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Pompili C, Boele F, Absolom K, Holch P, Clayton B, Smyllie E, Franks K, Velikova G. Patients' views of routine quality of life assessment following a diagnosis of early-stage non-small cell lung cancer. Interact Cardiovasc Thorac Surg 2021; 31:324-330. [PMID: 32830244 DOI: 10.1093/icvts/ivaa123] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/02/2020] [Accepted: 06/07/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES There is an increasing interest in the quality of life (QoL) evaluation following video-assisted thoracoscopic anatomical lung resection or stereotactic ablative body radiotherapy for early-stage non-small-cell lung cancer (NSCLC). A qualitative interview study was conducted to gain insight into the optimal methods of assessing and discussing QoL in clinical practice. METHODS A prospective observational longitudinal study of patients with early-stage NSCLC was conducted where repeated QoL measures were administered either online or on paper. A subset of participants was invited for qualitative interviews after the 6-month assessment or at the end of the study. The semi-structured interviews were transcribed verbatim and thematically analysed. RESULTS Twenty-three patients were interviewed. Generally, patients were content with recruitment and data collection procedures. Most opted to complete the assessments on paper instead of online; this choice was influenced by the level of technology literacy. Some found the questionnaires too generic to reflect their experiences. Barriers to questionnaire completion were mostly practical, and many acknowledged benefits of QoL assessment including allowing them to express problems and health issues, and following changes over time. Generally, participants would like to discuss QoL results during clinical consultations, but reported this rarely happened. CONCLUSIONS Lung cancer patient interviews confirm the acceptability of repeated QoL assessments, but online data capture is limited. Patients highlight the importance of discussing QoL aspects with their clinical team. Future strategies are needed to optimize the routine collection of patient-reported outcomes in clinical practice.
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Affiliation(s)
- Cecilia Pompili
- Section of Patient Centred Outcomes Research, Leeds Institute of Medical Research at St James's, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Florien Boele
- Section of Patient Centred Outcomes Research, Leeds Institute of Medical Research at St James's, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Kate Absolom
- Section of Patient Centred Outcomes Research, Leeds Institute of Medical Research at St James's, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Patricia Holch
- School of Social Sciences, Beckett University, Leeds, UK
| | - Beverly Clayton
- Section of Patient Centred Outcomes Research, Leeds Institute of Medical Research at St James's, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Emma Smyllie
- Section of Patient Centred Outcomes Research, Leeds Institute of Medical Research at St James's, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,Department of Thoracic Surgery, Leeds Teaching Hospital Trust, Leeds, UK
| | - Kevin Franks
- Department of Clinical Oncology, Leeds Teaching Hospital Trust, Leeds, UK
| | - Galina Velikova
- Section of Patient Centred Outcomes Research, Leeds Institute of Medical Research at St James's, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Dalmia S, Boele F, Absolom K, Brunelli A, Franks K, Bekker HL, Pompili C. Shared decision-making in early stage non-small cell lung cancer: A systematic review. Ann Thorac Surg 2021; 114:581-590. [PMID: 33581150 DOI: 10.1016/j.athoracsur.2021.01.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/25/2020] [Accepted: 01/12/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The United Kingdom National Institute for Health and Care Excellence guidelines recommend that patients and professionals make shared decisions between surgery and stereotactic ablative radiotherapy (SABR) when treating early stage non-small cell lung cancer (NSCLC). Variation by centre suggests treatment decisions may be disproportionately influenced by clinician judgment and treatment availability rather than patient preference. This systematic review critically evaluates studies of patient and clinician preferences for treatment of early stage NSCLC. METHODS Primary empirical research up to 30 April 2020 was identified from searches of MEDLINE, EMBASE, PsycInfo and Web of Science databases. Data extracted included: study characteristics and methods, preferences for NSCLC treatment and involvement in decision-making and risk of bias using the Mixed Methods Appraisal Tool. Findings were synthesized using descriptive data and narrative synthesis. RESULTS 23 studies were included in the review; 18 measured patient preferences, 4 clinician preferences and 1 both clinician and patient preferences. Patients and clinicians were both most likely to prefer a collaborative role in treatment decisions. Most patients did not recall there being a choice between surgery or SABR options, and thus experienced minimal decisional conflict. CONCLUSIONS For professionals to support patients in making informed, value based decisions about NSCLC treatments, better quality evidence is needed of the clinical and quality of life trade offs for both surgery and SABR.
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Affiliation(s)
- Sanjush Dalmia
- School of Medicine, University of Leeds. Worsley Building, Clarendon Way, Leeds, LS2 9JT, United Kingdom
| | - Florien Boele
- Leeds Institute of Health Sciences, University of Leeds. Worsley Building, Clarendon Way Leeds, LS2 9NL, United Kingdom; Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds. Beckett Street, Leeds, LS9 7TF, United Kingdom
| | - Kate Absolom
- Leeds Institute of Health Sciences, University of Leeds. Worsley Building, Clarendon Way Leeds, LS2 9NL, United Kingdom; Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds. Beckett Street, Leeds, LS9 7TF, United Kingdom
| | - Alessandro Brunelli
- Department of Thoracic Surgery, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Kevin Franks
- Department of Clinical Oncology, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Hilary Louise Bekker
- Leeds Institute of Health Sciences, University of Leeds. Worsley Building, Clarendon Way Leeds, LS2 9NL, United Kingdom
| | - Cecilia Pompili
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds. Beckett Street, Leeds, LS9 7TF, United Kingdom; Department of Thoracic Surgery, Leeds Teaching Hospital, Leeds, United Kingdom.
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3
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Consent in forefoot surgery; What does it mean to the patient? Foot (Edinb) 2020; 45:101741. [PMID: 33027730 DOI: 10.1016/j.foot.2020.101741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/03/2020] [Accepted: 08/29/2020] [Indexed: 02/04/2023]
Abstract
AIMS This study aimed to assess patient risk recall and find risk thresholds for patients undergoing elective forefoot procedures. METHODS Patients were interviewed in the pre-assessment clinic (PAC) or on day of surgery (DOS); some in both settings. A standardised questionnaire was used for all interviews, regardless of setting. Patients were tested on which risks they recalled from their consent process, asked for thresholds for five pre-chosen risks and asked about a sham risk. RESULTS Across all interviews, risk recall on DOS (2.34 risks/patient interview) was significantly lower (p=.05) than in PAC (2.95 risks/patient interview) - this was repeated when comparing results from patients interviewed in both settings only with PAC mean recall of 2.93 risks/patient interview and DOS mean recall of 2.57 risks/patient interview. The mean reported risk thresholds greatly exceeded NHS Lothian's observed complication rates for forefoot procedures. The five risks tested for thresholds produced the same order in each interview setting, suggesting a patient-perceived severity ranking. Patients answering the sham risk question incorrectly tended to recall fewer risks across all interviews. CONCLUSIONS This study shows that patient risk recall is poor, as previous literature outlines, reinforcing that consent process improvements could be made. It also illustrates the value of PAC visits in patient education, as shown by higher levels of recall when compared to DOS.
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Stewart I, Leary A, Khakwani A, Borthwick D, Tod A, Hubbard R, Beckett P, Tata LJ. Do working practices of cancer nurse specialists improve clinical outcomes? Retrospective cohort analysis from the English National Lung Cancer Audit. Int J Nurs Stud 2020; 118:103718. [PMID: 32859375 DOI: 10.1016/j.ijnurstu.2020.103718] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cancer nurse specialists are advanced practitioners who offer continuity of care and expert support for people diagnosed with specific cancers. Health Education England's Cancer Workforce Plan prioritises expansion of cancer nurse specialist numbers by 2021 as part of the Cancer Taskforce Strategy for England. OBJECTIVE To assess whether working practices of advanced practice specialist nurses are associated with clinical outcomes for people with lung cancer. METHODS Adults with non-small cell lung cancer followed from 30 days post-diagnosis in English secondary care were obtained from the English National Lung Cancer Audit, 2007 to 2011. A national survey of lung cancer nurse specialists provided information on self-reported working practices. Mortality and unplanned admissions from 30 days to 12 months post diagnosis were respectively analysed using Cox and Poisson regression. Outcomes were assessed according to patients' receipt of initial assessments by a lung cancer nurse specialist and according to trust-level reported working practices. Regression models were adjusted for individual sociodemographic and clinical characteristics, error adjusted for intracorrelations within regional cancer networks, and presented separately according to patients' treatment pathways (surgery, chemotherapy, radiotherapy, or no anti-cancer therapy). RESULTS Data for 108,115 people with lung cancer were analysed and associations with mortality and unplanned admissions were infrequent. Among people receiving only radiotherapy, however, the hazard for death was 17% lower among those who received an assessment by a lung cancer nurse specialist, compared with no assessment (hazard ratio = 0.83, 95% confidence interval 0.73-0.94; p = 0.003). The hazard was also lower among those receiving surgery (hazard ratio = 0.91, 0.84-0.99; p = 0.028). Among those receiving radiotherapy, nurse specialists' reported confidence within multidisciplinary team settings was associated with a lower risk of death (hazard ratio = 0.88, 0.78-1.00; p = 0.049) and a lower rate of unplanned cancer-related admissions (incidence rate ratio = 0.83, 0.73-0.95; p = 0.007). Lung cancer nurse specialist assessments before/at diagnosis, were associated with a 5% lower rate of unplanned admissions, compared to when assessments occurred after diagnosis. CONCLUSION The contribution of nurse specialist working practices was occasionally associated with better outcomes for people with lung cancer. These were not limited to a single treatment pathway, but do indicate discrete relationships within pathways. Our study provides initial measures of overall lung cancer nurse specialist working practices at trusts, however, more detailed studies with longitudinal measurement of lung cancer nurse specialist-patient interaction are needed to better ascertain impacts on long-term patient outcomes. The findings highlight opportunities for potential improvement in effectiveness of service and care management.
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Affiliation(s)
- Iain Stewart
- Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB, UK; NIHR Biomedical Research Centre, University of Nottingham, NG5 1PB, UK.
| | - Alison Leary
- London South Bank University, Division of Primary and Social Care, SE1 0AA, UK
| | - Aamir Khakwani
- Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB, UK
| | - Diana Borthwick
- Western General Hospital, Edinburgh Cancer Centre, EH4 2JT, UK
| | - Angela Tod
- University of Sheffield, School of Nursing and Midwifery, S10 2LA, UK
| | - Richard Hubbard
- Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB, UK
| | - Paul Beckett
- Derby Teaching Hospitals NHS Foundation Trust, DE22 3NE, UK
| | - Laila J Tata
- Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB, UK
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5
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Evaluation of Risk for Thoracic Surgery. Surg Oncol Clin N Am 2020; 29:497-508. [PMID: 32883454 DOI: 10.1016/j.soc.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Modern surgical practice places increased emphasis on treatment outcomes. There has been a paradigm shift from paternalistic ways of practicing medicine to patients having a major involvement in decision making and treatment planning. The combination of these two factors undoubtedly leaves the surgeon open to greater scrutiny in respect of results and outcomes. In dealing with this it is important that the surgeon, wider multidisciplinary team, and patient appreciate the idea of surgical risk. This article reviews the latest evidence relating to risk assessment in thoracic surgery and suggests how this should be incorporated into clinical practice.
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Pompili C, Holch P, Rogers Z, Absolom K, Clayton B, Franks K, Bekker H, Velikova G. Patients' confidence in treatment decisions for early stage non-small cell lung cancer (NSCLC). Health Qual Life Outcomes 2020; 18:237. [PMID: 32682425 PMCID: PMC7368734 DOI: 10.1186/s12955-020-01496-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/13/2020] [Indexed: 12/22/2022] Open
Abstract
Background In early-stage Non-Small Cell Lung Cancer (NSCLC) patients, little is known about how to measure patient participation in Shared-Decision Making (SDM). We examined the psychometric properties and clinical acceptability of the Decision Self-Efficacy scale (DSE) in a cohort of patients undergoing to Stereotactic Ablative Radiotherapy (SABR) or Video-assisted Thoracoscopic Surgery (VATS) to capture patient involvement in treatment decisions. Methods In the context of a prospective longitudinal study (Life after Lung Cancer-LiLAC) involving 244 patients with early-stage NSCLC, 158 (64.7%) patients completed the DSE either on paper or electronically online prior to treatment with SABR or VATS pulmonary resection. DSE psychometric properties were examined using: principal components analysis of item properties and internal structure, and internal construct validity; we also performed a sensitivity analysis according to Eastern Cooperative Oncology Group Performance Status (ECOG PS), gender, age and treatment received (VATS or SABR) difference. Results Exploratory factor analysis using polychoric correlations substantiated that the 11 item DSE is one scale accounting for 81% of the variance. We calculated a value of 0.96 for Cronbach’s alpha for the total DSE score. DSE scores did not differ by gender (p = 0.37), between the two treatment groups (p = 0.09) and between younger and older patients (p = 0.4). However, patients with an ECOG PS > 1 have a DSE mean of 73.8 (SD 26) compared to patients with a PS 0–1 who have a DSE mean of 85.8 (SD 20.3 p = 0.002). Conclusion Findings provide preliminary evidence for the reliability and validity of the DSE questionnaire in this population. However, future studies are warranted to identify the most appropriate SDM tool for clinical practice in the lung cancer treatment field.
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Affiliation(s)
- Cecilia Pompili
- Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK. .,St James' Institute of Oncology, Beckett Street, Leeds, LS9 7TF, UK.
| | - Patricia Holch
- Department of Psychology, Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Zoe Rogers
- Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | - Kate Absolom
- Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | - Beverly Clayton
- Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | | | - Hilary Bekker
- Leeds Unit of Complex Intervention Development (LUCID), School of Medicine, University of Leeds, Leeds, UK
| | - Galina Velikova
- Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
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7
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Hauber B, Penrod JR, Gebben D, Musallam L. The Value of Hope: Patients' and Physicians' Preferences for Survival in Advanced Non-Small Cell Lung Cancer. Patient Prefer Adherence 2020; 14:2093-2104. [PMID: 33154633 PMCID: PMC7608144 DOI: 10.2147/ppa.s248295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 09/19/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Immuno-oncology treatments offer patients with advanced non-small cell lung cancer (NSCLC) treatment options with greater probability of durable survival and a different toxicity profile compared with traditional chemotherapy. The objective of this study was to explore the importance of increases in the probability of long-term survival versus changes in expected (median) survival and treatment toxicities among patients with advanced NSCLC and physicians. PATIENTS AND METHODS In a discrete-choice experiment, oncologists and patients diagnosed with NSCLC chose between profiles of treatments for advanced NSCLC offering different combinations of benefits (expected, best-case, and worst-case survival) and risks. We analyzed preference data from each sample using a random-parameters logit model that controls for preference heterogeneity and the panel nature of the data. RESULTS Both patients and physicians expressed a strong preference for improving the probability of best-case survival; however, patients viewed increases in the probability of long-term survival as more important than increases in expected survival, while the opposite was true for physicians. Both patients and physicians weighted survival to be more important than toxicities. CONCLUSION This study identified a potentially important divergence between physician and patient perspectives on survival statistics. Physicians placed more importance on increases in expected survival than did patients with NSCLC. The importance patients placed on long-term survival reinforce previous research identifying the primacy of hope as a value among seriously ill patients. The findings underscore the importance of considering patients' priorities and in shared decision-making when choosing treatment.
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Affiliation(s)
- Brett Hauber
- RTI Health Solutions, Research Triangle Park, NC, USA
- Correspondence: Brett Hauber Email
| | | | - David Gebben
- RTI Health Solutions, Research Triangle Park, NC, USA
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Lippiett KA, Richardson A, Myall M, Cummings A, May CR. Patients and informal caregivers' experiences of burden of treatment in lung cancer and chronic obstructive pulmonary disease (COPD): a systematic review and synthesis of qualitative research. BMJ Open 2019; 9:e020515. [PMID: 30813114 PMCID: PMC6377510 DOI: 10.1136/bmjopen-2017-020515] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To identify, characterise and explain common and specific features of the experience of treatment burden in relation to patients living with lung cancer or chronic obstructive pulmonary disease (COPD) and their informal caregivers. DESIGN Systematic review and interpretative synthesis of primary qualitative studies. Papers were analysed using constant comparison and directed qualitative content analysis. DATA SOURCES CINAHL, EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science searched from January 2006 to December 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Primary qualitative studies in English where participants were patients with lung cancer or COPD and/or their informal caregivers, aged >18 years that contain descriptions of experiences of interacting with health or social care in Europe, North America and Australia. RESULTS We identified 127 articles with 1769 patients and 491 informal caregivers. Patients, informal caregivers and healthcare professionals (HCPs) acknowledged lung cancer's existential threat. Managing treatment workload was a priority in this condition, characterised by a short illness trajectory. Treatment workload was generally well supported by an immediacy of access to healthcare systems and a clear treatment pathway. Conversely, patients, informal caregivers and HCPs typically did not recognise or understand COPD. Treatment workload was balanced with the demands of everyday life throughout a characteristically long illness trajectory. Consequently, treatment workload was complicated by difficulties of access to, and navigation of, healthcare systems, and a fragmented treatment pathway. In both conditions, patients' capacity to manage workload was enhanced by the support of family and friends, peers and HCPs and diminished by illness/smoking-related stigma and social isolation. CONCLUSION This interpretative synthesis has affirmed significant differences in treatment workload between lung cancer and COPD. It has demonstrated the importance of the capacity patients have to manage their workload in both conditions. This suggests a workload which exceeds capacity may be a primary driver of treatment burden. PROSPERO REGISTRATION NUMBER CRD42016048191.
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Affiliation(s)
- Kate Alice Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Carl R May
- London School of Hygiene and Tropical Medicine, London, UK
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9
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Are working practices of lung cancer nurse specialists associated with variation in peoples’ receipt of anticancer therapy? Lung Cancer 2018; 123:160-165. [DOI: 10.1016/j.lungcan.2018.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/16/2018] [Indexed: 11/20/2022]
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10
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Johnson M, Tod AM, Brummell S, Collins K. Discussing potential recurrence after lung cancer surgery: Uncertainties and challenges. Eur J Cancer Care (Engl) 2018; 27:e12870. [PMID: 29863300 DOI: 10.1111/ecc.12870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 04/06/2018] [Accepted: 04/30/2018] [Indexed: 12/25/2022]
Abstract
Patients with lung cancer who undergo surgery may potentially be cured. The resulting pathological staging gives an indication of 5-year survival and whether further treatment is recommended. To date, there is little research evidence regarding the way potential recurrence is communicated to patients by staff. This qualitative research used case studies to explore how information disclosure about possible recurrence was managed following lung cancer surgery and aimed to identify practice implications for clinical teams. Twelve patients were recruited and first postoperative surgical and subsequent oncology or follow-up consultations were recorded and transcribed. The perspective of the professionals involved in these clinics was ascertained through 30 in-depth interviews. Key themes in the data were identified using Framework Analysis. Recurrence risk was communicated to patients in a number of ways and levels of clarity and openness. Information provided by participants about early warning signs of recurrence varied. Findings indicate information provided was linked to the patient's prognosis and individual professionals' underlying communication approach. This study provides a unique insight into the views of lung cancer specialists regarding information disclosure and reveals the challenging nature and complexity of discussing recurrence following lung cancer surgery.
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Affiliation(s)
- Matthew Johnson
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Centre for Health and Social Care Research, Faculty of Health & Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Angela Mary Tod
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Stephen Brummell
- Centre for Health and Social Care Research, Faculty of Health & Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Karen Collins
- Centre for Health and Social Care Research, Faculty of Health & Wellbeing, Sheffield Hallam University, Sheffield, UK
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"Even if I Don't Remember, I Feel Better". A Qualitative Study of Patients with Early-Stage Non-Small Cell Lung Cancer Undergoing Stereotactic Body Radiotherapy or Surgery. Ann Am Thorac Soc 2018; 13:1361-9. [PMID: 27182889 DOI: 10.1513/annalsats.201602-130oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RATIONALE While surgical resection is recommended for most patients with early stage lung cancer according to the National Comprehensive Cancer Network guidelines, stereotactic body radiotherapy is increasingly being used. Provider-patient communication regarding the risks and benefits of each approach may be a modifiable factor leading to improved patient-centered outcomes. OBJECTIVES To qualitatively describe the experiences of patients undergoing either surgery or stereotactic body radiotherapy for early stage non-small cell lung cancer. METHODS We qualitatively evaluated and used content analysis to describe the experiences of 13 patients with early clinical stage non-small cell lung cancer before undergoing treatment in three health care systems in the Pacific Northwest, with a focus on knowledge obtained, communication, and feelings of distress. MEASUREMENTS AND MAIN RESULTS Although most participants reported rarely having been told about other options for treatment and could not readily recall many details about specific risks of recommended treatment, they were satisfied with their care. The patients paradoxically described clinicians as displaying caring and empathy despite not explicitly addressing their concerns and worries. We found that the communication domains that underlie shared decision making occurred infrequently, but that participants were still pleased with their role in the decision-making process. We did not find substantially different themes based on where the participant received care or the treatment selected. CONCLUSIONS Patients were satisfied with all aspects of their care, despite reporting little knowledge about risks or other treatment options, no direct elicitation of worries from providers, and a lack of shared decision making. While the development of effective communication strategies to address these gaps is warranted, their effect on patient-centered outcomes, such as distress and decisional conflict, is unclear.
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12
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Weder W, Moghanaki D, Stiles B, Siva S, Rocco G. The great debate flashes: surgery versus stereotactic body radiotherapy as the primary treatment of early-stage lung cancer. Eur J Cardiothorac Surg 2017; 53:295-305. [DOI: 10.1093/ejcts/ezx410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/23/2017] [Accepted: 10/28/2017] [Indexed: 12/25/2022] Open
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13
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Powell HA, Baldwin DR. Treatment recommendations for stage I non-small cell lung cancer: does patient preference matter? ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:411. [PMID: 29152511 DOI: 10.21037/atm.2017.08.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Helen A Powell
- Department of Thoracic Medicine, Frimley Park Hospital, Frimley Health NHS Foundation Trust, Camberley, UK
| | - David R Baldwin
- Department of Respiratory Medicine, David Evans Building, Nottingham University Hospitals NHS Trust, Nottingham, UK
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14
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Golden SE, Thomas CR, Moghanaki D, Slatore CG. Dumping the information bucket: A qualitative study of clinicians caring for patients with early stage non-small cell lung cancer. PATIENT EDUCATION AND COUNSELING 2017; 100:861-870. [PMID: 28034611 DOI: 10.1016/j.pec.2016.12.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/07/2016] [Accepted: 12/20/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the quality of patient-clinician communication and shared decision making (SDM) when two disparate treatments for early stage non-small cell lung cancer (NSCLC) are discussed. METHODS We conducted a qualitative study to evaluate the experiences of 20 clinicians caring for patients with clinical Stage I NSCLC prior to treatment, focusing on communication practices. We used directed content analysis and a patient-centered communication theoretical model to guide understanding of communication strategies. RESULTS All clinicians expressed the importance of providing information, especially for mitigating patient worry, despite recognition that patients recall only a small amount of the information given. When patients expressed distress, clinicians exhibited empathy but preferred to provide more information in order to address patient concerns. Most clinicians reported practicing SDM, however, they also reported not clearly eliciting patient preferences and values, a key part of SDM. CONCLUSION Communication with patients about treatment options for early stage NSCLC primary includes information giving. We found that only a few communication domains associated with SDM occurred regularly, and SDM may not be necessary in this clinical context. PRACTICE IMPLICATIONS Clinicians may need to incorporate nurse navigators or more written materials for effectively discussing potentially equivalent treatment options with their patients.
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Affiliation(s)
- Sara E Golden
- Health Services Research & Development, VA Portland Health Care System, Portland, OR, USA.
| | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
| | - Drew Moghanaki
- Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA; Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Christopher G Slatore
- Health Services Research & Development, VA Portland Health Care System, Portland, OR, USA; Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Department of Medicine, Oregon Health & Science University, Portland, OR, USA; Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System; Portland, OR, USA.
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15
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Allmark P, Tod AM. Ethical challenges in conducting clinical research in lung cancer. Transl Lung Cancer Res 2016; 5:219-26. [PMID: 27413698 DOI: 10.21037/tlcr.2016.03.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED The article examines ethical challenges that arise with clinical lung cancer research focusing on design, recruitment, conduct and dissemination. DESIGN problems related to equipoise can arise in lung cancer studies. Equipoise is an ethics precondition for RCTs and exists where there is insufficient evidence to decide which of two or more treatments is best. Difficulties arise in deciding what level of uncertainty constitutes equipoise and who should be in equipoise, for example, patients might not be even where clinicians are. Patient and public involvement (PPI) can reduce but not remove the problems. Recruitment: (I) lung cancer studies can be complex, making it difficult to obtain good quality consent. Some techniques can help, such as continuous consent. But researchers should not expect consent to be the sole protection for participants' welfare. This protection is primarily done elsewhere in the research process, for example, in ethics review; (II) the problem of desperate volunteers: some patients only consent to a trial because it gives them a 50/50 option of the treatment they want and can be disappointed or upset if randomised to the other arm. This is not necessarily unfair, given clinical equipoise. However, it should be avoided where possible, for example, by using alternative trial designs; (III) the so-called problem of therapeutic misconception: this is the idea that patients are mistaken if they enter trials believing this to be in their clinical best interest. We argue the problem is misconceived and relates only to certain health systems. Conduct: lung cancer trials face standard ethical challenges with regard to trial conduct. PPI could be used in decisions about criteria for stopping rules. DISSEMINATION as in other trial areas, it is important that all results, including negative ones, are reported. We argue also that the role of PPI with regard to dissemination is currently under-developed.
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Affiliation(s)
- Peter Allmark
- 1 Centre for Health and Social Care Research (CHSCR), Sheffield Hallam University, 32 Collegiate Crescent, Sheffield S10 2BP, UK ; 2 School of Nursing and Midwifery, University of Sheffield, Sheffield S10 2TN, UK
| | - Angela M Tod
- 1 Centre for Health and Social Care Research (CHSCR), Sheffield Hallam University, 32 Collegiate Crescent, Sheffield S10 2BP, UK ; 2 School of Nursing and Midwifery, University of Sheffield, Sheffield S10 2TN, UK
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Siva S, Ball D. Curing Operable Stage I Non-Small Cell Lung Cancer With Stereotactic Ablative Body Radiotherapy: The Force Awakens. Oncologist 2016; 21:393-8. [PMID: 26984447 PMCID: PMC4828125 DOI: 10.1634/theoncologist.2015-0477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/02/2016] [Indexed: 12/25/2022] Open
Abstract
In 2016, surgery is the standard of care for peripheral stage I non-small cell lung cancer. However, recent thought-provoking randomized evidence suggests stereotactic ablative body radiotherapy (SABR) has survival outcomes similar to those of surgery. Albeit limited, patient-reported outcomes and quality of life suggest that SABR compares favorably to surgery because it is noninvasive and associated with relatively few treatment-related complications. This article explores the current scientific landscape of surgery and SABR in this patient cohort.
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Affiliation(s)
- Shankar Siva
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - David Ball
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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