementation barriers. CONCLUSIONS Although SSR makes diagnostic reports more complete, this study shows important barriers in implementing SSR in oncologic pathology. The next step is to use these factors for developing and testing implementation tools to improve SSR implementation.
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Affiliation(s)
- Julie E M Swillens
- 1Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen
| | | | - Iris D Nagtegaal
- 3Department of Pathology, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- 1Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen
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Hopstaken JS, Verweij L, van Laarhoven CJHM, Blijlevens NMA, Stommel MWJ, Hermens RPMG. Effect of Digital Care Platforms on Quality of Care for Oncological Patients and Barriers and Facilitators for Their Implementation: Systematic Review. J Med Internet Res 2021; 23:e28869. [PMID: 34559057 PMCID: PMC8501408 DOI: 10.2196/28869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/17/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Oncological health care services are challenged by the increasing number of cancer survivors, long-term follow-up care, and fragmentation of care. Digital care platforms are potential tools to deliver affordable, patient-centered oncological care. Previous reviews evaluated only one feature of a digital care platform or did not evaluate the effect on enhancement of information, self-efficacy, continuity of care, or patient- and health care provider-reported experiences. Additionally, they have not focused on the barriers and facilitators for implementation of a digital care platform in oncological care. OBJECTIVE The aim of this systematic review was to collect the best available evidence of the effect of a digital care platform on quality of care parameters such as enhancement of available information, self-efficacy, continuity of care, and patient- and health care provider-reported experiences. Additionally, barriers and facilitators for implementation of digital care platforms were analyzed. METHODS The PubMed (Medline), Embase, CINAHL, and Cochrane Library databases were searched for the period from January 2000 to May 2020 for studies assessing the effect of a digital care platform on the predefined outcome parameters in oncological patients and studies describing barriers and facilitators for implementation. Synthesis of the results was performed qualitatively. Barriers and facilitators were categorized according to the framework of Grol and Wensing. The Mixed Methods Appraisal Tool was used for critical appraisal of the studies. RESULTS Seventeen studies were included for final analysis, comprising 8 clinical studies on the effectiveness of the digital care platform and 13 studies describing barriers and facilitators. Usage of a digital care platform appeared to enhance the availability of information and self-efficacy. There were no data available on the effect of a digital care platform on the continuity of care. However, based on focus group interviews, digital care platforms could potentially improve continuity of care by optimizing the exchange of patient information across institutes. Patient-reported experiences such as satisfaction with the platform were considerably positive. Most barriers for implementation were identified at the professional level, such as the concern for increased workload and unattended release of medical information to patients. Most facilitators were found at the patient and innovation levels, such as improved patient-doctor communication and patient empowerment. There were few barriers and facilitators mentioned at the economic and political levels. CONCLUSIONS The use of digital care platforms is associated with better quality of care through enhancement of availability of information and increased self-efficacy for oncological patients. The numerous facilitators identified at the patient level illustrate that patients are positive toward a digital care platform. However, despite these favorable results, robust evidence concerning the effectiveness of digital care platforms, especially from high-quality studies, is still lacking. Future studies should therefore aim to further investigate the effectiveness of digital care platforms, and the barriers and facilitators to their implementation at the economic and political levels.
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Affiliation(s)
- Jana S Hopstaken
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lynn Verweij
- Department of Hematology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Cees J H M van Laarhoven
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Martijn W J Stommel
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
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Steenbeek MP, van Bommel MHD, Harmsen MG, Hoogerbrugge N, van Doorn HC, Keurentjes JHM, van Beurden M, Zweemer RP, Gaarenstroom KN, Penders CGJ, Brood-van Zanten MMA, Vos MC, Piek JM, van Lonkhuijzen LRCW, Apperloo MJA, Coppus SFPJ, IntHout J, de Hullu JA, Hermens RPMG. Evaluation of a patient decision aid for BRCA1/2 pathogenic variant carriers choosing an ovarian cancer prevention strategy. Gynecol Oncol 2021; 163:371-377. [PMID: 34456057 DOI: 10.1016/j.ygyno.2021.08.019] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Risk-reducing surgery is advised to BRCA1/2 pathogenic variant (PV) carriers around the age of 40 years to reduce ovarian cancer risk. In the TUBA-study, a multicenter preference study (NCT02321228), BRCA1/2-PV carriers are offered a choice: the standard strategy of risk-reducing salpingo-oophorectomy or the novel strategy of risk-reducing salpingectomy with delayed oophorectomy. We evaluated feasibility and effectiveness of a patient decision aid for this choice. METHODS Premenopausal BRCA1/2-PV carriers were counselled for risk-reducing surgical options in the TUBA-study; the first cohort was counselled without and the second cohort with decision aid. Evaluation was performed using digital questionnaires for participating women and their healthcare professionals. Outcome measures included actual choice, feasibility (usage and experiences) and effectiveness (knowledge, cancer worry, decisional conflict, decisional regret and self-estimated influence on decision). RESULTS 283 women were counselled without and 282 women with decision aid. The novel strategy was chosen less frequently in women without compared with women with decision aid (67% vs 78%, p = 0.004). The decision aid was graded with an 8 out of 10 by both women and professionals, and 78% of the women would recommend this decision aid to others. Users of the decision aid reported increased knowledge about the options and increased insight in personal values. Knowledge on cancer risk, decisional conflict, decisional regret and cancer worry were similar in both cohorts. CONCLUSIONS The use of the patient decision aid for risk-reducing surgery is feasible, effective and highly appreciated among BRCA1/2-PV carriers facing the decision between salpingo-oophorectomy or salpingectomy with delayed oophorectomy.
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Affiliation(s)
- Miranda P Steenbeek
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Majke H D van Bommel
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands.
| | - Marline G Harmsen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Nicoline Hoogerbrugge
- Radboud University Medical Center, Department of Human Genetics, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Helena C van Doorn
- Department of Gynecology, Erasmus MC Cancer Clinic, 's, Gravendijkwal 230, 3015, CE, Rotterdam, the Netherlands
| | - José H M Keurentjes
- Department of Gynecologic Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Marc van Beurden
- Centre for Gynecological Oncology Amsterdam (CGOA), Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Ronald P Zweemer
- Department of Gynecological Oncology, UMC Utrecht Cancer Centre, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Katja N Gaarenstroom
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
| | - Charlotte G J Penders
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, GROW-School for Oncology and Developmental Biology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Monique M A Brood-van Zanten
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - M Caroline Vos
- Gynecologic Oncologic Centre South location Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5000, LC, Tilburg, the Netherlands
| | - Jurgen M Piek
- Gynecologic Oncologic Centre South location Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - Luc R C W van Lonkhuijzen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Mirjam J A Apperloo
- Department of Obstetrics and Gynecology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934, AD, Leeuwarden, the Netherlands
| | - Sjors F P J Coppus
- Department of Obstetrics and Gynecology, Maxima Medical Centre, De Run 4600, 5504, DB, Veldhoven, the Netherlands
| | - Joanna IntHout
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department for Health Evidence, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Joanne A de Hullu
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- Radboud University Medical Center, Scientific Institute for Quality of Healthcare, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
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Steenbeek MP, Harmsen MG, Hoogerbrugge N, de Jong MA, Maas AHEM, Prins JB, Bulten J, Teerenstra S, van Bommel MHD, van Doorn HC, Mourits MJE, van Beurden M, Zweemer RP, Gaarenstroom KN, Slangen BFM, Brood-van Zanten MMA, Vos MC, Piek JMJ, van Lonkhuijzen LRCW, Apperloo MJA, Coppus SFPJ, Massuger LFAG, IntHout J, Hermens RPMG, de Hullu JA. Association of Salpingectomy With Delayed Oophorectomy Versus Salpingo-oophorectomy With Quality of Life in BRCA1/2 Pathogenic Variant Carriers: A Nonrandomized Controlled Trial. JAMA Oncol 2021; 7:1203-1212. [PMID: 34081085 DOI: 10.1001/jamaoncol.2021.1590] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Most women with a BRCA1/2 pathogenic variant undergo premature menopause with potential short- and long-term morbidity due to the current method of ovarian carcinoma prevention: risk-reducing salpingo-oophorectomy (RRSO). Because the fallopian tubes play a key role in ovarian cancer pathogenesis, salpingectomy with delayed oophorectomy may be a novel risk-reducing strategy with benefits of delaying menopause. Objective To compare menopause-related quality of life after risk-reducing salpingectomy (RRS) with delayed oophorectomy with RRSO in carriers of the BRCA1/2 pathogenic variant. Design, Setting, and Participants A multicenter nonrandomized controlled preference trial (TUBA study), with patient recruitment between January 16, 2015, and November 7, 2019, and follow-up at 3 and 12 months after surgery was conducted in all Dutch university hospitals and a few large general hospitals. In the Netherlands, RRSO is predominantly performed in these hospitals. Patients at the clinical genetics or gynecology department between the ages of 25 and 40 years (BRCA1) or 25 to 45 years (BRCA2) who were premenopausal, had completed childbearing, and were undergoing no current treatment for cancer were eligible. Interventions Risk-reducing salpingo-oophorectomy at currently recommended age or RRS after completed childbearing with delayed oophorectomy. After RRSO was performed, hormone replacement therapy was recommended for women without contraindications. Main Outcomes and Measures Menopause-related quality of life as assessed by the Greene Climacteric Scale, with a higher scale sum (range, 0-63) representing more climacteric symptoms. Secondary outcomes were health-related quality of life, sexual functioning and distress, cancer worry, decisional regret, and surgical outcomes. Results A total of 577 women (mean [SD] age, 37.2 [3.5] years) were enrolled: 297 (51.5%) were pathogenic BRCA1 variant carriers and 280 (48.5%) were BRCA2 pathogenic variant carriers. At the time of analysis, 394 patients had undergone RRS and 154 had undergone RRSO. Without hormone replacement therapy, the adjusted mean increase from the baseline score on the Greene Climacteric Scale was 6.7 (95% CI, 5.0-8.4; P < .001) points higher during 1 year after RRSO than after RRS. After RRSO with hormone replacement therapy, the difference was 3.6 points (95% CI, 2.3-4.8; P < .001) compared with RRS. Conclusions and Relevance Results of this nonrandomized controlled trial suggest that patients have better menopause-related quality of life after RRS than after RRSO, regardless of hormone replacement therapy. An international follow-up study is currently evaluating the oncologic safety of this therapy. Trial Registration ClinicalTrials.gov Identifier: NCT02321228.
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Affiliation(s)
- Miranda P Steenbeek
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marline G Harmsen
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marieke Arts de Jong
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Steven Teerenstra
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Majke H D van Bommel
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Helena C van Doorn
- Department of Gynecology, Erasmus MC Cancer Clinic, Rotterdam, the Netherlands
| | - Marian J E Mourits
- Department of Gynecologic Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Marc van Beurden
- Centre for Gynecological Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Ronald P Zweemer
- Department of Gynecological Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands
| | - Katja N Gaarenstroom
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, GROW-School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Monique M A Brood-van Zanten
- Department of Obstetrics and Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.,Department of Obstetrics and Gynecology, AmsterdamUMC, Amsterdam, the Netherlands
| | - M Caroline Vos
- Gynecologic Oncologic Centre South location Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Jurgen M J Piek
- Gynecologic Oncologic Centre South location Catharina Hospital, Eindhoven, the Netherlands
| | | | - Mirjam J A Apperloo
- Department of Obstetrics and Gynecology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Sjors F P J Coppus
- Department of Obstetrics and Gynecology, Maxima Medical Centre, Veldhoven, the Netherlands
| | - Leon F A G Massuger
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joanna IntHout
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joanne A de Hullu
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
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Gelderblom ME, Van Lieshout LAM, Piek JMJ, De Hullu JA, Hermens RPMG. Patients' and professionals' perspectives on implementation of opportunistic salpingectomy: a mixed-method study. BMC Health Serv Res 2021; 21:736. [PMID: 34303378 PMCID: PMC8310584 DOI: 10.1186/s12913-021-06767-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To prevent ovarian cancer, several international societies have issued guidelines which recommend to discuss opportunistic salpingectomy with women undergoing pelvic surgery after completion of childbearing. The opportunistic salpingectomy refers to the additional removal of Fallopian tubes during pelvic surgery for another indication to reduce the risk of developing ovarian cancer. These recommendations emphasize the importance of counselling on benefits and risks of opportunistic salpingectomy but offer no guidance on their implementation in daily practice. The lack of a tailored implementation strategy has resulted in a wide variation in current practice. To reduce this practice variation, we identified influencing factors on implementing opportunistic salpingectomy from patients' and professionals' perspectives. METHODS We conducted a mixed-method study between 2019 and 2020 throughout the Netherlands. In a qualitative phase, we conducted interviews with gynecologic patients (N = 11) and their professionals (N = 20) to explore barriers and facilitators, using an interview guide. In the quantitative phase, we quantified these barriers and facilitators among patients who underwent a hysterectomy or sterilization and were counselled on the opportunistic salpingectomy (N = 77), and members of the Dutch Society of Obstetrics and Gynecology (N = 204), using questionnaires. For both phases, barriers and facilitators were classified into the following domains: innovation, patient, healthcare professional, social setting, organization, and economic and political context. RESULTS For patients, main barriers were lack of knowledge about: the existence of the opportunistic salpingectomy (45%), size of the surgery (44%) and its associated possible disadvantages (37%). In addition, patients attributed their reluctance to concerns about the removal of healthy organs (46%). For professionals, main barriers were: patients' lack of knowledge of the size of surgery (85%) and its associated possible disadvantages (77%), the gap in evidence on long term risks and benefits (43%), the lack of feasibility in certain patients and during vaginal surgery (66%). Both patients (41%) and professionals (67%) identified the need for counselling material as facilitator. CONCLUSION To reduce the variety in care regarding opportunistic salpingectomy, consensus and uniform counselling is needed. Including the opportunistic salpingectomy in gynecological guidelines and a decision aid for counselling could serve as tools to facilitate implementation.
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Affiliation(s)
- Malou E Gelderblom
- Department of Obstetrics and Gynecology, Radboud Institute for Health Sciences, Radboud University Medical Centre, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Laura A M Van Lieshout
- Department of Obstetrics and Gynecology, Radboud Institute for Health Sciences, Radboud University Medical Centre, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
- Department of Obstetrics and gynecology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, The Netherlands
| | - Jurgen M J Piek
- Department of Obstetrics and gynecology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, The Netherlands
| | - Joanne A De Hullu
- Department of Obstetrics and Gynecology, Radboud Institute for Health Sciences, Radboud University Medical Centre, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Department of IQ Health Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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van Kalsbeek RJ, van der Pal HJH, Hjorth L, Winther JF, Michel G, Haupt R, Uyttebroeck A, O'Brien K, Kepakova K, Follin C, Muraca M, Kepak T, Araujo-Soares V, Bardi E, Blondeel A, Bouwman E, Brown MC, Frederiksen LE, Essiaf S, Hermens RPMG, Kienesberger A, Korevaar JC, Mader L, Mangelschots M, Mulder RL, van den Oever S, Rijken M, Roser K, Skinner R, Pluijm SMF, Loonen JJ, Kremer LCM. The European multistakeholder PanCareFollowUp project: novel, person-centred survivorship care to improve care quality, effectiveness, cost-effectiveness and accessibility for cancer survivors and caregivers. Eur J Cancer 2021; 153:74-85. [PMID: 34153717 DOI: 10.1016/j.ejca.2021.05.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/12/2021] [Accepted: 05/20/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The majority of childhood cancer survivors are at risk of treatment-related adverse health outcomes. Survivorship care to mitigate these late effects is endorsed, but it is not available for many adult survivors of childhood cancer in Europe. The PanCareFollowUp project was initiated to improve their health and quality of life (QoL) by facilitating person-centred survivorship care. METHODS The PanCareFollowUp consortium was established in 2018, consisting of 14 project partners from ten European countries, including survivor representatives. The consortium will develop two PanCareFollowUp Interventions, including a person-centred guideline-based model of care (Care Intervention) and eHealth lifestyle coaching (Lifestyle Intervention). Their development will be informed by several qualitative studies and systematic reviews on barriers and facilitators for implementation and needs and preferences of healthcare providers (HCPs) and survivors. Implementation of the PanCareFollowUp Care Intervention as usual care will be evaluated prospectively among 800 survivors from Belgium, Czech Republic, Italy and Sweden for survivor empowerment, detection of adverse health conditions, satisfaction among survivors and HCPs, cost-effectiveness and feasibility. The feasibility of the PanCareFollowUp Lifestyle Intervention will be evaluated in the Netherlands among 60 survivors. RESULTS Replication manuals, allowing for replication of the PanCareFollowUp Care and Lifestyle Intervention, will be published and made freely available after the project. Moreover, results of the corresponding studies are expected within the next five years. CONCLUSIONS The PanCareFollowUp project is a novel European collaboration aiming to improve the health and QoL of all survivors across Europe by developing and prospectively evaluating the person-centred PanCareFollowUp Care and Lifestyle Interventions.
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Affiliation(s)
- Rebecca J van Kalsbeek
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, Utrecht, 3584 CS, the Netherlands.
| | - Helena J H van der Pal
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, Utrecht, 3584 CS, the Netherlands; PanCare, Jacobus Bellamylaan 16, Bussum, 1401 AZ, the Netherlands
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Paediatrics, Lasarettsgatan 40, Lund, 221 85, Sweden
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Centre, Strandboulevarden 49 Copenhagen, 2100, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, Aarhus, 8200, Denmark
| | - Gisela Michel
- University of Lucerne, Department of Health Sciences and Medicine, Frohburgstrasse 3, P.O. Box 4466, Lucerne, 6002, Switzerland
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Via G. Gaslini, 5, Genoa, 16147, Italy
| | - Anne Uyttebroeck
- Department of Oncology, Paediatric Oncology, KU Leuven, Department of Paediatric Haematology and Oncology, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - Kylie O'Brien
- Pintail, Limited, 77 Springhill Avenue, Blackrock, Dublin, Ireland
| | - Katerina Kepakova
- International Clinical Research Centre (FNUSA-ICRC) at St. Anne's University Hospital, Masaryk University, Pekařská 53, Brno, 656 91, Czech Republic
| | - Cecilia Follin
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Oncology, Lasarettsgatan 40, Lund, 221 85, Sweden
| | - Monica Muraca
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Via G. Gaslini, 5, Genoa, 16147, Italy
| | - Tomas Kepak
- International Clinical Research Centre (FNUSA-ICRC) at St. Anne's University Hospital, Masaryk University, Pekařská 53, Brno, 656 91, Czech Republic
| | - Vera Araujo-Soares
- Department of Health Technology & Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, the Netherlands
| | - Edit Bardi
- St Anna Children's Hospital, Kinderspitalgasse 6, Vienna, 1090, Austria; Kepler University Clinic, Department of Pediatric and Adolescent Medicine, Krankenhausstraße 26-30, Linz, 4020, Austria
| | - Anne Blondeel
- European Society for Paediatric Oncology, C/o BLSI, Clos Chapelle-aux-Champs 30, Bte 1.30.30, Brussels, BE-1200, Belgium
| | - Eline Bouwman
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Department of Hematology, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, the Netherlands
| | - Morven C Brown
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, United Kingdom; Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Herschel Building, Brewery Lane, Newcastle Upon Tyne, NE1 7RU, United Kingdom
| | - Line E Frederiksen
- Childhood Cancer Research Group, Danish Cancer Society Research Centre, Strandboulevarden 49 Copenhagen, 2100, Denmark
| | - Samira Essiaf
- European Society for Paediatric Oncology, C/o BLSI, Clos Chapelle-aux-Champs 30, Bte 1.30.30, Brussels, BE-1200, Belgium
| | - Rosella P M G Hermens
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare) Geert Grooteplein 21, Nijmegen, 6525 EZ, the Netherlands
| | - Anita Kienesberger
- Childhood Cancer International Europe, Servitengasse 5/16, Vienna, 1090, Austria
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (Nivel), P.O. Box 1568, Utrecht, 3500 BN, the Netherlands
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Centre, Strandboulevarden 49 Copenhagen, 2100, Denmark; Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland
| | - Marlies Mangelschots
- Department of Oncology, Paediatric Oncology, KU Leuven, Department of Paediatric Haematology and Oncology, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - Renée L Mulder
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, Utrecht, 3584 CS, the Netherlands
| | - Selina van den Oever
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, Utrecht, 3584 CS, the Netherlands
| | - Mieke Rijken
- Netherlands Institute for Health Services Research (Nivel), P.O. Box 1568, Utrecht, 3500 BN, the Netherlands; University of Eastern Finland, Department of Health and Social Management, P.O. Box 1627, Kuopio, FI-70211, Finland
| | - Katharina Roser
- University of Lucerne, Department of Health Sciences and Medicine, Frohburgstrasse 3, P.O. Box 4466, Lucerne, 6002, Switzerland
| | - Rod Skinner
- Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Herschel Building, Brewery Lane, Newcastle Upon Tyne, NE1 7RU, United Kingdom; Great North Children's Hospital, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4 LP, United Kingdom; Translational and Clinical Research Institute, Wolfson Childhood Cancer Research Centre, Herschel Building, Brewery Lane, Newcastle Upon Tyne, NE1 7RU, United Kingdom
| | - Saskia M F Pluijm
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, Utrecht, 3584 CS, the Netherlands
| | - Jacqueline J Loonen
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Department of Hematology, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, the Netherlands
| | - Leontien C M Kremer
- Princess Máxima Centre for Paediatric Oncology, Heidelberglaan 25, Utrecht, 3584 CS, the Netherlands; Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands; Faculty of Medicine, Utrecht University and Utrecht Medical Centre, Universiteitsweg 98, Utrecht, 3584 CG, the Netherlands
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van den Berg M, van der Meij E, Bos AME, Boshuizen MCS, Determann D, van Eekeren RRJP, Lok CAR, Schaake EE, Witteveen PO, Wondergem MJ, Braat DDM, Beerendonk CCM, Hermens RPMG. Development and testing of a tailored online fertility preservation decision aid for female cancer patients. Cancer Med 2021; 10:1576-1588. [PMID: 33580749 PMCID: PMC7940215 DOI: 10.1002/cam4.3711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022] Open
Abstract
Background Decision making regarding future fertility can be very difficult for female cancer patients. To support patients in decision making, fertility preservation decision aids (DAs) are being developed. However, to make a well‐informed decision, patients need personalized information tailored to their cancer type and treatment. Tailored cancer‐specific DAs are not available yet. Methods Our DA was systematically developed by a multidisciplinary steering group (n = 21) in an iterative process of draft development, three rounds of alpha testing, and revisions. The drafts were based on current guidelines, literature, and patients' and professionals' needs. Results In total, 24 cancer‐specific DAs were developed. In alpha testing, cancer survivors and professionals considered the DA very helpful in decision making, and scored an 8.5 (scale 1–10). In particular, the cancer‐specific information and the tool for recognizing personal values were of great value. Revisions were made to increase readability, personalization, usability, and be more careful in giving any false hope. Conclusions A fertility preservation DA containing cancer‐specific information is important in the daily care of female cancer patients and should be broadly available. Our final Dutch version is highly appraised, valid, and usable in decision making. After evaluating its effectiveness with newly diagnosed patients, the DA can be translated and adjusted according to (inter)national guidelines.
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Affiliation(s)
- Michelle van den Berg
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elleke van der Meij
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annelies M E Bos
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - Christianne A R Lok
- Centre for Gynecological Oncology Amsterdam, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Eva E Schaake
- Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marielle J Wondergem
- Department of Hematology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Didi D M Braat
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catharina C M Beerendonk
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Myren BJ, Hermens RPMG, Koksma JJ, Bastiaans S, de Hullu JA, Zusterzeel PLM. Openness to new perspectives created by patient participation at the morbidity and mortality meeting. Patient Educ Couns 2021; 104:343-351. [PMID: 33051126 DOI: 10.1016/j.pec.2020.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/12/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Morbidity and mortality meetings (M&MMs) at surgical departments may improve when patients participate, leading to different learning points. A gynecological oncology department invited patients to join their M&MMs. The practical constraints and experiences important from the perspective of patients and their healthcare professionals were evaluated. METHODS Semi-structured interviews were conducted with patients and professionals who attended M&MMs at a gynecological oncology department between 2016 and 2018. The interviews were transcribed and coded and thematic content analysis was performed. RESULTS Eight patients and 17 healthcare professionals participated. Eleven themes related to interpersonal dynamics. The five shared themes are: patient-doctor relationship, language, openness of communication, learning and personal impact. All participants suggested maintaining the new practical design of the M&MMs. CONCLUSIONS Patients and healthcare professionals valued patient participation in the M&MMs. Patient participation is possible when professionals are open to discussing and learning from adverse events (AEs). In this setting, patients feel that they are taken seriously and gain a better understanding of the course of an AE. PRACTICE IMPLICATIONS Involving patients in M&MMs led to new insights, better understanding, and improved processing of AEs. Collaborating with patients and using their feedback seems to be effective when developing innovations in healthcare.
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Affiliation(s)
- B J Myren
- Department of Gynaecology and Obstetrics, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6500 HB Nijmegen, the Netherlands.
| | - R P M G Hermens
- IQ Healthcare, Radboud University Medical Centre, the Netherlands.
| | - J J Koksma
- Health Academy, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - S Bastiaans
- Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - J A de Hullu
- Department of Gynaecology and Obstetrics, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6500 HB Nijmegen, the Netherlands.
| | - P L M Zusterzeel
- Department of Gynaecology and Obstetrics, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6500 HB Nijmegen, the Netherlands.
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IJsbrandy C, Ottevanger PB, Gerritsen WR, van Harten WH, Hermens RPMG. Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study. J Cancer Surviv 2020; 15:163-177. [PMID: 32986232 PMCID: PMC7822788 DOI: 10.1007/s11764-020-00921-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/25/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To tailor implementation strategies that maximize adherence to physical cancer rehabilitation (PCR) guidelines, greater knowledge concerning determinants of adherence to those guidelines is needed. To this end, we assessed the determinants of adherence to PCR guidelines in the patient and cancer center. METHODS We investigated adherence variation of PCR guideline-based indicators regarding [1] screening with the Distress Thermometer (DT), [2] information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), [3] advice to take part in PA and PCRPs, [4] referral to PCRPs, [5] participation in PCRPs, and [6] PA uptake (PAU) in nine cancer centers. Furthermore, we assessed patient and cancer center characteristics as possible determinants of adherence. Regression analyses were used to determine associations between guideline adherence and patient and cancer center characteristics. In these analyses, we assumed the patient (level 1) nested within the cancer center (level 2). RESULTS Nine hundred and ninety-nine patients diagnosed with cancer between January 2014 and June 2015 were included. Of the 999 patients included in the study, 468 (47%) received screening with the DT and 427 (44%) received information provision concerning PA and PCRPs. Subsequently, 550 (56%) patients were advised to take part in PA and PCRPs, which resulted in 174 (18%) official referrals. Ultimately, 280 (29%) patients participated in PCRPs, and 446 (45%) started PAU. Screening with the DT was significantly associated with information provision concerning PA and PCRPs (OR 1.99, 95% CI 1.47-2.71), advice to take part in PA and PCRPs (OR 1.79, 95% CI 1.31-2.45), referral to PCRPs (OR 1.81, 95% CI 1.18-2.78), participation in PCRPs (OR 2.04, 95% CI 1.43-2.91), and PAU (OR 1.69, 95% CI 1.25-2.29). Younger age, male gender, breast cancer as the tumor type, ≥2 cancer treatments, post-cancer treatment weight gain/loss, employment, and fatigue were determinants of guideline adherence. Less variation in scores of the indicators between the different cancer centers was found. This variation between centers was too low to detect any association between center characteristics with the indicators. CONCLUSIONS The implementation of PCR guidelines is in need of improvement. We found determinants at the patient level associated with guideline-based PCR care. IMPLICATIONS FOR CANCER SURVIVORS Implementation strategies that deal with the determinants of adherence to PCR guidelines might improve the implementation of PCR guidelines and the quality of life of cancer survivors.
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Affiliation(s)
- Charlotte IJsbrandy
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, PO Box 9101, Nijmegen, 6500, HB, The Netherlands. .,Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands. .,Department of Radiation Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, MB-HTSR, University of Twente, Enschede, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
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Schutte HW, van den Broek GB, Steens SCA, Hermens RPMG, Honings J, Marres HAM, Merkx MAW, Weijs WLJ, Arens AIJ, van Engen-van Grunsven ACH, van Herpen CML, Kaanders JHAM, van den Hoogen FJA, Takes RP. Impact of optimizing diagnostic workup and reducing the time to treatment in head and neck cancer. Cancer 2020; 126:3982-3990. [PMID: 32634271 PMCID: PMC7496336 DOI: 10.1002/cncr.33037] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/07/2020] [Accepted: 04/28/2020] [Indexed: 12/14/2022]
Abstract
Background Timely and efficient diagnostic workup of patients with head and neck cancer (HNC) is challenging. This observational study describes the implementation of an optimized multidisciplinary oncological diagnostic workup for patients with HNC and its impact on diagnostic and treatment intervals, survival, costs, and patient satisfaction. Methods All patients with newly diagnosed HNC who underwent staging and treatment at the Radboud University Medical Center were included. Conventional workup (CW) in 2009 was compared with the fast‐track, multidisciplinary, integrated care program, that is, optimized workup (OW), as implemented in 2014. Results The study included 486 patients with HNC (218 with CW and 268 with OW). The time‐to‐treatment interval was significantly lower in the OW cohort than the CW cohort (21 vs 34 days; P < .0001). The 3‐year overall survival rate was 12% higher after OW (72% in the CW cohort vs 84% in the OW cohort; P = .002). After correction for confounders, the 3‐year risk of death remained significantly lower in the OW cohort (hazard ratio, 1.73; 95% confidence interval, 1.14‐2.63; P = .010). Total diagnostic costs were comparable in the 2 cohorts. The general satisfaction score, as measured with the Consumer Quality Index for Oncological Care, was significantly better in a matched OW group than the CW group (9.1 vs 8.5; P = .007). Conclusions After the implementation of a fast‐track, multidisciplinary, integrated care program, the time‐to‐treatment interval was significantly reduced. Overall survival and patient satisfaction increased significantly, whereas costs did not change. This demonstrates the impact and improved quality of care achieved by efficiently organizing the diagnostic phase of HNC management. After the implementation of a fast‐track, multidisciplinary, integrated care program for patients with head and neck cancer, this study shows a significant reduction in the time‐to‐diagnosis and time‐to‐treatment intervals, a significant increase in 3‐year overall survival, and an increase in patient satisfaction without increased diagnostic costs. This demonstrates the impact and improved quality of care achieved by efficiently organizing the diagnostic phase of head and neck cancer management.
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Affiliation(s)
- Henrieke W Schutte
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan C A Steens
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem L J Weijs
- Department of Oral and Maxillofacial Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anne I J Arens
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Carla M L van Herpen
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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Abstract
PURPOSE OF REVIEW This review describes the gaps in cancer patient information and comprehension and provides examples of interventions aimed at filling the gaps. RECENT FINDINGS Despite the technologically advanced era, unmet information needs remain a challenge in current cancer care, even though the beneficial effects of adequate information provision are well described.It starts with the basics of patient-physician communication and information exchange. Barriers are described both patient and physician-specific. For patients to comprehend and recall information correctly, information provision should be tailored to the specific patient in content, as well as in readability level. Tailored content based on bidirectional and iterative information exchange (i.e., patients reported outcomes, followed by specific/personalized feedback) is of focus in the current development of interventions aimed at meeting the gaps. However, the effects of such interventions are not overwhelming and the explanation could be multifactorial. SUMMARY Unmet informational needs are still a gap in current cancer care. The effect of eHealth interventions is not yet well established. Key is to educate patients and (future) healthcare professionals in eHealth. Future research should focus on identifying what kind of interventions are able to fill the gaps.
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Affiliation(s)
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
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Baysal Ö, Van den Berg M, Beldman F, Braat DDM, Nelen WLDM, Hermens RPMG, Beerendonk CCM. Key recommendations for high-quality female oncofertility care based on international clinical practice guidelines. Reprod Biomed Online 2020; 40:409-422. [PMID: 32057675 DOI: 10.1016/j.rbmo.2019.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
RESEARCH QUESTION Which guideline-based key recommendations can be selected for high-quality female oncofertility care? DESIGN The Delphi method was used to select a set of key recommendations for female oncofertility care. First, recommendations from (inter)national clinical practice guidelines were selected in four domains: risk communication, referral, counselling and decision-making. Thereafter, they were scored, per domain, on their importance for high-quality oncofertility care by a multidisciplinary, oncofertility expert panel, consisting of patients, referrers and counsellors, in two Delphi rounds. Finally, the selected key recommendations were presented for approval in a third round. Differences in perspectives between subgroups of the expert panel were analysed. RESULTS A panel of 86 experts was asked to select key recommendations for high-quality oncofertility care. Eleven key recommendations were selected. Key recommendations in the domains risk communication and referral focused on information provision and offering referral to a reproductive specialist to female cancer patients. With the counselling domain, key recommendations focused on all aspects of counselling, including different methods, safety, pros and cons. In the decision-making domain, key recommendations focused on shared decision-making and supporting the decision with written information. The final set of key recommendations was approved by 91% of the experts. Differences in perspectives were found between subgroups. Patients found recommendations on decision-making and information provision more important. CONCLUSION A set of 11 key recommendations for high-quality female oncofertility care was selected by a multidisciplinary expert panel. The involvement of the perspectives of patients, referrers and counsellors led to this valid, acceptable and credible set of key recommendations.
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Affiliation(s)
- Özlem Baysal
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, the Netherlands.
| | - Michelle Van den Berg
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, the Netherlands
| | - Floor Beldman
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, the Netherlands
| | - Didi D M Braat
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, the Netherlands
| | - Willianne L D M Nelen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, the Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | - Catharina C M Beerendonk
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, the Netherlands
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Bouwman E, Hermens RPMG, Blijlevens NMA, Prins JB, Loonen JJ. Nurse-led video-coaching interventions in childhood, adolescent and young adult cancer survivors (REVIVER): a protocol for mixed methods feasibility research. Pilot Feasibility Stud 2019; 5:150. [PMID: 31890262 PMCID: PMC6921525 DOI: 10.1186/s40814-019-0535-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/26/2019] [Indexed: 11/12/2022] Open
Abstract
Background Successful cancer treatment can lead to cancer survivors being predisposed to an increased lifelong risk of adverse late health effects. Therefore, high-quality cancer survivorship care to earlier detect and treat late effects or to preserve survivor’s health is essential. Nevertheless, this care needs to be sustainable and cost-effective as well. We developed three different screen-to-screen nurse-led eHealth interventions for survivors of childhood, adolescent and young adult-onset cancer, collectively called the REVIVER interventions. Elaborating on person-centred care principles with content based on cognitive behavioural therapy modules and/or motivational interviewing techniques, these interventions aim to empower and coach survivors to improve (1) symptoms of cancer-related fatigue, (2) self-efficacy and self-management or (3) lifestyle. With the REVIVER study, we aim to evaluate the interventions’ feasibility and gain insights into the potential effectiveness. Methods The REVIVER study involves a mixed methods design, including (1) interviews till data saturation with cancer survivors who completed the interventions as well as with all involved medical professionals, (2) reviews of nurses reports and (3) a single-group, pre-post evaluation among cancer survivors. Eligible survivors are survivors of childhood, adolescent and young adult-onset cancer who are referred to one of the interventions, in complete remission of cancer, 16–44 years old at enrolment, completed treatment at least 5 years ago and have access to a device with Internet options. We will assess feasibility in terms of demand, adherence, acceptability, practicality and integration/implementation. Health-related quality of life, as primary outcome of the potential effectiveness evaluation, will be assessed at three different time points: prior to the intervention; immediately following the intervention and 6 months post-intervention. Secondary outcome measures include changes in level of fatigue, self-efficacy, self-management and lifestyle. Discussion This is the first study to evaluate the feasibility and potential effectiveness of eHealth nurse-led interventions elaborating on person-centred care, using cognitive behavioural therapy and/or motivational interviewing techniques as an innovative and promising approach for providing CAYA cancer survivorship care. If the interventions prove to be feasible and potential effective, a randomized controlled trial will be conducted to test the (cost)-effectiveness.
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Affiliation(s)
- Eline Bouwman
- 1Centre of Expertise for Cancer Survivorship, Department of Haematology, Radboud University Medical Centre, Geert Grooteplein Zuid 10 (Route 558), 6525 GA Nijmegen, NL Netherlands
| | - Rosella P M G Hermens
- 2Radboud Institute for Health Sciences (RIHS), Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Geert Grooteplein Noord 21 (Route 114), 6525 EZ Nijmegen, Netherlands
| | - Nicole M A Blijlevens
- 3Department of Haematology, Radboud University Medical Centre, Geert Grooteplein Zuid 8 (Route 476), 6525 GA Nijmegen, Netherlands
| | - Judith B Prins
- 4Department of Medical Psychology, Radboud University Medical Centre, Geert Grooteplein Zuid 10 (Route 840), 6525 GA Nijmegen, Netherlands
| | - Jacqueline J Loonen
- 1Centre of Expertise for Cancer Survivorship, Department of Haematology, Radboud University Medical Centre, Geert Grooteplein Zuid 10 (Route 558), 6525 GA Nijmegen, NL Netherlands
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van Overveld LFJ, Takes RP, Braspenning JCC, Baatenburg de Jong RJ, de Boer JP, Brouns JJA, Bun RJ, Dik EA, van Dijk BAC, van Es RJJ, Hoebers FJP, Kolenaar B, Kropveld A, Langeveld TPM, Verschuur HP, de Visscher JGAM, van Weert S, Witjes MJH, Smeele LE, Merkx MAW, Hermens RPMG. Variation in Integrated Head and Neck Cancer Care: Impact of Patient and Hospital Characteristics. J Natl Compr Canc Netw 2019; 16:1491-1498. [PMID: 30545996 DOI: 10.6004/jnccn.2018.7061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 07/17/2018] [Indexed: 11/17/2022]
Abstract
Background: Monitoring and effectively improving oncologic integrated care requires dashboard information based on quality registrations. The dashboard includes evidence-based quality indicators (QIs) that measure quality of care. This study aimed to assess the quality of current integrated head and neck cancer care with QIs, the variation between Dutch hospitals, and the influence of patient and hospital characteristics. Methods: Previously, 39 QIs were developed with input from medical specialists, allied health professionals, and patients' perspectives. QI scores were calculated with data from 1,667 curatively treated patients in 8 hospitals. QIs with a sample size of >400 patients were included to calculate reliable QI scores. We used multilevel analysis to explain the variation. Results: Current care varied from 29% for the QI about a case manager being present to discuss the treatment plan to 100% for the QI about the availability of a treatment plan. Variation between hospitals was small for the QI about patients discussed in multidisciplinary team meetings (adherence: 95%, range 88%-98%), but large for the QI about malnutrition screening (adherence: 50%, range 2%-100%). Higher QI scores were associated with lower performance status, advanced tumor stage, and tumor in the oral cavity or oropharynx at the patient level, and with more curatively treated patients (volume) at hospital level. Conclusions: Although the quality registration was only recently launched, it already visualizes hospital variation in current care. Four determinants were found to be influential: tumor stage, performance status, tumor site, and volume. More data are needed to assure stable results for use in quality improvement.
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Garvelink MM, Jillissen M, Knops A, Kremer JAM, Hermens RPMG, Meinders MJ. Implementation of the three good questions-A feasibility study in Dutch hospital departments. Health Expect 2019; 22:1272-1284. [PMID: 31560835 PMCID: PMC6882265 DOI: 10.1111/hex.12960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/12/2019] [Accepted: 08/18/2019] [Indexed: 01/04/2023] Open
Abstract
Objectives To determine the feasibility of pragmatic implementation strategies for three good questions (in Dutch: Drie Goede Vragen; 3GV. What are my options; what are the risks and benefits related to these options; and what does this mean for my situation?) to increase shared decision‐making (SDM) efforts in Dutch secondary care, and identify barriers and facilitators of implementation. Methods Convergent mixed‐method design: pre‐post surveys with patients attending one of six clinical departments in a Dutch Hospital, post‐intervention interviews with patients and health‐care professionals. Primary outcomes: feasibility (reach, use of 3GV). Secondary outcomes: SDM, experiences with 3GV and decision making. Interviews focused on barriers and facilitators of 3GV use. Interviews were content coded and categorized into determinants of behaviour change. Results 35% of the respondents who had heard of 3GV (52%) used all three questions. 3GV use did not lead to more SDM (SDMQ9 M = Δ0.3;SE = 2.2) but patients felt empowered to decide (88%) and to SDM (86%). Barriers were as follows: time investment, other SDM projects and perception that the need to use 3GV differs per patient/consultation. Respondents preferred to use 3GV as they saw fit for the consultation, instead of literally asking them. Facilitators: easy, accessible information materials that can be flexibly used. Conclusion Implementation of 3GV seemed feasible, although influenced by contextual characteristics (eg type of decisions, patients, on‐going interventions). 3GV contributed to important elements of SDM, and respondents were willing to apply them in a way that suited their situation. Practice implications We recommend continuation of current and new implementation strategies to enable 3GV implementation in secondary care.
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Affiliation(s)
- Mirjam M Garvelink
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Quebec, QC, Canada.,Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Marja Jillissen
- Radboud university medical center, Improvement & Implementation Group, Nijmegen, The Netherlands
| | - Anouk Knops
- Netherlands Patients Federation, Utrecht, The Netherlands
| | - Jan A M Kremer
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Marjan J Meinders
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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IJsbrandy C, Hermens RPMG, Boerboom LWM, Gerritsen WR, van Harten WH, Ottevanger PB. Implementing physical activity programs for patients with cancer in current practice: patients' experienced barriers and facilitators. J Cancer Surviv 2019; 13:703-712. [PMID: 31347009 PMCID: PMC6828940 DOI: 10.1007/s11764-019-00789-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/11/2019] [Indexed: 12/29/2022]
Abstract
Purpose The present study aimed to identify patients’ experienced barriers and facilitators in implementing physical activity programs for patients with cancer. Methods We interviewed 34 patients in focus-group-interviews from three different hospital-types. We included patients with cancer who were either receiving curative treatment or had recently completed it. Barriers and facilitators were explored in six domains: (1) physical activity programs, (2) patients, (3) healthcare professionals (HCPs), (4) social setting, (5) organization, and (6) law and governance. Results We found 12 barriers and 1 facilitator that affect the implementation of physical activity programs. In the domain of physical activity programs, the barrier was physical activity programs not being tailored to the patient’s needs. In the domain of patients, lacking responsibility for one’s own health was a barrier. Knowledge and skills for physical activity programs and non-commitment of HCPs impeded implementation in the domain of HCPs. Barriers in the domain of organization included inconvenient place, time of day, and point in the health treatment schedule for offering the physical activity programs, inadequate capacity, inaccessibility of contact persons, lack of information about physical activity programs, non-involvement of the general practitioner in the cancer care process, and poor communication between secondary and primary HCPs. Insufficient insurance-coverage of physical activity programs was a barrier in the domain of law and governance. In the domain of physical activity programs, contact with peers facilitated implementation. We found no barriers or facilitators at the social setting. Conclusions Factors affecting the implementation of physical activity programs occurred in various domains. Most of the barriers occurred in the domain of organization. Implications for Cancer survivors An implementation strategy that deals with the barriers might improve the implementation of physical activity programs and quality of life of cancer survivors. Electronic supplementary material The online version of this article (10.1007/s11764-019-00789-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotte IJsbrandy
- Radboud Institute for Health Science (RIHS), Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Radboud Institute for Health Science (RIHS), Department of Medical Oncology, Radboud University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosella P. M. G. Hermens
- Radboud Institute for Health Science (RIHS), Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Laura W. M. Boerboom
- Radboud Institute for Health Science (RIHS), Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Winald R. Gerritsen
- Radboud Institute for Health Science (RIHS), Department of Medical Oncology, Radboud University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Wim H. van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Health Technology and Services Research, MB-HTSR, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
| | - Petronella B. Ottevanger
- Radboud Institute for Health Science (RIHS), Department of Medical Oncology, Radboud University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Spitaels D, Vankrunkelsven P, Grypdonck L, Dusar FR, Aertgeerts B, Luyten FP, Hermens RPMG. Quality of Care for Knee Osteoarthritis in Primary Care: A Patient's Perspective. Arthritis Care Res (Hoboken) 2019; 72:1358-1366. [PMID: 31325228 DOI: 10.1002/acr.24034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 07/16/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe the quality of osteoarthritis care in general practice from a patient's perspective and to identify novel associations between process quality indicators and patient-reported outcome and experience measures. METHODS For this study, 235 individuals with knee osteoarthritis completed a survey based on both process and outcome indicators. Process indicators were extracted from international guidelines and included the domains: diagnosis, self-management, treatment, and follow-up. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and RAND 36-item Short Form health survey (SF-36) were used to assess patient-reported outcomes. Patient-reported experience with care was evaluated with the European Task Force on Patient Evaluations of General Practice Care (EUROPEP) instrument. A series of multilevel regression analyses were then performed to analyze determinants at the patient level (i.e., age, sex, body mass index, and education) and associations between process and outcome indicators. RESULTS Overall, low adherence to the process indicators was observed (38%), particularly on informing patients about the importance of weight loss (24% [95% confidence interval (95% CI) 19-31]) or referring them for physical therapy (41% [95% CI 33-49]). Patients described their quality of life as moderate, with an overall score of 63% and 35% on the SF-36 and WOMAC surveys, respectively. Regarding the determinants, patients with a higher education level were better informed (odds ratio [OR] 3.4; P = 0.0003). Associations between process and outcome indicators were scarce, with the exception of patient satisfaction with care and use of nonsteroidal antiinflammatory drugs (NSAIDs) (OR 2.9; P = 0.0014). CONCLUSION Patients with knee osteoarthritis receive suboptimal conservative management. They report a moderate quality of life. This study confirms the evidence suggesting that NSAIDs are the backbone of osteoarthritis pain management but also adds evidence from a patient's perspective.
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Affiliation(s)
- David Spitaels
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | | | - Lies Grypdonck
- Former Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | | | - Bert Aertgeerts
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | | | - Rosella P M G Hermens
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium, and Radboud Institute for Health Sciences, IQ Healthcare, and Radboud University Medical Center, Nijmegen, The Netherlands
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Swillens JEM, Sluijter CE, Overbeek LIH, Nagtegaal ID, Hermens RPMG. Identification of barriers and facilitators in nationwide implementation of standardized structured reporting in pathology: a mixed method study. Virchows Arch 2019; 475:551-561. [PMID: 31270615 PMCID: PMC6861434 DOI: 10.1007/s00428-019-02609-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/05/2019] [Accepted: 06/16/2019] [Indexed: 12/24/2022]
Abstract
Standardized structured reporting (SSR) enables high-quality pathology reporting, but implementing SSR is slow. The objective of this study is to identify both barriers and facilitators that pathologists encounter in SSR, in order to develop tailored implementation tools to increase SSR usage. We used a mixed method design: a focus group interview helped to identify barriers and facilitators in SSR. The findings were classified into the following domains: innovation, individual professional, social setting, organization, and economic and political context. We used a web-based survey among Dutch pathologists to quantify the findings. Ten pathologists participated in the focus group interview, and 97 pathologists completed the survey. The results of both showed that pathologists perceive barriers related to SSR itself. Particularly its incompatibility caused lack of nuance (73%, n = 97) in the standardized structured pathology report. Regarding the individual professional, knowledge about available SSR-templates was lacking (28%, n = 97), and only 44% (n = 94) of the respondents agreed that using SSR facilitates the most accurate diagnosis. Related to social setting, support from the multidisciplinary team members was lacking (45%, n = 94). At organization level, SSR leads to extra work (52%, n = 94) because of its incompatibility with other information systems (38%, n = 93). Main facilitators of SSR were incorporation of speech recognition (54%, n = 94) and improvement in communication during multidisciplinary team meetings (69%, n = 94). Both barriers and facilitators existed in various domains. These factors can be used to develop implementation tools to encourage SSR usage.
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Affiliation(s)
- J E M Swillens
- Radboud Institute for Health Sciences (RIHS), Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Geert Grooteplein 21, POB 9101, 6500, HB, Nijmegen, The Netherlands.
| | - C E Sluijter
- PALGA Foundation, Randhoeve 225A, 3995, GA, Houten, The Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Department of Pathology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, POB 9101, 6500, HB, Nijmegen, The Netherlands
| | - L I H Overbeek
- PALGA Foundation, Randhoeve 225A, 3995, GA, Houten, The Netherlands
| | - I D Nagtegaal
- PALGA Foundation, Randhoeve 225A, 3995, GA, Houten, The Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Department of Pathology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, POB 9101, 6500, HB, Nijmegen, The Netherlands
| | - R P M G Hermens
- Radboud Institute for Health Sciences (RIHS), Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Geert Grooteplein 21, POB 9101, 6500, HB, Nijmegen, The Netherlands
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