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Rogers MJ, Matheson L, Garrard B, Maher B, Cowdery S, Luo W, Reed M, Riches S, Pitson G, Ashley DM. Comparison of outcomes for cancer patients discussed and not discussed at a multidisciplinary meeting. Public Health 2017; 149:74-80. [PMID: 28575751 DOI: 10.1016/j.puhe.2017.04.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 09/07/2016] [Revised: 03/15/2017] [Accepted: 04/24/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Comparison of outcomes for cancer patients discussed and not discussed at a multidisciplinary meeting (MDM). STUDY DESIGN Retrospective analysis of the association of MDM discussion with survival. METHODS All newly diagnosed cancer patients from 2009 to 2012, presenting to a large regional cancer service in South West Victoria, Australia (620 colorectal, 657 breast, 593 lung and 511 haematological) were recorded and followed up to 5 years after diagnosis. Treatment patterns and survival of patients whose treatment was discussed at an MDM compared to those who were not, were explored. RESULTS The proportion of patients presented to an MDM within 60 days after diagnosis was 56% (n = 366) for breast cancer, 59% (n = 363) for colorectal cancer, 27% (n = 137) for haematological malignancies and 60% (n = 355) for lung cancer. Seventy-three percent (n = 886) of patients discussed at an MDM had their tumour stage recorded in their medical records while only 52% (n = 604) of patients not discussed had their tumour stage recorded (P < 0.01). We found for haematological and lung cancer patients that those presented to an MDM prior to treatment had a significant reduction in mortality (lung cancer hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.50-0.76, P < 0.01) (haematological cancer HR 0.58, 95% CI 0.35-0.96, P = 0.03) compared to patients whose cases were not discussed at an MDM after adjusting for the potential cofounders of age, stage, comorbidities and treatment. This was not the case for colorectal and breast cancer patients where there was no significant difference. CONCLUSION MDM discussion has been recommended as best practice in the management of cancer patients, however, from a public health perspective this creates potential issues around access and resources. It is likely that MDM presentation patterns and outcomes across tumour streams are linked in complex ways. We believe that our data would demonstrate that these patterns differ across tumour streams and that more detailed work is required to better allocate relatively scarce and potentially costly MDM resources to tumour streams and patient groups that may get the most benefit.
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Affiliation(s)
- M J Rogers
- Barwon South Western Regional Integrated Cancer Services, Barwon Health, Geelong, Victoria, Australia.
| | - L Matheson
- Barwon South Western Regional Integrated Cancer Services, Barwon Health, Geelong, Victoria, Australia.
| | - B Garrard
- Barwon South Western Regional Integrated Cancer Services, Barwon Health, Geelong, Victoria, Australia.
| | - B Maher
- Barwon South Western Regional Integrated Cancer Services, Barwon Health, Geelong, Victoria, Australia.
| | - S Cowdery
- Barwon South Western Regional Integrated Cancer Services, Barwon Health, Geelong, Victoria, Australia; School of Medicine, Deakin University, Geelong, Victoria, Australia.
| | - W Luo
- Pattern Recognition and Data Analytics, Deakin University, Geelong, Victoria, Australia.
| | - M Reed
- Barwon South Western Regional Integrated Cancer Services, Barwon Health, Geelong, Victoria, Australia.
| | - S Riches
- Barwon South Western Regional Integrated Cancer Services, Barwon Health, Geelong, Victoria, Australia.
| | - G Pitson
- Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia.
| | - D M Ashley
- Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia; School of Medicine, Deakin University, Geelong, Victoria, Australia.
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Young H, Hogg J, Garrard B. Making Sense of Bereavement in People with Profound Intellectual and Multiple Disabilities: Carer Perspectives. J Appl Res Intellect Disabil 2016; 30:1035-1044. [PMID: 27554862 DOI: 10.1111/jar.12285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with intellectual disabilities are thought to have a reduced capacity for understanding death. Drawing on cognitive theory, researchers have suggested that those with profound intellectual and multiple disabilities mainly perceive loss as a mismatch between past and present experiences. However, very little research has considered how carers conceptualize bereavement in relation to this group. METHOD Semi-structured interviews obtained responses from seven carers. Transcripts were examined using interpretative phenomenological analysis. RESULTS Two superordinate themes emerged: 'difficulty articulating the experience of loss' and 'making sense of bereavement through familiar patterns'. CONCLUSIONS Carers conceptualize bereavement primarily in cognitive terms, but also take account of relational factors mediating loss. Implications for training and further research are outlined.
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Affiliation(s)
| | - James Hogg
- White Top Research Unit, University of Dundee, Dundee, UK
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