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Serra-Barril MA, Ferro-Garcia T, Fernandez-Ortega P, Sanchez-Lopez C, Martinez-Momblan MA, Benito-Aracil L, Romero-Garcia M. The role experience of advanced practice nurses in oncology: An interpretative phenomenological study. J Adv Nurs 2024; 80:2512-2524. [PMID: 38054402 DOI: 10.1111/jan.15997] [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: 08/05/2023] [Revised: 11/06/2023] [Accepted: 11/19/2023] [Indexed: 12/07/2023]
Abstract
AIM(S) To understand the experiences of advanced practice nurses working in cancer care. DESIGN Phenomenological qualitative study. METHODS Three focus groups were held to collect qualitative data. Participants were recruited through theoretical non-probabilistic sampling of maximum variation, based on 12 profiles. Data saturation was achieved with a final sample of 21 oncology advanced practice nurses who were performing advanced clinical practice roles in the four centers from December 2021 to March 2022. An interpretative phenomenological analysis was performed following Guba and Lincoln's criteria of trustworthiness. The centers' ethics committee approved the study, and all participants gave written informed consent. Data analysis was undertaken with NVivo 12 software. RESULTS Three broad themes emerged from the data analysis: the role performed, facilitators and barriers in the development of the role and nurses' lived experience of the role. CONCLUSION Advanced practice nurses are aware that they do not perform their role to its full potential, and they describe different facilitators and barriers. Despite the difficulties, they present a positive attitude as well as a capacity for leadership, which has allowed them to consolidate the advanced practice nursing role in unfavourable environments. IMPLICATIONS FOR THE PROFESSION These results will enable institutions to establish strategies at different levels in the implementation and development of advanced practice nursing roles. REPORTING METHOD Reporting complied with COREQ criteria for qualitative research. PATIENT OR PUBLIC CONTRIBUTIONS No patient or public contribution.
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Affiliation(s)
- M Antònia Serra-Barril
- Innovation and Quality Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
| | - Tàrsila Ferro-Garcia
- Innovation and Quality Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
| | - Paz Fernandez-Ortega
- Department of Public Health, Mental Health and Maternal Care, Faculty of Medicine and Health Sciences, University of Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Sanchez-Lopez
- Catalan Institute of Oncology, Oncology Hospitalization/Inpatient Unit, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Antonia Martinez-Momblan
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
| | - Llúcia Benito-Aracil
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
- IDIBELL, Institute of Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Romero-Garcia
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
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Sugiyama A, Okumiya H, Fujimoto K, Utsunomiya K, Shimomura Y, Sanuki M, Kume K, Yano T, Kagawa R, Bando H. Integrated Electronic Health Record of Multidisciplinary Professionals Throughout the Cancer Care Pathway: A Pilot Study Exploring Patient-Centered Information in Breast Cancer Patients. J Multidiscip Healthc 2024; 17:2069-2081. [PMID: 38736534 PMCID: PMC11088412 DOI: 10.2147/jmdh.s455281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/20/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose The aim of this pilot study was to first aggregate and then integrate the medical records of various healthcare professionals involved with breast cancer patients to reveal if and how patient-centered information is documented in multidisciplinary cancer care. Patients and Methods We aggregated 20 types of medical records from various healthcare professionals such as physicians, nurses and allied healthcare professionals (AHPs) throughout three breast cancer patients' care pathways in a department of breast surgery at a university hospital. Purposeful sampling was used, and three cases were examined. The number of integrated type of records was 14, 14, 17 in case 1, 2 and 3, respectively. We manually annotated and analyzed them exploratively using a thematic analysis. The tags were produced using both a deductive template approach and a data-driven inductive approach. All records were then given tags. We defined patient-centered information related tags and biomedical information related tags and then analyzed for if and how patient-centered information was documented. Results The number of patient-centered information related tags accounted for 30%, 30% and 20% of the total in case 1, 2 and 3, respectively. In all cases, patient-centered information was distributed across various medical records. The Progress Note written by doctors provided much of the patient-centered information, while other records contained information not described elsewhere in the Progress Notes. The records of nurses and AHPs included more patient-centered information than the doctors' notes. Each piece of patient-centered information was documented in fragments providing from each of the healthcare professionals' viewpoints. Conclusion The documented information throughout the breast cancer care pathway in the cases examined was dominated by biomedical information. However, our findings suggest that integrating fragmented patient-centered information from various healthcare professionals' medical records produces holistic patient-centered information from multiple perspectives and thus may facilitate an enhanced multidisciplinary patient-centered care.
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Affiliation(s)
- Atsuko Sugiyama
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
- Research and Development Center, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
| | - Hayato Okumiya
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Katsuhiko Fujimoto
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Kazuki Utsunomiya
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Yuka Shimomura
- Research and Development Center, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Masaru Sanuki
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Keitaro Kume
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takahiro Yano
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Rina Kagawa
- Department of Biomedical Informatics and Management, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Hiroko Bando
- Department of Breast-Thyroid-Endocrine Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Valentini V, Alfieri S, Coco C, D'Ugo D, Crucitti A, Pacelli F, Persiani R, Sofo L, Picciocchi A, Doglietto GB, Barbaro B, Vecchio FM, Ricci R, Damiani A, Savino MC, Boldrini L, Cellini F, Meldolesi E, Romano A, Chiloiro G, Gambacorta MA. Four steps in the evolution of rectal cancer managements through 40 years of clinical practice: Pioneering, standardization, challenges and personalization. Radiother Oncol 2024; 194:110190. [PMID: 38438019 DOI: 10.1016/j.radonc.2024.110190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sergio Alfieri
- Chirurgia Digestiva, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Claudio Coco
- U.O.C. Chirurgia Generale 2, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico D'Ugo
- Unità di chirurgia generale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Fabio Pacelli
- Unità chirurgica del peritoneo e del retroperitoneo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Persiani
- Unità di chirurgia generale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Sofo
- Divisione di Chirurgia Addominale, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Aurelio Picciocchi
- Dipartimento di Chirurgia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Battista Doglietto
- Chirurgia Digestiva, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Brunella Barbaro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fabio Maria Vecchio
- Dipartimento di Patologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Ricci
- Dipartimento di Patologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Damiani
- Gemelli Generator Real World Data Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Savino
- Gemelli Generator Real World Data Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elisa Meldolesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angela Romano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuditta Chiloiro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Ostroff C. Multidisciplinary teams and social science: a patient perspective. Colorectal Dis 2024; 26:1061-1067. [PMID: 38519855 DOI: 10.1111/codi.16957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
Multidisciplinary teams (MDTs) are common in colorectal cancer and have been deemed important when providing care. Yet they take place outside of the patient, often with little consideration of the patient's views, goals and desires. In this paper specific examples from a patient perspective are integrated with the social science literature to provide an overview of areas of disconnect between MDT recommendations and the individual patient. The reasons for these disconnects are explored, including how MDTs relate to dyadic patient-clinician relationships, weak incorporation of patient-oriented outcomes in MDTs, poor integration of nonmedical patient information and the patient perspective and the impact of team dynamics and cognitive decision biases. Consideration of these issues should facilitate higher-quality MDT recommendations that are also more acceptable to patients.
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Affiliation(s)
- Cheri Ostroff
- Business, University of South Australia, Adelaide, Australia
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Rousset-Jablonski C, Lortal B, Lantheaume S, Arnould L, Simon H, Tuszynski AS, Courtier M, Debbah S, Lefrançois M, Balbin S, Kably AS, Toledano A. French national survey on breast cancer care: caregiver and patient views. Breast Cancer 2024:10.1007/s12282-024-01576-4. [PMID: 38635135 DOI: 10.1007/s12282-024-01576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To improve the quality of care for patients with breast cancer, an analysis of the health-care pathway, considering feedback from both health-care practitioners (HCPs) and patients, is needed. METHODS Between 2020 and 2022, we conducted a survey at French breast cancer centers and analyzed information from questionnaires completed by HCPs and patients. We collected information on center organization, diagnostic processes, treatment decisions and modalities, supportive care, patient advocacy groups, and work issues. RESULTS Twenty-three breast cancer centers were included and questionnaires completed by 247 HCPs and 249 patients were analyzed. The centers closely followed the legal French framework for cancer treatments, which includes formal diagnostic announcements, multidisciplinary tumor boards, personalized treatment summaries, and supportive care access. HCPs and patients were satisfied with the time to diagnosis (≤ 2 weeks as evaluated by 75% of patients), time to surgery (mean 61 days), time between surgery and chemotherapy (mean 47 days), and time between surgery and radiotherapy (mean 81 days). Fertility preservation counseling for women under 40 years of age was systematically offered by 67% of the HCPs. The majority (67%) of the patients indicated that they had received a personalized treatment summary; the topics discussed included treatments (92%), tumor characteristics (84%), care pathways (79%), supportive care (52%), and breast reconstruction (33%). Among HCPs, 44% stated that reconstructive surgery was offered to all eligible patients and 57% and 45% indicated coordination between centers and primary care physicians for adverse effects management and access to supportive care should be improved, for chemotherapy and radiotherapy, respectively. Regarding patient advocacy groups, 34% of HCPs did not know whether patients had contact and only 23% of patients declared that they had such contact. For one-third of working patients, work issues were not discussed. Twenty-eight percent of patients claimed that they had faced difficulties for supportive care access. Among HCPs, 13% stated that a formal personalized survivorship treatment program was administered to almost all patients and 37% almost never introduced the program to their patients. Compliance to oral treatments was considered very good for 75-100% of patients by 62% of HCPs. CONCLUSIONS This study provides an updated analysis of breast cancer care pathways in France. Overall, the initial processes of diagnosis, announcement, and treatment were swift and were in agreement with the best care standards. No barriers to accessing care were identified. Based on the study findings, we proposed several strategies to improve the quality of care for patients in supportive care, coordination with primary care physicians, reconstructive surgery, and fertility preservation access.
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Affiliation(s)
- Christine Rousset-Jablonski
- Centre Léon Bérard, Lyon, France.
- Unité INSERM U1290 RESHAPE, Lyon, France.
- Hôpital Femme Mère Enfant, Bron, France.
| | | | | | | | | | | | | | | | | | | | | | - Alain Toledano
- Institut de Radiothérapie et de Radiochirurgie Hartmann - ELSAN, Levallois-Perret, France
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Snowden A, Young J, Savinc J. Can proactive support prevent unscheduled care? A controlled observational retrospective cohort study in cancer patients in Scotland. BMC Health Serv Res 2024; 24:457. [PMID: 38609990 PMCID: PMC11010331 DOI: 10.1186/s12913-024-10923-2] [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: 03/22/2023] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Preventative spend is a global health and social care strategy. Improving Cancer Journeys (ICJ) is a proactive, holistic, multidisciplinary project consistent with this agenda, currently being rolled out across Scotland and parts of UK. ICJ helps people with cancer access whatever support they need to mitigate their most pressing concerns. This study hypothesised that ICJ service users should subsequently use less unscheduled care than matched cohorts not using ICJ. METHODS Retrospective observational cohort study using linked national datasets. N = 1,214 ICJ users in Glasgow were matched for age, sex, deprivation, cancer type, stage, and diagnosis year to two control groups: 1. Cancer patients from Glasgow before ICJ (pre-2014), 2. Cancer patients from rest of Scotland during study period (2014-2018). Cancer registrations were linked for 12-month baseline and study periods to: NHS24 calls, A&E admissions, inpatient hospital admissions, unscheduled care, number & cost of psychotropic prescriptions. Per-person mean service uses were compared between groups. RESULTS There was a significant increase in NHS24 calls in the ICJ group (0.36 per person vs. -0.03 or 0.35), more and longer A&E attendances in ICJ (0.37 per person vs. 0.19 or 0.26; 2.19 h per person vs. 0.81-0.92 h), more and longer hospital admissions in ICJ (4.25 vs. 2.59 or 2.53; 12.05 days vs. 8.37 or 8.64), more care pathways involving more steps in ICJ (0.77 spells vs. 0.39 or 0.57; 1.88 steps vs. 1.56 or 1.21), more psychotropic drug prescriptions and higher costs in ICJ (1.88 prescription vs. 1.56 or 1.21; £9.51 vs. £9.57 or £6.95) in comparison to both control groups. DISCUSSION ICJ users sourced significantly more unscheduled care than matched cohorts. These findings were consistent with much of the comparable literature examining the impact of non-health interventions on subsequent health spend. They also add to the growing evidence showing that ICJ reached its intended target, those with the greatest need. Together these findings raise the possibility that those choosing to use ICJ may also be self-identifying as a cohort of people more likely to use unscheduled care in future. This needs to be tested prospectively, because this understanding would be very helpful for health and social care planners in all countries where proactive holistic services exist.
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Affiliation(s)
- Austyn Snowden
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, Scotland.
| | - Jenny Young
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, Scotland
| | - Jan Savinc
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, Scotland
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Chambers AJ, Enoch JF, Wong J, Spigelman A. When teams disagree: Investigating the incidence and causes of dissent occurring in cancer multidisciplinary team meetings. Asia Pac J Clin Oncol 2024; 20:234-239. [PMID: 36670329 DOI: 10.1111/ajco.13919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/05/2022] [Accepted: 12/26/2022] [Indexed: 01/22/2023]
Abstract
AIM Multidisciplinary teams (MDT) are commonly involved in the care of patients with cancer. How frequently dissent occurs within MDT has not been studied. This study aimed to determine how frequently dissent was documented in cancer MDT meetings at our institution, the reasons for this, and the opinions of MDT members on how dissent should be documented and communicated. METHODS A retrospective review of records from cancer MDT meetings at our institution from 2016 to 2020 was performed to identify cases where dissent was documented and the reasons for this. MDT members were invited to complete an online survey assessing their perceptions of how frequently dissent occurred, how comfortable they felt voicing dissenting opinions, and their opinions on how dissent should be documented and communicated. RESULTS Dissent was recorded in 30 of 7737 MDT case discussions (0.39%). The incidence of dissent varied from 0 to 1.2% between cancer streams. The most common reason for dissent involved the role of surgery. 27% of survey respondents felt either very or somewhat uncomfortable voicing dissenting opinions. Only 3% felt that dissent should not be documented, and none that it should not be communicated in some way, although there were wide ranging of views on how this should occur. CONCLUSION Dissent was rarely documented within cancer MDT meetings at our institution, likely due to underreporting. Measuring the incidence of dissent within an MDT may be a useful performance metric. MDT should develop policies for how dissent should be managed, documented, and communicated.
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Affiliation(s)
- Anthony J Chambers
- Department of Surgical Oncology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jade F Enoch
- Department of Surgical Oncology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jasmine Wong
- Department of Surgical Oncology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Allan Spigelman
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
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Orlowski C, Lai J, Vereker M, Antill Y, Richardson G, White M, Gregory P, Kemp S, Morgan J, Ooi C, Senior J, David S. Impact of multidisciplinary team meetings on the management of patients with breast cancer in a large private healthcare facility. Asia Pac J Clin Oncol 2024; 20:285-291. [PMID: 36791022 DOI: 10.1111/ajco.13947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 09/26/2022] [Accepted: 01/29/2023] [Indexed: 02/16/2023]
Abstract
AIMS Multidisciplinary meetings (MDMs) play a crucial role in decision-making in breast cancer patient care. This study aimed to firstly assess the impact of breast cancer MDMs in decision-making for breast cancer patients and secondly to determine the concordance between MDM recommendations and implementation of clinical practice. METHODS Patient cases to be presented at the weekly breast cancer MDMs were identified and prospectively enrolled. Management plans were predicted by the treating surgeon with the pre-MDM management plans then compared to MDM recommendations. Changes in decision-making were assessed in the following domains: further surgery, systemic therapy (endocrine, chemotherapy or targeted), radiotherapy, enrolment in a clinical trial, further investigations, and referral to other specialists or services. Patient records were subsequently reviewed at 3 months post-MDM to assess the rate of implementation of MDM recommendations and any reasons for discordance. RESULTS Out of 50 cases, 66% (CI 53-79%; p < .005) experienced a change in management plan as a result of MDM discussion, with a total of 66 episodes of recorded change per decision-making domain affecting the following: further surgery (7.6%), endocrine therapy (4.5%), chemotherapy (19.7%), targeted therapy (4.5%), radiotherapy (18.2%), enrolment for a clinical trial (12.1%), additional investigations (22.7%), and further referrals (10.6%). MDM recommendations were implemented in 83.7% of cases. CONCLUSION The breast cancer MDMs were found to substantially impact on the management plans for breast cancer patients, with 83.7% of MDM recommendations being implemented into clinical practice. This study reinforces the importance of MDMs in the management of these patients, as well as highlighting the need for further investigating and addressing the potential barriers to the implementation of MDM recommendations.
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Affiliation(s)
| | - John Lai
- Cabrini Health, Melbourne, Victoria, Australia
- Epworth Freemasons Hospital, Melbourne, Victoria, Australia
| | - Melissa Vereker
- Cabrini Institute, Cabrini Health, Melbourne, Victoria, Australia
| | - Yoland Antill
- Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Gary Richardson
- Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | | | | | - Sarah Kemp
- Cabrini Health, Melbourne, Victoria, Australia
| | | | - Corinne Ooi
- Cabrini Health, Melbourne, Victoria, Australia
| | | | - Steven David
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Zhang Z, Tian L, Liu J, Jiang H, Wang P. Evidence summary on managing radiotherapy-induced oral mucositis in patients with head and neck cancer. Asia Pac J Oncol Nurs 2024; 11:100386. [PMID: 38440157 PMCID: PMC10909976 DOI: 10.1016/j.apjon.2024.100386] [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: 11/04/2023] [Accepted: 01/24/2024] [Indexed: 03/06/2024] Open
Abstract
Objective To summarize the best evidence for managing radiotherapy-induced oral mucositis in patients with head and neck cancer, and improve the quality of care. Methods According to the "6S" evidence pyramid model, we searched local and other part of world published clinical guidelines, expert consensus, evidence summary, and systematic review. The literature quality assessment followed the Appraisal of Guidelines for Research and Evaluation (AGREE II). for guidelines, AMSTAR-2 for systematic reviews, and Joanna Briggs Institute (JBI) Evidence-Based Health Care Center's quality evaluation tool for expert opinions and expert consensus articles. The quality of other literature was evaluated according to the type of original literature. If there were any conflicts about the conclusions drawn from different sources of evidence, this study followed the principle of high-quality evidence priority and the latest published authoritative literature priority. The "JBI Evidence Pre-grading and Evidence Recommendation Level System 2014" was adopted for the evidence lacking a grading system. Quality evaluation, evidence extraction, and summary were performed by 2 or more researchers, combined with the advice of the head and neck cancer radiotherapy professionals. Results Finally, a total of ten pieces of literature were included. Twenty-two best evidence items for radiotherapy-induced oral mucositis management were summarized from six aspects, including multidisciplinary management, oral assessment, basic oral care, pain management, nutritional support, and application of honey or propolis. Conclusions This study provides clinical caregivers with the evidence-based measures on managing radiotherapy-induced oral mucositis. Clinical backgrounds, patients' condition, willingness, economy, and cost-effectiveness should be fully considered when promoting evidence transformation. Applying evidence-based approaches with high feasibility, strong appropriateness, clinical significance and high effectiveness could reduce the incidence of severe radiotherapy-induced oral mucositis in patients with head and neck cancer. Systematic review registration This study has been registered on the Fudan University Centre for Evidence-based Nursing. Registration No. is ES20232732.
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Affiliation(s)
- Zimo Zhang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Li Tian
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Juan Liu
- Beijing Haidian Hospital, Beijing, China
| | - Hua Jiang
- Peking University Faculty of Nursing, Beijing, China
| | - Panfeng Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
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Gorris MA, Needham ML, Finnegan KC, Obermiller CS, Witek L, Randle RW, Burns CA. Multidisciplinary Endocrine Tumor Board: Assessment of the Patient Experience. J Patient Exp 2024; 11:23743735241229383. [PMID: 38323320 PMCID: PMC10845982 DOI: 10.1177/23743735241229383] [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: 02/08/2024] Open
Abstract
Research surrounding tumor boards has focused on patient outcomes and care coordination. Little is known about the patient experience with tumor boards. This survey examined aspects of the patient experience for patients presented at our multidisciplinary endocrine tumor board (ETB). A 15-item survey was distributed via the online patient portal to patients over the age of 18 whose case had been discussed at our ETB over an 18-month period. Descriptive statistics were reported, and a Fisher's exact test was used to examine relationships between variables. A total of 47 patients completed the survey (46%). A majority (72%) report their provider explained what the ETB is, and 77% report being informed their case would be discussed. Most patients were satisfied their case was being discussed (72%). A number of patients did report moderate or severe anxiety knowing their case was being discussed (15%). Sixty-four percent of patients report the ETB recommendations were clearly explained; however, satisfaction with the recommendations was slightly lower (53%). Despite the somewhat low satisfaction with the recommendations, 75% of patients felt more confident in their treatment plan knowing their case was discussed. Finally, if given the chance, 66% responded that they would have been interested in participating in their own ETB discussion. This study provides some insight into the patient experience surrounding tumor board discussions. Overall, patients are satisfied when their case is discussed at ETB. Patients can also experience anxiety about these discussions, and many patients desire to be present for their own discussions.
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Affiliation(s)
- Matthew A Gorris
- Division of Endocrinology and Metabolism, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | | | - Kayla C Finnegan
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Corey S Obermiller
- Informatics and Analytics, Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Lauren Witek
- Informatics and Analytics, Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Reese W Randle
- Department of General Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Cynthia A Burns
- Division of Endocrinology and Metabolism, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
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Muñoz-Villaverde S, Martínez-García M, Serrano-Oviedo L, Gómez-Romero FJ, Sobrado-Sobrado AM, Cidoncha-Moreno MÁ, Riesgo-Martín J, Pedreira-Robles G, Garcimartin P. Impact of telenurse-led intervention in clinical trials on health literacy, empowerment, and health outcomes in patients with solid tumours: a pilot quasi-experimental study. BMC Nurs 2024; 23:86. [PMID: 38308260 PMCID: PMC10835870 DOI: 10.1186/s12912-023-01641-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/05/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, decentralised clinical trials incorporated self-monitoring, self-reporting, and telenursing tools to address health literacy and health empowerment of patients enrolled in clinical trials. We aimed to determine the impact of an educational intervention using telenursing consultations on health literacy, health empowerment, and health-related quality of life in cancer patients enrolled in clinical trials by measuring the level of satisfaction with the care received and assessing the views of healthcare professionals concerning the advanced practice nurse (APN) role in oncology clinical trials. METHODS In this pilot analytical, descriptive, longitudinal, quasi-experimental, and pre-post test study, an educational intervention was conducted by 5 visits with an APN using synchronous teleconsultation in patients starting cancer treatment for the first time in a clinical trial (n = 60), and health professionals working with the APN (n = 31). A descriptive analysis of the samples and questionnaires were utilised along with statistical comparisons. RESULTS After the intervention, patients' health literacy (31.7%), health empowerment (18.3%), and health-related quality of life (33.3%) increased (p < 0.05), with a decrease and trend towards resolution of care needs (p < 0.05). Satisfaction with the quality and care received in terms of perceived convenience, transition, and continuity of care showed positive results in 64.9 ± 20.7, 77.6 ± 19.5, and 72.1 ± 20.4 of respondents, respectively. On the overall assessment of the APN role, healthcare professionals expressed a high level of agreement with the statements related to their work performance. CONCLUSIONS The data indicates that a clinical trial APN-led telenursing educational intervention results in an overall increase in health literacy, an improvement in health empowerment and health-related quality of life, and a decrease in care needs of oncology clinical trials patients. Patients stated that they received a high quality of care and health professionals indicated high levels of acceptance with APNs. Based on these results, we suggest that the APN role should gain more recognition in the Spanish healthcare system and their professional competencies should be aligned with those of other countries.
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Affiliation(s)
- Sergio Muñoz-Villaverde
- Oncology Clinical Trials Unit, Hospital del Mar, Barcelona, Spain
- Cancer Research Programme, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Casc Antic Primary Care Centre, Catalan Institute of Health, Barcelona Territorial Management, Barcelona, Spain
| | - María Martínez-García
- Oncology Clinical Trials Unit, Hospital del Mar, Barcelona, Spain
- Cancer Research Programme, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Leticia Serrano-Oviedo
- Translational Research Unit, University General Hospital of Ciudad Real, Servicio de Salud de Castilla-La Mancha (SESCAM), Ciudad Real, Spain.
| | - Francisco Javier Gómez-Romero
- Translational Research Unit, University General Hospital of Ciudad Real, Servicio de Salud de Castilla-La Mancha (SESCAM), Ciudad Real, Spain
- Faculty of Medicine of Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain
| | | | | | - Juan Riesgo-Martín
- Casc Antic Primary Care Centre, Catalan Institute of Health, Barcelona Territorial Management, Barcelona, Spain
| | - Guillermo Pedreira-Robles
- ESIMar (Mar Nursing School), Universitat Pompeu Fabra Affiliated, Parc de Salut Mar, Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Paloma Garcimartin
- Nursing department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Research Group in Nursing Care, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Biomedical Network Research Centre for Cardiovascular Diseases, CIBERCV (Carlos III Health Institute), Madrid, Spain
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12
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Sapet M, Migala C, Daguenet E, Collet P, Boussoualim K, Thomas T, Guyotat D, Augeul-Meunier K. Advanced practice nurse management in multiple myeloma treated with oral therapy. Bull Cancer 2023; 110:1251-1259. [PMID: 37696744 DOI: 10.1016/j.bulcan.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Therapeutic approaches in Multiple Myeloma (MM) have considerably changed over the last few years, with effective oral chemotherapy and continuous treatment. In this context, the objective of this study was to examine the circuitry of an advanced practitioner nurse (APN)-led intervention that provided supportive care for MM patients treated with oral chemotherapy. METHODS This population-based study was conducted at the hematology department - Institut de Cancérologie Lucien Neuwirth (ICLN, Saint-Priest-en-Jarez), from April 2017 to September 2020. A follow-up program was established with a specialized APN in oncology. RESULTS All APN interventions were recorded, representing 1240 phone calls and 162 consultations for 42 MM patients. Eighty-two calls were referred to the physician with 45 consultations triggered. Most of the calls were frequent within the few first months, with a high request for information and reassurance, especially for treatment-naive or relapsed patients. In our study, the APN was able to manage multiple side effects through care organization (i.e., hospitalizations, transfusions) and a careful coordination between the primary care team and the hospital. DISCUSSION In order to respond to the high need for care pathway and safety improvement, especially in elderly population, we have initiated an original follow-up by an APN for MM patients treated with oral chemotherapy. While the role of APN has become prominent in the oncology field in recent years, its holistic approach has to be emphasized in further studies to bring a comprehensive perspective to health care coordination in the future.
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Affiliation(s)
- Manon Sapet
- University Hospital of Saint-Étienne, Department of Rheumatology, 42055 Saint-Étienne cedex 2, France.
| | - Cécile Migala
- Cancer Institute Lucien Neuwirth, Coordination platform, Saint-Priest-en-Jarez, France
| | - Elisabeth Daguenet
- Cancer Institute Lucien Neuwirth, Hematology Department, Saint-Priest-en-Jarez, France
| | - Philippe Collet
- Cancer Institute Lucien Neuwirth, Hematology Department, Saint-Priest-en-Jarez, France
| | - Karima Boussoualim
- University Hospital of Saint-Étienne, Department of Rheumatology, 42055 Saint-Étienne cedex 2, France
| | - Thierry Thomas
- University Hospital of Saint-Étienne, Department of Rheumatology, 42055 Saint-Étienne cedex 2, France
| | - Denis Guyotat
- Cancer Institute Lucien Neuwirth, Hematology Department, Saint-Priest-en-Jarez, France
| | - Karine Augeul-Meunier
- Cancer Institute Lucien Neuwirth, Hematology Department, Saint-Priest-en-Jarez, France
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13
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Bozzao A, Weber D, Crompton S, Braz G, Csaba D, Dhermain F, Finocchiaro G, Flannery T, Kramm C, Law I, Marucci G, Oliver K, Ostgathe C, Paterra R, Pesce G, Smits M, Soffietti R, Terkola R, Watts C, Costa A, Poortmans P. European Cancer Organisation Essential Requirements for Quality Cancer Care: Adult glioma. J Cancer Policy 2023; 38:100438. [PMID: 37634617 DOI: 10.1016/j.jcpo.2023.100438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023]
Abstract
European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCCs) are explanations of the organisation and actions necessary to provide high-quality care to patients with a specific cancer type. They are compiled by a working group of European experts representing disciplines involved in cancer care, and provide oncology teams, patients, policymakers and managers with an overview of the essential requirements in any healthcare system. The focus here is on adult glioma. Gliomas make up approximately 80% of all primary malignant brain tumours. They are highly diverse and patients can face a unique cognitive, physical and psychosocial burden, so personalised treatments and support are essential. However, management of gliomas is currently very heterogeneous across Europe and there are only few formally-designated comprehensive cancer centres with brain tumour programmes. To address this, the ERQCC glioma expert group proposes frameworks and recommendations for high quality care, from diagnosis to treatment and survivorship. Wherever possible, glioma patients should be treated from diagnosis onwards in high volume neurosurgical or neuro-oncology centres. Multidisciplinary team working and collaboration is essential if patients' length and quality of life are to be optimised.
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Affiliation(s)
- Alessandro Bozzao
- NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, Rome, Italy; School of Medicine and Psychology, "Sapienza" University - Rome, Rome, Italy; European Society of Oncologic Imaging (ESOI), Rome, Italy
| | - Damien Weber
- Paul Scherrer Institute, Center for Proton Therapy, Villigen, Switzerland; European Society for Radiotherapy and Oncology (ESTRO), Villigen, Switzerland
| | | | - Graça Braz
- European Oncology Nursing Society (EONS), Oporto, Portugal; Portuguese Oncology Institute, Outpatient Clinic Department, Oporto, Portugal
| | - Dégi Csaba
- International Psycho-Oncology Society (IPOS), Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Frederic Dhermain
- European Organisation for Research and Treatment of Cancer (EORTC) Brain Tumour Group, Villejuif, France; Head of the Brain Tumor Board, Gustave Roussy University Hospital, Radiation Oncology, Villejuif, France
| | - Gaetano Finocchiaro
- Organisation of European Cancer Institutes (OECI), Milano, Italy; IRCCS Ospedale San Raffaele, Department of Neurology, Milano, Italy
| | - Thomas Flannery
- European Cancer Leagues (ECL), Belfast, Ireland; Royal Victoria Hospital Belfast, Department of Neurosurgery, Belfast, Ireland
| | - Christof Kramm
- The European Society for Paediatric Oncology (SIOPE), Goettingen, Germany; University Medical Center Goettingen, Division of Pediatric Hematology and Oncology, Goettingen, Germany
| | - Ian Law
- European Association of Nuclear Medicine (EANM), Copenhagen, Denmark; Rigshospitalet, Dept of Clinical Physiology, Nuclear Medicine & PET, Copenhagen, Denmark
| | - Gianluca Marucci
- European Society of Pathology (ESP), Milan, Italy; European Confederation of Neuropathological Societies (Euro-CNS), Milan, Italy; Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | - Rosina Paterra
- Fondazione IRCCS Istituto Neurologico Besta, Milano, Italy
| | - Gianfranco Pesce
- European School of Oncology (ESO), Bellinzona, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Marion Smits
- European Society of Radiology (ESR), Rotterdam, the Netherlands; Erasmus MC, Department of Radiology and Nuclear Medicine, University Hospital Rotterdam, Rotterdam, the Netherlands
| | - Riccardo Soffietti
- European Academy of Neurology (EAN), Turin, Italy; University and City of Health and Science Hospital, Department of Neuro-Oncology, Turin, Italy
| | - Robert Terkola
- European Society of Oncology Pharmacy (ESOP), the Netherlands; University of Groningen, University Medical Centre Groningen, the Netherlands; University of Florida College of Pharmacy, Department of Pharmacotherapy and Translational Research, Gainesville, USA
| | - Colin Watts
- European Association of Neurosurgical Societies, Birmingham, UK; Neurosurgical Oncology Section, Institute of Cancer and Genomic Sciences, Birmingham, UK
| | | | - Philip Poortmans
- European Society for Radiotherapy and Oncology (ESTRO), Antwerp, Belgium; Iridium Netwerk and University of Antwerp, Antwerp, Belgium
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14
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Chang JC, Varghese SA, Behrens EM, Gmuca S, Kennedy JS, Liebling EJ, Lerman MA, Mehta JJ, Rutstein BH, Sherry DD, Stingl CJ, Weaver LK, Weiss PF, Burnham JM. Improving Outcomes of Pediatric Lupus Care Delivery With Provider Goal-Setting Activities and Multidisciplinary Care Models. Arthritis Care Res (Hoboken) 2023; 75:2267-2276. [PMID: 37070611 PMCID: PMC10582195 DOI: 10.1002/acr.25134] [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: 12/16/2022] [Revised: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE The present study was undertaken to evaluate high-quality care delivery in the context of provider goal-setting activities and a multidisciplinary care model using an electronic health record (EHR)-enabled pediatric lupus registry. We then determined associations between care quality and prednisone use among youth with systemic lupus erythematosus (SLE). METHODS We implemented standardized EHR documentation tools to autopopulate a SLE registry. We compared pediatric Lupus Care Index (pLCI) performance (range 0.0-1.0; 1.0 representing perfect metric adherence) and timely follow-up 1) before versus during provider goal-setting activities and population management, and 2) in a multidisciplinary lupus nephritis versus rheumatology clinic. We estimated associations between pLCI and subsequent prednisone use adjusted for time, current medication, disease activity, clinical features, and social determinants of health. RESULTS We analyzed 830 visits by 110 patients (median 7 visits per patient [interquartile range 4-10]) over 3.5 years. The provider-directed activity was associated with improved pLCI performance (adjusted β 0.05 [95% confidence interval (95% CI) 0.01, 0.09]; mean 0.74 versus 0.69). Patients with nephritis in multidisciplinary clinic had higher pLCI scores (adjusted β 0.06 [95% CI 0.02, 0.10]) and likelihood of timely follow-up than those in rheumatology (adjusted relative risk [RR] 1.27 [95% CI 1.02, 1.57]). A pLCI score of ≥0.50 was associated with 0.72-fold lower adjusted risk of subsequent prednisone use (95% CI 0.53, 0.93). Minoritized race, public insurance, and living in areas with greater social vulnerability were not associated with reduced care quality or follow-up, but public insurance was associated with higher risk of prednisone use. CONCLUSION Greater attention to quality metrics is associated with better outcomes in childhood SLE. Multidisciplinary care models with population management may additionally facilitate equitable care delivery.
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Affiliation(s)
- Joyce C. Chang
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
- Division of Immunology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Shreya A. Varghese
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Edward M. Behrens
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Sabrina Gmuca
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
- Clinical Futures, A CHOP Research Institute Center for Emphasis, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jane S. Kennedy
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Emily J. Liebling
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Melissa A. Lerman
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Jay J. Mehta
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Beth H. Rutstein
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - David D. Sherry
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Cory J. Stingl
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Lehn K. Weaver
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Pamela F. Weiss
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
- Clinical Futures, A CHOP Research Institute Center for Emphasis, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jon M. Burnham
- Division of Rheumatology, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
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15
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Serra-Barril MA, Ferro-Garcia T, Falco-Pegueroles A, Delgado-Hito P, Romero-Garcia M, Benito-Aracil L. Patients' and professionals' experiences with advanced practice nursing in cancer care: A qualitative study. Eur J Oncol Nurs 2023; 66:102407. [PMID: 37769540 DOI: 10.1016/j.ejon.2023.102407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/03/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE The growing complexity of cancer treatments requires changes in how care is organized and who provides it. The incorporation of advanced practice nursing roles within multidisciplinary teams can improve care in cancer patients. This study aims to understand the lived experience of cancer patients and multidisciplinary professionals in relation to the care provided by advanced practice nurses (APN). METHODS Phenomenological qualitative study. Data were collected through in-depth interviews and a field diary. Participants were recruited through convenience sampling; until theoretical data saturation was achieved. An interpretative phenomenological analysis was performed, following Guba and Lincoln's criteria for trustworthiness. RESULTS Interviews were performed with 18 professionals and 11 patients, from high-complexity public hospitals between March-December 2021. The main themes that emerged were: Advanced practice nurse role and competencies, Benefits provided by the APN, and Relevant aspects of nursing care. CONCLUSION Advanced practice nurses play a fundamental role in cancer care, making positive contributions to the patient experience and to the multidisciplinary team's work. Elucidating the contribution of advanced practice nurses in oncology will facilitate the definition of their specific competencies and, in turn, the implementation of training and management strategies to consolidate this figure in specialized centers.
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Affiliation(s)
- M Antònia Serra-Barril
- Innovation and Quality Department, Catalan Institute of Oncology, Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, Campus Bellvitge, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Tarsila Ferro-Garcia
- Innovation and Quality Department, Catalan Institute of Oncology, Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, Campus Bellvitge, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Anna Falco-Pegueroles
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, Campus Bellvitge, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Pilar Delgado-Hito
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, Campus Bellvitge, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institute of Biomedical Research, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Marta Romero-Garcia
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, Campus Bellvitge, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Llúcia Benito-Aracil
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, Campus Bellvitge, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institute of Biomedical Research, Feixa Llarga s/n., 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
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16
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Kenis I, Kinnaer LM, Van Hecke A, Foulon V. How patient-centered is education and counseling of patients treated with oral anticancer drugs? A multicenter cross-sectional study. PATIENT EDUCATION AND COUNSELING 2023; 115:107927. [PMID: 37556896 DOI: 10.1016/j.pec.2023.107927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE In this multicenter cross-sectional study, the quality of patient-centered education and counseling for patients treated with oral anticancer drugs was examined. METHODS The CONTACT-Patient-Centered Care Questionnaire was administered to 266 patients, recruited in 11 Flemish hospitals. The questionnaire consists of 80 items, each evaluating the degree of performance of a key element in patient-centered education and counseling. RESULTS In total, 15 key elements were seriously underperformed (degree of performance < 50%). Elements regarding adherence monitoring, specific topics in patient education, and involvement of the community pharmacist and home care nurse received a very low score. Only six key elements were systematically performed (degree of performance ≥ 90%), among which the elements on communication style and involvement of the general practitioner. CONCLUSION This study uncovered three major gaps in patient-centered education and counseling of patients on oral anticancer drugs: unmet patient information needs due to shortcomings in patient education, inadequate adherence monitoring, and lacking collaboration with community pharmacists and home care nurses. PRACTICE IMPLICATIONS This study highlights the need for interdisciplinary and patient-centered education and counseling of patients using OACD, including all key stakeholders: physicians, nurses, hospital pharmacists, general practitioners, community pharmacist and home care nurses.
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Affiliation(s)
- Ilyse Kenis
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Lise-Marie Kinnaer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Nursing Director, Ghent University Hospital, Ghent, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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17
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Turner JH. Cancer Care by Committee to be Superseded by Personal Physician-Patient Partnership Informed by Artificial Intelligence. Cancer Biother Radiopharm 2023; 38:497-505. [PMID: 37366774 DOI: 10.1089/cbr.2023.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Multidisciplinary tumor boards (MTBs) have become the reference standard of cancer management, founded upon randomized controlled trial (RCT) evidence-based guidelines. The inordinate delays inherent in awaiting formal regulatory agency approvals of novel therapeutic agents, and the rigidities and nongeneralizability of this regimented approach, often deny cancer patients timely access to effective innovative treatment. Reluctance of MTBs to accept theranostic care of patients with advanced neuroendocrine tumors (NETs) and metastatic castrate-resistant prostate cancer resulted in decades of delay in the incorporation of 177Lu-octreotate and 177Lu-prostate-specific membrane antigen (PSMA) into routine clinical oncology practice. Recent developments in immunotherapy and molecular targeted precision therapy, based on N-of-One individual multifactorial genome analyses, have greatly increased the complexity of decision-making. Burgeoning specialist workload and tight time frames now threaten to overwhelm the logistically, and emotionally, demanding MTB system. It is hypothesized that the advent of advanced artificial intelligence technology and Chatbot natural language algorithms will shift the cancer care paradigm from a MTB management model toward a personal physician-patient shared-care partnership for real-world practice of precision individualized holistic oncology.
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Affiliation(s)
- J Harvey Turner
- Department of Nuclear Medicine, Fiona Stanley Fremantle Hospitals Group, The University of Western Australia, Murdoch, Australia
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18
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Askelin B, Hind A, Paterson C. Exploring Clinical Decision-Making among the Uro-oncology Multidisciplinary Team: A Qualitative Study. Semin Oncol Nurs 2023; 39:151447. [PMID: 37179175 DOI: 10.1016/j.soncn.2023.151447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The aim of this qualitative study was to understand the clinical decision-making process among the genitourinary oncology (GU) multidisciplinary team (MDT) and how patients are engaged in the process. DATA SOURCES A qualitative descriptive study design was conducted and has been reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ). Members of the GU MDT were recruited from a metropolitan tertiary hospital and cancer regional center in Australia serving a population of 550,000. Semistructured interviews were conducted, and the audiorecordings were transcribed; an inductive thematic analysis was used to provide insight from multiple perspectives. CONCLUSION Three themes emerged: (1) the role and scope of the uro-oncology MDT, (2) lack of person-centered clinical decision-making, and (3) the barriers and facilitators. Amid the COVID-19 pandemic, the MDT discussions transitioned to virtual application, which was found to be convenient and efficient and improved attendance. The GU cancer MDT had a prominent biomedical focus that lacked person-centered considerations. Additional research is needed to explore how person-centered outcomes can be incorporated into the clinical decision-making process. IMPLICATION FOR NURSING PRACTICE The GU MDT is increasingly important in the care of uro-oncology patients. There appears to be barriers to the implementation of person-centered discussions in the MDT. The effective delivery of multidisciplinary care is contingent on an appropriate mechanism for collaborative communication between all MDT members and patients given the limited involvement of the patient in the MDT itself.
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Affiliation(s)
- Blake Askelin
- Faculty of Health, and School of Nursing, Midwifery and Public Health, University of Canberra, Bruce ACT, Australia
| | - Alicia Hind
- Faculty of Health; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group; and School of Nursing, Midwifery and Public Health, University of Canberra, Bruce ACT, Australia
| | - Catherine Paterson
- Faculty of Health; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group; Professor, School of Nursing, Midwifery and Public Health, University of Canberra, Bruce ACT, Australia; Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra Hospital, Australia; and Robert Gordon University, Aberdeen, Scotland, UK.
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Wihl J, Falini V, Borg S, Stahl O, Jiborn T, Ohlsson B, Nilbert M. Implementation of the measure of case discussion complexity to guide selection of prostate cancer patients for multidisciplinary team meetings. Cancer Med 2023; 12:15149-15158. [PMID: 37255390 PMCID: PMC10417062 DOI: 10.1002/cam4.6189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 04/24/2023] [Accepted: 05/21/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Multidisciplinary team meetings (MDTMs) provide an integrated team approach to ensure individualized and evidence-based treatment recommendations and best expert advice in cancer care. A growing number of patients and more complex treatment options challenge MDTM resources and evoke needs for case prioritization. In this process, decision aids could provide streamlining and standardize evaluation of case complexity. We applied the recently developed Measure of Case Discussion Complexity, MeDiC, instrument with the aim to validate its performance in another healthcare setting and diagnostic area as a means to provide cases for full MDTM discussions. METHODS The 26-item MeDiC instrument evaluates case complexity and was applied to 364 men with newly diagnosed prostate cancer in Sweden. MeDiC scores were generated from individual-level health data and were correlated with clinicopathological parameters, healthcare setting, and the observed clinical case selection for MDTMs. RESULTS Application of the MeDiC instrument was feasible with rapid scoring based on available clinical data. Patients with high-risk prostate cancers had significantly higher MeDiC scores than patients with low or intermediate-risk cancers. In the total study, population affected lymph nodes and metastatic disease significantly influenced MDTM referral, whereas comorbidities and age did not predict MDTM referral. When individual patient MeDiC scores were compared to the clinical MDTM case selection, advanced stage, T3/T4 tumors, involved lymph nodes, presence of metastases and significant physical comorbidity were identified as key MDTM predictive factors. CONCLUSIONS Application of the MeDiC instrument in prostate cancer may be used to streamline case selection for MDTMs in cancer care and may complement clinical case selection.
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Affiliation(s)
- Jessica Wihl
- Department of Clinical Sciences, Division of Oncology and PathologyLund UniversityLundSweden
- Regional Cancer Centre South, Region SkåneLundSweden
- Department of Hematology, Oncology and Radiation PhysicsSkåne University HospitalLundSweden
| | - Victor Falini
- Regional Cancer Centre South, Region SkåneLundSweden
| | - Sixten Borg
- Regional Cancer Centre South, Region SkåneLundSweden
- Health Economics Unit, Department of Clinical Sciences in MalmöLund UniversityLundSweden
| | - Olof Stahl
- Department of Clinical Sciences, Division of Oncology and PathologyLund UniversityLundSweden
- Regional Cancer Centre South, Region SkåneLundSweden
- Department of Hematology, Oncology and Radiation PhysicsSkåne University HospitalLundSweden
| | - Thomas Jiborn
- Regional Cancer Centre South, Region SkåneLundSweden
- Department of UrologySkåne University HospitalMalmöSweden
| | - Bjorn Ohlsson
- Regional Cancer Centre South, Region SkåneLundSweden
| | - Mef Nilbert
- Department of Clinical Sciences, Division of Oncology and PathologyLund UniversityLundSweden
- Department of Hematology, Oncology and Radiation PhysicsSkåne University HospitalLundSweden
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20
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Alfieri S, Brunelli C, Borreani C, Capri G, Angi M, Bianchi GV, Lo Dico S, Spada P, Fusetti V, Zecca E, Caraceni A. Characterizing Different Multidisciplinary Team Models Implemented Within One Comprehensive Cancer Center. J Multidiscip Healthc 2023; 16:1845-1855. [PMID: 37404961 PMCID: PMC10317525 DOI: 10.2147/jmdh.s402348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/15/2023] [Indexed: 07/06/2023] Open
Abstract
Background The multidisciplinary approach is considered "best practice" in oncology. Multidisciplinary Teamwork (MDTW) can be broadly classified into Multidisciplinary Team Meetings (MDTM) and Multidisciplinary Cancer Clinics (MDCC; involving also patients), yet both models are heterogeneously implemented. Purpose This study aims at describing the different MDTW implemented models in a Comprehensive Cancer Center. Methods All clinical unit directors of the hospital were contacted to identify any MDTW activities the personnel of the unit were involved in. Structured interviews were carried out to collect MDTWs information, ie, type (MDTM vs MDCC), team composition, aims, disease phase, use of Patient Reported Outcome Measures (PROMs). Descriptive analyses and Social Network Analysis (SNA) were performed. Results Among 38 structured interviews, 25 concerned MDTMs and 13 in MDCCs. Responders were mainly surgeons (35%) and oncologists (29%), 35% of them were team leaders. Teams were mostly composed of physicians only (64% in MDTMs, 69% in MDCCs). Case managers (8% and 31%), palliative care specialists (12% and 23%) and psychologists (20% and 31%) were involved to a lesser extent, mainly when dealing with advanced disease. MDTWs were mainly aimed at integrating the skills of the different specialists (respectively 72% for MDTMs and 64% for MDCCs) and offering the best overall patient care pathway (64%, 61.5%). MDTWs were directed at patients in both diagnostic (72%, 61.5%) and locally advanced/metastatic (32%, 38.4%) disease. PROMs were seldom used (24%, 23%). SNA shows a similar density in the two MDTWs, but in the MDCCs two nodes remain isolated (pathologists and radiologists). Conclusion Despite a high number of MDTWs for advanced/metastatic disease, there is limited involvement of palliative care specialists, psychologists, and nurses.
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Affiliation(s)
- Sara Alfieri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Borreani
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Capri
- Medical Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Martina Angi
- General Oncology Surgery 4, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia V Bianchi
- Medical Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Lo Dico
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pierangelo Spada
- Nursing, Technicians and Rehabilitation Management Service (SITRA), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Viviana Fusetti
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Biomedicine and Prevention Department, University of Rome “Tor Vergata”, Rome, Italy
| | - Ernesto Zecca
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Clinical and Community Sciences, Università degli Studi, Milan, Italy
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21
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Pangarsa EA, Rizky D, Tandarto K, Setiawan B, Santosa D, Hadiyanto JN, Kyana S, Suharti C. The effect of multidisciplinary team on survival rates of women with breast cancer: a systematic review and meta-analysis. Ann Med Surg (Lond) 2023; 85:2940-2948. [PMID: 37363480 PMCID: PMC10289736 DOI: 10.1097/ms9.0000000000000914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/14/2023] [Indexed: 06/28/2023] Open
Abstract
Breast cancer is quite frequent all around the world. This disease was responsible for an estimated 2.1 million malignancies in 2022, making it the seventh-highest cause of cancer deaths globally. A multidisciplinary team (MDT) care policy was developed in the United Kingdom (UK) in 1995 to enhance the quality of care for cancer patients. The purpose of this systematic review and meta-analysis study is to assess the effects of MDT on breast cancer survival rates. Methods This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Systematic search was conducted in several international databases including Google Scholar, PubMed, EBSCOhost, and Proquest from 2012 to 2022. The authors used RevMan 5.4 to do the meta-analysis of the pooled hazard ratio. Newcastle-Ottawa Scale to measure the risk of bias. Newcastle-Ottawa Scale evaluated participant selection, comparability, and reporting of results using eight subscale items. Egger's test funnel plot was used to assess the potential publication bias for this study. Results A total of 1187 studies were identified from research database. The authors found a total of six studies from six different countries (China, the UK, Taiwan, Australia, Africa, and France) included for this study. Based on the meta-analysis of the pooled hazard ratio of the included studies, the authors found that the overall effect size of the study was 0.80 (CI 95%: 0.73-0.88). Conclusions Breast cancer patients who participated in well-organized MDT discussions had a greater survival rate than those who did not.
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Affiliation(s)
- Eko A. Pangarsa
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Daniel Rizky
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Kevin Tandarto
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Budi Setiawan
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Damai Santosa
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Jessica N. Hadiyanto
- Department of Internal Medicine, Dr. Kariadi General Hospital/Faculty of Medicine, Diponegoro University, Indonesia
| | - Salma Kyana
- Department of Internal Medicine, Dr. Kariadi General Hospital/Faculty of Medicine, Diponegoro University, Indonesia
| | - Catharina Suharti
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
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Strönisch A, Märdian S, Flörcken A. Centralized and Interdisciplinary Therapy Management in the Treatment of Sarcomas. Life (Basel) 2023; 13:life13040979. [PMID: 37109507 PMCID: PMC10144040 DOI: 10.3390/life13040979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Sarcoma treatment requires a high level of expertise due to its rarity and heterogeneity. Sarcoma patients should, therefore, be referred to an expert centre as early as possible to ensure optimal treatment. Numerous studies have been carried out to provide evidence for this strategy. In compliance with the 2020 PRISMA guidelines, a systematic search was conducted in PubMed, EMBASE, Ovid Medline, ClinicalTrials.gov and Cochrane Library databases. The subject of these studies was the centralised treatment of adult sarcoma patients at expert centres and the use of interdisciplinary tumour boards. Uncertainty in therapy, delays in referral to expert centres, and limited access to therapeutic modalities continue to be a challenge in sarcoma therapy. At expert centres, diagnostic procedures were more frequently and adequately performed, and treatment was associated with an improvement in outcomes in the majority of studies: patients benefited from longer survival, lower local recurrence rates and a better postoperative outcome. The implementation of an interdisciplinary tumour board was associated with discrepant results. In a greater number of studies, it was associated with a lower local relapse rate, better overall survival and surgical outcome. In two studies, however, a shorter overall survival was observed. The establishment of expert centres and the consistent use of interdisciplinary tumour boards are important structures for ensuring multidisciplinary therapy approaches. There is growing evidence that this holds great potential for optimising sarcoma therapy.
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Affiliation(s)
- Annika Strönisch
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sven Märdian
- Centre for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anne Flörcken
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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23
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Cárcamo Ibarra PM, López González UA, Esteban Hurtado A, Orrego Castro N, Diez Domingo S. Exploring the opinion of Spanish medical specialists about the usefulness of radiomics in oncology. Rev Esp Med Nucl Imagen Mol 2023:S2253-8089(23)00025-3. [PMID: 36842730 DOI: 10.1016/j.remnie.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/26/2023]
Abstract
AIM To describe the knowledge and opinion of health professionals regarding the usefulness of radiomics in oncology. METHODS A 12-question questionnaire (multiple-choice responses, Likert-type scale, and open response) was developed and sent to professionals related to diagnosis/treatment of oncological diseases (Oncology, Radiodiagnosis, Nuclear Medicine, Radiation Oncology, Hematology-Oncology, Radiophysics and Pathology). Participants were classified into two groups according to their level of training: attending physicians and residents. RESULTS 114 professionals completed the survey (54% residents, mostly from Nuclear Medicine and Radiodiagnostic specialties). Attending physicians obtained a better performance in the area pf knowledge compared to residents. Both groups of respondents agreed regarding the usefulness of radiomics to help make more accurate diagnoses and promoting the work of medical teams and the most frequent disadvantages were related to the lack of systematization in the acquisition of images and extraction of parameters, the need for the training of professionals and concern about the replacement of human work by technological tools. CONCLUSIONS Radiomics is a novel field and the most general aspects are known by health professionals. The professionals surveyed were optimistic about the benefits provided by radiomics and other types of tools. The main problem detected was the lack of systematization in its implementation. The replacement of professionals and job loss is a concern, albeit less prevalent, and may respond to a generational phenomenon.
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Affiliation(s)
- P M Cárcamo Ibarra
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Spain.
| | - U A López González
- Servicio de Medicina Preventiva, Hospital Universitario Doctor Peset, Valencia, Spain
| | - A Esteban Hurtado
- Servicio de Medicina Nuclear, Hospital Universitario Doctor Peset, Valencia, Spain
| | - N Orrego Castro
- Servicio de Medicina Nuclear, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S Diez Domingo
- Servicio de Protección Radiológica, Hospital Clínico Universitario de Valencia, Valencia, Spain
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24
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Waters M, de Jersey S, Brebner N, Reeves MM. Understanding workforce needs of allied health staff in regional cancer care centres: Informing recruitment and succession planning. Aust J Rural Health 2023; 31:114-123. [PMID: 36200731 DOI: 10.1111/ajr.12925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/15/2022] [Accepted: 09/08/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To describe: (1) the type and frequency of interventions undertaken by regional cancer specialist Allied Health Professionals (AHPs); and (2) regional generalist AHPs' exposure and confidence in undertaking these interventions. DESIGN Multiphase, observational study including a prospective study and a cross-sectional survey. SETTING Two regional Queensland Hospitals. PARTICIPANTS Cancer specialist AHPs (n = 13 in a prospective study; n = 7 in a cross-sectional survey) and generalist AHPs (n = 36 in a cross-sectional survey), across six disciplines from two regional hospitals and cancer services. MAIN OUTCOME MEASURES Phase 1: Frequency of cancer care AHP occasions of service and interventions. Phase 2: Current practice in cancer care AHP interventions; confidence; access to training, professional development and mentorship; barriers to working in cancer care, among cancer care and generalist AHPs. RESULTS Over 10-months, cancer care AHPs collectively delivered 12 393 interventions across 8850 occasions of service. Only four cancer care interventions were exclusively or predominantly carried out by cancer care AHPs-laryngectomy pre-operative counselling, laryngectomy rehabilitation and tracheostomy management (speech pathology) and lymphoedema management (physiotherapy). Generalist AHPs reported slightly lower confidence across all tasks if asked to carry out known interventions in a cancer setting compared with familiar settings. The primary perceived barrier to working in cancer care was lack of skills/experience/training reported by most CC AHPs, generalist Physiotherapists and Speech Pathologists, but not other generalist AHPs. CONCLUSION There was a significant overlap in interventions undertaken in the cancer care and generalist setting for AHPs. Appropriate on-boarding to contextualise interventions to cancer care is recommended to overcome reported lower confidence.
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Affiliation(s)
- Martine Waters
- Central Integrated Regional Cancer Care Services, Queensland Health, Brisbane, Queensland, Australia.,Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Susan de Jersey
- Centre for Allied Health Research and Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
| | - Neil Brebner
- Cancer Care Services, Wide Bay Hospital and Health Service, Bundaberg, Queensland, Australia
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25
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Lozada WA, Enokihara MM, Pedrosa MS, Gonzaga AL, Wainstein AJ, Drummond-Lage AP. Impact of second histopathological review of melanocytic skin lesions at a melanoma reference center in Brazil. Ital J Dermatol Venerol 2023; 158:49-54. [PMID: 36800805 DOI: 10.23736/s2784-8671.23.07494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND After the biopsy of a suspicious melanocytic lesion, patients depend on the pathologist's precision of specimen evaluation. METHODS We assessed the agreement between histopathological reports made by general pathologists and reviewed by a dermatopathologist to evaluate the impact on the patient's management. RESULTS In 79 cases analyzed, underdiagnosis was observed in 21.6% and overdiagnosis in 17.7%, resulting in changes in the patients' conduct. The assessment of the Clark level, ulceration and histological type showed mild agreement (P<0.001); the Breslow thickness, surgical margin, and staging showed moderate agreement (P<0.001). CONCLUSIONS A dermatopathologist's review should be incorporated into the routine of reference services for pigmented lesions.
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Affiliation(s)
- Walter A Lozada
- Department of Post-Graduation, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
| | - Milvia M Enokihara
- Department of Pathology, Federal University of São Paulo, São Paulo, Brazil
| | - Moises S Pedrosa
- Department of Post-Graduation, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
| | - Ana L Gonzaga
- Department of Post-Graduation, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
| | - Alberto J Wainstein
- Department of Post-Graduation, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
| | - Ana P Drummond-Lage
- Department of Post-Graduation, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil -
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26
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Kusamura S, Baratti D, De Simone M, Pasqual EM, Ansaloni L, Marrelli D, Robella M, Accarpio F, Valle M, Scaringi S, Biacchi D, Palopoli C, Gazzanelli S, Guaglio M, Deraco M. Diagnostic and Therapeutic Pathway in Diffuse Malignant Peritoneal Mesothelioma. Cancers (Basel) 2023; 15:cancers15030662. [PMID: 36765620 PMCID: PMC9913096 DOI: 10.3390/cancers15030662] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
Diffuse malignant peritoneal mesothelioma (DMPM) is a rare form of mesothelioma that carries a very poor prognosis. The 5-year overall survival is about 20% (±5.9). Survival is optimal for patients suitable for cytoreductive surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), with a median OS ranging from 34 to 92 months. However, selecting patients for surgery remains a complex task and requires a careful preoperative workup, rational analysis of prognostic profiles, and risk prediction models. Systemic chemotherapy could be offered: (1) in the adjuvant setting for high-risk patients; (2) for patients not eligible for CRS; and (3) for those with recurrent disease. It mainly includes the combination of Platin compound with Pemetrexed or immunotherapy. The biology of DMPM is still largely unknown. However, progress has been made on some fronts, such as telomere maintenance mechanisms, deregulation of apoptosis, tyrosine kinase pathways, and mutation of BRCA1-associated protein 1 (BAP1). Future perspectives should include translational research to improve our understanding of the disease biology to identify druggable targets. We should also clear the role of immune checkpoint inhibitors and investigate new locoregional technologies, such as pressurized intraperitoneal aerosol chemotherapy (PIPAC) or normothermic intraperitoneal chemotherapy (NIPEC).
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Affiliation(s)
- Shigeki Kusamura
- Peritoneal Surface Malignancies Unit, Fondazione Istituto Nazionale dei Tumori IRCCS Milano, 20133 Milan, Italy
| | - Dario Baratti
- Peritoneal Surface Malignancies Unit, Fondazione Istituto Nazionale dei Tumori IRCCS Milano, 20133 Milan, Italy
| | | | - Enrico Maria Pasqual
- AOUD Center Advanced Surgical Oncology, DAME University of Udine, 33100 Udine, Italy
| | - Luca Ansaloni
- Unit of General Surgery, San Matteo Hospital, 27100 Pavia, Italy
| | - Daniele Marrelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | | | - Fabio Accarpio
- CRS and HIPEC Unit, Pietro Valdoni, Umberto I Policlinico di Roma, 00161 Rome, Italy
| | - Mario Valle
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | | | - Daniele Biacchi
- CRS and HIPEC Unit, Pietro Valdoni, Umberto I Policlinico di Roma, 00161 Rome, Italy
| | - Carmen Palopoli
- U.O.C.—P.S.G. con O.B.I. Azienda Ospedaliera Universitaria “G. Martino”, 98125 Messina, Italy
| | - Sergio Gazzanelli
- CRS and HIPEC Unit, Pietro Valdoni, Umberto I Policlinico di Roma, 00161 Rome, Italy
| | - Marcello Guaglio
- Peritoneal Surface Malignancies Unit, Fondazione Istituto Nazionale dei Tumori IRCCS Milano, 20133 Milan, Italy
| | - Marcello Deraco
- Peritoneal Surface Malignancies Unit, Fondazione Istituto Nazionale dei Tumori IRCCS Milano, 20133 Milan, Italy
- Correspondence:
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Joseph R, Hart NH, Bradford N, Wallen MP, Han CY, Pinkham EP, Hanley B, Lock G, Wyld D, Wishart L, Koczwara B, Chan A, Agbejule OA, Crichton M, Teleni L, Holland JJ, Edmiston K, Naumann L, Brown T, Chan RJ. Essential elements of optimal dietary and exercise referral practices for cancer survivors: expert consensus for medical and nursing health professionals. Support Care Cancer 2023; 31:46. [DOI: 10.1007/s00520-022-07509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022]
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28
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Witjes VM, Braspenning JCC, Hoogerbrugge N, Smolders YHCM, Hermkens DMA, Mourits MJE, Ligtenberg MJL, Ausems MGEM, de Hullu JA. Healthcare professionals' perspectives on implementation of universal tumor DNA testing in ovarian cancer patients: multidisciplinary focus groups. Fam Cancer 2023; 22:1-11. [PMID: 35570228 PMCID: PMC9829642 DOI: 10.1007/s10689-022-00294-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/19/2022] [Indexed: 01/13/2023]
Abstract
Universal tumor DNA testing in epithelial ovarian cancer patients can function not only as an efficient prescreen for hereditary cancer testing, but may also guide treatment choices. This innovation, introduced as Tumor-First workflow, offers great opportunities, but ensuring optimal multidisciplinary collaboration is a challenge. We investigated factors that were relevant and important for large-scale implementation. In three multidisciplinary online focus groups, healthcare professionals (gynecologic oncologists, pathologists, clinical geneticists, and clinical laboratory specialists) were interviewed on factors critical for the implementation of the Tumor-First workflow. Recordings were transcribed for analysis in Atlas.ti according to the framework of Flottorp that categorizes seven implementation domains. Healthcare professionals from all disciplines endorse implementation of the Tumor-First workflow, but more detailed standardization and advice regarding the logistics of the workflow were needed. Healthcare professionals explored ways to stay informed about the different phases of the workflow and the results. They emphasized the importance of including all epithelial ovarian cancer patients in the workflow and monitoring this inclusion. Overall, healthcare professionals would appreciate supporting material for the implementation of the Tumor-First workflow in the daily work routine. Focus group discussions have revealed factors for developing a tailored implementation strategy for the Tumor-First workflow in order to optimize care for epithelial ovarian cancer patients. Future innovations affecting multidisciplinary oncology teams including clinical geneticists can benefit from the lessons learned.
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Affiliation(s)
- Vera M. Witjes
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jozé C. C. Braspenning
- grid.10417.330000 0004 0444 9382Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicoline Hoogerbrugge
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne H. C. M. Smolders
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorien M. A. Hermkens
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marian J. E. Mourits
- grid.4494.d0000 0000 9558 4598Department of Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolijn J. L. Ligtenberg
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Margreet G. E. M. Ausems
- grid.7692.a0000000090126352Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joanne A. de Hullu
- grid.10417.330000 0004 0444 9382Department of Obstetrics and Gynecology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Niyibizi BA, Muhizi E, Rangira D, Ndoli DA, Nzeyimana IN, Muvunyi J, Irakoze M, Kazindu M, Rugamba A, Uwimana K, Cao Y, Rugengamanzi E, de Dieu Kwizera J, Manirakiza AVC, Rubagumya F. Multidisciplinary approach to cancer care in Rwanda: the role of tumour board meetings. Ecancermedicalscience 2023; 17:1515. [PMID: 37113712 PMCID: PMC10129399 DOI: 10.3332/ecancer.2022.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Indexed: 04/29/2023] Open
Abstract
Introduction Cancer treatment is complex and necessitates a multidisciplinary approach. Tumour Board Meetings (TBMs) provide a multidisciplinary platform for health care providers to communicate about treatment plans for patients. TBMs improve patient care, treatment outcomes and, ultimately, patient satisfaction by facilitating information exchange and regular communication among all parties involved in a patient's treatment. This study describes the current status of case conference meetings in Rwanda including their structure, process and outcomes. Methods The study included four hospitals providing cancer care in Rwanda. Data gathered included patients' diagnosis, number of attendance and pre-TBM treatment plan, as well as changes made during TBMs, including diagnostic and management plan changes. Results From 128 meetings that took place at the time of the study, Rwanda Military Hospital hosted 45 (35%) meetings, King Faisal Hospital had 32 (25%), Butare University Teaching Hospital (CHUB) had 32 (25%) and Kigali University Teaching Hospital (CHUK) had 19 (15%). In all hospitals, General Surgery 69 (29%) was the leading speciality in presenting cases. The top three most presented disease site were head and neck 58 (24%), gastrointestinal 28 (16%) and cervix 28 (12%). Most (85% (202/239)) presented cases sought inputs from TBMs on management plan. On average, two oncologists, two general surgeons, one pathologist and one radiologist attended each meeting. Conclusion TBMs in Rwanda are increasingly getting recognised by clinicians. To influence the quality of cancer care provided to Rwandans, it is crucial to build on this enthusiasm and enhance TBMs conduct and efficiency.
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Affiliation(s)
| | - Eulade Muhizi
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Gynecology, Munini District Hospital, Nyabihu, Rwanda
| | - Daniella Rangira
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto M5T 3M7, Canada
| | - Diane A Ndoli
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
| | | | - Jackson Muvunyi
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
| | - Magnifique Irakoze
- Department of Gynecology, Kigali University Teaching Hospital, Kigali, Rwanda
| | - Madeleine Kazindu
- Rwanda Cancer Relief, Kigali, Rwanda
- School of Medicine, College of Medical and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Alex Rugamba
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Internal Medicine, Ruhango Provincial Hospital, Ruhango, Rwanda
| | - Khadidja Uwimana
- Rwanda Cancer Relief, Kigali, Rwanda
- School of Medicine, College of Medical and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Yuanzhen Cao
- Department of Internal Medicine, Dartmouth–Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Eulade Rugengamanzi
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Jean de Dieu Kwizera
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Internal Medicine, Gisenyi Hospital, Rubavu, Gisenyi, Rwanda
| | - Achille VC Manirakiza
- Rwanda Cancer Relief, Kigali, Rwanda
- Unit of Oncology, Department of Internal Medicine, King Faisal Hospital, Kigali, Rwanda
| | - Fidel Rubagumya
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
- School of Medicine, College of Medical and Health Sciences, University of Rwanda, Kigali, Rwanda
- Unit of Oncology, Department of Internal Medicine, King Faisal Hospital, Kigali, Rwanda
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Kočo L, Siebers CCN, Schlooz M, Meeuwis C, Oldenburg HSA, Prokop M, Mann RM. Mapping Current Organizational Structure and Improvement Points of Breast Cancer Multidisciplinary Team Meetings - An Interview Study. J Multidiscip Healthc 2022; 15:2421-2430. [PMID: 36304726 PMCID: PMC9596230 DOI: 10.2147/jmdh.s380293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of the study was to map current organization, and document potential improvement points of breast cancer multidisciplinary team meetings (MDTMs), in order to support the optimization of the present breast cancer MDTM organization. Methods From January 2019 to February 2021, 24 core team members of the breast cancer multidisciplinary team (MDT) in three hospitals were interviewed. Semi-structured interviews were performed based on an interview guide. All interviews were recorded and transcribed verbatim. Deductive coding was performed on the transcripts by two independent researchers. The codes were organized in categories and themes. Results In total 24 healthcare professionals; surgeons, medical oncologists, radiotherapists, pathologists, radiologists, and specialized nurses, from three different hospitals were interviewed. According to the participants, improving efficiency before and during MDTMs is possible by ensuring proper preparation of attendees, implementing more structure during discussions, improving access to and availability of patient data and optimizing general meeting discipline. Conclusion Preparation, structure, data availability and meeting discipline were highlighted as essential factors for efficient breast cancer MDTM improvement. These topics seem to be applicable to other types of oncology MDTMs as well. Improving MDTM efficiency on the long term ensures high-quality discussions for all breast cancer patients.
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Affiliation(s)
- Lejla Kočo
- Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands,Correspondence: Lejla Kočo, Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands, Tel +31 24 361 87 66, Email
| | - Carmen C N Siebers
- Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carla Meeuwis
- Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Hester S A Oldenburg
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mathias Prokop
- Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ritse M Mann
- Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Eaton V, Zambrano A, Sanabria V, Lopez R, Kyei I, Mra R, Sarchet V, Kremzier M, Borras J, Aung TK, Morton Doherty R, Henshall S, Camacho R. Innovative Methodology for Strengthening a Multidisciplinary Team Approach in Cities in Low- and Middle-Income Countries. JCO Glob Oncol 2022; 8:e2200149. [PMID: 36252159 PMCID: PMC9812446 DOI: 10.1200/go.22.00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Delivering high-quality cancer care to patients through a multidisciplinary team (MDT) care approach remains a challenge, particularly in low- and middle-income countries characterized by fragmented health systems and limited human resources for cancer care. City Cancer Challenge (C/Can) is supporting cities in low- and middle-income countries as they work to improve access to equitable quality cancer care. C/Can has developed an innovative methodology to address the MDT gap, piloted in four cities-Asunciòn, Cali, Kumasi, and Yangon. METHODS Collaborating with a network of partners, C/Can and ASCO have developed a package of technical cooperation support focusing on two priority areas that have emerged as core needs: first developing consensus-based, city-wide patient management guidelines for the most common cancers and second, building capacity for the implementation of MDTs in institutions providing cancer care in the city. RESULTS The real-time application of C/Can's MDT approach in Cali and Asuncion underlined the importance of engaging the right stakeholders early on and embedding MDT guidelines in local and national regulatory frameworks to achieve their sustainable uptake. The results in Cali and Asuncion were essential for informing the process in Yangon, asserting the clear benefits of city-to-city knowledge exchange. Finally, the global COVID-19 pandemic prompted a rapid adaptation of the methodology from an in-person to virtual format; the unexpected success of the virtual program in Kumasi has led to its application in subsequent C/Can cities. CONCLUSION The application of C/Can's methodology in this first set of cities has reinforced not only the importance of both resource appropriate guidelines and a highly trained health workforce but also the need for commitment to work across institutions and disciplines.
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Affiliation(s)
- Vanessa Eaton
- American Society for Clinical Oncology, Alexandria, VA
| | | | - Valeria Sanabria
- Hospital Nacional de Itauguá del MoH—Hospital de Clínicas de la Universidad Nacional de Asunción—Centro Médico La Costa, Asunción, Paraguay
| | | | | | - Rai Mra
- Myanmar Medical Association, Yangon, Myanmar
| | | | | | | | | | - Rebecca Morton Doherty
- City Cancer Challenge, Geneva, Switzerland,Rebecca Morton Doherty, MSc, City Cancer Challenge Foundation, 9 rue du Commerce, Geneva 1204, Switzerland; e-mail:
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Prades J, Coll-Ortega C, Dal Lago L, Goffin K, Javor E, Lombardo C, de Munter J, Ponce J, Regge D, Salazar R, Valentini V, Borras JM. Use of information and communication technologies (ICTs) in cancer multidisciplinary team meetings: an explorative study based on EU healthcare professionals. BMJ Open 2022; 12:e051181. [PMID: 36202578 PMCID: PMC9540836 DOI: 10.1136/bmjopen-2021-051181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Multidisciplinary teams in cancer care are increasingly using information and communication technology (ICT), hospital health information system (HIS) functionalities and ICT-driven care components. We aimed to explore the use of these tools in multidisciplinary team meetings (MTMs) and to identify the critical challenges posed by their adoption based on the perspective of professionals representatives from European scientific societies. DESIGN This qualitative study used discussion of cases and focus group technique to generate data. Thematic analysis was applied. SETTING Healthcare professionals working in a multidisciplinary cancer care environment. PARTICIPANTS Selection of informants was carried out by European scientific societies in accordance with professionals' degree of experience in adopting the implementation of ICT and from different health systems. RESULTS Professionals representatives of 9 European scientific societies were involved. Up to 10 ICTs, HIS functionalities and care components are embedded in the informational and decision-making processes along three stages of MTMs. ICTs play a key role in opening MTMs to other institutions (eg, by means of molecular tumour boards) and information types (eg, patient-reported outcome measures), and in contributing to the internal efficiency of teams. While ICTs and care components have their own challenges, the information technology context is characterised by the massive generation of unstructured data, the lack of interoperability between systems from different hospitals and HIS that are conceived to store and classify information rather than to work with it. CONCLUSIONS The emergence of an MTM model that is better integrated in the wider health system context and incorporates inputs from patients and support systems make traditional meetings more dynamic and interconnected. Although these changes signal a second transition in the development process of multidisciplinary teams, they occur in a context marked by clear gaps between the information and management needs of MTMs and the adequacy of current HIS.
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Affiliation(s)
- Joan Prades
- Catalan Cancer Strategy, Department of Health, Barcelona, Spain
- University of Barcelona (UB & IDIBELL), Barcelona, Spain
| | | | - Lissandra Dal Lago
- Department of Medicine, Jules Bordet Institute & Université Libre de Bruxelles, 1 Rue Héger Bordet, 1000, Bruxelles, Belgium
- International Society of Geriatric Oncology (SIOG), Geneva, Switzerland
| | - Karolien Goffin
- University Hospital Leuven, KU Leuven, Leuven, Belgium
- European Association of Nuclear Medicine, Vienna, Austria
| | - Eugen Javor
- Pharmacy Department, General Hospital Bjelovar, Bjelovar, Croatia
- European Society of Oncology Pharmacy (ESOP), Hamburg, Germany
| | - Claudio Lombardo
- Organisation of European Cancer Institutes (OECI), Brussels, Belgium
- SOS Europe, Via B. Bosco 57/9A, 16121, Genova, Italy
| | - Johan de Munter
- Cancer Center, University Hospital Ghent, Gent, Belgium
- European Oncology Nursing Society, Brussels, Belgium
| | - Jordi Ponce
- Department of Gynaecology, Bellvitge University Hospital, Barcelona, Spain
- University of Barcelona (IDIBELL), Hospitalet de Llobregat, Spain
- European Society of Gynaecological Oncology (ESGO), Prague, Czechia
| | - Daniele Regge
- Department of Surgical Sciences, University of Turin, Turin, 10124, Italy
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
- European Society of Radiology (ESR), Vienna, Austria
| | - Ramón Salazar
- Institut Català d'Oncologia, Hospitalet de Llobregat, Spain
- Oncobell Program, Institut de Recerca Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
- European Society of Medical Oncology (ESMO), Lugano, Switzerland
| | - Vincenzo Valentini
- Radiation Oncology and Hematology Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica S.Cuore- ROME (I), Rome, Italy
- European SocieTy for Radiotherapy & Oncology (ESTRO), Brussels, Belgium
| | - Josep M Borras
- Catalan Cancer Strategy, Department of Health, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Hospitalet, Barcelona, Spain
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Basile M, Di Brino E, Rumi F, Palmeri M, Cicchetti A. Analysis of the multidisciplinary approach for the management of patients affected by chronic myeloid leukaemia. INTEGRATED HEALTHCARE JOURNAL 2022. [DOI: 10.1136/ihj-2020-000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BackgroundChronic myelogenous leukaemia (CML) is a pathological clinical condition with a yearly incidence between 10 and 15 cases per million people, 14 in Italy. Its incidence increases with age, reaching 20–25 yearly cases per million individuals in people over 70 years. A growing importance has been given to the need of a multidisciplinary approach (MDA) for the management of patients with CML.ObjectiveTo analyse the importance of MDA as compared with the current Italian standard of care for the management of CML patients based on the involvement of several health professional figures.MethodsA group of healthcare professionals from several healthcare structures were gathered in a first Advisory Board (AB) and divided into as many groups as the number of belonging health structures representative of the Italian provision of therapeutic approaches for CML. In a second AB, the results were validated by the same panel of experts.ResultsThe number of dedicated health professionals within the dedicated ward ranged from 1 to 13. Most structures rely on several professionals intervening only in case of necessity. Only one centre provides a booking service based on clinical needs to avoid waiting times. Most centres report there is basically no disagreement in the definition of the clinical pathway and there is a high adherence to national and international CML guidelines.ConclusionsThe development of forms of interorganisational and interprofessional coordination to improve the diagnosis and the treatment of CML patients have been for long on the agenda of policy makers, managers and professionals for more than 20 years. This analysis represents a starting reference to consider for the evaluation of an MDA in the Italian context.
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Kinnaer LM, Van de Vyver M, Kenis I, Decoene E, Foulon V, Van Hecke A. A qualitative evaluation of the process of creating and implementing an interprofessional care pathway for patients treated with oral anticancer drugs. Eur J Oncol Nurs 2022; 61:102218. [DOI: 10.1016/j.ejon.2022.102218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 11/25/2022]
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Prgomet D, Bišof V, Prstačić R, Curić Radivojević R, Brajković L, Šimić I. THE MULTIDISCIPLINARY TEAM (MDT) IN THE TREATMENT OF HEAD AND NECK CANCER - A SINGLE-INSTITUTION EXPERIENCE. Acta Clin Croat 2022; 61:77-87. [PMID: 37250663 PMCID: PMC10218076 DOI: 10.20471/acc.2022.61.s4.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
Head and neck cancers are associated with significant morbidity and mortality despite advancements in treatment in recent decades. A multidisciplinary approach to the treatment of these diseases is thus of essential importance and is becoming the gold standard. Head and neck tumors also endanger relevant structures of the upper aerodigestive tracts, including bodily functions such as voice, speech, swallowing, and breathing. Damage to these functions can significantly influence quality of life. Thus, our study examined not only the roles of head and neck surgeons, oncologists and radiotherapists, but also the importance of the participation of different scientific professions such as anesthesiologists, psychologists, nutritionists, stomatologists, and speech therapists in the work of a multidisciplinary team (MDT). Their participation results in a significant improvement of patient quality of life. We also present our experiences in the organization and work of the MDT as part of the Center for Head and Neck Tumors of the Zagreb Clinical Hospital Center.
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Affiliation(s)
- Drago Prgomet
- Department of ENT and Head and Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, Zagreb University, Croatia
| | - Vesna Bišof
- School of Medicine, Zagreb University, Croatia
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ratko Prstačić
- Department of ENT and Head and Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, Zagreb University, Croatia
| | | | - Lovorka Brajković
- Department of Psychology, Faculty of Croatian Studies, Zagreb, Croatia
| | - Ivana Šimić
- Department of ENT and Head and Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
- Faculty of Education and Rehabilitation Sciences, Zagreb University, Croatia
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Whitelaw S, Bell A, Clark D. The expression of 'policy' in palliative care: A critical review. Health Policy 2022; 126:889-898. [PMID: 35840439 DOI: 10.1016/j.healthpol.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Abstract
The importance of 'policy' within palliative care has steadily increased over the past 25 years. Whilst this has been welcomed within the palliative care field and seen as a route to greater recognition, we focus here on a more critical perspective that challenge the effectiveness of a 'policy turn' in palliative care. Applying Bacchi's "What's the Problem Represented to Be?" (WPR) framework to data from a systematic search, we address the research question, "in what ways has 'policy' been articulated in palliative care literature?". The paper describes the construction of 'the problem' context and reflects critically on the robustness and pragmatic utility of such representations. In particular, we identify five elements as prominent and problematic: (1) a lack of empirical evidence that connects policy to practice; (2) the dominance of 'Global North' approaches; (3) the use of a policy narrative based on 'catastrophe' in justifying the need for palliative care; (4) the use of idealistic and aspirational 'calls to action'; and (5) a disengaged and antagonistic orientation to existing health systems. We conclude by suggesting that the efficacy of palliative care policy could be enhanced via greater emphases on 'Global South' perspectives, 'assets-based' approaches and attention to pragmatic implementation.
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Affiliation(s)
- Sandy Whitelaw
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom.
| | - Anthony Bell
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom
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Walraven JEW, van der Hel OL, van der Hoeven JJM, Lemmens VEPP, Verhoeven RHA, Desar IME. Factors influencing the quality and functioning of oncological multidisciplinary team meetings: results of a systematic review. BMC Health Serv Res 2022; 22:829. [PMID: 35761282 PMCID: PMC9238082 DOI: 10.1186/s12913-022-08112-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background Discussing patients with cancer in a multidisciplinary team meeting (MDTM) is customary in cancer care worldwide and requires a significant investment in terms of funding and time. Efficient collaboration and communication between healthcare providers in all the specialisms involved is therefore crucial. However, evidence-based criteria that can guarantee high-quality functioning on the part of MDTMs are lacking. In this systematic review, we examine the factors influencing the MDTMs’ efficiency, functioning and quality, and offer recommendations for improvement. Methods Relevant studies were identified by searching Medline, EMBASE, and PsycINFO databases (01–01-1990 to 09–11-2021), using different descriptions of ‘MDTM’ and ‘neoplasm’ as search terms. Inclusion criteria were: quality of MDTM, functioning of MDTM, framework and execution of MDTM, decision-making process, education, patient advocacy, patient involvement and evaluation tools. Full text assessment was performed by two individual authors and checked by a third author. Results Seventy-four articles met the inclusion criteria and five themes were identified: 1) MDTM characteristics and logistics, 2) team culture, 3) decision making, 4) education, and 5) evaluation and data collection. The quality of MDTMs improves when the meeting is scheduled, structured, prepared and attended by all core members, guided by a qualified chairperson and supported by an administrator. An appropriate amount of time per case needs to be established and streamlining of cases (i.e. discussing a predefined selection of cases rather than discussing every case) might be a way to achieve this. Patient centeredness contributes to correct diagnosis and decision making. While physicians are cautious about patients participating in their own MDTM, the majority of patients report feeling better informed without experiencing increased anxiety. Attendance at MDTMs results in closer working relationships between physicians and provides some medico-legal protection. To ensure well-functioning MDTMs in the future, junior physicians should play a prominent role in the decision-making process. Several evaluation tools have been developed to assess the functioning of MDTMs. Conclusions MDTMs would benefit from a more structured meeting, attendance of core members and especially the attending physician, streamlining of cases and structured evaluation. Patient centeredness, personal competences of MDTM participants and education are not given sufficient attention.
Supplementary information The online version contains supplementary material available at 10.1186/s12913-022-08112-0.
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Lucarini A, Garbarino GM, Orlandi P, Garofalo E, Bragaglia L, Laracca GG, Canali G, Pecoraro A, Mercantini P. From “Cure” to “Care”: The Role of the MultiDisciplinary Team on Colorectal Cancer Patients’ Satisfaction and Oncological Outcomes. J Multidiscip Healthc 2022; 15:1415-1426. [PMID: 35785259 PMCID: PMC9249348 DOI: 10.2147/jmdh.s362550] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Alessio Lucarini
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy
- Correspondence: Alessio Lucarini, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy, Email
| | - Giovanni Maria Garbarino
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy
| | - Pierfrancesco Orlandi
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy
| | - Eleonora Garofalo
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy
| | - Lorenzo Bragaglia
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy
| | - Giovanni Guglielmo Laracca
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy
| | - Giulia Canali
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy
| | - Alessandra Pecoraro
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy
| | - Paolo Mercantini
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy
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Tremblay D, Touati N, Kilpatrick K, Durand MJ, Turcotte A, Prady C, Poder TG, Richard PO, Soldera S, Berbiche D, Généreux M, Roy M, Laflamme B, Lessard S, Landry M, Giordano É. Building resilience in oncology teams: Protocol for a realist evaluation of multiple cases. PLoS One 2022; 17:e0268393. [PMID: 35551336 PMCID: PMC9098052 DOI: 10.1371/journal.pone.0268393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Teams caring for people living with cancer face many difficult clinical situations that are compounded by the pandemic and can have serious consequences on professional and personal life. This study aims to better understand how a multi-component intervention builds resilience in oncology teams. The intervention is based on a salutogenic approach, theories and empirical research on team resilience at work. This intervention research involves partnership between researchers and stakeholders in defining situations of adversity and solutions appropriate to context. Methods The principles of realist evaluation are used to develop context-mechanism-outcome configurations of a multi-component intervention developed by researchers and field partners concerned with the resilience of oncology teams. The multiple case study involves oncology teams in natural contexts in four healthcare establishments in Québec (Canada). Qualitative and quantitative methods are employed. Qualitative data from individual interviews, group interviews and observation are analyzed using thematic content analysis. Quantitative data are collected through validated questionnaires measuring team resilience at work and its effect on teaming processes and cost-effectiveness. Integration of these data enables the elucidation of associations between intervention, context, mechanism and outcome. Discussion The study will provide original data on contextual factors and mechanisms that promote team resilience in oncology settings. It suggests courses of action to better manage difficult situations that arise in a specialized care sector, minimize their negative effects and learn from them, during and after the waves of the pandemic. The mechanisms for problem resolution and arriving at realistic solutions to professional workforce and team effectiveness challenges can help improve practices in other settings.
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Affiliation(s)
- Dominique Tremblay
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de Recherche Charles-Le Moyne, Longueuil, Québec, Canada
- * E-mail:
| | - Nassera Touati
- École Nationale d’administration Publique, Montréal, Québec, Canada
| | - Kelley Kilpatrick
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Susan E. French Chair in Nursing Research and Innovative Practice, Montréal, Québec, Canada
| | - Marie-José Durand
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de Recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Annie Turcotte
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de Recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Catherine Prady
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Thomas G. Poder
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux de l’Est-de-l’Île-de-Montréal, Montréal, Québec, Canada
| | - Patrick O. Richard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Sara Soldera
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Djamal Berbiche
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de Recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Mélissa Généreux
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Mathieu Roy
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
- Institut National de Santé Publique du Québec, Montréal, Québec, Canada
| | | | - Sylvie Lessard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de Recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Marjolaine Landry
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
- Centre de Recherche du CHUS, Sherbrooke, Québec, Canada
| | - Émilie Giordano
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de Recherche Charles-Le Moyne, Longueuil, Québec, Canada
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Shen J, Wang M, Li F, Li Y, Zhou J, Sun W. Non-Inferiority Study on the Precise Implementation of Multidisciplinary Continuous Nursing Intervention in Patients with Breast Cancer Experiencing Negative Emotions. Cancer Manag Res 2022; 14:1759-1770. [PMID: 35634536 PMCID: PMC9130099 DOI: 10.2147/cmar.s354214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/17/2022] [Indexed: 12/09/2022] Open
Affiliation(s)
- Jun Shen
- Department of Breast Surgery, The First People’s Hospital of LianYunGang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, LianYunGang, People’s Republic of China
| | - Meng Wang
- Department of Breast Surgery, The First People’s Hospital of LianYunGang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, LianYunGang, People’s Republic of China
| | - Fan Li
- Department of Breast Surgery, The First People’s Hospital of LianYunGang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, LianYunGang, People’s Republic of China
| | - Yan Li
- Department of Breast Surgery, The First People’s Hospital of LianYunGang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, LianYunGang, People’s Republic of China
| | - Jun Zhou
- Department of Breast Surgery, The First People’s Hospital of LianYunGang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, LianYunGang, People’s Republic of China
| | - Wenwen Sun
- Department of Breast Surgery, The First People’s Hospital of LianYunGang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, LianYunGang, People’s Republic of China
- Correspondence: Wenwen Sun, Department of Breast Surgery, The First People’s Hospital of LianYunGang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, No. 6 Zhenhua East Road, High-Tech Square, LianYunGang, 222002, People’s Republic of China, Tel +86-18961325179, Email
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Guilabert M, Prades J, Borras JM, Maestu I, Guerra JA, Fumadó L, Mira JJ. A Web-Based Self-assessment Model for Evaluating Multidisciplinary Cancer Teams in Spain: Development and Validation Pilot Study. J Med Internet Res 2022; 24:e29063. [PMID: 35266870 PMCID: PMC8949680 DOI: 10.2196/29063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/02/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background Tumor boards constitute the main consensus and clinical decision–making body of multidisciplinary teams (MDTs) in cancer care. With the increasing clinical complexity of treatment options (eg, targeted therapies, multimodal treatments) and the progressive incorporation of new areas of intervention (eg, survivorship care), tumor boards are now required to play a central role in all cancer processes. However, although frameworks are in place to evaluate MDT quality, only few web-based tools are available for this purpose; indeed, no web-based MDT evaluation tools have been developed for or adapted to the Spanish National Health System. Objective The first aim of this study was to develop a web-based self-assessment model (Autoevaluación de Equipos Multidisciplinares de Atención al Cáncer [AEMAC]) for evaluating multidisciplinary cancer teams in Spain and the second aim was to validate this tool by testing its metric properties, acceptability, and usability. Methods We designed and validated the AEMAC program in 3 stages. In the first stage (research), we reviewed the available scientific evidence and performed a qualitative case study of good practice in multidisciplinary care within the Spanish National Health System (n=4 centers and 28 health care professionals). The results were used to define the thematic areas and quality criteria for the self-evaluation model, which were then discussed and validated by a group of experts. The second stage (development) involved the technological development of a web app that would be accessible from any mobile device. In the third stage (piloting and validation), we conducted 4 pilot tests (n=15 tumor boards, 243 professionals) and used the results to analyze the acceptability and usefulness of the tool. Results We designed a self-assessment model based on 5 thematic areas encompassing a total of 25 quality components, which users rated on a 3-option development scale. The evaluation process, which was managed entirely from the web app, consisted of individual self-assessment, group prioritization, and creation of an improvement plan. Cronbach alpha (.86), McDonald’s omega (0.88), and various fit indices (comparative fit index between 0.95 and 1 and goodness-of-fit index between 0.97 and 0.99 for all 5 aspects) confirmed internal consistency. The mean rating for overall satisfaction with the tool and for consistency between the content of the tool and the reality of tumor boards was 7.6 out of 10. Conclusions The results obtained during the period of research and piloting of the AEMAC program showed that it has an appropriate structure and metric properties and could therefore be implemented in a real context and generalized to other hospitals. As a virtual tool, it helps to measure the key aspects of MDT quality, such as effectiveness of collaboration and communication, leadership, and the organizational environment.
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Affiliation(s)
| | - Joan Prades
- Department of Health, Catalonian Cancer Strategy, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Josep M Borras
- Department of Health, Catalonian Cancer Strategy, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Inmaculada Maestu
- Medical Oncology Service, Doctor Peset University Hospital, Valencia, Spain
| | - Juan Antonio Guerra
- Department of Hematology and Oncology, Fuenlabrada University Hospital, Fuenlabrada, Spain
| | - Lluís Fumadó
- Urological Cancer Functional Unit, Hospital del Mar-Parc de Salut Mar-IMIM, Barcelona, Spain
| | - José Joaquin Mira
- Health Psychology Department, Miguel Hernandez University, Elche, Spain.,Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, Sant Joan d'Alacant, Spain.,Alicante-Sant Joan Health Department, Alicante, Spain
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- see Authors' Contributions,
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42
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Belda-Ferre M, Garcia-Segui A, Pacheco-Bru JJ, Valencia-Guadalajara VJ, Verdú-Verdú LP, Sánchez-Cano E, Chillón-Sempere FS, Vázquez-Mazón F. Multicenter study on multidisciplinary committees in advanced prostate cancer. Actas Urol Esp 2022; 46:106-113. [PMID: 35135737 DOI: 10.1016/j.acuroe.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/12/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVE Although Multidisciplinary Teams (MDTs) are recommended in the management of Advanced Prostate Cancer (APC), their functioning in real practice has been poorly evaluated. We carried out a multicenter study with the objective of evaluating the functioning of uro-oncology MDTs in 6 hospitals. MATERIALS AND METHODS A descriptive cross-sectional study was performed. The level of Compliance with the Fundamental Quality Requirements (CFQR) of the MDTs was evaluated by means of a questionnaire filled out by the coordinators of the MDTs in each hospital. The information on the perspective of the members of the MDTs was evaluated through an anonymous survey. RESULTS A high level of CFQR in MDTs was evidenced (75%), showing deficiencies in terms of protocol update, agendas, audits, and scientific production. The survey was answered by 62.32% of the 69 physicians surveyed (urologists, oncologists, radiation therapists, radiologists, and pathologists). The 88.4% consider the duration of the meetings appropriate. There are disparate opinions concerning the protection of the MDT meeting time as well as protocol update. Of the patients with APC presented at the MDTs meeting, 62,8% require intervention from two specialties. Only 50% of respondents believe that all CRPC cases are discussed and that there is a prior agenda. The decisions made by the MDTs are reflected in the clinical history in 65.1% and are binding only in 60.5% of the cases. Half of the respondents have not been trained in MDTs. Most participants (90.7%) agree on the fact that MDTs. convey benefits. CONCLUSIONS The evaluations of the MDTs identify rectifiable deficiencies by modifying hospital inertia and care planning.
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Affiliation(s)
- M Belda-Ferre
- Servicio de Urología, Hospital General Universitario de Elche, Elche, Alicante, Spain.
| | - A Garcia-Segui
- Servicio de Urología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - J J Pacheco-Bru
- Servicio de Urología, Hospital Universitari Sant Joan d'Alacant, Alicante, Spain
| | | | - L P Verdú-Verdú
- Servicio de Urología, Hospital Marina Baixa, Alicante, Spain
| | - E Sánchez-Cano
- Servicio de Urología, Hospital Universitario del Vinalopó, Alicante, Spain
| | - F S Chillón-Sempere
- Servicio de Urología, Hospital General Universitario de Alicante, Alicante, Spain
| | - F Vázquez-Mazón
- Servicio de Oncología, Hospital General Universitario de Elche, Alicante, Spain
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43
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Belda-Ferre M, Garcia-Segui A, Pacheco-Bru J, Valencia-Guadalajara V, Verdú-Verdú L, Sánchez-Cano E, Chillón-Sempere S, Vázquez-Mazón F. Estudio multicéntrico sobre los comités multidisciplinarios en cáncer de próstata avanzado. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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44
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Aguiar PM, Mori ALPM, Lima MGFD, Rossi MSPN, Nicoletti MA, Martins KOF, Lopes ALM, Coan TCM, Fugita OEH, Storpirtis S. The effects of pharmacist interventions on health outcomes in patients with advanced prostate cancer in Brazil. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902021000219273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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45
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Nursing, psychotherapy and advanced cancer: A scoping review. Eur J Oncol Nurs 2021; 56:102090. [PMID: 35026499 DOI: 10.1016/j.ejon.2021.102090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Many individuals with advanced cancer have unmet psychological needs and often lack access to supportive care. Psychotherapy for adults with advanced cancer is a promising way to address some of the challenges in meeting these care needs. Nurses are the largest cohort of healthcare workers who can practice as psychotherapists and are positioned ideally to integrate these interventions as part of routine care. The purpose of this scoping review is to map the literature on psychotherapeutic interventions among adults with advanced cancer and to explore the nursing role in this body of evidence. METHODS We conducted a scoping review for relevant quantitative, qualitative, and mixed methods studies. The content of included studies was analyzed and grouped based on two broad categories that describe how nursing's role was mentioned, described, and utilized: 1. Nurses are not the interventionist/psychotherapist and, 2. Nurses are mentioned as the interventionist/psychotherapist. RESULTS Eighty-six studies were included. Overall, majority of studies did not mention a role for nursing in any capacity. Some studies mentioned a non-interventionist role for nursing in the research study. Fourteen studies mentioned nurses as interventionists/psychotherapists. These studies focused on feasibility, acceptability and patient related outcomes of brief psychotherapies. Dignity therapy was the most common psychotherapy in studies where nurses were utilized as interventionists, followed by life review and supportive expressive therapies. Very few studies discussed nursing's role in this area and nursing's capacity to deliver this form of care. CONCLUSION There is paucity in nursing research focused on psychotherapy for adults with advanced cancer. It is feasible and acceptable for nurses to deliver brief psychotherapies to adults with advanced cancer, and the integration of these techniques in everyday practice has great potential that must be explored. The development of this knowledge base is needed to support future education, research, and practice policy agendas.
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46
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Fradgley EA, Booth K, Paul C, Zdenkowski N, Rankin NM. Facilitating High Quality Cancer Care: A Qualitative Study of Australian Chairpersons' Perspectives on Multidisciplinary Team Meetings. J Multidiscip Healthc 2021; 14:3429-3439. [PMID: 34938082 PMCID: PMC8687680 DOI: 10.2147/jmdh.s332972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Aim Multidisciplinary team meetings (MDMs) are a critical element of quality care for people diagnosed with cancer. The MDM Chairperson plays a significant role in facilitating these meetings, which are often time-poor environments for clinical decision making. This study examines the perceptions of MDM Chairpersons including their role and the factors that determine the quality of a Chair, as well as the Chairperson's perception of the value of personally attending meetings. Methods This qualitative study used telephone interviews to explore the experiences of MDM Chairpersons from metropolitan and regional New South Wales, Australia. Using a state-wide register, 43 clinicians who chaired lung, genitourinary, gastrointestinal, and breast cancer meetings were approached to participate. Thematic data analysis was used to develop and organise themes. Results Themes from the 16 interviews identified the perceived need for an expert and efficient MDM Chairperson with emphasis on personal rather than technical skills. The remaining themes related to the benefits of meetings to ensure quality and consistency of care; improve inter-professional relationships; and provide communication with and reassurance for patients. Conclusion The role of the MDM Chairperson requires expert management and leadership skills to ensure meetings support quality patient-centred care. MDMs are perceived to provide multiple benefits to both clinicians and patients. Efforts to train Chairs and to maximise clinician and patient benefits may be warranted given the costly and time-consuming nature of MDMs.
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Affiliation(s)
- Elizabeth A Fradgley
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kate Booth
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicholas Zdenkowski
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicole M Rankin
- Faculty of Medicine and Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
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Murakami N, Tanabe K, Morita T, Fujikawa Y, Koseki S, Kajiura S, Nakajima K, Hayashi R. Process Evaluation of the Regional Referral Clinical Pathway for Home-Based Palliative Care and Outreach Program: A Questionnaire Survey of the Medical Staff and Bereaved Families. Am J Hosp Palliat Care 2021; 39:1029-1038. [PMID: 34872375 PMCID: PMC9386762 DOI: 10.1177/10499091211055901] [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: 11/21/2022] Open
Abstract
Background: The purpose of this study was to clarify how the Regional Referral Clinical Pathway for Home-based Palliative Care (RRCP-HPC) and an outreach program by a palliative care team (PCT) lead to an improvement in the outcome. Design and Methods: We conducted questionnaire surveys using the mailing method involving the regional medical staff involved in cancer patients introduced to the PCT of a single hospital, as well as bereaved families. The questionnaire was prepared through interviews with the medical staff and bereaved families. Subsequently, factor analysis was performed to identify factor structures and calculate the correlation coefficient with each outcome. Results: For the questionnaire survey involving the medical staff, responses were collected from 119 regional medical institutions and 84 regional medical staff. The response rate per institution was 51.3%. Similarly, for the questionnaire survey involving bereaved families, the response rate was 42.4%. For the survey involving the medical staff, 6 factors, such as “improved awareness of an interdisciplinary team,” were extracted. For the survey involving the bereaved families, 4 factors, such as “improvement of communications between patients and healthcare professionals,” were extracted. There were significant (≥moderate) correlations between these factors and all outcomes. Conclusion: In this study, we clarified the process of achieving palliative care until death at home without difficulties using the outreach program and RRCP-HPC. The results suggest the importance of improving communications. The outreach program and RRCP-HPC may have contributed to palliative care at home without difficulties through an improvement in communications.
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Affiliation(s)
- Nozomu Murakami
- Department of Palliative Care Surgery, 13869Kouseiren Takaoka Hospital, Toyama, Japan
| | - Kouichi Tanabe
- Drug Informatics, Faculty of Pharmacy, 12942Meijo University, Aichi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara Hospital, Shizuoka, Japan
| | - Yasunaga Fujikawa
- A Board of Palliative Care, Saiseikai Takaoka Hospital, Toyama, Japan
| | - Shiro Koseki
- Home Palliative Care Committee, Takaoka Medical Service Region, Toyama, Japan
| | - Shinya Kajiura
- Department of Clinical Oncology, 476163Toyama University Hospital, Toyama, Japan
| | - Kazunori Nakajima
- Department of Palliative Care Surgery, 13869Kouseiren Takaoka Hospital, Toyama, Japan
| | - Ryuji Hayashi
- Department of Clinical Oncology, 476163Toyama University Hospital, Toyama, Japan
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Zengul AG, Zengul FD, Ozaydin B, Oner N, Fiveash JB. Identifying research themes and trends in the top 20 cancer journals through textual analysis. J Cancer Policy 2021; 30:100313. [DOI: 10.1016/j.jcpo.2021.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 09/28/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
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Mano MS, Çitaku FT, Barach P. Implementing multidisciplinary tumor boards in oncology: a narrative review. Future Oncol 2021; 18:375-384. [PMID: 34787482 DOI: 10.2217/fon-2021-0471] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The healthcare industry compares unfavorably with other ultra-safe industries such as aviation and nuclear power plants, which address complexity by reducing the vulnerability of a single person and promoting teams and strong systems. A multidisciplinary tumor board (MTB) is an evidence-based organizational approach to implementing a more effective concept in oncology practice. Studies addressing the correlation between MTBs and cancer outcomes show promising results, and other potential benefits are also addressed. The objectives of this article are to define and characterize MTBs in modern oncology practice, review the current literature on MTBs effectiveness and address challenges to the implementation and maintenance of MTBs. In this commentary-type narrative review, the authors present their opinions and, whenever possible, substantiate recommendations by citing supportive literature.
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Affiliation(s)
- Max S Mano
- Grupo Oncoclínicas, São Paulo, Brazil.,Academy of Leadership Sciences Switzerland, Switzerland
| | | | - Paul Barach
- Academy of Leadership Sciences Switzerland, Switzerland.,Wayne State University School of Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA.,Interdisciplinary Research Institute for Health Law & Science, Sigmund Freud University, Vienna, Austria
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50
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Smith F, Hellström A, Gunnarsdóttir KÁ, Genell A, Eriksson E, Mannefred C, Björk-Eriksson T, Vaughn L. Exploring the meaning, role and experiences of a patient-led social innovation for people affected by cancer: a new collaborative care model complementing traditional cancer rehabilitation in Sweden. BMJ Open Qual 2021; 10:bmjoq-2021-001400. [PMID: 34686486 PMCID: PMC8543647 DOI: 10.1136/bmjoq-2021-001400] [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: 02/11/2021] [Accepted: 10/12/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Kraftens Hus is the first support centre in Sweden designed by and for people affected by cancer, including patients, family, friends, staff members and local community representatives (collectively ‘stakeholders’). The purpose of this study was to explore the meaning, role and experiences of Kraftens Hus stakeholders using a patient and public involved methodology. Methods To understand and map the experiences of visitors to Kraftens Hus, we applied concept mapping (CM), a mixed methods approach where data are collected and analysed in four structured steps designed to capture the diverse perspectives of multiple stakeholders. Qualitative interviews with relevant stakeholders supplemented the CM findings. Results The final concept map contained six clusters of ideas. Within the clusters, there was a recurring theme that cancer-affected people value accessible and long-term psychosocial support (PSS). The intended emotional, social and practical needs identified in a previous design process seem to have been addressed and appreciated by Kraftens Hus visitors. Conclusion Kraftens Hus is an example of a new patient-led social innovation based on a life-event perspective and integration of resources from different sectors in society. By focusing on life, not the disease, the care continuum expands, and long-term PSS is provided alongside cancer treatment. The evaluation confirms that PSS should focus on health and well-being in the broadest sense.
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Affiliation(s)
- Frida Smith
- Regional Cancer Centre West, Western Sweden Healthcare Region, Goteborg, Sweden .,Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden
| | - Andreas Hellström
- Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden.,Centre for Healthcare Improvement, Center for Healthcare Improvement, Gothenburg, Sweden
| | | | - Anna Genell
- Regional Cancer Centre West, Western Sweden Healthcare Region, Goteborg, Sweden
| | - Erik Eriksson
- Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden
| | - Carina Mannefred
- Regional Cancer Centre West, Western Sweden Healthcare Region, Goteborg, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Centre West, Western Sweden Healthcare Region, Goteborg, Sweden.,Department of Oncology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Lisa Vaughn
- Collage of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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