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Kenfield SA, Van Blarigan EL, Graff RE, Borno HT, Macaire G, Chan JM. Nutrition Guidance for Patients on Androgen Deprivation Therapy. Eur Urol Focus 2023; 9:427-430. [PMID: 36935290 DOI: 10.1016/j.euf.2023.02.009] [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: 01/05/2023] [Revised: 02/04/2023] [Accepted: 02/28/2023] [Indexed: 03/19/2023]
Abstract
Dietary guidance for men with prostate cancer on androgen deprivation therapy (ADT) should focus on reducing the risk of prostate cancer-specific outcomes and other chronic diseases, including cardiovascular disease (CVD). National guidelines for both CVD prevention and cancer survivors recommend a diet rich in fruits and vegetables and low in red/processed meat, refined grains, and added fats and sugars. Additional observational studies and randomized controlled trials are needed to examine short- and long-term effects of diet on clinical, biological, and patient-reported outcomes for men treated with ADT.
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Affiliation(s)
- Stacey A Kenfield
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA.
| | - Erin L Van Blarigan
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Rebecca E Graff
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Hala T Borno
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Greta Macaire
- Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA, USA
| | - June M Chan
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
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2
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Lawford BJ, Master H, Larsen JB, Bartholdy C, Corrigan P, Ginnerup-Nielsen E, Le C, Teoli A, Bennell KL, Metcalf B, Hinman RS, Button K, Collins NJ, Cottrell E, Henrotin Y, Skou ST, Thoma LM, Wellsandt E, White DK, Holden MA. What should a toolkit to aid the delivery of therapeutic exercise for hip and knee osteoarthritis look like? Qualitative analysis of an international survey of 318 researchers, clinicians, and consumers by the OARSI Rehabilitation Discussion Group. Musculoskeletal Care 2023. [PMID: 36631968 DOI: 10.1002/msc.1732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND We aimed to identify important components of, and practical resources relevant for inclusion in, a toolkit to aid exercise delivery for people with hip/knee osteoarthritis. METHOD An online international multi-disciplinary survey was conducted across 43 countries (139 clinicians, 44 people with hip/knee osteoarthritis and 135 osteoarthritis researchers). Participants were presented with the seeding statement 'Practical resources to aid the implementation of exercise for people with hip/knee osteoarthritis should…' and asked to provide up to 10 open text responses. Responses underwent refinement and qualitative content analysis to create domains and categories. RESULTS Refinement of 551 open text responses yielded 72 unique statements relevant for analysis. Statements were organised into nine broad domains, suggesting that resources to aid exercise delivery should: (1) be easily accessible; (2) be of high quality; (3) be developed by, and for, stakeholders; (4) include different ways of delivering information; (5) include different types of resources to support exercise and non-exercise components of self-management; (6) include resources on recommended exercises and how to perform/progress them; (7) include tools to support motivation and track progress; (8) include resources to enable tailoring of the programme to the individual and; (9) facilitate access to professional and peer support. CONCLUSION Our findings identified important components of, and practical resources to include within, a toolkit to aid delivery of exercise for people with hip/knee osteoarthritis. These findings have implications for exercise providers and lay the foundation for the development of a toolkit to help ensure exercise provision aligns with current international recommendations.
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Affiliation(s)
- Belinda J Lawford
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jesper B Larsen
- Department of Health Science and Technology, Musculoskeletal Health and Implementation, Aalborg University, Aalborg, Denmark
| | - Cecilie Bartholdy
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Patrick Corrigan
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | | | - Christina Le
- University of Alberta in Edmonton, Edmonton, Alberta, Canada
| | - Anthony Teoli
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec, Canada
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Ben Metcalf
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Rana S Hinman
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Parkville, Australia
| | - Kate Button
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Cottrell
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, UK
| | - Yves Henrotin
- Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Marche-en-Famenne, Belgium.,Motricity Sciences Department, musculoSKeletal Innovative Research Lab (mSKIL), Institute of Pathology, University of Liège, Liège, Belgium.,Center for Interdisciplinary Research on Medicines (CIRM), Institute of Pharmacy, University of Liège, Liège, Belgium.,The Osteoarthritis Foundation, Boncelles, Belgium
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Louise M Thoma
- Division of Physical Therapy, Department of Health Sciences, School of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth Wellsandt
- Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Daniel K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Melanie A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, UK
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Keinki C, Momberg A, Clauß K, Bozkurt G, Hertel E, Freuding M, Josfeld L, Huebner J. Effect of question prompt lists for cancer patients on communication and mental health outcomes-A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:1335-1346. [PMID: 33593643 DOI: 10.1016/j.pec.2021.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 12/03/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To provide a systematic review on the effects of question prompt lists (QPL) in oncological settings. METHODS A systematic literature search was conducted in Medline, PsycINFO and the Cochrane Collaboration. Randomized controlled studies (RCTs) that evaluated QPL-only interventions were included. Risk of bias of included studies was evaluated using the Cochrane RoB 2 tool. Data concerning effects on communicative processes in patient-physician relationship and psychological outcomes were analyzed. RESULTS 10 RCTs met the inclusion criteria. Results suggest that QPLs lead to a shift of topics discussed. There were weak indications that QPL interventions increase anxiety shortly before and after consultations, but may decline anxiety during follow-up. Patients consistently perceive QPLs as more helpful than usual information sheets. QPL-only interventions show limited impact on communicative processes and psychological outcomes. They help not to forget or discuss important questions. CONCLUSION With a better integration in patient-physician communication QPLs may become a useful tool for patients and physicians. Future research is needed to investigate if there is greater benefit from QPL interventions in specific settings. PRACTICE IMPLICATIONS QPLs are an inexpensive tool to influence communicative processes positively in oncological consultations.
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Affiliation(s)
- Christian Keinki
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany.
| | - Annika Momberg
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Katrin Clauß
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Gültekin Bozkurt
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Elizabeth Hertel
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Maren Freuding
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Lena Josfeld
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Jutta Huebner
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
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McLaughlin K, Hedden L, Pollock P, Higano C, Murphy RA. Assessing the nutritional needs of men with prostate cancer. Nutr J 2019; 18:81. [PMID: 31791348 PMCID: PMC6889583 DOI: 10.1186/s12937-019-0506-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 11/18/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Nutrition is important for prostate cancer (PC) survivorship care to help achieve a healthy weight, reduce treatment side effects and reduce the risk of developing other chronic diseases. We aimed to advance the understanding of the nutritional needs of men with PC and services that could be potentially implemented to address them. METHODS We conducted a needs assessment of nutrition services for men with PC drawing on four perspectives; 1) patient evaluation of a nutrition education session in British Columbia (BC), 2) survey of BC health professionals, 3) an environmental scan of existing nutrition services across Canada and 4) a scoping literature review. RESULTS Patients expressed a need for more nutrition information and a desire for additional nutrition services. More than 60% of health professionals believed there is a need for more nutrition services for men with PC, and reported the focus should be on weight management or management of PC progression. The environmental scan revealed few existing services for men with PC across Canada, most were inclusive of multiple cancers and not tailored for men with PC. Eighteen completed studies were identified in the scoping literature review. The majority provided combined diet and exercise programs with various formats of delivery such as individual, group and home-based. Overall, 78% of studies reported improvements in one or more of the following measures: dietary intake/ diet quality, body composition, self-efficacy, quality of life, fatigue, practicing health behavior goals and physical function/ exercise. Four studies assessed feasibility, adherence or satisfaction with all reporting positive findings. CONCLUSION Despite the high prevalence of PC in Canada, and the perceived need for more support by patients and health professionals, there are limited nutrition services for men with PC. Evidence from the literature suggests nutrition services are effective and well-accepted by men with PC. Our findings define a need for standardized nutrition services for men with PC that assess and meet long term nutritional needs. Our findings also provide insight into the type and delivery of nutrition services that may help close the gap in care for men with PC.
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Affiliation(s)
- Kaitlin McLaughlin
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay Hedden
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, BC, Canada
- Vancouver Prostate Centre, Vancouver, BC, Canada
| | | | - Celestia Higano
- Vancouver Prostate Centre, Vancouver, BC, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- University of Washington, Fred Hutchinson Cancer Research, Seattle, WA, USA
| | - Rachel A Murphy
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
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Nyrop KA, Lee JT, Deal AM, Ki Choi S, Muss HB. Weight-Related Communications Between Oncology Clinicians and Women With Obesity at Early Breast Cancer Diagnosis: Findings From a Review of Electronic Health Records. Nutr Cancer 2019; 72:576-583. [DOI: 10.1080/01635581.2019.1645863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Kirsten A. Nyrop
- Division of Hematology and Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jordan T. Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison M. Deal
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Seul Ki Choi
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hyman B. Muss
- Division of Hematology and Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Nutrition care guidelines for men with prostate cancer undergoing androgen deprivation therapy: do we have enough evidence? Prostate Cancer Prostatic Dis 2018; 22:221-234. [PMID: 30279584 DOI: 10.1038/s41391-018-0099-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/24/2018] [Accepted: 09/16/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND To review the evidence available to support clinical practice guidelines for dietary interventions aimed at mitigating the side effects of androgen deprivation therapy (ADT) in men with prostate cancer, and to identify future research priorities. METHODS An analytical model was designed to select and interpret evidence for the effect of dietary interventions on ADT side effects. Key terms identified articles that investigated dietary interventions to mitigate ADT side effects among men treated for prostate cancer. Medline, Embase, Proquest, CINAHL, Cochrane databases, and PubMed were searched from inception through June, 2018. Clinical trial registries were also searched for up-to-date study protocols. Articles were not restricted on design. Methodological quality was assessed using the mixed methods appraisal tool. RESULTS Sixteen articles met inclusion criteria, each with distinct dietary interventions. Twelve studies used interventions that combined diet with physical activity and/or medication and/or counselling. Four articles examined the effect of diet alone on ADT side effects. Of those, three articles measured changes to participants' dietary intake and influence on ADT side effects. One article showed daily caffeinated beverages improved cancer-related fatigue. Two articles showed no impact of isoflavone supplementation on hot flushes, quality of life, body mass index, or blood lipids. Dietary intake and compliance was poorly reported across all studies limiting knowledge of acceptability and feasibility for dietary interventions. Information on the nutrition care practices and views of clinicians treating men for prostate cancer is limited. No articles measured the impact of diet on long-term ADT side effects. Methodological quality of included papers ranged from weak to strong. CONCLUSIONS Current evidence for dietary interventions to mitigate ADT side effects is limited. Further investigations are warranted to explore the impact of changes in dietary intake on ADT side effects before practice guidelines can be considered.
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Tsang DS, Jones JM, Samadi O, Shah S, Mitsakakis N, Catton CN, Jeon W, To J, Breunis H, Alibhai SMH. Healthy Bones Study: can a prescription coupled with education improve bone health for patients receiving androgen deprivation therapy?—a before/after study. Support Care Cancer 2018. [DOI: 10.1007/s00520-018-4150-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Malnutrition and cachexia among cancer out-patients in Nairobi, Kenya. J Nutr Sci 2017; 6:e63. [PMID: 29308197 PMCID: PMC5748382 DOI: 10.1017/jns.2017.61] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/04/2017] [Accepted: 10/04/2017] [Indexed: 12/29/2022] Open
Abstract
Cancer is the third leading cause of death in Kenya. However, there is scarce information on the nutritional status of cancer patients to guide in decision making. The present study sought to assess the risk of malnutrition, and factors associated with malnutrition and cachexia, among cancer out-patients, with the aim of informing nutrition programmes for cancer management in Kenya and beyond. This was a facility-based cross-sectional study performed at Kenyatta National Hospital and Texas Cancer Centre in Nairobi, Kenya. The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool (MUST). Diagnoses of malnutrition and cachexia were done using the European Society of Clinical Nutrition and Metabolism (ESPEN) and Fearon criteria, respectively. A total of 512 participants were assessed. Those at risk of malnutrition were 33·1 % (12·5 % at medium risk, 20·6 % at high risk). Prevalence of malnutrition was 13·4 %. The overall weight loss >5 % over 3 months was 18·2 % and low fat-free mass index was 43·1 %. Prevalence of cachexia was 14·1 % compared with 8·5 % obtained using the local criteria. Only 18·6 % participants had received any form of nutrition services. Age was a predictor of malnutrition and cachexia in addition to site of cancer for malnutrition and cigarette smoking for cachexia. The use of the MUST as a screening tool at the first point of care should be explored. The predictive value of current nutrition assessment tools, and the local diagnostic criteria for malnutrition and cachexia should be reassessed to inform the development of appropriate clinical guidelines and future capacity-building initiatives that will ensure the correct identification of patients at risk for timely care.
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Gagliardi AR, Légaré F, Brouwers MC, Webster F, Badley E, Straus S. Patient-mediated knowledge translation (PKT) interventions for clinical encounters: a systematic review. Implement Sci 2016; 11:26. [PMID: 26923462 PMCID: PMC4770686 DOI: 10.1186/s13012-016-0389-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 02/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-mediated knowledge translation (PKT) interventions engage patients in their own health care. Insight on which PKT interventions are effective is lacking. We sought to describe the type and impact of PKT interventions. METHODS We performed a systematic review of PKT interventions, defined as strategies that inform, educate and engage patients in their own health care. We searched MEDLINE, EMBASE and the Cochrane Library from 2005 to 2014 for English language studies that evaluated PKT interventions delivered immediately before, during or upon conclusion of clinical encounters to individual patients with arthritis or cancer. Data were extracted on study characteristics, PKT intervention (theory, content, delivery, duration, personnel, timing) and outcomes. Interventions were characterized by type of patient engagement (inform, activate, collaborate). We performed content analysis and reported summary statistics. RESULTS Of 694 retrieved studies, 16 were deemed eligible (5 arthritis, 11 cancer; 12 RCTs, 4 cohort studies; 7 low, 3 uncertain, 6 high risk of bias). PKT interventions included print material in 10 studies (brochures, booklets, variety of print material, list of websites), electronic material in 10 studies (video, computer program, website) and counselling in 2 studies. They were offered before, during and after consultation in 4, 1 and 4 studies, respectively; as single or multifaceted interventions in 10 and 6 studies, respectively; and by clinicians, health educators, researchers or volunteers in 4, 3, 5 and 1 study, respectively. Most interventions informed or activated patients. All studies achieved positive impact in one or more measures of patient knowledge, decision-making, communication and behaviour. This was true regardless of condition, PKT intervention, timing, personnel, type of engagement or delivery (single or multifaceted). No studies assessed patient harms, or interventions for providers to support PKT intervention delivery. Two studies evaluated the impact on providers of PKT interventions aimed at patients. CONCLUSIONS Single interventions involving print material achieved beneficial outcomes as did more complex interventions. Few studies were eligible, and no studies evaluated patient harms, or provider outcomes. Further research is warranted to evaluate these PKT interventions in more patients, or patients with different conditions; different types of PKT interventions for patients and for providers; and potential harms associated with interventions.
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Yamada J, Shorkey A, Barwick M, Widger K, Stevens BJ. The effectiveness of toolkits as knowledge translation strategies for integrating evidence into clinical care: a systematic review. BMJ Open 2015; 5:e006808. [PMID: 25869686 PMCID: PMC4401869 DOI: 10.1136/bmjopen-2014-006808] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this systematic review was to evaluate the effectiveness of toolkits as a knowledge translation (KT) strategy for facilitating the implementation of evidence into clinical care. Toolkits include multiple resources for educating and/or facilitating behaviour change. DESIGN Systematic review of the literature on toolkits. METHODS A search was conducted on MEDLINE, EMBASE, PsycINFO and CINAHL. Studies were included if they evaluated the effectiveness of a toolkit to support the integration of evidence into clinical care, and if the KT goal(s) of the study were to inform, share knowledge, build awareness, change practice, change behaviour, and/or clinical outcomes in healthcare settings, inform policy, or to commercialise an innovation. Screening of studies, assessment of methodological quality and data extraction for the included studies were conducted by at least two reviewers. RESULTS 39 relevant studies were included for full review; 8 were rated as moderate to strong methodologically with clinical outcomes that could be somewhat attributed to the toolkit. Three of the eight studies evaluated the toolkit as a single KT intervention, while five embedded the toolkit into a multistrategy intervention. Six of the eight toolkits were partially or mostly effective in changing clinical outcomes and six studies reported on implementation outcomes. The types of resources embedded within toolkits varied but included predominantly educational materials. CONCLUSIONS Future toolkits should be informed by high-quality evidence and theory, and should be evaluated using rigorous study designs to explain the factors underlying their effectiveness and successful implementation.
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Affiliation(s)
- Janet Yamada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Melanie Barwick
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kimberley Widger
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Bonnie J Stevens
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Tsang DS, Alibhai SM. Bone health care for patients with prostate cancer receiving androgen deprivation therapy. Hosp Pract (1995) 2014; 42:89-102. [PMID: 24769788 DOI: 10.3810/hp.2014.04.1107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patients with prostate cancer often receive androgen deprivation therapy (ADT) as part of their treatment regimen. However, treatment with ADT causes multiple side effects, including reduced bone mineral density (BMD), lower lean body mass, and a higher risk for fractures. Several organizations provide clinical practice guidelines for osteoporosis screening, prevention, and treatment in this population, but adherence to these guidelines remains low. Areas for improvement in provider adherence include baseline and follow-up BMD testing, as well as counseling regarding healthy bone behaviors such as calcium/vitamin D intake, lifestyle changes, and physical exercise. Comparison of osteoporosis care in breast cancer and non-oncology populations shows that suboptimal bone health care is not isolated to prostate cancer. A summary of the literature examining improvements in patient adherence and provider delivery of bone health care is included in this review, but high-quality studies are lacking. Patients may be the most receptive to written educational information delivered at or near the time of ADT initiation. Involvement of a primary care practitioner and oncologist in care delivery is associated with higher BMD test use. Institution-level programs that automatically initiate osteoporosis screening and management may be effective at reducing the incidence of hip fracture. Lastly, suggestions are provided for future approaches to knowledge translation and quality of care studies to improve bone health.
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Affiliation(s)
- Derek S Tsang
- Resident Physician, Department of Radiation Oncology, University of Toronto, Toronto, Canada
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12
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Soeyonggo T, Locke J, Giudice MED, Alibhai S, Fleshner NE, Warde P. National survey addressing the information needs of primary care physicians: Side effect management of patients on androgen deprivation therapy. Can Urol Assoc J 2014; 8:E227-34. [PMID: 24839488 DOI: 10.5489/cuaj.1015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Androgen deprivation therapy (ADT) is a common treatment for prostate cancer with numerous side effects. We assess primary care physicians' (PCPs) knowledge of ADT side effects and their interest in increasing their knowledge in this area. METHODS A list of active Canadian PCPs was obtained using the Canadian Medical Directory. A cross-sectional survey was distributed to 600 randomly selected physicians. We collected PCPs' demographic information, experience with ADT management, knowledge regarding ADT side effects and desired sources for obtaining knowledge on ADT management. RESULTS In total, we received 103 completed questionnaires. Of these, 89% of PCPs had patients on ADT. One-third of respondents prescribed ADT and over half of them administered ADT annually. Thirty-eight percent felt their knowledge of ADT side effects was inadequate and 50% felt uncomfortable counselling patients on ADT. Many PCPs were less familiar with the incidence of functional side effects of ADT (i.e., hot flashes, fatigue and erectile dysfunction) compared to life-threatening side effects (i.e., cardiovascular events, metabolic syndrome, fractures). In terms of increasing their knowledge of ADT side effects, 82% of PCPs would use educational resources if they were available (52% and 32% preferred continued medical education [CME] events and educational pamphlets, respectively). CONCLUSIONS PCPs play an important role in managing ADT side effects. There is poor awareness of the prevalence of ADT side effects, and many are uncomfortable in managing these side effects. These areas may be addressed through CME programs and educational pamphlets.
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Affiliation(s)
- Tony Soeyonggo
- Department of Family Medicine, Queen's University, Kingston, ON
| | | | | | | | - Neil Eric Fleshner
- Department of Surgery (Urology), University of Toronto, Princess Margaret Hospital, Toronto, ON
| | - Padraig Warde
- Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, Toronto, ON
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Walker LM, Tran S, Wassersug RJ, Thomas B, Robinson JW. Patients and partners lack knowledge of androgen deprivation therapy side effects. Urol Oncol 2013; 31:1098-105. [DOI: 10.1016/j.urolonc.2011.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 11/23/2011] [Accepted: 12/20/2011] [Indexed: 10/14/2022]
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Millar H, Davison J. Nutrition Education for Osteoporosis Prevention in Men With Prostate Cancer Initiating Androgen Deprivation Therapy. Clin J Oncol Nurs 2012; 16:497-503. [DOI: 10.1188/12.cjon.497-503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Soeyonggo T, Alibhai SM. REPLY. BJU Int 2012; 110:E162. [DOI: 10.1111/j.1464-410x.2012.11250_4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Prostate carcinogenesis with diabetes and androgen-deprivation-therapy-related diabetes: an update. EXPERIMENTAL DIABETES RESEARCH 2012; 2012:801610. [PMID: 22792092 PMCID: PMC3389736 DOI: 10.1155/2012/801610] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 05/10/2012] [Indexed: 01/06/2023]
Abstract
Prostate cancer and the androgen deprivation therapy (ADT) thereof are involved in diabetes in terms of diabetes-associated carcinogenesis and ADT-related metabolic disorder, respectively. The aim of this study is to systematically review relevant literature. About 218,000 men are estimated to be newly diagnosed with prostate cancer every year in the United States. Approximately 10% of them are still found with metastasis, and in addition to them, about 30% of patients with nonmetastatic prostate cancer recently experience ADT. Population-based studies have shown that dissimilar to other malignancies, type 2 diabetes is associated with a lower incidence of prostate cancer, whereas recent large cohort studies have reported the association of diabetes with advanced high-grade prostate cancer. Although the reason for the lower prevalence of prostate cancer among diabetic men remains unknown, the lower serum testosterone and PSA levels in them can account for the increased risk of advanced disease at diagnosis. Meanwhile, insulin resistance already appears in 25–60% of the patients 3 months after the introduction of ADT, and long-term ADT leads to a higher incidence of diabetes (reported hazard ratio of 1.28–1.44). Although the possible relevance of cytokines such as Il-6 and TNF-α to ADT-related diabetes has been suggested, its mechanism is poorly understood.
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Soeyonggo T, Warde P, Fleshner N, Timilshina N, Alibhai SM. Information needs of men on androgen deprivation therapy. BJU Int 2011; 109:1503-9. [DOI: 10.1111/j.1464-410x.2011.10475.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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