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Whish‐Wilson GA, Edbrooke L, Cavalheri V, Calulo Rivera ZT, Cavallaro M, Seller DR, Granger CL, Parry SM. Empowering Recovery: A Co-Designed Intervention to Transform Care for Operable Lung Cancer. Health Expect 2025; 28:e70196. [PMID: 40186447 PMCID: PMC11971569 DOI: 10.1111/hex.70196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Revised: 02/04/2025] [Accepted: 02/12/2025] [Indexed: 04/07/2025] Open
Abstract
BACKGROUND Patients undergoing surgery for lung cancer experience significant symptom burden and physical impairments. Exercise rehabilitation programmes have been shown to improve symptoms and aid recovery, however, implementation into routine practice has proven challenging. OBJECTIVE To develop a robust understanding of the key design requirements of an exercise-based pre- and post-operative rehabilitation prototype intervention designed to support patients with operable lung cancer prepare for and recover from thoracic surgery, and co-design an acceptable intervention prototype with key stakeholders. DESIGN, SETTING AND PARTICIPANTS An experience-based co-design (EBCD) study involving patients, caregivers, clinicians, consumer advocates and researchers from across Australia. Two rounds of EBCD workshops were held between November 2023 and May 2024. Workshops were underpinned by the COM-B Model and Theoretical Domains Framework. Qualitative data were thematically analysed by two independent researchers. Identified barriers and facilitators were mapped to the Behaviour Change Wheel, and used to develop the final intervention prototype, which was presented using the Template for Intervention Description and Replication (TIDieR) guide. RESULTS Eleven patients (55% female, mean age 66.4 (±9.3) years), one caregiver, and 16 professionals (physiotherapists, nurses, respiratory physicians, a thoracic surgeon, consumer advocates and researchers) participated. Retention between workshop rounds was high (86%). Nineteen major themes were developed, including unmet education needs; the link between mental health and recovery; and the influence of unexpected, persistent symptoms and functional decline. Core intervention principles included flexibility, individualisation and continuity. Essential components included screening/assessment, education, exercise, behaviour change, and mental health support. The intervention prototype was refined in the second workshop round. CONCLUSIONS This EBCD study successfully identified key experiences and barriers in preparing for and recovering from lung cancer surgery and engaged stakeholders in complex intervention design, culminating in the development of a flexible, multi-modal pre- and post-operative rehabilitation programme prototype. Future projects will evaluate the prototype acceptability and feasibility. PATIENT OR PUBLIC CONTRIBUTION Past patients and their caregivers with lived experience of undergoing/caring for someone undergoing lung cancer surgery, and multidisciplinary professionals, participated in co-design workshops to develop and refine the exercise-based rehabilitation intervention goals, priorities, and prototype.
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Affiliation(s)
- Georgina A. Whish‐Wilson
- Department of PhysiotherapySchool of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Lara Edbrooke
- Department of PhysiotherapySchool of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
- Department of Health Services ResearchPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Vinicius Cavalheri
- Curtin School of Allied HealthCurtin UniversityPerthWestern AustraliaAustralia
- Curtin enAble Institute, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
- Allied Health, South Metropolitan Health ServicePerthWestern AustraliaAustralia
| | - Zoe T. Calulo Rivera
- Department of PhysiotherapySchool of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
- Department of PhysiotherapyThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Madeline Cavallaro
- Department of PhysiotherapySchool of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Daniel R. Seller
- Physiotherapy Team, ORA Therapies, Health New Zealand – Te Whatu Ora, Capital, Coast & Hutt ValleyWellingtonNew Zealand
- School of Physiotherapy, Northern Centre (Wellington)University of OtagoWellingtonNew Zealand
| | - Catherine L. Granger
- Department of PhysiotherapySchool of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
- Department of PhysiotherapyThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Selina M. Parry
- Department of PhysiotherapySchool of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
- Department of PhysiotherapyThe Royal Melbourne HospitalMelbourneVictoriaAustralia
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Cooke S, Nelson D, Argin AA, Laparidou D, Young R, Waller J, Kane R, McInnerney D, Quaife SL, Peake MD, Mitchinson L. Identifying and exploring patient engagement interventions for people diagnosed with lung cancer: A rapid systematic review. Lung Cancer 2025; 202:108484. [PMID: 40090262 DOI: 10.1016/j.lungcan.2025.108484] [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: 11/01/2024] [Revised: 03/02/2025] [Accepted: 03/03/2025] [Indexed: 03/18/2025]
Abstract
PURPOSE To identify and synthesise evidence describing patient engagement interventions that have been used to support people diagnosed with lung cancer. METHODS A rapid systematic review was conducted following guidance from the Cochrane Rapid Reviews Methods group and reported using the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) checklist. Keyword searches were performed in MEDLINE and supplemented by Google Scholar searches. Searches were restricted to peer-reviewed articles conducted in high-income countries and published in English. Data was extracted using the Template for Intervention Description and Replication (TIDieR) checklist, tabulated, and narratively synthesised. Data extraction and quality assessment were conducted by two independent reviewers. RESULTS Thirty-four studies were included in the final analysis. Studies show a positive impact of interventions across a range of engagement outcomes including patient and caregiver knowledge, patient activation, and decision making. Interventions were also shown to reduce healthcare use, reduce symptom severity, and improve psychosocial outcomes. Barriers to implementing interventions included: the timing/delivery of interventions, poor digital literacy, system and technical barriers, and poor uptake and adherence by advanced patients. Factors supporting intervention implementation included: participatory research/co-production approaches, providing training and support for those delivering interventions, involving caregivers, and employing broad recruitment strategies. The overall risk of bias for studies ranged from moderate to high. CONCLUSION The identified interventions demonstrate significant potential for enhancing patient engagement and improving outcomes for lung cancer patients. Findings from this review will support the design and implementation of future interventions to help people with cancer engage with healthcare. REVIEW REGISTRATION The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024521052) on 06/03/24.
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Affiliation(s)
- S Cooke
- Lincoln Institute for Rural and Coastal Health, College of Health and Science, University of Lincoln, Lincoln UK.
| | - D Nelson
- Lincoln Institute for Rural and Coastal Health, College of Health and Science, University of Lincoln, Lincoln UK; Macmillan Cancer Support, London, UK.
| | - A Arslan Argin
- Lincoln Institute for Rural and Coastal Health, College of Health and Science, University of Lincoln, Lincoln UK.
| | - D Laparidou
- Community and Health Research Unit, College of Health and Science, University of Lincoln, Lincoln UK.
| | - R Young
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - J Waller
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - R Kane
- School of Health and Care Sciences, College of Health and Science, University of Lincoln, Lincoln, UK.
| | - D McInnerney
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - S L Quaife
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - M D Peake
- Glenfield Hospital, University of Leicester, Leicester, UK; Cancer Research UK, London, UK.
| | - L Mitchinson
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
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Skaarhoej MG, Olesen ML, Frimann SS, Bergenholtz H, Rosted E. Guided self-determination for patients with non-small cell lung cancer: Patients' experiences of a nurse-led person-centred intervention. Eur J Oncol Nurs 2025; 76:102864. [PMID: 40117907 DOI: 10.1016/j.ejon.2025.102864] [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: 12/17/2024] [Revised: 03/05/2025] [Accepted: 03/09/2025] [Indexed: 03/23/2025]
Abstract
PURPOSE Guided self-determination is an empowering person-centred approach that has proven useful in empowering different patient groups but has not yet been tested in lung cancer patients. The purpose of the study was to examine how patients with stage III non-small cell lung cancer in concomitant chemoradiotherapy could benefit from a guided self-determination course. METHODS A prospective intervention study with both quantitative and qualitative data. Patients (n = 20) were offered four guided self-determination conversations with a nurse. Symptoms and quality of life were measured through questionnaires and semi-structured interviews elicited thirteen patients' experiences. Thematic analysis was conducted, and the Consolidated Criteria for Mixed Method Research was used for reporting. RESULTS No difference in quality of life were found but significant worsening of pain, dyspnea, diarrhoea and dysphagia. Six themes were generated describing that in a new, uncertain and lonely situation with a life-threatening disease, the patients appreciated a respectful relationship with a nurse, and conversations with the nurse became a lifeline. Some patients felt increasingly empowered through new insights, while others felt that it became too intimate. CONCLUSION When patients with a serious disease can draw on nurses' knowledge and experience, they are empowered to manage everyday life. Some patients need supportive and reflective conversations, while others benefit from concrete problem-solving objectives.
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Affiliation(s)
- Mie Grube Skaarhoej
- Zealand University Hospital, Department of Oncology and Palliative Care, Denmark
| | - Mette Linnet Olesen
- Copenhagen University Hospital, Rigshospitalet, Childrens and Families Health Department, Juliane Marie Centre, Interdisciplinary Research Unit for Women, Denmark
| | - Sisse Storm Frimann
- Zealand University Hospital, Department of Oncology and Palliative Care, Denmark
| | - Heidi Bergenholtz
- Zealand University Hospital, Research Support Unit, Denmark; REHPA, National Knowledge Center for Rehabilitation and Palliative Care, University of Southern Denmark, Department of Clinical Research, Denmark
| | - Elizabeth Rosted
- Zealand University Hospital, Department of Oncology and Palliative Care, Denmark; University of Southern Denmark, Department of Regional Health Research, Denmark.
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Sautter JM, Henstenburg JA, Crafford AG, Rowe-Nicholls I, Diaz VS, Bartholomew KA, Evans JS, Johnson MR, Zhou J, Ajeya D. Health outcomes reported by healthcare providers and clients of a community-based medically tailored meal program. BMC Nutr 2024; 10:147. [PMID: 39497206 PMCID: PMC11533393 DOI: 10.1186/s40795-024-00955-6] [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: 06/18/2024] [Accepted: 10/23/2024] [Indexed: 11/07/2024] Open
Abstract
BACKGROUND Medically tailored meal (MTM) programs provide home-delivered meals to people living with serious illness and poor nutritional status. Client outcome studies have found evidence of decreased healthcare utilization and cost savings associated with MTM program participation, and inconclusive evidence of change in health measures. The purpose of this study was to use a novel observational framework to describe the client profile and change in health outcomes using routinely collected health and program data from a community-based MTM program at MANNA (Philadelphia, PA). METHODS Clients reported their self-rated health and experiences of food insecurity and malnutrition. Healthcare providers reported clients' body mass index, systolic blood pressure, and hemoglobin A1C. These health outcomes, measured at program intake and 3-6 months later, were linked with administrative data for 1,959 clients who completed at least two months of MTM services in 2020, 2021, and 2022. RESULTS Clients exhibited substantial heterogeneity in demographics and health status at intake. Self-reported malnutrition risk decreased significantly over program duration (p < .001). Nearly one-third of clients with poor health reported improvement over time. Over 60% of clients with obesity experienced stable BMI. Clients with hypertension experienced significant improvements in systolic blood pressure (p < .001). Clients with diabetes and available data (n = 45) demonstrated significant reduction in hemoglobin A1C (p = .005). CONCLUSION We found evidence that participation in MANNA's MTM program was associated with favorable health outcomes for clients with serious illness and nutritional risk. Community-based organizations can maximize the completeness of their data by focusing on routinely collected internal data like validated health screeners and surveys.
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Affiliation(s)
- Jessica M Sautter
- Department of Sociology & Criminal Justice, Saint Joseph's University, 5600 City Ave, Philadelphia, PA, 19131, USA.
| | - Jule Anne Henstenburg
- Metropolitan Area Neighborhood Nutrition Alliance (MANNA), 420 N 20th St Philadelphia, Philadelphia, PA, 19130, USA.
| | - Adrian Glass Crafford
- Metropolitan Area Neighborhood Nutrition Alliance (MANNA), 420 N 20th St Philadelphia, Philadelphia, PA, 19130, USA
| | - Ian Rowe-Nicholls
- Department of Sociology & Criminal Justice, Saint Joseph's University, 5600 City Ave, Philadelphia, PA, 19131, USA
| | - Victor S Diaz
- Thomas Jefferson University Sidney Kimmel Medical College, 1025 Walnut St #100, Philadelphia, PA, 19107, USA
| | | | - Julia S Evans
- Thomas Jefferson University Sidney Kimmel Medical College, 1025 Walnut St #100, Philadelphia, PA, 19107, USA
| | - Maria R Johnson
- Thomas Jefferson University Sidney Kimmel Medical College, 1025 Walnut St #100, Philadelphia, PA, 19107, USA
| | - Jeffrey Zhou
- Thomas Jefferson University Sidney Kimmel Medical College, 1025 Walnut St #100, Philadelphia, PA, 19107, USA
| | - Deeksha Ajeya
- Drexel University College of Medicine, 60 N. 36th Street, Philadelphia, PA, 19104, USA
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Goodwin EJ, Zaniletti I, Solano J, Bettenhausen JL, Coller RJ, Plencner LM, DePorre A, Gupta RC, Heller K, Jones L, Jones LN, Kyler KE, Larson IA, Queen M, Smith TK, Wright SM, Hall M, Colvin JD. Parental Health Literacy and Acute Care Utilization in Children With Medical Complexity. Hosp Pediatr 2024; 14:e426-e431. [PMID: 39308304 DOI: 10.1542/hpeds.2023-007663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 05/18/2024] [Accepted: 06/01/2024] [Indexed: 10/02/2024]
Abstract
OBJECTIVE Health literacy is the ability to find, understand, and use information and services to inform health-related decisions and actions. Inadequate health literacy is associated with health disparities, poor health outcomes, and increased emergency department (ED) visits and hospitalizations. Children with medical complexity (CMC) have high rates of acute health care utilization. We examined the association of parental health literacy with acute care utilization and costs in CMC. METHODS This cross-sectional study included parents of CMC receiving primary care at a free-standing children's hospital. We measured parental health literacy using the Single Item Literacy Screener, which measures the assistance needed to read health care materials. Our main predictor was parental health literacy, categorized as adequate versus inadequate. In a sensitivity analysis, we categorized health literacy as never needing assistance versus needing any assistance. Main outcomes were annual ED visits, hospitalizations, and associated costs. RESULTS Of the 236 parents of CMC, 5.5% had inadequate health literacy. Health literacy was not associated with acute care utilization or associated costs. In our sensitivity analysis, CMC whose parents need any assistance to read health care materials had 188% higher ED costs (adjusted rate ratio 2.88 [95% confidence interval: 1.63-5.07]) and 126% higher hospitalization costs (adjusted rate ratio 2.26 [95% confidence interval: 1.49-3.44]), compared with CMC whose parents never need assistance. CONCLUSIONS Inadequate parental health literacy was not associated with acute care utilization. However, CMC of parents needing any assistance to read health materials had higher ED and hospitalization costs. Further multicenter studies are needed.
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Affiliation(s)
- Emily J Goodwin
- Children's Mercy Kansas City, Kansas City, Missouri
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
| | | | - Joy Solano
- Children's Mercy Kansas City, Kansas City, Missouri
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Jessica L Bettenhausen
- Children's Mercy Kansas City, Kansas City, Missouri
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Ryan J Coller
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Laura M Plencner
- Children's Mercy Kansas City, Kansas City, Missouri
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Adrienne DePorre
- Children's Mercy Kansas City, Kansas City, Missouri
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
| | | | - Kayla Heller
- Saint Louis University School of Medicine and SSM Health Cardinal Glennon Children's Hospital, St Louis, Missouri
| | - Laura Jones
- Children's Mercy Kansas City, Kansas City, Missouri
| | - Leah N Jones
- Children's Mercy Kansas City, Kansas City, Missouri
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Kathryn E Kyler
- Children's Mercy Kansas City, Kansas City, Missouri
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
| | | | - Margaret Queen
- University of Kansas School of Medicine, Kansas City, Kansas
- Saint Luke's Health System, Lee's Summit, Missouri
| | - Tyler K Smith
- Children's Mercy Kansas City, Kansas City, Missouri
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
| | - S Margaret Wright
- Children's Mercy Kansas City, Kansas City, Missouri
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Matt Hall
- Children's Mercy Kansas City, Kansas City, Missouri
- Children's Hospital Association, Lenexa, Kansas
| | - Jeffrey D Colvin
- Children's Mercy Kansas City, Kansas City, Missouri
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
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Chandanabhumma PP, Ratakonda S, Panko T, Cuculick J, Hauser P, Paasche-Orlow MK, Fetters MD, McKee MM. Examining the differences of perceptions and experience with online health information accessibility between deaf and hearing individuals: A qualitative study. PATIENT EDUCATION AND COUNSELING 2024; 122:108169. [PMID: 38325209 DOI: 10.1016/j.pec.2024.108169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/06/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Describe and compare the experiences and preferences of Deaf and hearing individuals with different levels of health literacy in accessing, interpreting, and acting upon online health information. METHODS We conducted semi-structured interviews with 17 Deaf and 10 hearing participants with high and low health literacy from three healthcare sites. We conducted thematic analysis of the transcripts to explore information navigation experiences, information sources and dissemination preferences. RESULTS We found thematic differences between Deaf and hearing participants with high and low health literacy in terms of information needs, information search experiences, information search perceptions, and preferred information dissemination approaches. Relative to hearing counterparts, Deaf participants were more likely to encounter challenges in accessing and understanding online information. Deaf participants with low health literacy were more likely to rely on visual graphics to support their understanding of the information than those with high health literacy. Deaf participants advocated for tailored approaches to disseminate health information to Deaf communities. CONCLUSION Our findings suggest that differences in online health information navigation experiences and accessibility may inform disparities in health literacy outcomes between Deaf and hearing individuals. PRACTICE IMPLICATIONS Online health information should be presented in a manner accessible to Deaf community members.
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Affiliation(s)
| | | | - Tiffany Panko
- National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, USA
| | - Jessica Cuculick
- National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, USA
| | - Peter Hauser
- National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, USA
| | | | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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