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Braulke F, Kober K, Rieken S, Brand T, Hartz T, Seipke S, Asendorf T, Haier J. Adherence to interdisciplinary tumor board recommendations as an expression of quality-assured patient care: results of a bicentric German analysis. J Cancer Res Clin Oncol 2023; 149:14775-14784. [PMID: 37592032 PMCID: PMC10602985 DOI: 10.1007/s00432-023-05253-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Interdisciplinary tumor boards (ITBs) represent a central part of standard cancer care defining a guidelines-guided treatment plan adapted to the patient's capabilities, comorbidities and wishes in a multi-professional team. The implementation rate of ITB recommendations can be monitored by structured adherence analyses. But (inter)national definitions how to measure the level of implementation are missing. Here, we present results of 4 years of ITB adherence analyses in a bicentric German Comprehensive Cancer Center (CCC). METHODS Between 2018 and 2021, for at least 1 month, the implementation rate of recommendations of 8 different ITBs of 2 CCC sites was evaluated manually according to harmonized criteria between both sites regarding the degree of implementation of ITB's recommendations. RESULTS In total, 1104 cases were analyzed (65% male, 35% female). Mean distance from patient's home to the CCC was 57 km (range 0.8-560.6 km). For 949 cases (86%) with known follow-up, the adherence rate was 91.9% (95% CI 0.9; 0.935). In 8.1%, ITB decisions were not implemented due to medical reasons (45.4%), patient's wish (35.1%) and unknown reasons (19.5%). Logistic regression revealed neither age (OR = 0.998, p = 0.90), nor gender (OR = 0.98, p = 0.92) or the distance from patient's home to the CCC (OR = 1.001, p = 0.54) were significantly associated with ITB adherence. CONCLUSION ITB adherences analyses can serve as a quality management tool to monitor the implementation rate of ITB recommendations and to stay in contact with practitioners, other hospitals and state cancer registries to share data and resources in accordance with data protection requirements for continuously improvement of quality management and patient care.
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Affiliation(s)
- Friederike Braulke
- Comprehensive Cancer Center, University Medical Center Göttingen, von-Bar-Str. 2/4, 37075, Göttingen, Germany.
| | - Kathrin Kober
- Comprehensive Cancer Center, University Medical Center Göttingen, von-Bar-Str. 2/4, 37075, Göttingen, Germany
| | - Stefan Rieken
- Department of Radiation Therapy and Radiooncology, University Medical Center Göttingen, Göttingen, Germany
| | - Tonia Brand
- Klinisches Krebsregister Niedersachsen, Hannover, Germany
| | - Tobias Hartz
- Klinisches Krebsregister Niedersachsen, Hannover, Germany
| | - Stefanie Seipke
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Thomas Asendorf
- Institute of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Jörg Haier
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hannover, Germany
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Braulke F, Para S, Alt-Epping B, Tewes M, Bäumer M, Haberland B, Mayer-Steinacker R, Hopprich A, de Wit M, Grabe M, Bender-Säbelkampf S, Weßling C, Aulmann C, Gerlach C, Regincos P, Fischer F, Haarmann S, Huys T, Drygas S, Rambau A, Kiani A, Schnabel A, Buhl C, Seipke S, Hiemer S, Polata S, Meßmann M, Hansmeier A, Anastasiadou L, Letsch A, Wecht D, Hellberg-Naegele M, Krug U, Wedding U, van Oorschot B. Systematic symptom screening in patients with advanced cancer treated in certified oncology centers: results of the prospective multicenter German KeSBa project. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04818-8. [PMID: 37145199 PMCID: PMC10374724 DOI: 10.1007/s00432-023-04818-8] [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: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE Guidelines recommend a structured symptom screening (SC) for especially advanced cancer patients (CPs). The aim of this multicenter German prospective quality assurance project KeSBa (Kennzahl Symptom- und Belastungserfassung) was to gain knowledge on SC procedures in Oncology Centers (OCs) for advanced cancer patients and a first impression on the consequences of SC. METHODS The KeSBa project consisted of three phases: pilot, 3 months screening and feedback phase. Participating OCs decided to use either the Minimal Documentation System (MIDOS) or the Integrated Palliative care Outcome Scale (IPOS) and defined the cutoff values for positive screening results. RESULTS Out of 172 certified German OCs, 40 (23%) participated in the KeSBa pilot phase, 29 (16.8%) in the 3 months screening phase using MIDOS (n = 18, 58.6%) or IPOS (n = 11, 41.3%) and in the feedback round. 25/29 performed paper-based screening (86.2%). 2.963 CPs were screened. Results were documented for 1255 (42.2%, SC +) positive and 874 (29.5%, SC-) negative screenings depending on the center´s schedules: 452 SC + CPs (28.4%) and 42 SC- CPs (2.6%) had contact to specialized palliative care or other supportive specialist teams afterwards, 458 SC + CPs (28.8%) and 605 SC- CPs (38.1%) remained in standard oncology care. In the feedback round missing resources (personal and IT) and improved communication were mentioned most often. CONCLUSION Routine SC is feasible in advanced CPs treated in OCs but associated with considerable workload. In 42.2% of CPs SC was classified as positive, indicating the need of further diagnostics or professional judgment. SC requires staff and IT resources.
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Affiliation(s)
- Friederike Braulke
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Servet Para
- Interdisciplinary Center Palliative Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Bernd Alt-Epping
- Department of Palliative Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Mitra Tewes
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Markus Bäumer
- Kliniken Maria Hilf GmbH Mönchengladbach, Mönchengladbach, Germany
| | | | | | - Anne Hopprich
- Department of Radiooncology and Radiotherapy, University Medical Center Mainz, Mainz, Germany
| | - Maike de Wit
- Cancer Center Berlin-Neukölln - Vivantes Klinikum Neukölln, Berlin, Germany
| | - Michaela Grabe
- Cancer Center Rems-Murr-Hospital Winnenden, Winnenden, Germany
| | | | | | | | - Christina Gerlach
- Department of Palliative Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Pascale Regincos
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Soraya Haarmann
- Kliniken Heilbronn GmbH, Fachklinik Löwenstein, Löwenstein, Germany
| | | | - Sabine Drygas
- Brüderkrankenhaus St. Josef Paderborn, Paderborn, Germany
| | - Anett Rambau
- Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
| | - Alexander Kiani
- Klinikum Bayreuth GmbH, and Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | | | - Christoph Buhl
- Department of Oncology, Hematology, Palliative Medicine, Special Pain Therapy, Hospital Leverkusen, Leverkusen, Germany
| | - Stefanie Seipke
- Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | | | - Silke Polata
- Evangelisches Waldkrankenhaus Berlin-Spandau, Berlin, Germany
| | - Maximilian Meßmann
- Department of Palliative Medicine, Hospital St. Elisabeth Straubing GmbH, Straubing, Germany
| | | | | | - Anne Letsch
- Department of Hematology and Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Daniel Wecht
- Specialist Care in Oncology and Palliative Care, University Hospital Gießen and Marburg, Marburg, Germany
| | | | - Utz Krug
- Department of Oncology, Hematology, Palliative Medicine, Special Pain Therapy, Hospital Leverkusen, Leverkusen, Germany
| | - Ulrich Wedding
- Department of Palliative Care, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Birgitt van Oorschot
- Interdisciplinary Center Palliative Medicine, University Hospital Würzburg, Würzburg, Germany
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