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Fadem SJ, Crabtree BF, O'Malley DM, Mikesell L, Ferrante JM, Toppmeyer DL, Ohman-Strickland PA, Hemler JR, Howard J, Bator A, April-Sanders A, Kurtzman R, Hudson SV. Adapting and implementing breast cancer follow-up in primary care: protocol for a mixed methods hybrid type 1 effectiveness-implementation cluster randomized study. BMC PRIMARY CARE 2023; 24:235. [PMID: 37946132 PMCID: PMC10634067 DOI: 10.1186/s12875-023-02186-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Advances in detection and treatment for breast cancer have led to an increase in the number of individuals managing significant late and long-term treatment effects. Primary care has a role in caring for patients with a history of cancer, yet there is little guidance on how to effectively implement survivorship care evidence into primary care delivery. METHODS This protocol describes a multi-phase, mixed methods, stakeholder-driven research process that prioritizes actionable, evidence-based primary care improvements to enhance breast cancer survivorship care by integrating implementation and primary care transformation frameworks: the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework and the Practice Change Model (PCM). Informed by depth interviews and a four round Delphi panel with diverse stakeholders from primary care and oncology, we will implement and evaluate an iterative clinical intervention in a hybrid type 1 effectiveness-implementation cluster randomized design in twenty-six primary care practices. Multi-component implementation strategies will include facilitation, audit and feedback, and learning collaboratives. Ongoing data collection and analysis will be performed to optimize adoption of the intervention. The primary clinical outcome to test effectiveness is comprehensive breast cancer follow-up care. Implementation will be assessed using mixed methods to explore how organizational and contextual variables affect adoption, implementation, and early sustainability for provision of follow-up care, symptom, and risk management activities at six- and 12-months post implementation. DISCUSSION Study findings are poised to inform development of scalable, high impact intervention processes to enhance long-term follow-up care for patients with a history of breast cancer in primary care. If successful, next steps would include working with a national primary care practice-based research network to implement a national dissemination study. Actionable activities and processes identified could also be applied to development of organizational and care delivery interventions for follow-up care for other cancer sites. TRIAL REGISTRATION Registered with ClinicalTrials.gov on June 2, 2022: NCT05400941.
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Affiliation(s)
- Sarah J Fadem
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Benjamin F Crabtree
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Denalee M O'Malley
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Lisa Mikesell
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
- School of Communication and Information, Rutgers University, New Brunswick, NJ, USA
| | - Jeanne M Ferrante
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | | | | | - Jennifer R Hemler
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jenna Howard
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Alicja Bator
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Rachel Kurtzman
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- NORC at the University of Chicago, Bethesda, MD, USA
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA.
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Lam CS, Alagoz E, Jawara D, Murtha JA, Breuer CR, Pati B, Eierman L, Farrar-Edwards D, Voils CI, Funk LM. Patient and Provider Perceptions About Communication After Bariatric Surgery: A Qualitative Analysis. J Surg Res 2023; 291:58-66. [PMID: 37348437 PMCID: PMC10524725 DOI: 10.1016/j.jss.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Communication between patients and providers can strongly influence patient behavior after surgery. The objective of this study was to assess patient and provider perceptions of how communication affected weight-related behaviors after bariatric surgery. MATERIALS AND METHODS Semistructured interviews with bariatric surgery patients and providers were conducted from April-November 2020. Patients who had Medicaid within 3 y of surgery were defined as socioeconomically disadvantaged. Interview guides were derived from Andersen's Behavioral Model of Health Services and Torain's Framework for Surgical Disparities. Participants described postoperative experiences regarding diet, physical activity, and follow-up care. A codebook was developed deductively based on the two theories. Directed content analysis identified themes pertaining to patient-provider communication. RESULTS Forty-five participants were interviewed, including 24 patients (83% female; 79% White), six primary care providers, four health psychologists, five registered dietitians, and six bariatric surgeons. Four themes regarding communication emerged: (1) Patients experiencing weight regain did not want to follow-up with providers to discuss their weight; (2) Patients from socioeconomically disadvantaged backgrounds had less trust and required more rapport-building from providers to enhance trust; (3) Patients felt that providers did not get to know them personally, which was perceived as a lack of personalized communication; and (4) Providers often changed their language to be simpler, so patients could understand them. CONCLUSIONS Patient-provider communication after bariatric surgery is essential, but perceptions about the elements of communication differ between patients and providers. Reassuring patients who have attained less weight loss than expected and establishing trust with socioeconomically vulnerable patients could strengthen care after bariatric surgery.
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Affiliation(s)
- Chloe S Lam
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Esra Alagoz
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Dawda Jawara
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Jacqueline A Murtha
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Catherine R Breuer
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Bhabna Pati
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Lindsey Eierman
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Corrine I Voils
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin; Department of Surgery, William S. Middleton Memorial Veterans Administration Hospital, Madison, Wisconsin
| | - Luke M Funk
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin; Department of Surgery, William S. Middleton Memorial Veterans Administration Hospital, Madison, Wisconsin.
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Mertz S, Benjamin C, Girvalaki C, Cardone A, Gono P, May SG, Comerford E, Than KS, Birch K, Roach M, Myers S, Sasane M, Lavi L, Cameron A, Cardoso F. Progression-free survival and quality of life in metastatic breast cancer: The patient perspective. Breast 2022; 65:84-90. [PMID: 35870420 PMCID: PMC9307669 DOI: 10.1016/j.breast.2022.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/10/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Objective Materials and methods Results Conclusion Overall survival benefit combined with good QoL are the most important endpoints for mBC patients. Time without disease progression is meaningful to patients when coupled with no worsening in or improvements in QoL. Quality of life is highly individual and evolves throughout the treatment journey. Surrogate endpoints are confusing; more patient-centered language is needed. Healthcare professionals should account for disease and psychological well-being.
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Affiliation(s)
- Shirley Mertz
- Metastatic Breast Cancer Network, 165 West 46th St, Suite 712, New York, NY, 10036, USA
| | - Christine Benjamin
- SHARE Cancer Support, 165 West 46th St, Suite 712, New York, NY, 10036, USA
| | - Charis Girvalaki
- European Cancer Patient Coalition, 40, Rue de Montoyer/Montoyerstraat, B-1000, Brussels, Belgium
| | - Antonella Cardone
- European Cancer Patient Coalition, 40, Rue de Montoyer/Montoyerstraat, B-1000, Brussels, Belgium
| | - Paulina Gono
- European Cancer Patient Coalition, 40, Rue de Montoyer/Montoyerstraat, B-1000, Brussels, Belgium
| | - Suepattra G May
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA.
| | - Erin Comerford
- Sanofi Genzyme. 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Kyi-Sin Than
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA
| | - Kelly Birch
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA
| | - Meaghan Roach
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA
| | - Sky Myers
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA
| | - Medha Sasane
- Sanofi Genzyme. 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Liat Lavi
- Sanofi Genzyme. 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Anna Cameron
- Sanofi Genzyme. 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation and ABC Global Alliance, Lisbon, Portugal
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Austin JD, Allicock M, Fernandez ME, Balasubramanian BA, Lee SC. Understanding the Delivery of Patient-Centered Survivorship Care Planning: An Exploratory Interview Study With Complex Cancer Survivors. Cancer Control 2021; 28:10732748211011957. [PMID: 34689577 PMCID: PMC8718161 DOI: 10.1177/10732748211011957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Understanding key elements of the survivorship care planning process, such as patient-centered communication (PCC) and health self-efficacy, are critical for delivering patient-centered survivorship care to cancer survivors with multiple chronic conditions (“complex cancer survivors”). Building upon our team’s recent research efforts to examine the survivorship care planning process from a patient-centered lens, this exploratory study leveraged an ongoing quasi-experimental trial to elucidate the experience of complex cancer survivors with survivorship care planning and post-treatment management. Methods: We conducted a hypothesis-generating thematic content analysis on 8 interview transcripts. Results: Survivors reported positive experiences communicating with their oncology care team but the presence of multiple chronic conditions in addition to cancer creates additional barriers to patient-centered survivorship care. Conclusion: These findings support the need for further in-depth research aimed at improving PCC across all care teams and enabling self-management by delivering more personalized survivorship care planning that aligns with survivor’s needs, values, and preferences.
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Affiliation(s)
- Jessica D Austin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,UTHealth School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Dallas, TX, USA.,UTHealth School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA
| | - Bijal A Balasubramanian
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,UTHealth School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA
| | - Simon Craddock Lee
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Taylor A, Bleiker J, Hodgson D. Compassionate communication: Keeping patients at the heart of practice in an advancing radiographic workforce. Radiography (Lond) 2021; 27 Suppl 1:S43-S49. [PMID: 34393068 DOI: 10.1016/j.radi.2021.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/23/2021] [Accepted: 07/21/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Compassion is a poorly understood concept in diagnostic and therapeutic radiography, but an increase in its focus was recommended in the Francis Report (2013). Much of the healthcare literature including policy and protocol has focussed on benchmarking and individualising compassion. Two separately conducted doctoral research projects, one therapeutic and one diagnostic, aimed to conceptualise compassion in order to understand its meaning and behavioural expression. METHODS A constructivist approach was taken with appropriate ethical approval. Patients and carers, student radiographers and radiographers took part in interviews and focus groups and tweets were harvested from a Twitter journal club discussion between radiographers of the second author's published literature review. Data were transcribed and analysed thematically. FINDINGS Key aspects of communication are fundamental to giving compassionate patient-centred care. These include verbal and non-verbal cues, actively listening and engaging and establishing rapport with the patient. Specific skills associated with these are also identified in these studies. CONCLUSION Keeping the patient as a person at the centre of radiographic practice in the rapidly evolving technical and cultural environment in which it exists requires timely and appropriate behavioural expressions of compassion from radiographers deploying a range of highly specific communication and interpersonal skills. IMPLICATIONS FOR PRACTICE When undertaking reflective practice, radiographers could consider key aspects of how they communicate with patients, including: verbal (in particular the language they use with patients and their tone of voice); non-verbal (especially eye contact and smiling and their body language). They could also usefully explore and develop skills in reading their patients' body language as well as their own in order to pick up subtle or hidden cues that might suggest a patient is suffering emotionally or psychologically. Finally, they could think about the sort of targeted questions they could ask of patients when welcoming them into the x-ray or treatment room that would both facilitate the procedure and leave the patient feeling that their radiographer had taken a genuine interest in them and their situation. These reflections could then be used to possibly modify their existing communications with their patients.
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Affiliation(s)
- A Taylor
- Weston Park Cancer Centre, Sheffield, United Kingdom. https://twitter.com/@AmyTaylM
| | - J Bleiker
- University of Exeter, Exeter, United Kingdom
| | - D Hodgson
- Sheffield Hallam University, Sheffield, United Kingdom
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The Behavioural Display of Compassion in Radiation Therapy: Purpose, Meaning and Interpretation. J Med Imaging Radiat Sci 2020; 51:S59-S71. [PMID: 33199246 DOI: 10.1016/j.jmir.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Providing high quality patient care is a worldwide standard of proficiency across the radiographic workforce. As compassion and compassionate behaviours are considered synonymous with patient-centred care, the focus of professional practice throughout healthcare should be on a system that places compassion at its heart. Inadequate care and dispassionate practice have been blamed for failings within the National Health Service. United Kingdom healthcare legislation has been criticised for its failure to provide meaning or clarity to practical compassionate care. Consequently, it has hindered the ability of National Health Service Trusts, service delivery managers and Medical Radiation Technologists to interpret and implement policy recommendations regarding compassionate practice at a local level. AIMS To support the implementation of compassionate legislation, the study sought to understand the perspectives of those in receipt and those delivering compassionate practice. The research aimed to develop a context specific definition of compassion and identify commonly recognised compassionate behaviours. This article reports on the display of compassion through the behaviours of Medical Radiation Technologists. METHODS/MATERIALS Co-production underpinned the qualitative methodological inquiry and design of the research. Eleven focus groups were conducted, five with Medical Radiation Technologists three with cancer patients and care-givers and three with student Medical Radiation Technologists. On completion of thematic analysis from those groups, three co-production workshops were conducted, integrating the data to ensure the co-produced findings were equally representative of the perspectives of the three participant groups. RESULTS An understanding of compassionate display is illustrated through the construction of a conceptual framework. The findings established observable behaviours which a Medical Radiation Technologist must engage in to undertake compassionate display. Three compassionate behavioural classifications were established through the analysis; 'embodied connection', 'characteristic expression' and 'indicative communication'. A Medical Radiation Technologist must engage in all the three core behaviours to gain comprehension of the patient and person. Comprehension enables the Medical Radiation Technologist to establish practices that aim to address the compassionate needs of the patient. DISCUSSION/CONCLUSION Adoption of the behaviours by Medical Radiation Technologists should enhance compassionate care received by patients within clinical practice. The conceptual framework provides both a theoretical and practical understanding of compassionate display, making it a valuable tool for training and assessment.
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Living with leg lymphedema: developing a novel model of quality lymphedema care for cancer survivors. J Cancer Surviv 2020; 15:140-150. [PMID: 32712757 PMCID: PMC7822774 DOI: 10.1007/s11764-020-00919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/10/2020] [Indexed: 11/03/2022]
Abstract
Purpose Lower-extremity lymphedema (LEL) is a lifelong consequence of cancer therapy and can lead to serious physical and psychosocial complications for many cancer survivors. However, clinical knowledge and treatment of LEL remain minimal. The purpose of this study was to integrate perspectives of lymphedema patients and healthcare providers (HCPs) on LEL to develop a novel model for quality lymphedema care. Methods A mixed-methods approach was implemented. Standardized questionnaires and semi-structured interviews were used to assess psychosocial well-being and experiences of LEL patients. Interviews were also used to evaluate the clinical experiences of HCPs working within tumour groups associated with cancer-related LEL. Thematic analysis was used to analyse qualitative data. Results Twenty-two patients and eleven HCPs participated in this study. Patient QOL, generalized anxiety and depressive symptom scores revealed a complex interplay between psychosocial well-being and supportive LEL care after cancer. Three themes emerged from interviews with patients (n = 19) and HCPs (n = 11): level of lymphedema knowledge, effectiveness of rehabilitation oncology services and barriers to care. Implications for Cancer Survivors We developed a novel model for quality lymphedema care that emphasizes the importance of continued physical and psychosocial support for LEL patients, while illustrating the importance of HCPs in facilitating a smooth transition for patients to LEL care after cancer treatment. Electronic supplementary material The online version of this article (10.1007/s11764-020-00919-2) contains supplementary material, which is available to authorized users.
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Abelsson T, Morténius H, Bergman S, Karlsson AK. Quality and availability of information in primary healthcare: the patient perspective. Scand J Prim Health Care 2020; 38:33-41. [PMID: 32003287 PMCID: PMC7054918 DOI: 10.1080/02813432.2020.1718311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To explore lived experiences of patients communicating with and receiving information from primary health care.Design: Qualitative study analysing transcribed interviews by descriptive content analysis.Setting: Recruitment and interviews took place in southern Sweden in three primary care centres where privacy and undisturbed interview environments was ensured.Subjects: 17 primary care patient informants, 9 men and 8 women aged 31 - 84 years with varying educational levels from primary school to post graduates.Main outcome measures: Thematic categories and subcategories reporting the lived experience of the patients.Results: The analysis yielded three categories and identified as a main theme a feeling of unpredictability based on the emotional aspects of feeling lost and vulnerable when trying to access primary care. The category" Need for easy access" illustrated emotional aspects of importance to patients when contacting primary health care." Need for individual adaptation" described the need to individually adapt health related information." Information exchange" comprised experiences of information evaluation and understanding new information.Conclusions: Patients generally trusted the information received, but experienced a lack of communication, which evoked feelings of unpredictability and abandonment. Experiences of limited access to primary health care and the need for varying degrees of adaptation on the part of the individual were factors of concern for how patients experienced the care.Key PointsSmooth communication and understandable information are fundamental for quality primary health care. This qualitative interview study identified the following key points from analysing the views of 17 patients:• Patients indicated a feeling of unpredictability due to lack of access to and communication with health professionals.• Patients sometimes reported an inability to understand information conveyed by health professionals.• Being able to form relationships with health professionals was crucial for patients' trust and understanding.
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Affiliation(s)
- Tobias Abelsson
- Department of Research, Education and Development, Region Halland, Halmstad, Sweden;
- Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
- CONTACT Tobias Abelsson Department of Research, Education and Development, Region Halland, Halmstad, Sweden
| | - Helena Morténius
- Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
- Department of Health Care, Region Halland, Halmstad, Sweden;
| | - Stefan Bergman
- Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
- FoU Spenshult, Halmstad, Sweden
| | - Ann-Kristin Karlsson
- Department of Research, Education and Development, Region Halland, Halmstad, Sweden;
- Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
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Truant TLO, Varcoe C, Gotay CC, Thorne S. Les soins aux survivants du cancer : vers une grande qualité, en toute équité. Can Oncol Nurs J 2020; 29:163-169. [PMID: 31966016 DOI: 10.5737/23688076293163169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Tracy L O Truant
- Directrice ancienne, Recherche, Éducation et Innovation, BC Cancer, Vancouver BC,
| | - Colleen Varcoe
- Professeure, École des sciences infirmières, University of British Columbia,
| | - Carolyn C Gotay
- Professeure émérite, School of Population and Public Health, University of British Columbia,
| | - Sally Thorne
- Professeure, École des sciences infirmières, University of British Columbia,
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What Twitter teaches us about patient-provider communication on pain. PLoS One 2019; 14:e0226321. [PMID: 31877158 PMCID: PMC6932781 DOI: 10.1371/journal.pone.0226321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/25/2019] [Indexed: 12/20/2022] Open
Abstract
The objective of this study was to understand how pain patients and health care providers (HCPs) are engaging on Twitter and what insights this engagement might provide. By identifying how information is spread by and between these audiences, organizations such as patient advocacy groups may be better poised to develop and share materials that facilitate online communication between HCPs and pain patients, with an end goal of improving a shared decision-making process around pain management. We analyzed the Twitter audiences most engaged on pain topics by conducting a Social Network Analysis (SNA) of a large network of connected users on Twitter. The analysis segmented users based on the sources they cited and measured their influence based on who follows them. As a point of comparison, we also conducted an SNA of Twitter audiences most engaged on oncology topics. Oncology was chosen as a comparison due to what was perceived to be a highly developed online network of both patients and physicians. The populations included in this research included 12,086 accounts that were highly engaged on pain-related topics, and 12,617 accounts that were highly engaged on oncology-related topics. Network statistics were generated for variables including: word use, sources cited, retweets, and mentions. We also statistically analyzed the Twitter follow relationships among select HCPs and patient groups within each SNA. The creation of separate pain and oncology SNAs allowed the team to compare relationships and engagement related to these topics. We found that on Twitter, pain patients and providers appear to interact less than oncology patients and providers. Pain patients do not appear to follow medical professionals or share medical or health-related information on Twitter to the same extent as oncology patients. In addition, we found that pain patients do not communicate on Twitter in the same language as HCPs. Our results are important because they underscore that challenges in communication are not just problematic in face-to-face interactions, but also in digital social network (Twitter) interactions, serving as an additional roadblock to what can be shared decision-making opportunities around pain management. Contributing to this roadblock is access to quality information and a potential need for an online, evidence-based resource hub that could benefit the pain patient community in the same way that cancer.gov serves as a source of aggregated materials for oncology patients and HCPs. This study is an illustration of how social media networks like Twitter can be used to better understand the relationships, language gaps, and shared resources between pain patients and providers and offers a template for using digital social network (Twitter) interactions to research other difficult-to-treat or rare disease states.
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Ben Hassine A, Souli I, Braiki R, Chouigui R, Amira A, Laaroussi H, Mejri B, Ladib M, Hidoussi A. La qualité de vie à la suite à d’une cystoprostatectomie totale chez les hommes: perception des patients tunisiens. Can Oncol Nurs J 2019; 29:219-225. [PMID: 31966005 PMCID: PMC6970011 DOI: 10.5737/23688076294219225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Introduction La cystoprostatectomie totale (CPT) entraîne souvent des changements dans la qualité de vie postopératoire et, par le fait même, des répercussions psychologiques, physiques, sociales et sexuelles difficiles à assumer. La présente étude vise à décrire la qualité de vie postopératoire d’hommes tunisiens âgés ayant subi une CPT à cause d’un cancer de la vessie. Méthodologie Il s’agit d’une étude descriptive quantitative, menée auprès de 40 hommes cystoprostatectomisés. Les instruments de mesure utilisés sont: le questionnaire Stoma-Qualité de vie (Stoma-QOL) de Prieto, Thorsen et Juul (2005) , traduit et validé en arabe, ainsi que la version arabe du questionnaire de l’index international de la fonction érectile (IIEF5), validée par Shamloul, Ghanem et Abou-Zeid (2004) . Résultats 77,5 % des participants obtiennent un score de qualité de vie médiocre. Toutes les dimensions de la qualité de vie sont touchées, à savoir l’image corporelle, physique et psychologique, la vie familiale et sociale, et enfin, la sexualité. En outre, tous les participants ont souffert d’impuissance sexuelle grave après l’intervention. Conclusion Le counseling pré et postopératoire s’avère nécessaire pour faciliter la transition après l’opération et assurer aux hommes ayant subi une CPT à cause d’un cancer de la vessie une meilleure qualité de vie liée à la santé.
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Affiliation(s)
- Asma Ben Hassine
- Faculté des sciences infirmières de l'Université Laval, Québec, QC, , Tel: +1 418-264-3424
| | - Intissar Souli
- Faculté des sciences de la santé de l'Université d'Ottawa, Ottawa,
| | - Raoua Braiki
- Faculté des sciences infirmières de l'Université Laval, Québec, QC,
| | - Rabeb Chouigui
- professeur principal paramédical, Université de Tunis, École supérieure des sciences et techniques de Tunis, TUNISIE,
| | - Abbessi Amira
- professeur principal paramédical, Université de Tunis, Institut supérieur des sciences infirmières de Tunis, TUNISIE,
| | - Hatem Laaroussi
- Faculté des sciences infirmières de l'Université Laval, Québec, QC,
| | - Boutheina Mejri
- Faculté des sciences infirmières de l'Université Laval, Québec, QC,
| | - Mohamed Ladib
- Faculté de médecine de l'Université de Sousse, TUNISIE,
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Implications for patient-provider communication and health self-efficacy among cancer survivors with multiple chronic conditions: results from the Health Information National Trends Survey. J Cancer Surviv 2019; 13:663-672. [PMID: 31309416 DOI: 10.1007/s11764-019-00785-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/03/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Cancer survivors with multiple chronic conditions experience significant challenges managing their health. The six core functions of patient-centered communication (PCC)-fostering healing relationships, exchanging information, responding to emotions, managing uncertainty, making decisions, and enabling patient self-management-represent a central component to facilitating a survivor's confidence to manage their health that has not been investigated in cancer survivors with multiple chronic conditions. METHOD Nationally representative data across two iterations of the Health Information National Trends Survey (HINTS) were merged with combined replicate weights using the jackknife replication method. Adjusted linear regression examined the association between PCC and health self-efficacy in a sample of breast, colorectal, and prostate cancer survivors and by multiple chronic conditions. RESULTS 53.9% reported that providers did not always respond to their emotions and 48.9% reported that they could not always rely on their providers to help them manage uncertainty. In the adjusted linear regression models, there was a significant positive association between PCC and health self-efficacy (β = 0.2, p = 0.01) for the entire sample. However, the association between PCC and health self-efficacy was attenuated in cancer survivors with multiple chronic conditions (β = 0.1, p = 0.53). CONCLUSION PCC alone is not enough to improve a cancer survivor's confidence in their ability to manage their health in the presence of multiple chronic conditions. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors with multiple chronic conditions need ongoing support, in addition to PCC, that render them prepared to manage their health after cancer.
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13
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Truant TLO, Varcoe C, Gotay CC, Thorne S. Toward equitably high-quality cancer survivorship care. Can Oncol Nurs J 2019; 29:156-162. [PMID: 31966022 DOI: 10.5737/23688076293156162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although models of cancer survivorship care are rapidly evolving, there is increasing evidence of health disparities among cancer survivors. In the current context, Canada's survivorship care systems privilege some and not others to receive high-quality care and optimize their health outcomes. The aim of this study was to improve survivorship care systems by helping clinicians and decision makers to a better understanding of how various psychosocial/political factors, survivors' health experiences and health management strategies might shape the development of and access to high-quality survivorship care for Canadians with cancer. Using a nursing epistemological approach informed by critical and intersectional perspectives, we conducted a three-phased Interpretive Description study. We engaged in critical textual analysis of documentary sources, a secondary analysis of interview transcripts from an existing database, and qualitative interviews with 34 survivors and 12 system stakeholders. On the basis of these data, we identified individual, group, and system factors that contributed to gaps between survivors' expected and actual survivorship care experiences. By understanding what shapes survivorship care systems and resources, we help illuminate and unravel the complex nature of the issue, supporting clinicians and decision makers to find multi-layered approaches for equitably high-quality survivorship care.
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Affiliation(s)
- Tracy L O Truant
- Former Director, Research, Education and Innovation, BC Cancer, Vancouver BC,
| | - Colleen Varcoe
- Professor, School of Nursing, University of British Columbia,
| | - Carolyn C Gotay
- Professor Emeritus, School of Population and Public Health, University of British Columbia,
| | - Sally Thorne
- Professor, School of Nursing, University of British Columbia,
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Abstract
PURPOSE OF REVIEW The transition from primary cancer treatment to posttreatment follow-up care is seen as critical to the long-term health of survivors. However, relatively little attention has been paid to understanding this pivotal period. This review will offer a brief outline of the significant work surrounding this pivotal time published in the past year. RECENT FINDINGS The growing number of cancer survivors has stimulated an emphasis on finding new models of care, whereby responsibility for survivorship follow-up is transitioned to primary care providers. A variety of models and tools have emerged for follow-up care. Survivorship care plans are heralded as a key component of survivorship care and a vehicle for supporting transition. Uptake of survivorship care plans and implementation of evidence-based models of survivorship care has been slow, hindered by a range of barriers. SUMMARY Evaluation is needed regarding survivorship models in terms of feasibility, survivor friendliness, cost effectiveness, and achievement of sustainable outcomes. How, and when, to introduce plans for transition to the patient and determine transition readiness are important considerations but need to be informed by evidence. Additional study is needed to identify best practice for the introduction and application of survivorship care plans.
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Reed SC, Walker R, Ziebell R, Rabin B, Nutt S, Chubak J, Nekhlyudov L. Cancer Survivors' Reported Discussions with Health Care Providers About Follow-Up Care and Receipt of Written Care Plans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1181-1188. [PMID: 28480500 DOI: 10.1007/s13187-017-1228-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Prior studies reveal gaps in cancer survivors' discussions with health care providers about follow-up care and receipt of care plans; however, whether survivorship care planning may vary by cancer type is not known. We surveyed 615 survivors of breast, colorectal, prostate, lung cancer, and melanoma enrolled in three health plans to examine cancer survivors' self-reported discussions of follow-up care, including the need for surveillance, late and long-term effects, emotional needs, and health behaviors. We assessed whether cancer survivors received a written treatment summary and post-treatment care instructions. Most (92%) survivors reported having a discussion about the need for surveillance; 75%, late and long-term effects; 69%, lifestyle and health behaviors; and 53%, emotional and social needs. Most (88%) reported receiving post-treatment care instructions and 47%, a treatment summary. While there was little difference among survivors' receipt of surveillance or health behavior recommendations by cancer type (p = 0.85 and p = 0.66, respectively), discussions of late and long-term effects occurred among 82% of prostate, 78% of breast, 73% of melanoma, 72% of colorectal, and 67% of lung survivors (p = 0.06). Approximately half of survivors reported discussions of emotional needs, with modest differences by cancer type (p = 0.08). Our findings indicate that most patient-provider discussions cover information on surveillance, with less emphasis on late and long-term effects, lifestyle and health behaviors, and substantially less focusing on emotional and social needs. No or modest differences in discussions occurred by cancer type. Whether tailoring information to individual cancer survivor needs is beneficial should be examined.
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Affiliation(s)
- Sarah C Reed
- Jane Addams College of Social Work, University of Illinois at Chicago, 1040 West Harrison Street, Chicago, IL, 60607-7134, USA.
| | - Rod Walker
- Kaiser Permanente Health Research Institute, Seattle, WA, USA
| | - Rebecca Ziebell
- Kaiser Permanente Health Research Institute, Seattle, WA, USA
| | - Borsika Rabin
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Stephanie Nutt
- Dell Medical School, University of Texas, Austin, TX, USA
| | - Jessica Chubak
- Kaiser Permanente Health Research Institute, Seattle, WA, USA
| | - Larissa Nekhlyudov
- Department of Population Medicine, Harvard Medical School and Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Handberg C, Midtgaard J, Nielsen CV, Thorne S, Lomborg K. Healthcare Professionals' Attitudes to Rehabilitation Programming for Male Cancer Survivors. Rehabil Nurs 2018; 43:127-137. [PMID: 27766645 DOI: 10.1002/rnj.298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study is to describe and interpret the attitudes and conduct of hospital healthcare professionals (HCPs) in association with male cancer survivors and their municipal rehabilitation participation. DESIGN Ethnographic fieldwork was conducted, consisting of participant observation and nine semistructured focus group interviews with 58 hospital HCPs. METHODS Using interpretive description methodology with symbolic interaction as a theoretical framework, data were collected through fieldwork in three oncology wards in Denmark. FINDINGS Attitudes about both gender and rehabilitation were identified as overarching obstructions within hospital HCP conduct toward promoting men's participation in cancer rehabilitation. CONCLUSIONS Gender and rehabilitation perceptions formed barriers in this context, suggesting that male cancer survivors' rehabilitation outcomes may be compromised by HCP attitudes and conduct. CLINICAL RELEVANCE These findings provide insight into approaches to guide HCPs to take responsibility for rehabilitation and to take gender into account in their work.
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Johnson M, Tod AM, Brummell S, Collins K. Discussing potential recurrence after lung cancer surgery: Uncertainties and challenges. Eur J Cancer Care (Engl) 2018; 27:e12870. [PMID: 29863300 DOI: 10.1111/ecc.12870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 04/06/2018] [Accepted: 04/30/2018] [Indexed: 12/25/2022]
Abstract
Patients with lung cancer who undergo surgery may potentially be cured. The resulting pathological staging gives an indication of 5-year survival and whether further treatment is recommended. To date, there is little research evidence regarding the way potential recurrence is communicated to patients by staff. This qualitative research used case studies to explore how information disclosure about possible recurrence was managed following lung cancer surgery and aimed to identify practice implications for clinical teams. Twelve patients were recruited and first postoperative surgical and subsequent oncology or follow-up consultations were recorded and transcribed. The perspective of the professionals involved in these clinics was ascertained through 30 in-depth interviews. Key themes in the data were identified using Framework Analysis. Recurrence risk was communicated to patients in a number of ways and levels of clarity and openness. Information provided by participants about early warning signs of recurrence varied. Findings indicate information provided was linked to the patient's prognosis and individual professionals' underlying communication approach. This study provides a unique insight into the views of lung cancer specialists regarding information disclosure and reveals the challenging nature and complexity of discussing recurrence following lung cancer surgery.
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Affiliation(s)
- Matthew Johnson
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Centre for Health and Social Care Research, Faculty of Health & Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Angela Mary Tod
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Stephen Brummell
- Centre for Health and Social Care Research, Faculty of Health & Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Karen Collins
- Centre for Health and Social Care Research, Faculty of Health & Wellbeing, Sheffield Hallam University, Sheffield, UK
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18
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Oliveira RAAD, Zago MMF, Thorne SE. Interaction between professionals and cancer survivors in the context of Brazilian and Canadian care. Rev Lat Am Enfermagem 2017; 25:e2972. [PMID: 29267543 PMCID: PMC5738956 DOI: 10.1590/1518-8345.2253.2972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/07/2017] [Indexed: 11/22/2022] Open
Abstract
Objective: analyze cancer survivors’ reports about their communication with health
professional team members and describe the similarities and differences in
interactional patterns between Brazilian and Canadian health care contexts. Method: This study adopted a qualitative health research approach to secondary analysis,
using interpretive description as the methodology, allowing us to elaborate a new
research question and look at the primary data from a different perspective. There
were in total eighteen participants; all of them were adults and elderly diagnosed
with urologic cancer. After being organized and read, the data sets were
classified into categories, and an analytic process was performed through
inductive thematic analysis. Results: This resulted in three categories of findings which we have framed as:
Communication between professional and survivor; The symptoms, the doubts, the
questions; and Actions and reaction. Conclusion: This comparative study allowed us to bring to the attention of health
professionals, especially nurses, findings regarding effective communication,
humanization and empathy, supporting both inside and outside support groups,
giving pieces of advice, and advocating for the survivor as is necessary. The
study also showed the importance of self-development of these professionals as
they fight for better quality in the health system for their patients.
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Affiliation(s)
- Rafaela Azevedo Abrantes de Oliveira
- Doctoral student, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. Scholarship holder at Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Brazil
| | - Márcia Maria Fontão Zago
- PhD, Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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19
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Economou D, Reb A. Communication Concerns When Transitioning to Cancer Survivorship Care. Semin Oncol Nurs 2017; 33:526-535. [DOI: 10.1016/j.soncn.2017.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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de Oliveira RAA, da Conceição VM, Araujo JS, Zago MMF. Concept analysis of cancer survivorship and contributions to oncological nursing. Int J Nurs Pract 2017; 24. [DOI: 10.1111/ijn.12608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/05/2017] [Accepted: 09/13/2017] [Indexed: 01/02/2023]
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Abstract
OBJECTIVES To review how mindfulness can be elicited in and strategically managed through communication, with a goal toward enhancing the patient/family relationship in the experience of cancer care. DATA SOURCES Published, peer-reviewed literature, research reports, and Web-based resources. CONCLUSION Mindful communication, an active process whereby the health care provider and patient /family unit are attentive to the timing, nature, and context of the dialogue exchange, helps direct care that is patient-centered, reflective, and relational. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses using a patient-centered approach to communication will be more equipped to use mindfulness-based strategies that can potentially shift the way cancer care is delivered.
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22
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Mayer DK, Nasso SF, Earp JA. Defining cancer survivors, their needs, and perspectives on survivorship health care in the USA. Lancet Oncol 2017; 18:e11-e18. [PMID: 28049573 DOI: 10.1016/s1470-2045(16)30573-3] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/01/2016] [Accepted: 08/12/2016] [Indexed: 12/21/2022]
Abstract
More people are living after a diagnosis of cancer than ever before and now account for around 5% of the US population. The specialty of cancer survivorship has been developing and growing since the mid-1980s, but the term survivor is open to debate by people living with cancer and those caring for them. Regardless of the term used, many ongoing physical, psychological, and social needs affect quality of life for people who are living with cancer and those who have survived the disease. Survivors prefer to have these needs addressed by their oncologist but also want their primary care provider to have a role. However, survivors also believe there are communication and coordination barriers between care providers. The existing method for delivering cancer care is becoming unsustainable and is not adequately configured to deliver high-quality cancer care to this growing population in the USA, especially when confronted with projected health-care shortages by 2020. In this Series paper, we define the term cancer survivor, discuss survivors' ongoing needs and preferences for care over time, and consider the implications for delivering coordinated cancer care in the USA.
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Affiliation(s)
- Deborah K Mayer
- University of North Carolina School of Nursing, University of North Carolina, Chapel Hill, NC, USA; University of North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | | | - Jo Anne Earp
- University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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23
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Hébert J, Fillion L. Development and validation of an individualized survivorship care plan (ISCP) for women with endometrial cancer during the transition of the end of active treatment to the cancer survivorship. Can Oncol Nurs J 2017; 27:33-42. [PMID: 31148653 DOI: 10.5737/236880762713342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Many cancer survivors finish their treatment without knowing the associated health risks and few are prepared to handle their health needs in the survivorship phase. Moreover, practical guides for follow- up care are not available and survivors' psychological and social needs often go unassessed. In this article, we propose the development and implementation of an individualized follow-up care plan (IFCP) after active treatment for women with endometrial cancers (WEC) to meet their needs for information and to facilitate the transition to the survivorship phase. Background The after-treatment phase is a distinct phase that is still neglected in the oncological continuum of care. It is the transition between two phases in the care trajectory-treatment and survivorship-that gives rise to many challenges for survivors, care providers and the healthcare system alike. Research goal Aiming to facilitate the transition between the end of active treatment and the cancer survivorship phases, we pursued two objectives: 1) Develop an individualized follow-up care plan (IFCP) based on both the literature and the perspective of WEC, healthcare professionals involved with the target clientele and oncology outreach managers, and 2) Have this IFCP validated by an interdisciplinary team. Methodology For the first objective, WEC-related needs at the end of active treatment (immediate end, three months and six months), as well as the perceptions of health professionals and oncology outreach managers were gathered by interview and group discussion on the benefit of an IFCP, its content and desired format. A content analysis of the interview data was performed using the Miles and Huberman approach (2003). For the second objective, an iterative consultation process with health professionals allowed for validation by consensus. These two objectives are the first qualitative phase of a mixed-methods sequential exploratory design that will make the development of an IFCP possible. In the second phase, we conducted a feasibility study of the implementation of the IFCP during the end of active treatment transition to cancer survivorship transition. This will be the subject of a second article. Results The interviews (n=47) revealed WECs' lack of preparation for the transition from the end of active treatment to the cancer survivorship. The following needs were specified: information (80%), emotional support, particularly to overcome their fear of recurrence (75%), the management of physical symptoms (45%), and support for adapting to change (45%). The data gathered from healthcare professionals and outreach managers support the utility of an IFCP in meeting these needs. The iterative validation process by the interdisciplinary team made consensus on the format and content possible. The final version of the IFCP is seen as a tool for information and communication in the survivorship phase. Some obstacles to its transfer to clinical practice are reported. Conclusion This study presents the entire process that led to the development of an IFCP that integrates both the needs of endometrial cancer survivors and the opinions of healthcare professionals and the oncology outreach managers organizing this care. Indications on how the IFCP could be implemented within this organization are also formulated.
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Affiliation(s)
- Johanne Hébert
- Professor, Department of Nursing, Université du Québec à Rimouski (UQAR)
| | - Lise Fillion
- Full professor, Faculty of Nursing, Université Laval
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Mazor KM, Street RL, Sue VM, Williams AE, Rabin BA, Arora NK. Assessing patients' experiences with communication across the cancer care continuum. PATIENT EDUCATION AND COUNSELING 2016; 99:1343-8. [PMID: 26979476 PMCID: PMC4931971 DOI: 10.1016/j.pec.2016.03.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 02/26/2016] [Accepted: 03/04/2016] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To evaluate the relevance, performance and potential usefulness of the Patient Assessment of cancer Communication Experiences (PACE) items. METHODS Items focusing on specific communication goals related to exchanging information, fostering healing relationships, responding to emotions, making decisions, enabling self-management, and managing uncertainty were tested via a retrospective, cross-sectional survey of adults who had been diagnosed with cancer. Analyses examined response frequencies, inter-item correlations, and coefficient alpha. RESULTS A total of 366 adults were included in the analyses. Relatively few selected Does Not Apply, suggesting that items tap relevant communication experiences. Ratings of whether specific communication goals were achieved were strongly correlated with overall ratings of communication, suggesting item content reflects important aspects of communication. Coefficient alpha was ≥.90 for each item set, indicating excellent reliability. Variations in the percentage of respondents selecting the most positive response across items suggest results can identify strengths and weaknesses. CONCLUSION The PACE items tap relevant, important aspects of communication during cancer care, and may be useful to cancer care teams desiring detailed feedback. PRACTICE IMPLICATIONS The PACE is a new tool for eliciting patients' perspectives on communication during cancer care. It is freely available online for practitioners, researchers and others.
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Affiliation(s)
- Kathleen M Mazor
- Meyers Primary Care Institute, 630 Plantation Street, Worcester, MA 01605, USA.
| | - Richard L Street
- Department of Communication, Texas A&M University, 456 Ross Street, College Station, TX 77843, USA.
| | - Valerie M Sue
- Kaiser Permanente, 300 Lakeside Drive, Oakland, CA 94612, USA.
| | - Andrew E Williams
- Maine Medical Center Research Institute, 81 Research Drive, Scarborough, ME 04074, USA.
| | - Borsika A Rabin
- Department of Family Medicine, University of Colorado-Denver, 13001 E 17th Place, Aurora, CO 80045, USA.
| | - Neeraj K Arora
- Patient-Centered Research Outcomes (PCORI) Research Branch, 1828L Street NW #900, Washington, DC 20036, USA.
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Trends in cancer survivors' experience of patient-centered communication: results from the Health Information National Trends Survey (HINTS). J Cancer Surviv 2016; 10:1067-1077. [PMID: 27193357 DOI: 10.1007/s11764-016-0550-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Two Institute of Medicine reports almost a decade apart suggest that cancer survivors often feel "lost in transition" and experience suboptimal quality of care. The six core functions of patient-centered communication: managing uncertainty, responding to emotions, making decisions, fostering healing relationships, enabling self-management, and exchanging information, represent a central aspect of survivors' care experience that has not been systematically investigated. METHODS Nationally representative data from four administrations of the Health Information National Trends Survey (HINTS) was merged with combined replicate weights using the jackknife replication method. Linear and logistic regression models were used to assess (1) characteristics of cancer survivors (N = 1794) who report suboptimal patient-centered communication and (2) whether survivors' patient-centered communication experience changed from 2007 to 2013. RESULTS One third to one half of survivors report suboptimal patient-centered communication, particularly on core functions of providers helping manage uncertainty (48 %) and responding to emotions (49 %). In a fully adjusted linear regression model, survivors with more education (Wald F = 2.84, p = .04), without a usual source of care (Wald F = 11.59, p < .001), and in poorer health (Wald F = 9.08, p < .001) were more likely to report less patient-centered communication. Although ratings of patient-centered communication improved over time (p trend = .04), this trend did not remain significant in fully adjusted models. CONCLUSIONS Despite increased attention to survivorship, many survivors continue to report suboptimal communication with their health care providers. IMPLICATIONS FOR CANCER SURVIVORS Survivorship communication should include managing uncertainty about future risk and address survivors' emotional needs. Efforts to improve patient-centered communication should focus on survivors without a usual source of care and in poorer health.
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Mellblom AV, Korsvold L, Finset A, Loge J, Ruud E, Lie HC. Providing Information About Late Effects During Routine Follow-Up Consultations Between Pediatric Oncologists and Adolescent Survivors: A Video-Based, Observational Study. J Adolesc Young Adult Oncol 2015; 4:200-8. [PMID: 26697269 PMCID: PMC4684659 DOI: 10.1089/jayao.2015.0037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Information about late effects is a prerequisite for survivors of childhood cancers to engage in self-management of their health. Yet, many lack such knowledge. This study investigated to what extent: (1) potential late effects were discussed with adolescent and young adult (AYA)-aged survivors (of pediatric cancer), and (2) information about late effects was provided by the pediatric oncologists (POs) during routine follow-up consultations. METHODS Consultations were recorded with 10 POs and 66 adolescents, aged 12-20 years, treated for leukemia (72.7%) or lymphoma (21.2%), or who had received hematopoietic stem-cell transplantation for a benign disease (7.6%). Discussions of potential late effects were identified and coded, and then the amount of information about late effects provided was categorized into three levels: none, basic, and extended information. RESULTS Potential late effects were discussed in 85% of the consultations. Of these, 71% were PO initiated, and 60% concerned existing health problems. The POs provided none, basic, and extended information about late effects in 41%, 30%, and 29% of these discussions. Patients' age, time since treatment, and risk of late effects were not associated with amount of potential late effects discussed, but the type of potential late effect (physical vs. psychosocial and current vs. future risk) and PO were. CONCLUSION Potential late effects were frequently discussed, thus providing ample opportunity to provide information about late effects to adolescent cancer survivors. The observed PO variability in providing such information indicates a need for standardization of information practices.
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Affiliation(s)
- Anneli V Mellblom
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway
| | - Live Korsvold
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway . ; Department of Pediatric Medicine, Women and Children's Unit, Oslo University Hospital , Rikshospitalet, Oslo, Norway
| | - Arnstein Finset
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway
| | - Jon Loge
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway . ; Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital (OUS) , Oslo, Norway
| | - Ellen Ruud
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway
| | - Hanne C Lie
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway . ; National Resource Centre for Late Effects After Cancer Treatment, Oslo University Hospital , Radiumhospitalet, Oslo, Norway
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Pascal J, Johnson N, Dickson-Swift V, McGrath P, Dangerfield F. Understanding receptivity to informal supportive cancer care in regional and rural Australia: a Heideggerian analysis. Eur J Cancer Care (Engl) 2015; 25:381-90. [PMID: 26047366 DOI: 10.1111/ecc.12337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 11/30/2022]
Abstract
The concept of receptivity is a new way of understanding the personal and social factors that affect a person living with and beyond cancer, and how these factors influence access to formal supportive care service provision and planning. This article contributes to new knowledge through applying the concept of receptivity to informal supportive cancer care in regional Australia. Literature indicates that a cancer diagnosis is a life-changing experience, particularly in regional communities, where survival rates are lower and there are significant barriers to accessing services. Heideggerian phenomenology informed the design of the study and allowed for a rich and nuanced understanding of participants lived experiences of informal supportive cancer care. These experiences were captured using in-depth interviews, which were subsequently thematically analysed. Nineteen participants were recruited from across regional Victoria, Australia. Participants self-reported a range of stages and types of cancer. Significantly, findings revealed that most participants were not referred to, and did not seek, formal supportive care. Instead, they were receptive to informal supportive care. Understanding receptivity and the role of anxiety and fear of death has implications for partners, family, community members, as well as professionals working with people with living with and beyond cancer.
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Affiliation(s)
- J Pascal
- Department of Public and Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Vic., 3550, Australia
| | - N Johnson
- Department of Public and Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Vic., 3550, Australia
| | - V Dickson-Swift
- Department of Public and Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Vic., 3550, Australia
| | - P McGrath
- Centre for Community Science, Population & Social Health Program, Griffith Health Institute, Griffith University, Meadowbrook, Qld, 4131, Australia
| | - F Dangerfield
- Department of Public and Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Vic., 3550, Australia
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Zapka J, Sterba KR, LaPelle N, Armeson K, Burshell DR, Ford ME. Physician perspectives on colorectal cancer surveillance care in a changing environment. QUALITATIVE HEALTH RESEARCH 2015; 25:831-844. [PMID: 25878188 PMCID: PMC5973790 DOI: 10.1177/1049732315580557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this formative qualitatively driven mixed-methods study was to refine a measurement tool for use in interventions to improve colorectal cancer (CRC) surveillance care. We employed key informant interviews to explore the attitudes, practices, and preferences of four physician specialties. A national survey, literature review, and expert consultation also informed survey development. Cognitive pretesting obtained participant feedback to improve the survey's face and content validity and reliability. Results showed that additional domains were needed to reflect contemporary interdisciplinary trends in survivorship care, evolving practice changes and current health policy. Observed dissonance in specialists' perspectives poses challenges for the development of interventions and psychometrically sound measurement. Implications for future research include need for a flexible care model with enhanced communication and role definitions among clinical specialists, improvements in surveillance at multilevels (patients, providers, and systems), and measurement tools that focus on multispecialty involvement and the changing practice and policy environment.
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Affiliation(s)
- Jane Zapka
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Nancy LaPelle
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kent Armeson
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dana R Burshell
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marvella E Ford
- Medical University of South Carolina, Charleston, South Carolina, USA
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30
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Taylor K, Thorne S, Oliffe JL. It's a sentence, not a word: insights from a keyword analysis in cancer communication. QUALITATIVE HEALTH RESEARCH 2015; 25:110-121. [PMID: 25201584 DOI: 10.1177/1049732314549606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Keyword analysis has been championed as a methodological option for expanding the insights that can be extracted from qualitative datasets using various properties available in qualitative software. Intrigued by the pioneering applications of Clive Seale and his colleagues in this regard, we conducted keyword analyses for word frequency and "keyness" on a qualitative database of interview transcripts from a study on cancer communication. We then subjected the results from these operations to an in-depth contextual inquiry by resituating word instances within their original speech contexts, finding that most of what had initially appeared as group variations broke down under close analysis. In this article, we illustrate the various threads of analysis, and explain how they unraveled under closer scrutiny. On the basis of this tentative exercise, we conclude that a healthy skepticism for the benefits of keyword analysis within a qualitative investigative process seems warranted.
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Affiliation(s)
- Kimberly Taylor
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Sally Thorne
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John L Oliffe
- University of British Columbia, Vancouver, British Columbia, Canada
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31
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Transition from Hospital to Daily Life: A Pilot Study. Rehabil Nurs 2015; 40:20-9. [DOI: 10.1002/rnj.180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 11/07/2022]
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32
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The experience of cognitive change in women with breast cancer following chemotherapy. J Cancer Surviv 2014; 9:375-87. [DOI: 10.1007/s11764-014-0387-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/20/2014] [Indexed: 10/24/2022]
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Pascal J, Johnson N, Dickson-Swift V, Kenny A. Returning home: psychosocial care during the re-entry phase of cancer survivorship in rural Australia. Eur J Cancer Care (Engl) 2014; 24:39-49. [PMID: 25163537 DOI: 10.1111/ecc.12232] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 11/30/2022]
Abstract
The purpose of this research was to highlight gaps in formal psychosocial care for cancer survivors in rural communities. The study was conducted in rural Victoria, Australia, and involved interviews with people with various stages of cancer progression, cancer diagnoses and survival times, who were interviewed about their experiences of psychosocial cancer care. Interviews focused on their experience of psychosocial care and were audio-recorded and transcribed verbatim. Data were thematically analysed to identify key themes. Findings demonstrate that psychosocial care is essentially informal within the re-entry period after cancer diagnosis and treatment. Despite current Australian clinical guidelines on psychosocial care for people with cancer, which indicate the need for the provision of formal psychosocial care, participants in this study largely cared for themselves, or received informal support from family, friends and community members. Many psychosocial needs remained unmet and professional support was lacking. While this study was conducted in rural Australia, many of our findings have been echoed in studies from other countries. The findings have implications for treatment protocols and discharge planning, health professional-patient-family relationships, and the long-term well-being of cancer survivors living in rural communities. A model for understanding the experience of formal supportive care during the re-entry phase of survivorship is proposed.
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Affiliation(s)
- J Pascal
- Department of Public and Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Vic., Australia
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Meeting reality: young adult cancer survivors' experiences of reentering everyday life after cancer treatment. Cancer Nurs 2014; 36:E17-26. [PMID: 23348661 DOI: 10.1097/ncc.0b013e318278d4fc] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cancer in young adults is rare, but the intensity of cancer treatment increases the risk of physical and psychosocial impacts on patients' entire lives. Young adult survivors are underrepresented in research, and knowledge of cancer survivors in this age group is scarce, especially knowledge of transition from cancer treatment to everyday life. OBJECTIVE The objective of this study was to explore how young adult cancer survivors experience reentering everyday life after cancer treatment. METHODS A qualitative, phenomenological approach was used and included 20 young adult survivors (aged 24-35 years) with different cancer diagnoses allocated to a rehabilitation program. Semistructured interviews were conducted, and the transcripts were analyzed qualitatively using Systematic Text Condensation method. RESULTS "Meeting reality" was identified as a bridging theme, explained by 4 main themes important to the informants: (1) lack of preparation, (2) late effects, (3) lack of understanding, and (4) being neither sick nor healthy. CONCLUSIONS Informants were unprepared for reentering everyday life after cancer treatment and experienced a mismatch of their expectations with reality, particularly in the holistic impact of late effects. Moreover, reentering everyday life was characterized by a lack of understanding from their network and even healthcare providers who conducted follow-ups. The informants experienced reentering everyday life as being much harder than expected, and they felt isolated as well as neither sick nor healthy. IMPLICATIONS FOR PRACTICE The results suggest a major shortcoming in both preparation for survivorship, multidisciplinary follow-ups, and knowledge. A shift to a more holistic perspective in survivorship care is suggested.
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35
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Prouty CD, Mazor KM, Greene SM, Roblin DW, Firneno CL, Lemay CA, Robinson BE, Gallagher TH. Providers' perceptions of communication breakdowns in cancer care. J Gen Intern Med 2014; 29:1122-30. [PMID: 24599795 PMCID: PMC4099451 DOI: 10.1007/s11606-014-2769-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 11/18/2013] [Accepted: 01/02/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Communication breakdowns in cancer care are common and represent a failure in patient-centered care. While multiple studies have elicited patients' perspectives on these breakdowns, little is known about cancer care providers' attitudes regarding the causes and potential solutions. OBJECTIVE To examine providers' (1) perceptions of the nature and causes of communication breakdowns with patients in cancer care and (2) suggestions for managing and preventing breakdowns. DESIGN Qualitative study of nine focus groups held at three sites (Massachusetts, Georgia and Washington). PARTICIPANTS Fifty-nine providers: 33% primary care physicians, 14% oncologists, 36% nurses, and 17% nurse practitioners, physician assistants, and others. APPROACH Directed content analysis of focus group transcripts. KEY RESULTS Providers' perceptions of the causes of communication breakdowns fell into three categories: causes related to patients, providers, or healthcare systems. Providers perceived that patients sometimes struggle to understand cancer and health-related information, have unrealistic expectations, experience emotional and psychological distress that interferes with information exchange; and may be reticent to share their confusion or concerns. Providers described their own and colleagues' contributions to these breakdowns as sharing inaccurate, conflicting, or uncoordinated information. Providers also described the difficulty in balancing hope with reality in discussions of prognosis. System issues named by providers included insufficient time with patients, payment systems, and changing protocols that inhibit communication and coordination of care. Potential solutions included greater patient engagement, team coordination, and systems that promote patient feedback. CONCLUSIONS Providers described multiple causes for communication breakdowns at the patient, provider, and system level. Multi-level interventions that coordinate care and encourage feedback may help to address or prevent communication breakdowns.
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Affiliation(s)
- Carolyn D Prouty
- Department of Medicine, University of Washington, Seattle, WA, USA
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36
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Buriak SE, Potter J. Impact of an online survivorship primer on clinician knowledge and intended practice changes. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:114-21. [PMID: 24104208 DOI: 10.1007/s13187-013-0556-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The number of adult cancer survivors in the USA is expected to double by the year 2050. A call for increased survivorship care and provider training came from the Institute of Medicine (IOM) in the form of a landmark report in 2006. A shortage of physicians complicates the burden of survivorship care. The purpose of this effort was to design, develop, and evaluate a fully accredited, evidence-based continuing medical education (CME) and continuing education (CE) intervention to address the established knowledge gap for breast cancer, prostate cancer, colorectal cancer, and non-Hodgkin lymphoma survivorship education. Delivered through the Medscape Education (WebMD) platform, the course covered epidemiology, survivor issues, and currently available guidelines using illustrative patient cases. Knowledge gain was evaluated using a pretest-posttest design. Program evaluation was assessed by survey. Additional areas examined included post-intervention inquiry regarding expected changes to clinical practice. The results of this educational intervention demonstrated the effectiveness of internet-based CME/CE for cancer survivorship. Learning gain was significant (p < 0.0005). Effect size (d = 1.71) suggested extremely high practical significance, as the difference between the means was larger than 1 standard deviation. Significant knowledge gains were observed for each survivorship knowledge question across all clinical specialties studied. Nearly 100% of participants agreed that the course contributed to survivorship care and was organized effectively. Participants reported that the course was designed effectively (97.2%), and 68.1% responded in favor of adopting alternative communication strategies with patients and families upon completion of the course.
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Affiliation(s)
- Susan E Buriak
- A.T. Still University, 800 W Jefferson St, Kirksville, MO, 63501, USA,
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Changing communication needs and preferences across the cancer care trajectory: insights from the patient perspective. Support Care Cancer 2013; 22:1009-15. [DOI: 10.1007/s00520-013-2056-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/12/2013] [Indexed: 01/12/2023]
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"How I kept track of it of course was my business": cancer patient self-monitoring as self-stylized work. Palliat Support Care 2013; 12:355-61. [PMID: 23916121 DOI: 10.1017/s1478951513000308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Self-monitoring behaviors of cancer patients benefit patients, caregivers, and providers, and yet the phenomenon of self-monitoring from the cancer-patient perspective has not been studied. We examined cancer patients' self-monitoring preferences and practices, focusing on the meaning of self-monitoring within the cancer experience. METHODS Semi-structured interviews were conducted among adult cancer patients who had been seen at least once at a rural United States cancer center. Questions sought out the meaning of self-monitoring and its practical aspects. Qualitative data were analyzed by adapting the four-stepped method by Giorgi for empirical phenomenological analysis. RESULTS Twenty participants were interviewed (11 women and 9 men). Transcribed interviews revealed that cancer patient self-monitoring is self-stylized work that ranges from simple to complex, while being both idiosyncratic and routine. Participants reported using tools with systems for use that fit their distinctive lives for the purpose of understanding and using information they deemed to be important in their cancer care. Three conceptual categories were discerned from the data that help to elucidate this self-stylized work as fitting their individual priorities and preferences, reflecting their identities, and being born of their work lives. SIGNIFICANCE OF RESULTS Findings highlight patients' unique self-monitoring preferences and practices, calling into question the assumption that the sole use of standardized tools are the most effective approach to engaging patients in this practice. Self-monitoring efforts can be validated when providers welcome or adapt to patients' self-stylized tools and systems. Doing so may present opportunity for improved communications and patient-centered care.
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[Multidisciplinary clinical management for prophylactic mastectomy: views of women from one centre in Quebec City]. Bull Cancer 2013; 100:201-11. [PMID: 23501099 DOI: 10.1684/bdc.2013.1708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Prophylactic mastectomy is an effective, although controversial strategy to reduce the risk of breast cancer in women carrying a BRCA1/2 mutation. A multidisciplinary pre- and post-operative clinical management is recommended for women who consider or undergo this surgery, because of its radical and irreversible nature as well as its possible impact on quality of life. OBJECTIVE This study aims to report on the experience of patients having undergone prophylactic mastectomy within a medical setting offering such a clinical management. METHODS A retrospective qualitative study was conducted with patients having had a prophylactic mastectomy between 2002 and 2006 at the centre des maladies du sein Deschênes-Fabia (CMSDF) in Quebec City. Fifteen women were interviewed and the narratives were analyzed using thematic content analysis method. RESULTS The participants generally appreciated the multidisciplinary approach that was used at the CMSDF and believed it was necessary. Improvements were suggested regarding information and post-surgical medical follow-up, some of which are now implemented. CONCLUSION The study results confirm the utility and the acceptability of a multidisciplinary clinical follow-up for women who undergo prophylactic mastectomy.
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Ross L, Petersen MA, Johnsen AT, Lundstrøm LH, Groenvold M. Cancer patients' evaluation of communication: a report from the population-based study 'The Cancer Patient's World'. Support Care Cancer 2012; 21:235-44. [PMID: 22678406 DOI: 10.1007/s00520-012-1516-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 05/28/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE The aims of this study were to assess how communication with health care staff is perceived by Danish cancer patients and to characterise those patients who report problems in communication. METHODS In a cross-sectional survey, a nationally representative sample of 2,202 cancer patients who had been in contact with a hospital department during the past year was invited to respond to a questionnaire. Communication with doctors and nurses was assessed separately as were their abilities as listeners, doctors' use of an understandable language, timing of the information, duration of consultations, and whether doctors criticised other doctors. RESULTS A total of 1,490 cancer patients responded to the questionnaire. Of these, 24 % reported one or more problems with the areas of communication measured. The problem most frequently reported (by 12 %) was not having sufficient time for consultations. More patients reported problems with doctors' communication and abilities as listeners than with nurses' skills in these areas. There was a general pattern that younger patients and those sampled in Copenhagen reported the highest degree of dissatisfaction with the communication. Those exposed to a high number of different treatment modalities were at especially high risk of experiencing problems. CONCLUSIONS A high proportion of patients reported one or more problems in the communication. However, the number reporting each of the specific problems was remarkably low. Special focus should be given to patients exposed to several treatment modalities and their communicative needs.
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Affiliation(s)
- Lone Ross
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.
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