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Mirat W, Moscova L, Lustman M, Dawidowicz S, Picot G, Lebel A, Cittée J, Ferrat E. Interprofessional follow-up of patients with cancer in France (the SINPATIC study): a preliminary, qualitative study of the patient's perspective. Fam Pract 2024:cmae023. [PMID: 38703057 DOI: 10.1093/fampra/cmae023] [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] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND In 2020, 19.2 million people were diagnosed with cancer, and nearly 10 million cancer patients died worldwide. An effective cancer care pathway must be based on coordination, multidisciplinarity, a personalized approach, and collaboration between stakeholders. Follow-up can be improved by good collaboration and communication between GPs and the cancer care team at a common level of organization. OBJECTIVES To study patients with solid cancers and assess their perceptions of the care pathway, the roles of the healthcare professionals involved, and interprofessional collaboration. METHODS In a preliminary, qualitative study (part of the SINPATIC study of general practitioners, oncologists, nurses, and patients), adult patients with cancer in the Paris area of France were interviewed between January and April 2018. Using purposive sampling, 10 patients were recruited from hospital departments and primary care. An interview guide explored 3 themes: the care pathway, the stakeholders' roles in follow-up, and interprofessional collaboration. RESULTS For patients, dealing with cancer is a complex process of awareness, care provision, decision-making, task assignment, a lack of clarification of professional roles, a piecemeal announcement of the diagnosis of cancer by several stakeholders, organizational and administrative difficulties, non-formal collaboration in inertia (tending towards collaboration under construction), and with cancer follow-up that was usually parallel, sometimes shared, rarely sequential. CONCLUSION This SINPATIC substudy provided us a better understanding of the complexity of the patient care pathway. Looking forward, the present findings might stimulate thoughts on the design and development of interventional studies.
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Affiliation(s)
- William Mirat
- Département de Médecine Générale, Faculté de Médecine, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Laura Moscova
- Département de Médecine Générale, Faculté de Médecine, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Matthieu Lustman
- Département de Médecine Générale, Faculté de Médecine, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Sebastien Dawidowicz
- Département de Médecine Générale, Faculté de Médecine, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Genevieve Picot
- Centre de la Formation et du Developpement des Compétences, APHP, Paris, France
| | - Audrey Lebel
- Departement d'Oncologie Médicale, APHP, Henri-Mondor Hospital, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Jacques Cittée
- Département de Médecine Générale, Faculté de Médecine, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Emilie Ferrat
- Département de Médecine Générale, Faculté de Médecine, Université Paris-Est Créteil (UPEC), Créteil, France
- Université Paris Est Créteil, INSERM, IMRB (CEpiA Team), Créteil, France
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Hayes BD, Young HG, Atrchian S, Vis-Dunbar M, Stork MJ, Pandher S, Samper S, McCorquodale S, Loader A, Voss C. Primary care provider-led cancer survivorship care in the first 5 years following initial cancer treatment: a scoping review of the barriers and solutions to implementation. J Cancer Surviv 2024; 18:352-365. [PMID: 36376712 DOI: 10.1007/s11764-022-01268-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To synthesize the barriers to primary care provider (PCP)-led cancer survivorship care (≤ 5 years after initial cancer treatment) experienced by healthcare systems around the world, and to explore potential solutions that would succeed within a developed country. METHODS A scoping review of peer-reviewed articles and grey literature was conducted. Four electronic databases (Medline, Embase, Web of Science Core Collection, and Google Scholar) were searched for articles prior to April 2021. RESULTS Ninety-seven articles published across the globe (USA, Canada, Australia, European Union, and UK) met the review inclusion/exclusion criteria. The four most frequently discussed barriers to PCP-led survivorship care in healthcare systems were as follows: (1) insufficient communication between PCPs and cancer specialists, (2) limited PCP knowledge, (3) time restrictions for PCPs to provide comprehensive survivorship care, and (4) a lack of resources (e.g., survivorship care guidelines). Potential solutions to combat these barriers were as follows: (1) improving interdisciplinary communication, (2) bolstering PCP education, and (3) providing survivorship resources. CONCLUSIONS This scoping review identified and summarized key barriers and solutions to the provision of PCP-led cancer survivorship care. Importantly, the findings from this review provide insight and direction to guide optimization of cancer care practice within BC's healthcare system. IMPLICATIONS FOR CANCER SURVIVORS Optimizing the PCP-led survivorship care model will be a valuable contribution to the field of cancer survivorship care and will hopefully lead to more widespread use of this model, ultimately lessening the growing demand for cancer-specific care by cancer specialists.
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Affiliation(s)
- Brian D Hayes
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - Hannah G Young
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - Siavash Atrchian
- BC Cancer, Kelowna, Canada
- Department of Surgery, Division of Radiation Oncology and Developmental Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Matthew J Stork
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Satvir Pandher
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Sofia Samper
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Sarah McCorquodale
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | | | - Christine Voss
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada.
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada.
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Sherwood M, Papadakos J, Kulasegaram K, Martimianakis MA, Kucharski E, Giuliani M. Exploring Family Physician Training Needs to Improve Cancer Patient Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1834-1844. [PMID: 37452226 DOI: 10.1007/s13187-023-02339-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
Family physicians have multifaceted roles in cancer patient care and oncology education among this group is unfortunately inadequate. This study explored the needs and perspectives of family physicians regarding their oncology training and experiences. As well, physician cancer care experiences, knowledge use, and continuing education practices were elucidated. The authors employed a qualitative approach with family physicians participating in semi-structured interviews. General practitioners in oncology were excluded. Purposeful sampling was used, with recruitment through Ontario regional primary cancer care leads and social media. Interviews were transcribed, and thematic analysis was conducted. Thirteen participants were interviewed-1.6:1 female: male, ages 30-39, practicing for an average of 9 years (0.5-30 years), with urban and suburban practices. Most trained in Canada as undergraduates and completed their residency in Ontario; 62% had participated in at least one oncology continuing medical education session. Three major themes emerged: delineation of roles, oncology knowledge and education, and palliative care. Participants reported role uncertainty after cancer diagnosis, with oncology teaching at all levels described as lacking relevance. Palliative care rotations were an avenue for oncology education and where participants returned to cancer care. Changing existing teaching, information access, and avenues of oncology experiences may be the next step to supporting successful cancer care by family physicians.
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Affiliation(s)
- Marissa Sherwood
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Janet Papadakos
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- The Institute for Education Research (TIER), University Health Network, Toronto, Ontario, Canada
| | | | - Maria A Martimianakis
- Wilson Centre for Research in Education, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Edward Kucharski
- Department of Family and Community Medicine, Toronto, Ontario, Canada
- Casey House Hospital, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
- The Institute for Education Research (TIER), University Health Network, Toronto, Ontario, Canada.
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada.
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Sandell T, Schütze H, Miller A. Acceptability of a shared cancer follow-up model of care between general practitioners and radiation oncologists: A qualitative evaluation. Health Expect 2023; 26:2441-2452. [PMID: 37583292 PMCID: PMC10632636 DOI: 10.1111/hex.13846] [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: 03/21/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023] Open
Abstract
INTRODUCTION Facilitators to implement shared cancer follow-up care into clinical practice include mechanisms to allow the oncologist to continue overseeing the care of their patient, two-way information sharing and clear follow-up protocols for general practitioners (GPs). This paper aimed to evaluate patients, GPs and radiation oncologists (ROs) acceptance of a shared care intervention. METHODS Semi-structured interviews were conducted pre- and post intervention with patients that were 3 years post radiotherapy treatment for breast, colorectal or prostate cancer, their RO, and their GP. Inductive and deductive thematical analysis was employed. RESULTS Thirty-two participants were interviewed (19 patients, 9 GPs, and 4 ROs). Pre intervention, there was support for GPs to play a greater role in cancer follow-up care, however, patients were concerned about the GPs cancer-specific skills. Patients, GPs and ROs were concerned about increasing the GPs workload. Post intervention, participants were satisfied that the GPs had specific skills and that the impact on GP workload was comparable to writing a referral. However, GPs expressed concern about remuneration. GPs and ROs felt the model provided patient choice and were suitable for low-risk, stable patients around 2-3 years post treatment. Patients emphasised that they trusted their RO to advise them on the most appropriate follow-up model suited to their individual situation. The overall acceptance of shared care depended on successful health technology to connect the GP and RO. There were no differences in patient acceptance between rural, regional, and cancer types. ROs presented differences in acceptance for the different cancer types, with breast cancer strongly supported. CONCLUSION Patients, GPs and ROs felt this shared cancer follow-up model of care was acceptable, but only if the RO remained directly involved and the health technology worked. There is a need to review funding and advocate for health technology advances to support integration. PATIENT OR PUBLIC CONTRIBUTION Patients treated with curative radiotherapy for breast, colorectal and prostate cancer, their RO and their GPs were actively involved in this study by giving their consent to be interviewed.
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Affiliation(s)
- Tiffany Sandell
- School of Graduate MedicineFaculty of Science, Medicine and Health, University of WollongongWollongongNew South WalesAustralia
- Illawarra Shoalhaven Local Health District, Cancer ServicesNowraNew South WalesAustralia
| | - Heike Schütze
- School of Graduate MedicineFaculty of Science, Medicine and Health, University of WollongongWollongongNew South WalesAustralia
- Office of Medical EducationFaculty of Medicine and Health, University of New South WalesSydneyNew South WalesAustralia
| | - Andrew Miller
- Illawarra Shoalhaven Local Health District, Cancer ServicesNowraNew South WalesAustralia
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Sandell T, Schütze H, Miller A, Ivers R. Patients' acceptance of a shared cancer follow-up model of care between general practitioners and radiation oncologists: A population-based survey using the theoretical Framework of Acceptability. BMC PRIMARY CARE 2023; 24:86. [PMID: 36973691 PMCID: PMC10044765 DOI: 10.1186/s12875-023-02032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION International and national guidelines highlight the need for general practitioner involvement during and after active cancer treatment and throughout long-term follow-up care. This paper aimed to evaluate patients' acceptance of radiation oncology shared follow-up care using the Theoretical Framework of Acceptability (TFA). METHODS This cross-sectional study was conducted at two cancer care centres in the Illawarra Shoalhaven region of Australia. A sample of patients scheduled for a radiation oncology follow-up consultation in 2021 were sent a 32-point self-complete paper-based survey. Data were analysed using descriptive, parametric and non-parametric statistical analysis. This paper followed the Checklist for Reporting of Survey Studies (CROSS). RESULTS Of the 414 surveys returned (45% response rate), the acceptance for radiation oncology shared cancer follow-up care was high (80%). Patients treated with only radiotherapy were 1.7 times more likely to accept shared follow-up care than those treated with multiple modalities. Patients who preferred follow-up care for fewer than three years were 7.5 times more likely to accept shared care than those who preferred follow-up care for five years. Patients who travelled more than 20 minutes to their radiation oncologist or to the rural cancer centre were slightly more likely to accept shared care than those who travelled less than twenty minutes to the regional cancer centre. A high understanding of shared care (Intervention Coherence) and a positive feeling towards shared care (Affective Attitude) were significant predictive factors in accepting shared radiation oncology follow-up care. CONCLUSION Health services need to ensure patient preferences are considered to provide patient-centred cancer follow-up care. Shared cancer follow-up care implementation should start with patients who prefer a shorter follow-up period and understand the benefits of shared care. However, patients' involvement needs to be considered alongside other clinical risk profiles and organisational factors. Future qualitative research using the TFA constructs is warranted to inform clinical practice change.
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Affiliation(s)
- Tiffany Sandell
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
- Cancer Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia.
| | - Heike Schütze
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Centre for Primary Health Care and Equity, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Andrew Miller
- Cancer Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Rowena Ivers
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Merner B, Schonfeld L, Virgona A, Lowe D, Walsh L, Wardrope C, Graham-Wisener L, Xafis V, Colombo C, Refahi N, Bryden P, Chmielewski R, Martin F, Messino NM, Mussared A, Smith L, Biggar S, Gill M, Menzies D, Gaulden CM, Earnshaw L, Arnott L, Poole N, Ryan RE, Hill S. Consumers' and health providers' views and perceptions of partnering to improve health services design, delivery and evaluation: a co-produced qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 3:CD013274. [PMID: 36917094 PMCID: PMC10065807 DOI: 10.1002/14651858.cd013274.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Partnering with consumers in the planning, delivery and evaluation of health services is an essential component of person-centred care. There are many ways to partner with consumers to improve health services, including formal group partnerships (such as committees, boards or steering groups). However, consumers' and health providers' views and experiences of formal group partnerships remain unclear. In this qualitative evidence synthesis (QES), we focus specifically on formal group partnerships where health providers and consumers share decision-making about planning, delivering and/or evaluating health services. Formal group partnerships were selected because they are widely used throughout the world to improve person-centred care. For the purposes of this QES, the term 'consumer' refers to a person who is a patient, carer or community member who brings their perspective to health service partnerships. 'Health provider' refers to a person with a health policy, management, administrative or clinical role who participates in formal partnerships in an advisory or representative capacity. This QES was co-produced with a Stakeholder Panel of consumers and health providers. The QES was undertaken concurrently with a Cochrane intervention review entitled Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. OBJECTIVES 1. To synthesise the views and experiences of consumers and health providers of formal partnership approaches that aimed to improve planning, delivery or evaluation of health services. 2. To identify best practice principles for formal partnership approaches in health services by understanding consumers' and health providers' views and experiences. SEARCH METHODS We searched MEDLINE, Embase, PsycINFO and CINAHL for studies published between January 2000 and October 2018. We also searched grey literature sources including websites of relevant research and policy organisations involved in promoting person-centred care. SELECTION CRITERIA We included qualitative studies that explored consumers' and health providers' perceptions and experiences of partnering in formal group formats to improve the planning, delivery or evaluation of health services. DATA COLLECTION AND ANALYSIS Following completion of abstract and full-text screening, we used purposive sampling to select a sample of eligible studies that covered a range of pre-defined criteria, including rich data, range of countries and country income level, settings, participants, and types of partnership activities. A Framework Synthesis approach was used to synthesise the findings of the sample. We appraised the quality of each study using the CASP (Critical Appraisal Skill Program) tool. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. The Stakeholder Panel was involved in each stage of the review from development of the protocol to development of the best practice principles. MAIN RESULTS We found 182 studies that were eligible for inclusion. From this group, we selected 33 studies to include in the final synthesis. These studies came from a wide range of countries including 28 from high-income countries and five from low- or middle-income countries (LMICs). Each of the studies included the experiences and views of consumers and/or health providers of partnering in formal group formats. The results were divided into the following categories. Contextual factors influencing partnerships: government policy, policy implementation processes and funding, as well as the organisational context of the health service, could facilitate or impede partnering (moderate level of confidence). Consumer recruitment: consumer recruitment occurred in different ways and consumers managed the recruitment process in a minority of studies only (high level of confidence). Recruiting a range of consumers who were reflective of the clinic's demographic population was considered desirable, particularly by health providers (high level of confidence). Some health providers perceived that individual consumers' experiences were not generalisable to the broader population whereas consumers perceived it could be problematic to aim to represent a broad range of community views (high level of confidence). Partnership dynamics and processes: positive interpersonal dynamics between health providers and consumers facilitated partnerships (high level of confidence). However, formal meeting formats and lack of clarity about the consumer role could constrain consumers' involvement (high level of confidence). Health providers' professional status, technical knowledge and use of jargon were intimidating for some consumers (high level of confidence) and consumers could feel their experiential knowledge was not valued (moderate level of confidence). Consumers could also become frustrated when health providers dominated the meeting agenda (moderate level of confidence) and when they experienced token involvement, such as a lack of decision-making power (high level of confidence) Perceived impacts on partnership participants: partnering could affect health provider and consumer participants in both positive and negative ways (high level of confidence). Perceived impacts on health service planning, delivery and evaluation: partnering was perceived to improve the person-centredness of health service culture (high level of confidence), improve the built environment of the health service (high level of confidence), improve health service design and delivery e.g. facilitate 'out of hours' services or treatment closer to home (high level of confidence), enhance community ownership of health services, particularly in LMICs (moderate level of confidence), and improve consumer involvement in strategic decision-making, under certain conditions (moderate level of confidence). There was limited evidence suggesting partnering may improve health service evaluation (very low level of confidence). Best practice principles for formal partnering to promote person-centred care were developed from these findings. The principles were developed collaboratively with the Stakeholder Panel and included leadership and health service culture; diversity; equity; mutual respect; shared vision and regular communication; shared agendas and decision-making; influence and sustainability. AUTHORS' CONCLUSIONS Successful formal group partnerships with consumers require health providers to continually reflect and address power imbalances that may constrain consumers' participation. Such imbalances may be particularly acute in recruitment procedures, meeting structure and content and decision-making processes. Formal group partnerships were perceived to improve the physical environment of health services, the person-centredness of health service culture and health service design and delivery. Implementing the best practice principles may help to address power imbalances, strengthen formal partnering, improve the experiences of consumers and health providers and positively affect partnership outcomes.
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Affiliation(s)
- Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Ariane Virgona
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
- Child and Family Evidence, Australian Institute of Family Studies, Melbourne, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Cheryl Wardrope
- Clinical Governance, Metro South Hospital and Health Service, Eight Mile Plains, Australia
| | | | - Vicki Xafis
- The Sydney Children's Hospitals Network, Sydney, Australia
| | - Cinzia Colombo
- Laboratory for medical research and consumer involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Nora Refahi
- Consumer Representative, Melbourne, Australia
| | - Paul Bryden
- Consumer Representative, Caboolture, Australia
| | - Renee Chmielewski
- Planning and Patient Experience, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | | | | | | | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Susan Biggar
- Consumer Representative, Melbourne, Australia
- Australian Health Practitioner Regulation Agency (AHPRA), Melbourne, Australia
| | - Marie Gill
- Gill and Wilcox Consultancy, Melbourne, Australia
| | - David Menzies
- Chronic Disease Programs, South Eastern Melbourne Primary Health Network, Heatherton, Australia
| | - Carolyn M Gaulden
- Detroit Wayne County Authority Health Residency Program, Michigan State University, Providence Hospital, Southfield, Michigan, USA
| | | | | | - Naomi Poole
- Strategy and Innovation, Australian Commission on Safety and Quality in Health Care, Sydney, Australia
| | - Rebecca E Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Watson L, Link C, Qi S, DeIure A. Quantifying the Impact of Family Doctors on the Care Experiences of Patients with Cancer: Exploring Evidence from the 2021 Ambulatory Oncology Patient Satisfaction Survey in Alberta, Canada. Curr Oncol 2023; 30:641-652. [PMID: 36661698 PMCID: PMC9857946 DOI: 10.3390/curroncol30010049] [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: 12/12/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
Oncology programs across Canada are reaching capacity as more Canadians are diagnosed with and treated for cancer each year. There is an increasing need to share care with family doctors, however it is unclear how this type of care impacts patient experiences, particularly while receiving active treatment. Retrospective data from the 2021 Ambulatory Oncology Patient Satisfaction Survey (AOPSS) in Alberta, Canada was used in this study. A unique question on the Alberta survey asks patients about their family doctor's involvement during their cancer care. Patient satisfaction across the six domains of person-centred care on the AOPSS was analyzed based on how involved a patient's family doctor was. Compared to patients who indicated their family doctor was "Not involved", patients with "Very involved" family doctors had significantly higher satisfaction scores in all six domains of care. The three domains which showed the largest positive impact of family doctor involvement were: Coordination & Integration of Care, Emotional Concerns, and Information, Communication & Education. The results demonstrate that involving family doctors in cancer care can be beneficial for patients. Based on the observed satisfaction increases in this study, shared care models may be preferred by many patients. These models of care can also help alleviate strain and capacity issues within cancer programs. The results could be used to support recommendations for cancer care teams to regularly involve and communicate with family doctors, to ensure that patients receive comprehensive and tailored care from all their health care providers.
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Affiliation(s)
- Linda Watson
- Applied Research & Patient Experience, Cancer Research & Analytics, Cancer Care Alberta—Alberta Health Services, Calgary, AB T2S 3C3, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Claire Link
- Applied Research & Patient Experience, Cancer Research & Analytics, Cancer Care Alberta—Alberta Health Services, Calgary, AB T2S 3C3, Canada
| | - Siwei Qi
- Applied Research & Patient Experience, Cancer Research & Analytics, Cancer Care Alberta—Alberta Health Services, Calgary, AB T2S 3C3, Canada
| | - Andrea DeIure
- Applied Research & Patient Experience, Cancer Research & Analytics, Cancer Care Alberta—Alberta Health Services, Calgary, AB T2S 3C3, Canada
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Sandell T, Schütze H. Factors influencing the translation of shared cancer follow-up care into clinical practice: a systematic review. BMJ Open 2022; 12:e055460. [PMID: 36038175 PMCID: PMC9438010 DOI: 10.1136/bmjopen-2021-055460] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The increasing incidence of cancer, coupled with improved survivorship, has increased demand for cancer follow-up care and the need to find alternative models of care. Shared cancer follow-up care in general practice is a safe option in terms of quality of life and cancer recurrence; however, there are barriers to translating this into practice. This review aimed to identify factors that influence the translation of shared cancer follow-up care into clinical practice. METHODS Systematic review. Seven electronic databases: MEDLINE, Science Citation Index, Academic Search Complete, CINAHL, APA Psychinfo, Health Source: Nursing/Academic Edition and Psychology and Behavioural Sciences Collection, were searched for published papers between January 1999 and December 2021. The narrative review included papers if they were available in full-text, English, peer-reviewed and focused on shared cancer follow-up care. RESULTS Thirty-eight papers were included in the final review. Five main themes emerged: (1) reciprocal clinical information sharing is needed between oncologists and general practitioners, and needs to be timely and relevant; (2) responsibility of care should be shared with the oncologist overseeing care; (3) general practitioners skills and knowledge to provide cancer follow-up care; (4) need for clinical management guidelines and rapid referral to support general practitioners to provide shared follow-up care and (5) continuity of care and satisfaction of care is vital for shared care. CONCLUSION The acceptability of shared cancer follow-up care is increasing. Several barriers still exist to translating this into practice. Work is required to develop a shared-care model that can support general practitioners, while the oncologist can oversee the care and implement two-way communication between general and oncologists' clinics. The move towards integrating electronic healthcare records and web-based platforms for information exchange provides a promise to the timely exchange of information. PROSPERO REGISTRATION NUMBER CRD42020191538.
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Affiliation(s)
- Tiffany Sandell
- School of Medicine, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Radiation Oncology, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Heike Schütze
- School of Medicine, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Centre for Primary Health Care and Equity, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
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Nicolaisen A, Lauridsen GB, Haastrup P, Hansen DG, Jarbøl DE. Healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective: a scoping review. Scand J Prim Health Care 2022; 40:11-28. [PMID: 35254205 PMCID: PMC9090364 DOI: 10.1080/02813432.2022.2036421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE General practice plays an important role in cancer trajectories, and cancer patients request the continuous involvement of general practice. The objective of this scoping review was to identify healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective. DESIGN, SETTING, AND SUBJECTS A scoping review of the literature published in Danish or English from 2010 to 2020 was conducted. Data was collected using identified keywords and indexed terms in several databases (PubMed, MEDLINE, EBSCO CINAHL, Scopus, and ProQuest), contacting key experts, searching through reference lists, and reports from selected health political, research- and interest organizations' websites. MAIN OUTCOME MEASURES We identified healthcare practices in cancer trajectories that increase quality care. Identified healthcare practices were grouped into four contextual domains and allocated to defined phases in the cancer trajectory. The results are presented according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR). RESULTS A total of 45 peer-reviewed and six non-peer-reviewed articles and reports were included. Quality of care increases in all phases of the cancer trajectory when GPs listen carefully to the full story and use action plans. After diagnosis, quality of care increases when GPs and practice staff have a proactive care approach, act as interpreters of diagnosis, treatment options, and its consequences, and engage in care coordination with specialists in secondary care involving the patient. CONCLUSION This scoping review identified healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective. The results support general practice in investigating own healthcare practices and identifying possibilities for quality improvement.KEY POINTSIdentified healthcare practices in general practice that increase the quality of care in cancer trajectories:Listen carefully to the full storyUse action plans and time-out-consultationsPlan and provide proactive careAct as an interpreter of diagnosis, treatment options, and its consequences for the patientCoordinate care with specialists, patients, and caregivers with mutual respectIdentified barriers for quality of care in cancer trajectories are:Time constraints in consultationsLimited accessibility for patients and caregiversHealth practices to increase the quality of care should be effective, safe, people-centered, timely, equitable, integrated, and efficient. These distinctions of quality of care, support general practice in investigating and improving quality of care in cancer trajectories.
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Affiliation(s)
- Anne Nicolaisen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- CONTACT Anne Nicolaisen Research Unit for General Practice, Department of Public Health, University of Southern Denmark, DK-5000Odense C, Denmark
| | - Gitte Bruun Lauridsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Peter Haastrup
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Dorte Gilså Hansen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- The Department of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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10
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Current pediatric cancer survivorship practices: a report from the Children’s Oncology Group. J Cancer Surviv 2022:10.1007/s11764-021-01157-w. [PMID: 35098485 PMCID: PMC8801272 DOI: 10.1007/s11764-021-01157-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/16/2021] [Indexed: 11/24/2022]
Abstract
Purpose The purpose of this study is to describe current survivor services provided by COG institutions. Methods A 190-question online survey was distributed to 209 COG member institutions over a 5-month period in 2017. Descriptive statistics were used to describe survivor services and explore their changes between 2007 and 2017. Results Representatives from 153 (73%) institutions completed the survey. Of these, 96% of institutions reported that they provide pediatric cancer survivor care either in a specialized late effects program (75%) or a regular pediatric oncology clinic (24%). However, only 29.8% of institutions reported that > 75% of eligible patients were seen in a survivorship clinic. The most prevalent reported barriers to survivor care were lack of dedicated time (58%) and lack of funding for program development (41%). In 2017, 88% of institutions provided a treatment summary compared to 31% in 2007. Conclusion The majority of COG institutions have dedicated care for pediatric and young adult survivors of childhood cancer; however, at most institutions, < 75% of eligible patients access this care. Research into more efficient technology strategies is needed to ensure all survivors the opportunity to receive appropriate follow-up care. Implications for Cancer Survivors This survey provides a snapshot of the status of late effects services within COG institutions and provides information on residual gaps in services. Next steps should focus on the importance of attendance in a survivorship clinic on the physical health and psychosocial outcomes in cancer survivors.
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11
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McDaniel SH, Morse DS, Edwardsen EA, Taupin A, Gurnsey MG, Griggs JJ, Shields CG, Reis S. Empathy and boundary turbulence in cancer communication. PATIENT EDUCATION AND COUNSELING 2021; 104:2944-2951. [PMID: 33947581 PMCID: PMC8517043 DOI: 10.1016/j.pec.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To describe and deepen our understanding of patient-centeredness, empathy, and boundary management in challenging conversations. Previous studies show frequent physician self-disclosure, while empathy and boundary management are infrequent. METHODS Three standardized patients (SPs) portrayed cancer patients consulting a new community-based physician, resulting in 39 audio-recorded SP visits to 19 family physicians and 20 medical oncologists. Transcripts underwent qualitative iterative thematic analysis, informed by grounded theory, followed by directed content analysis. We further defined the identified communicative categories with descriptive and correlational calculations. RESULTS We identified patient-centered physician response categories--empathy, affirmation, and acknowledgement; and physician-centered categories-transparency, self-disclosure, and projection. Acknowledgement and affirmation responses were frequent and empathy rare. Physician transparency and self-disclosure were common. Useful and not useful self-disclosures were highly correlated; empathy, useful and not useful transparency, and projection were moderately correlated. Most physicians used self-disclosure but few of these were judged patient-centered. CONCLUSIONS Physicians expressing empathy and patient-centered transparency were also more likely to use projection and physician-centered transparency, thus engaging in communication "boundary turbulence." Patients may benefit from physicians' improved use of empathy and boundary management.
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Affiliation(s)
- Susan H McDaniel
- Dr. Laurie Sands Distinguished Professor of Families & Health, Departments of Psychiatry & Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA.
| | - Diane S Morse
- Associate Professor of Psychiatry and Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Elizabeth A Edwardsen
- Associate Professor of Emergency Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Adam Taupin
- Equilibria Psychological and Consultation Services, Philadelphia, PA, USA
| | | | - Jennifer J Griggs
- Professor of Internal Medicine, Hematology & Oncology Division, University of Michigan, Ann Arbor, MI, USA
| | - Cleveland G Shields
- Professor of Marriage & Family Therapy, Purdue University, West Lafayette, IN, USA
| | - Shmuel Reis
- Professor of Medical Education, Faculty of Medicine, Hebrew University/Hadassah, Jerusalem, Israel
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12
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Zasada M, Yates M, Ayers N, Ide Z, Norton S, Galloway J, Taylor C. Exploring the macro-level, meso-level and micro-level barriers and facilitators to the provision of good quality early inflammatory arthritis (EIA) care in England and Wales. RMD Open 2021; 7:rmdopen-2021-001616. [PMID: 34400579 PMCID: PMC8370504 DOI: 10.1136/rmdopen-2021-001616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background Evidence from a national clinical audit of early inflammatory arthritis (EIA) shows considerable variability between hospitals in performance, unexplained by controlling for case-mix. Objective To explore the macro-level, meso-level and micro-level barriers and facilitators to the provision of good quality EIA care. Methods A qualitative study within 16 purposively sampled rheumatology units across England and Wales. Quality was assessed in relation to 11 quality indicators based on clinical opinion, evidence and variability observed in the data. Data from semi-structured interviews with staff (1–5 from each unit, 56 in total) and an online questionnaire (n=14/16 units) were integrated and analysed using the framework method for thematic analysis using a combined inductive and deductive approach (underpinned by an evidence-based framework of healthcare team effectiveness), and constant comparison of data within and between units and its relationship with the quality criteria. Findings Quality of care was influenced by an interplay between macro, meso and micro domains. The macro (eg, shared care arrangements and relationships with general practitioners) and meso (eg, managerial support and physical infrastructure) factors were found to act as crucial enablers of and barriers to higher quality service provision at the micro (team) level. These organisational factors directly influenced team structure and function, and thereby EIA care quality. Conclusions Variability in quality of EIA care is associated with an interplay between macro, meso and micro service features. Tackling macro and meso barriers is likely to have a significant impact on quality of EIA service, and ultimately patient experience and outcomes.
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Affiliation(s)
| | - Mark Yates
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Nicola Ayers
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Zoë Ide
- Patient Representative, London, UK
| | - Sam Norton
- Department of Psychology and Department of Inflammation Biology, King's College London, London, UK
| | - James Galloway
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
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13
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Pendharkar SR, Blades K, Kelly JE, Tsai WH, Lien DC, Clement F, Woiceshyn J, McBrien KA. Perspectives on primary care management of obstructive sleep apnea: a qualitative study of patients and health care providers. J Clin Sleep Med 2021; 17:89-98. [PMID: 32975193 DOI: 10.5664/jcsm.8814] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Difficulties in providing timely access to care have prompted interest in primary care delivery models for obstructive sleep apnea (OSA). Sustainable implementation of such models requires codesign with input from key stakeholders. The purpose of this study was to identify patient and provider perspectives on barriers and facilitators to optimal, patient-centered management of OSA in a primary care setting. METHODS This study was conducted in Alberta, Canada. Data from key stakeholders were collected through an online survey of primary care providers (n = 119), focus groups and interviews with patients living with OSA (n = 28), and workshops with primary care and sleep providers (n = 36). Quantitative survey data were reported using descriptive statistics, and qualitative data were analyzed using an inductive thematic approach. RESULTS Several barriers were identified, including poor specialist access, variable primary care providers knowledge of OSA, and lack of clarity about provider roles for OSA management. Barriers contributed to patients being poorly informed about OSA, leading them to separate OSA from their overall health and eroding trust in the system. Suggestions for improvement included integration of care providers in a comprehensive model of care, facilitated by improved system navigation and more effective use of technology. Themes were consistent across data collection methods and between stakeholder groups. CONCLUSIONS Although primary care delivery models may improve access to OSA management, stakeholders identified important challenges in the current system. Innovative models of care, developed with input from patients and providers, may mitigate barriers and support optimal primary care management of OSA.
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Affiliation(s)
- Sachin R Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kenneth Blades
- Ward of the 21st Century, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jenny E Kelly
- Ward of the 21st Century, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Willis H Tsai
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dale C Lien
- Respiratory Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Fiona Clement
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jaana Woiceshyn
- Haskayne School of Business, University of Calgary, Calgary, Alberta, Canada
| | - Kerry A McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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14
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Cheung V, Siddiq N, Devlin R, McNamara C, Gupta V. Shared-care model for complex chronic haematological malignancies. Can Oncol Nurs J 2021; 31:165-174. [PMID: 34036155 DOI: 10.5737/23688076312165174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Myeloproliferative neoplasms (MPNs) are a group of rare Philadelphia-negative chronic leukemias. Disease rarity has resulted in limited expertise concentrated in specialist centres. Patients are often referred to such expert centres for diagnostic issues, complex decision-making, access to novel drugs through clinical trials, and supportive care. Attending such appointments may increase financial and travel burden, increase caregiver stress, and negatively impact quality of life. To address this, the MPN program at Princess Margaret (PM) Cancer Centre has implemented a shared-care model, working with local healthcare providers to provide ongoing management, and supportive care for MPN patients closer to home. This decreases patient travel burden, while maintaining high-quality patient-centered care. In this article we share our experience implementing the shared-care model. This model is potentially applicable to other chronic hematological malignancies and rare chronic diseases. The ultimate goal of shared-care is not to centralize care, but instead to build a community of accessible care for the patient.
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Affiliation(s)
- Verna Cheung
- Clinical Nurse Specialist, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - Nancy Siddiq
- MSN in Education Nurse Practitioner (Adult), Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - Rebecca Devlin
- Scientific Associate, The Elizabeth and Tony Comper MPN Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - Caroline McNamara
- Staff Hematologist, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - Vikas Gupta
- Professor of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
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15
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Smith DT, Barrett J, Acher AW, Joachim A, Huynh B, Schreiter N, Stafford LC, Abbott DE, Alagoz E. Patient preferences for GI cancer surveillance and telemedical follow-up. Surg Oncol 2021; 38:101593. [PMID: 33945960 DOI: 10.1016/j.suronc.2021.101593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/26/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Surveillance care including routine physical exams and testing following gastrointestinal (GI) cancer treatment can be fiscally and emotionally burdensome for patients. Emerging technology platforms may provide a resource-wise surveillance strategy. However, effective implementation of GI cancer surveillance is limited by a lack of patient level perspective regarding surveillance. This study aimed to describe patient attitudes toward GI cancer surveillance and which care modalities such as telemedicine and care team composition best meet the patient's needs for follow-up care. METHODS Focused interviews were conducted with 15 GI cancer patients undergoing surveillance following curative-intent surgery. All interviews were audio recorded, transcribed verbatim, and uploaded to NVivo. Study personnel trained in qualitative methods consensus coded 10% of data inductively and iteratively developed a codebook and code descriptions. Using all transcripts, data matrices were developed to identify themes inherent in the transcripts. RESULTS Qualitative analysis revealed three overarching themes. First, increasing ease of access to surveillance care through telemedicine follow-up services may interfere with patients' preferred follow-up routine, which is an in-office visit. Second, specialist providers were trusted by patients to deliver surveillance care more than primary care providers (PCPs). Thirdly, patients desired improved psychosocial health support during the surveillance period. CONCLUSION These novel patient-level qualitative data demonstrate that replacing conventional in-office GI cancer surveillance care with telemedicine is not what many patients desire. These data also demonstrate that his cohort of patients prefer to see specialists for GI cancer surveillance care rather than PCPs. Future efforts to enhance surveillance should include increased psychosocial support. Telemedicine implementation should be personalized toward specific populations who may be interested in fewer in-office surveillance visits.
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Affiliation(s)
- David T Smith
- University of Wisconsin-Madison, School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53705, USA
| | - James Barrett
- University of Wisconsin-Madison, School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53705, USA
| | - Alexandra W Acher
- University of Wisconsin-Madison, School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53705, USA
| | - Alyssa Joachim
- University of Wisconsin-Madison, School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53705, USA
| | - Brandon Huynh
- University of Wisconsin-Madison, School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53705, USA
| | - Nicholas Schreiter
- University of Wisconsin-Madison, School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53705, USA
| | - Linda Cherney Stafford
- University of Wisconsin-Madison, School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53705, USA
| | - Daniel E Abbott
- University of Wisconsin-Madison, School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53705, USA
| | - Esra Alagoz
- University of Wisconsin-Madison, School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53705, USA.
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16
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Yin MY, Strege J, Gilbert EM, Stehlik J, McKellar SH, Elmer A, Anderson T, Aljuaid M, Nativi-Nicolau J, Koliopoulou AG, Davis E, Fang JC, Drakos SG, Selzman CH, Wever-Pinzon O. Impact of Shared Care in Remote Areas for Patients With Left Ventricular Assist Devices. JACC-HEART FAILURE 2021; 8:302-312. [PMID: 32241537 DOI: 10.1016/j.jchf.2020.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of a shared-care model on outcomes in patients with left ventricular assist devices (LVADs) living in remote locations. BACKGROUND Health care delivery through shared-care models has been shown to improve outcomes in patients with chronic diseases. However, the impact of shared-care models on outcomes in patients with LVAD is unknown. METHODS LVAD recipients in the authors' program (2007 to 2018) were classified based on the levels of care provided and training and resources used: level 1, was defined as outpatient primary care without LVAD-specific care; level 2 was level 1 services and outpatient LVAD-specific care; level 3 was level 2 services and inpatient LVAD-specific care and implantation center (IC). The Kaplan-Meier method was used to compare rates of survival, bleeding, pump thrombosis, infection, neurologic events, and readmissions among levels of care. RESULTS A total of 336 patients were included, with 255 patients (75.9%) cared for in shared-care facilities. Median follow-up was 810 (interquartile range: 321 to 1,096) days. In comparison to patients cared for by IC, patients at levels 2 and 3 shared-care centers had similar rates of death, bleeding, neurologic events, pump thromboses, and infections. However, the rates of death, pump thromboses, and infections were higher for level 1 patients than in IC patients. CONCLUSIONS Shared health care is an effective strategy to deliver care to patients with LVAD living in remote locations. However, patients in shared-care facilities unable to provide LVAD-specific care are at higher risk of unfavorable outcomes. Availability of LVAD-specific care should be strongly considered during patient selection and every effort made to ensure LVAD-specific training and resources are available at shared-care facilities.
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Affiliation(s)
- Michael Yaoyao Yin
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Jennifer Strege
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Edward M Gilbert
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Josef Stehlik
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Stephen H McKellar
- Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Ashley Elmer
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Thomas Anderson
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Mossab Aljuaid
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Jose Nativi-Nicolau
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | | | - Erin Davis
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - James C Fang
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Stavros G Drakos
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah
| | - Craig H Selzman
- Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Omar Wever-Pinzon
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah.
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17
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Sandell T, Schütze H, Miller A. A Shared Cancer Follow-Up Model of Care Between General Practitioners and Radiation Oncologists for Patients With Breast, Prostate, and Colorectal Cancer: Protocol for a Mixed Methods Implementation Study. JMIR Res Protoc 2021; 10:e21752. [PMID: 33464209 PMCID: PMC7854032 DOI: 10.2196/21752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/10/2020] [Accepted: 12/08/2020] [Indexed: 01/15/2023] Open
Abstract
Background The rising incidence of cancer and increasing numbers of cancer survivors have resulted in the need to find alternative models of care for cancer follow-up care. The acceptability for follow-up care in general practice is growing, and acceptance increases with shared-care models where oncologists continue to oversee the care. However, a major barrier to this model is the effective exchange of information in real time between oncologists and general practitioners. Improved communication technology plays an important role in the acceptability and feasibility of shared cancer follow-up care. Objective The aim of this study is to evaluate the feasibility and acceptability of a shared cancer follow-up model of care between patients, general practitioners and radiation oncologists. Methods This is a mixed methods, multisite implementation study exploring shared follow-up care for breast, colorectal, and prostate cancer patients treated with curative radiotherapy in New South Wales, Australia. This study uses web-based technology to support general practitioners in performing some aspects of routine radiotherapy follow-up care, while being overseen by a radiation oncologist in real time. The study has two phases: Phase 1 is designed to establish the level of agreement between general practitioners and radiation oncologists and Phase 2 is designed to implement shared follow-up care into practice and to evaluate this implementation. Results Recruitment of radiation oncologists, patients, and general practitioners commenced in December 2020 and will continue until February 2021. Data collection will occur during 2021, and data will be ready for analysis by the end of 2021. Conclusions Few studies have investigated the role of health technologies in supporting communication deficiencies for shared cancer follow-up care. The implementation and evaluation of models of care need to be conducted using a person-centered approach that is responsive to patients’ preferences and needs. Should the findings of the study be acceptable and feasible to radiation oncologists, general practitioners, and patients, it can be quickly implemented and expanded to other tumor groups or to medical oncology and hematology. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12620001083987; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380057 International Registered Report Identifier (IRRID) PRR1-10.2196/21752
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Affiliation(s)
- Tiffany Sandell
- Wollongong Hospital, Wollongong, Australia.,University of Wollongong, Wollongong, Australia
| | - Heike Schütze
- University of Wollongong, Wollongong, Australia.,University of New South Wales, Sydney, Australia
| | - Andrew Miller
- Wollongong Hospital, Wollongong, Australia.,University of Wollongong, Wollongong, Australia
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18
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Sharing Cancer Survivorship Care between Oncology and Primary Care Providers: A Qualitative Study of Health Care Professionals' Experiences. J Clin Med 2020; 9:jcm9092991. [PMID: 32947973 PMCID: PMC7563389 DOI: 10.3390/jcm9092991] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022] Open
Abstract
Survivorship care that is shared between oncology and primary care providers may be a suitable model to effectively and efficiently care for the growing survivor population, however recommendations supporting implementation are lacking. This qualitative study aimed to explore health care professionals’ (HCPs) perceived facilitators and barriers to the implementation, delivery and sustainability of shared survivorship care. Data were collected via semi-structured focus groups and analysed by inductive thematic analysis. Results identified four overarching themes: (1) considerations for HCPs; (2) considerations regarding patients; (3) considerations for planning and process; and (4) policy implications. For HCPs, subthemes included general practitioner (GP, primary care physician) knowledge and need for further training, having clear protocols for follow-up, and direct communication channels between providers. Patient considerations included identifying patients suitable for shared care, discussing shared care with patients early in their cancer journey, and patients’ relationships with their GPs. Regarding process, subthemes included rapid referral pathways back to hospital, care coordination, and ongoing data collection to inform refinement of a dynamic model. Finally, policy implications included development of policy to support a consistent shared care model, and reliable and sustainable funding mechanisms. Based on study findings, a set of recommendations for practice and policy were developed.
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19
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Fok RWY, Low LL, Quah HMJ, Vasanwala F, Low SG, Soh LL, Mohamad F, Loh KWJ, Soong YL, Ke Y, Chan A, Tan NC. Roles and recommendations from primary care physicians towards managing low-risk breast cancer survivors in a shared-care model with specialists in Singapore-a qualitative study. Fam Pract 2020; 37:547-553. [PMID: 32030402 PMCID: PMC7474530 DOI: 10.1093/fampra/cmaa009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Breast cancer is prevalent and has high cure rates. The resultant increase in numbers of breast cancer survivors (BCS) may overwhelm the current oncology workforce in years to come. We postulate that primary care physicians (PCPs) could play an expanded role in comanaging survivors, provided they are given the appropriate tools and training to do so. OBJECTIVE To explore the perspectives of PCPs towards managing BCS in a community-based shared-care programme with oncologists. METHODS Eleven focus groups and six in-depth interviews were conducted with seventy PCPs recruited by purposive sampling. All sessions were audio-recorded, transcribed verbatim and coded by three independent investigators. Thematic data analysis was performed and the coding process facilitated by NVivo 12. RESULTS Majority of PCPs reported currently limited roles in managing acute and non-cancer issues, optimizing comorbidities and preventive care. PCPs aspired to expand their role to include cancer surveillance, risk assessment and addressing unmet psychosocial needs. PCPs preferred to harmonize cancer survivorship management of their primary care patients who are also BCS, with defined role distinct from oncologists. Training to understand the care protocol, enhancement of communication skills, confidence and trust were deemed necessary. PCPs proposed selection criteria of BCS and adequacy of their medical information; increased consultation time; contact details and timely access to oncologists (if needed) in the shared-care programme. CONCLUSIONS PCPs were willing to share the care of BCS with oncologists but recommended role definition, training, clinical protocol, resources and access to oncologist's consultation to optimize the programme implementation.
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Affiliation(s)
- Rose Wai-Yee Fok
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Lian Leng Low
- Family Medicine and Continuing Care, Singapore General Hospital, Singapore.,Family Medicine Academy Clinical Programme, Duke-NUS Graduate Medical School Singapore, Singapore
| | - Hui Min Joanne Quah
- Family Medicine Academy Clinical Programme, Duke-NUS Graduate Medical School Singapore, Singapore.,SingHealth Polyclinics, Singapore
| | | | - Sher Guan Low
- Post-Acute and Continuing Care, Sengkang Community Hospital, Singapore
| | - Ling Ling Soh
- Post-Acute and Continuing Care, Sengkang Community Hospital, Singapore
| | - Farid Mohamad
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Kiley Wei-Jen Loh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Yu Ke
- Department of Pharmacy, National University of Singapore, Singapore
| | - Alexandre Chan
- Family Medicine Academy Clinical Programme, Duke-NUS Graduate Medical School Singapore, Singapore.,Department of Pharmacy, National University of Singapore, Singapore.,Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - Ngiap-Chuan Tan
- Family Medicine Academy Clinical Programme, Duke-NUS Graduate Medical School Singapore, Singapore.,SingHealth Polyclinics, Singapore
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20
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Lisy K, Kent J, Piper A, Jefford M. Facilitators and barriers to shared primary and specialist cancer care: a systematic review. Support Care Cancer 2020; 29:85-96. [PMID: 32803729 DOI: 10.1007/s00520-020-05624-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/09/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To care for the growing population of cancer survivors, health services worldwide must reconsider how to deliver care to people living with and beyond a cancer diagnosis. Shared care, defined as cancer care that is shared between specialist and primary care providers, is one model that has been investigated; however, practical guidance to support implementation is lacking. This systematic review aimed to explore facilitators and barriers to implementing shared cancer care and to develop practice and policy recommendations to support implementation. METHODS A systematic literature search was conducted in June 2019 across MEDLINE, Embase, Emcare, and PsycINFO databases. Quantitative and qualitative data relevant to the review question were extracted and synthesized following a mixed methods approach. RESULTS Thirteen papers were included in the review, 10 qualitative and three quantitative. Included articles were from Australia (n = 8), the USA (n = 3), and one each from the UK and the Netherlands. Sixteen themes were developed under four categories of patient, healthcare professional, process, and policy factors. Key themes included the perceived need for primary care provider training, having clearly defined roles for each healthcare provider, providing general practitioners with diagnostic and treatment summaries, as well as protocols or guidelines for follow-up care, ensuring rapid and accurate communication between providers, utilizing electronic medical records and survivorship care plans as communication tools, and developing consistent policy to reduce fragmentation across services. CONCLUSION Recommendations for practice and policy were generated based on review findings that may support broader implementation of shared cancer care.
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Affiliation(s)
- Karolina Lisy
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.
| | - Jennifer Kent
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Amanda Piper
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Jefford
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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21
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Shared Care During Breast and Colorectal Cancer Treatment: Is It Associated With Patient-Reported Care Quality? J Healthc Qual 2020; 41:281-296. [PMID: 30829854 DOI: 10.1097/jhq.0000000000000192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
There is growing evidence that shared care, where the oncologist, primary care physician, and/or other specialty physicians jointly participate in care, can improve the quality of patients' cancer care. This cross-sectional study of breast and colorectal cancer patients (N = 534) recruited from the New Jersey State Cancer Registry examined patient and health system factors associated with receipt of shared care during cancer treatment into the early survivorship phase. We also assessed whether shared care was associated with quality indicators of cancer care: receipt of comprehensive care, follow-up care instructions, and written treatment summaries. Less than two-thirds of participants reported shared care during their cancer treatment. The odds of reporting shared care were 2.5 (95% CI: 1.46-4.17) times higher for colorectal than breast cancer patients and 52% (95% CI: 0.24-0.95) lower for uninsured compared with privately insured, after adjusting for other sociodemographic, clinical/tumor, and health system factors. No significant relationships were observed between shared care and quality indicators of cancer care. Given a substantial proportion of patients did not receive shared care, there may be missed opportunities for integrating primary care and nononcology specialists in cancer care, who can play critical roles in care coordination and managing comorbidities during cancer treatment.
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22
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Qaderi SM, Swartjes H, Custers JAE, de Wilt JHW. Health care provider and patient preparedness for alternative colorectal cancer follow-up; a review. Eur J Surg Oncol 2020; 46:1779-1788. [PMID: 32571636 DOI: 10.1016/j.ejso.2020.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/06/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022] Open
Abstract
Follow-up after curative treatment for colorectal cancer (CRC) puts pressure on outpatient services due to the growing number of CRC survivors. The aim of this state-of-the-art review was to evaluate setting, manner and provider of follow-up. Moreover, perceptions of CRC survivors and health care providers regarding standard and alternative follow-up were examined. After a comprehensive literature search of the PubMed database, 69 articles were included reporting on CRC follow-up in the hospital, primary care and home setting. Hospital-based follow-up is most common and has been provided by surgeons, medical oncologists, and gastroenterologists, as well as nurses. Primary care-based follow-up has been provided by general practitioners or nurses. Even though most hospital- or primary care-based follow-up care requires patients to visit the clinic, telephone-based care has proven to be a feasible alternative. Most patients perceived follow-up as positive; valuing screening and detection for disease recurrence and appreciating support for physical and psychosocial symptoms. Hospital-based follow-up performed by the medical specialist or nurse is highly preferred by patients and health care providers. However, willingness of both patients and health care providers for alternative, primary care or remote follow-up exists. Nurse-led and GP-led follow-up have proven to be cost-effective alternatives compared to specialist-led follow-up. If proven safe and acceptable, remote follow-up can become a cost-effective alternative. To decrease the personal and financial burden of follow-up for a growing number of colorectal cancer survivors, a more acceptable, flexible and dynamic care follow-up mode consisting of enhanced communication and role definitions among clinicians is warranted.
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Affiliation(s)
- S M Qaderi
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - H Swartjes
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J A E Custers
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J H W de Wilt
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
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23
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Nababan T, Hoskins A, Watters E, Leong J, Saunders C, Slavova-Azmanova N. 'I had to tell my GP I had lung cancer': patient perspectives of hospital- and community-based lung cancer care. Aust J Prim Health 2020; 26:147-152. [PMID: 32290950 DOI: 10.1071/py19191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/11/2020] [Indexed: 11/23/2022]
Abstract
Lung cancer care spans both hospital- and community-based healthcare settings, and suboptimal communication between healthcare providers impacts on continuity and quality of care. Patients' experiences regarding: (1) communication between healthcare providers; and (2) the role of their GP during cancer treatment was explored in interviews with 47 Western Australian lung cancer patients. Thematic analysis using a phenomenological approach was undertaken to derive key themes regarding participant experiences. Poor communication between hospital cancer specialists (HCSs) influenced participants' treatment choices and perceptions of the quality of their care. Information provided by HCSs to GPs was often delayed or incomplete, and many participants perceived themselves as a messenger between healthcare settings. Participants' opinions about the GP role during cancer treatment ranged from 'no role' to an 'active member of the treating team'. A new model of cancer care is needed where the GP is considered part of the treating team. Early involvement of GPs and two-way communication between hospital and primary care during the disease continuum is required for this to occur.
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Affiliation(s)
- Tara Nababan
- Cancer and Palliative Care Research and Evaluation Unit, Medical School, University of Western Australia, Nedlands, WA 6009, Australia; and Corresponding author.
| | - Anke Hoskins
- Cancer and Palliative Care Research and Evaluation Unit, Medical School, University of Western Australia, Nedlands, WA 6009, Australia
| | - Emily Watters
- Cancer and Palliative Care Research and Evaluation Unit, Medical School, University of Western Australia, Nedlands, WA 6009, Australia
| | - Jeanie Leong
- Department of Respiratory Medicine, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Christobel Saunders
- Cancer and Palliative Care Research and Evaluation Unit, Medical School, University of Western Australia, Nedlands, WA 6009, Australia
| | - Neli Slavova-Azmanova
- Cancer and Palliative Care Research and Evaluation Unit, Medical School, University of Western Australia, Nedlands, WA 6009, Australia
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24
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Wybrew R, Loynd M, Wybrew M, Samuel L. Case Report: Management of an Elderly Patient With Metastatic Radioiodine-Resistant Differentiated Thyroid Cancer in a Rural Community, Remote From Specialist Oncology Services. Front Endocrinol (Lausanne) 2020; 11:581014. [PMID: 33597920 PMCID: PMC7883396 DOI: 10.3389/fendo.2020.581014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/03/2020] [Indexed: 11/13/2022] Open
Abstract
This case report describes an elderly patient with radioiodine-resistant differentiated thyroid cancer and additional multiple metastases living in a rural setting, remote from the specialist oncology service. This case is of interest because effective systemic therapies for treatment-resistant cancers, such as lenvatinib, are now available but can potentially cause significant toxicities that require extensive medical management. Here, we discuss how patient care was provided collaboratively by the local community teams integrated with remote specialist oncology services. A 77-year-old patient presented with symptoms of cauda equina secondary to a large metastatic sacral deposit. The deposit was biopsied, and histology revealed a diagnosis of differentiated follicular thyroid cancer that was treated with external beam radiotherapy and thyroidectomy, followed by radioiodine. However, the disease was found to be resistant to radioiodine therapy, and the patient subsequently developed back pain due to new bone metastases. After further palliative external beam radiotherapy, the patient was started on systemic treatment with lenvatinib. Treatment has continued for more than 2.5 years with a slow but steady improvement in symptoms and quality of life. Monitoring and assessment of lenvatinib therapy and management of associated toxicities was coordinated remotely from a specialist cancer center over 200 miles away, using the skills of the local medical and nursing teams. This case report demonstrates how a cooperative effort using local teams and video-conferencing links to a specialist cancer center can be applied to safely treat a patient with a medication that may result in significant potential toxicities that require attentive and dynamic management.
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Affiliation(s)
| | - Michael Loynd
- Cancer Nursing Service, Caithness General Hospital, Wick, United Kingdom
| | - Maria Wybrew
- Prince’s Street Practice, Thurso, United Kingdom
| | - Leslie Samuel
- Anchor Unit – Clinic D, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- *Correspondence: Leslie Samuel,
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25
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Abdur Rahman M, Rashid MM, Le Kernec J, Philippe B, Barnes SJ, Fioranelli F, Yang S, Romain O, Abbasi QH, Loukas G, Imran M. A Secure Occupational Therapy Framework for Monitoring Cancer Patients' Quality of Life. SENSORS (BASEL, SWITZERLAND) 2019; 19:E5258. [PMID: 31795384 PMCID: PMC6928807 DOI: 10.3390/s19235258] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/07/2019] [Accepted: 11/22/2019] [Indexed: 02/02/2023]
Abstract
Once diagnosed with cancer, a patient goes through a series of diagnosis and tests, which are referred to as "after cancer treatment". Due to the nature of the treatment and side effects, maintaining quality of life (QoL) in the home environment is a challenging task. Sometimes, a cancer patient's situation changes abruptly as the functionality of certain organs deteriorates, which affects their QoL. One way of knowing the physiological functional status of a cancer patient is to design an occupational therapy. In this paper, we propose a blockchain and off-chain-based framework, which will allow multiple medical and ambient intelligent Internet of Things sensors to capture the QoL information from one's home environment and securely share it with their community of interest. Using our proposed framework, both transactional records and multimedia big data can be shared with an oncologist or palliative care unit for real-time decision support. We have also developed blockchain-based data analytics, which will allow a clinician to visualize the immutable history of the patient's data available from an in-home secure monitoring system for a better understanding of a patient's current or historical states. Finally, we will present our current implementation status, which provides significant encouragement for further development.
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Affiliation(s)
- Md. Abdur Rahman
- Department of Cyber Security and Forensic Computing, College of Computer and Cyber Sciences (C3S), University of Prince Mugrin, Madinah 41499, Saudi Arabia
| | - Md. Mamunur Rashid
- Consumer and Organisational Digital Analytics (CODA) Research Centre, King’s Business School, King’s College, London WC2B 4BG, UK; (M.M.R.); (S.J.B.)
| | - Julien Le Kernec
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK; (J.L.K.); (F.F.); (S.Y.); (Q.H.A.); (M.I.)
- Laboratoire ETIS, Université Paris Seine, Université Cergy-Pontoise, ENSEA, CNRS, UMR8051, 95000 Paris, France;
- School of Information and Communication, University of Electronic, Science, and Technology of China, Chengdu 610000, China
| | - Bruno Philippe
- Pneumology Department, René Dubos Hospital, 95300 Pontoise, France;
| | - Stuart J. Barnes
- Consumer and Organisational Digital Analytics (CODA) Research Centre, King’s Business School, King’s College, London WC2B 4BG, UK; (M.M.R.); (S.J.B.)
| | - Francesco Fioranelli
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK; (J.L.K.); (F.F.); (S.Y.); (Q.H.A.); (M.I.)
| | - Shufan Yang
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK; (J.L.K.); (F.F.); (S.Y.); (Q.H.A.); (M.I.)
| | - Olivier Romain
- Laboratoire ETIS, Université Paris Seine, Université Cergy-Pontoise, ENSEA, CNRS, UMR8051, 95000 Paris, France;
| | - Qammer H. Abbasi
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK; (J.L.K.); (F.F.); (S.Y.); (Q.H.A.); (M.I.)
| | - George Loukas
- Computing and Mathematical Sciences, University of Greenwich, London SE1 09LS, UK;
| | - Muhammad Imran
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK; (J.L.K.); (F.F.); (S.Y.); (Q.H.A.); (M.I.)
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26
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Høeg BL, Bidstrup PE, Karlsen RV, Friberg AS, Albieri V, Dalton SO, Saltbæk L, Andersen KK, Horsboel TA, Johansen C. Follow-up strategies following completion of primary cancer treatment in adult cancer survivors. Cochrane Database Syst Rev 2019; 2019:CD012425. [PMID: 31750936 PMCID: PMC6870787 DOI: 10.1002/14651858.cd012425.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most cancer survivors receive follow-up care after completion of treatment with the primary aim of detecting recurrence. Traditional follow-up consisting of fixed visits to a cancer specialist for examinations and tests are expensive and may be burdensome for the patient. Follow-up strategies involving non-specialist care providers, different intensity of procedures, or addition of survivorship care packages have been developed and tested, however their effectiveness remains unclear. OBJECTIVES The objective of this review is to compare the effect of different follow-up strategies in adult cancer survivors, following completion of primary cancer treatment, on the primary outcomes of overall survival and time to detection of recurrence. Secondary outcomes are health-related quality of life, anxiety (including fear of recurrence), depression and cost. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, four other databases and two trials registries on 11 December 2018 together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA We included all randomised trials comparing different follow-up strategies for adult cancer survivors following completion of curatively-intended primary cancer treatment, which included at least one of the outcomes listed above. We compared the effectiveness of: 1) non-specialist-led follow-up (i.e. general practitioner (GP)-led, nurse-led, patient-initiated or shared care) versus specialist-led follow-up; 2) less intensive versus more intensive follow-up (based on clinical visits, examinations and diagnostic procedures) and 3) follow-up integrating additional care components relevant for detection of recurrence (e.g. patient symptom education or monitoring, or survivorship care plans) versus usual care. DATA COLLECTION AND ANALYSIS We used the standard methodological guidelines by Cochrane and Cochrane Effective Practice and Organisation of Care (EPOC). We assessed the certainty of the evidence using the GRADE approach. For each comparison, we present synthesised findings for overall survival and time to detection of recurrence as hazard ratios (HR) and for health-related quality of life, anxiety and depression as mean differences (MD), with 95% confidence intervals (CI). When meta-analysis was not possible, we reported the results from individual studies. For survival and recurrence, we used meta-regression analysis where possible to investigate whether the effects varied with regards to cancer site, publication year and study quality. MAIN RESULTS We included 53 trials involving 20,832 participants across 12 cancer sites and 15 countries, mainly in Europe, North America and Australia. All the studies were carried out in either a hospital or general practice setting. Seventeen studies compared non-specialist-led follow-up with specialist-led follow-up, 24 studies compared intensity of follow-up and 12 studies compared patient symptom education or monitoring, or survivorship care plans with usual care. Risk of bias was generally low or unclear in most of the studies, with a higher risk of bias in the smaller trials. Non-specialist-led follow-up compared with specialist-led follow-up It is uncertain how this strategy affects overall survival (HR 1.21, 95% CI 0.68 to 2.15; 2 studies; 603 participants), time to detection of recurrence (4 studies, 1691 participants) or cost (8 studies, 1756 participants) because the certainty of the evidence is very low. Non-specialist- versus specialist-led follow up may make little or no difference to health-related quality of life at 12 months (MD 1.06, 95% CI -1.83 to 3.95; 4 studies; 605 participants; low-certainty evidence); and probably makes little or no difference to anxiety at 12 months (MD -0.03, 95% CI -0.73 to 0.67; 5 studies; 1266 participants; moderate-certainty evidence). We are more certain that it has little or no effect on depression at 12 months (MD 0.03, 95% CI -0.35 to 0.42; 5 studies; 1266 participants; high-certainty evidence). Less intensive follow-up compared with more intensive follow-up Less intensive versus more intensive follow-up may make little or no difference to overall survival (HR 1.05, 95% CI 0.96 to 1.14; 13 studies; 10,726 participants; low-certainty evidence) and probably increases time to detection of recurrence (HR 0.85, 95% CI 0.79 to 0.92; 12 studies; 11,276 participants; moderate-certainty evidence). Meta-regression analysis showed little or no difference in the intervention effects by cancer site, publication year or study quality. It is uncertain whether this strategy has an effect on health-related quality of life (3 studies, 2742 participants), anxiety (1 study, 180 participants) or cost (6 studies, 1412 participants) because the certainty of evidence is very low. None of the studies reported on depression. Follow-up strategies integrating additional patient symptom education or monitoring, or survivorship care plans compared with usual care: None of the studies reported on overall survival or time to detection of recurrence. It is uncertain whether this strategy makes a difference to health-related quality of life (12 studies, 2846 participants), anxiety (1 study, 470 participants), depression (8 studies, 2351 participants) or cost (1 studies, 408 participants), as the certainty of evidence is very low. AUTHORS' CONCLUSIONS Evidence regarding the effectiveness of the different follow-up strategies varies substantially. Less intensive follow-up may make little or no difference to overall survival but probably delays detection of recurrence. However, as we did not analyse the two outcomes together, we cannot make direct conclusions about the effect of interventions on survival after detection of recurrence. The effects of non-specialist-led follow-up on survival and detection of recurrence, and how intensity of follow-up affects health-related quality of life, anxiety and depression, are uncertain. There was little evidence for the effects of follow-up integrating additional patient symptom education/monitoring and survivorship care plans.
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Affiliation(s)
- Beverley L Høeg
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Pernille E Bidstrup
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Randi V Karlsen
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Anne Sofie Friberg
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Rigshospitalet, Copenhagen University HospitalDepartment of OncologyCopenhagenDenmark
| | - Vanna Albieri
- Danish Cancer Society Research CenterStatistics and Pharmaco‐Epidemiology UnitStrandboulevarden 49CopenhagenDenmark
| | - Susanne O Dalton
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Zealand University HospitalDepartment of OncologyNæstvedDenmark
| | - Lena Saltbæk
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Zealand University HospitalDepartment of OncologyNæstvedDenmark
| | - Klaus Kaae Andersen
- Danish Cancer Society Research CenterStatistics and Pharmaco‐Epidemiology UnitStrandboulevarden 49CopenhagenDenmark
| | - Trine Allerslev Horsboel
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Christoffer Johansen
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Rigshospitalet, Copenhagen University HospitalDepartment of OncologyCopenhagenDenmark
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27
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Loh KWJ, Ng T, Choo SP, Saw HM, Mahendran R, Tan C, Chang GCY, Ong YJ, Yee ACP, Chan A, Soo KC. Cancer Supportive and Survivorship Care in Singapore: Current Challenges and Future Outlook. J Glob Oncol 2019; 4:1-8. [PMID: 30241247 PMCID: PMC6223422 DOI: 10.1200/jgo.17.00117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Despite being a relatively young nation, Singapore has established itself as a leading multifaceted medical hub, both regionally and globally. Although Singapore continues to pursue excellence in oncology care, cancer supportive care and survivorship care remain in the infancy stage. In an effort to advance this important aspect of oncology care in Singapore, the first cancer supportive and survivorship care forum was held in December 2016, involving 74 oncology practitioners. The primary goals of this forum were to raise awareness of the importance of cancer supportive and survivorship care and to provide a platform for oncology practitioners of diverse backgrounds to converge and address the challenges associated with the delivery of cancer supportive and survivorship care in Singapore. Key challenges identified during this forum included, but were not limited to, care fragmentation in an oncologist-centric model of care, poor integration of allied health and rehabilitation services, passive engagement of community partners, lack of specialized skill sets and knowledge in supportive and survivorship care, and patient-related barriers such as poor health literacy. The survivorship care model commonly used in Singapore places an imbalanced emphasis on surveillance for cancer recurrence and second primary cancers, with little attention given to the supportive and survivorship needs of the survivors. In summary, these challenges set the stage for the development and use of a more survivor-centric model, one that focuses not only on cancer surveillance, but also on the broad and unique physical and psychosocial needs of survivors of cancer in Singapore.
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Affiliation(s)
- Kiley Wei-Jen Loh
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Terence Ng
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Su Pin Choo
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Hay Mar Saw
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Rathi Mahendran
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Celia Tan
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Gail Chia Yang Chang
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Yew Jin Ong
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Alethea Chung Pheng Yee
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Alexandre Chan
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Khee Chee Soo
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
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Blocka J, Durie BGM, Huhn S, Mueller-Tidow C, Försti A, Hemminki K, Goldschmidt H. Familial Cancer: How to Successfully Recruit Families for Germline Mutations Studies? Multiple Myeloma as an Example. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:635-644.e2. [PMID: 31377209 DOI: 10.1016/j.clml.2019.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/15/2019] [Accepted: 06/27/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Identification of germline mutations related to an increased cancer risk enables diagnostic, preventive, and therapeutic measures for individuals carrying the disease variant. However, recruitment of families for studies on these mutations can be challenging. Herein we present some of the obstacles that can arise during such studies. We suggest solutions for overcoming or avoiding these difficulties, enabling an efficient and ethically correct family recruitment. PATIENTS AND METHODS We describe a study on germline mutations associated with familial risk of multiple myeloma using next-generation sequencing of the whole genome. To date, the study has recruited 54 participants/16 families from different centers in Germany. It was performed at the University Hospital of Heidelberg and German Cancer Research Center. RESULTS We were confronted with ethical/psychological concerns of patients and family members, a large number of ineligible families, a profound time investment by the participants and the study team, incidental findings, and participants' death. We present solutions to these difficulties such as: knowledge of and adherence to the laws protecting participants' rights, an exact clarification of the inclusion and exclusion criteria, a clear division of tasks within members of the study team, a collaboration with general practitioners/oncologists and patients' support groups, a detailed and understandable informed consent including information about incidental findings, and a choice of a representative in case of participant's death. CONCLUSION A successful recruitment for studies on familial cancer is challenging, yet possible. It can be facilitated by applying the previously mentioned strategies.
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Affiliation(s)
- Joanna Blocka
- Department of Hematology, Oncology, and Rheumatology, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Brian G M Durie
- Department of Hematology and Oncology, Cedars-Sinai Outpatient Cancer Center, Los Angeles, CA
| | - Stefanie Huhn
- Department of Hematology, Oncology, and Rheumatology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Carsten Mueller-Tidow
- Department of Hematology, Oncology, and Rheumatology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Asta Försti
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Kari Hemminki
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Hematology, Oncology, and Rheumatology, University Hospital of Heidelberg, Heidelberg, Germany; Department of Hematology and Oncology, National Center of Tumor Diseases, Heidelberg, Germany
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Outpatient Cancer Care Delivery in the Context of E-Oncology: A French Perspective on "Cancer outside the Hospital Walls". Cancers (Basel) 2019; 11:cancers11020219. [PMID: 30769858 PMCID: PMC6406853 DOI: 10.3390/cancers11020219] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/06/2019] [Accepted: 02/10/2019] [Indexed: 01/21/2023] Open
Abstract
In oncology, the treatment of patients outside of hospitals has become imperative due to an increasing number of patients who are older and live longer, along with issues such as medical desertification, oncologist hyperspecialization, and difficulties in financing mounting health expenditures. Treatments have become less "invasive", with greater precision and efficiency. Patients can therefore receive most of their care outside of hospitals. The development of e-health can address these new imperatives. In this letter, we describe the different e-health tools and their potential clinical impacts in oncology, as already reported at every level of care, including education, prevention, diagnosis, treatment, and monitoring. A few randomized studies have yet demonstrated the clinical benefit. We also comment on issues and limits of "cancer outside the hospital walls" from the point of view of patients, health care professionals, health facilities, and public authorities. Care providers in hospitals and communities will have to adapt to these changes within well-coordinated networks in order to better meet patient expectations regarding increasing education and personalizing management. Ultimately, controlled studies should aim to definitively demonstrate areas of interest, benefits, and incentives, for not only patients, but also caregivers (formal and informal) and health care providers, health care facilities, and the nation.
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Friesen-Storms JH, Bours GJ, Snijders IC, van der Weijden T, Jie KSG, Beurskens AJ. A conversation approach based on shared goal-setting and shared decision-making for nurses in cancer aftercare: A developmental study. Eur J Oncol Nurs 2018; 35:107-116. [PMID: 30057077 DOI: 10.1016/j.ejon.2018.06.002] [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: 10/13/2017] [Revised: 06/02/2018] [Accepted: 06/11/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to develop and pretest a systematic conversation approach for nurses to tailor aftercare to oncology patient's goals, unmet needs and wishes. METHODS We used an iterative developmental process for complex interventions: 1. Identifying problems 2. Identifying overall objectives 3. Designing the intervention 4. Pretesting and adapting the intervention. RESULTS The main results of the problem identification were: non-systematic and incomplete screening of potential issues, caveats in providing information, and shared decision-making. The overall objective formulated was: To develop a model for aftercare conversations based on shared goal-setting and decision-making. The conversation approach consists of four phases: 1. Preparation of the consultation including a questionnaire, 2. Shared goal-setting by means of a tool visualizing domains of life, and 3. Shared care planning by means of an overview of possible choices in aftercare, a database with health care professionals and a cancer survivorship care plan. 4. EVALUATION The results of the pretest revealed that the conversation approach needs to be flexible and tailored to the patient and practice setting, and embedded in the care processes. The conversation approach was perceived as enhancing patient-centeredness and leading to more in-depth consultations. CONCLUSION The conversation approach was developed in co-creation with stakeholders. The results of the pretest revealed important implications and suggestions for implementation in routine care. The aftercare conversation approach can be used by nurses to provide tailored patient-centered evidence-based aftercare. Tailored aftercare should support oncology patient's goals, unmet needs and wishes. Further tailoring is needed.
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Affiliation(s)
- Jolanda Hhm Friesen-Storms
- Research Centre for Autonomy and Participation for Persons with a Chronic Illness, Zuyd Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands; Maastricht University, CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Maastricht, The Netherlands.
| | - Gerrie Jjw Bours
- Research Centre for Autonomy and Participation for Persons with a Chronic Illness, Zuyd Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands; Maastricht University, CAPHRI Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
| | | | - Trudy van der Weijden
- Maastricht University, CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Maastricht, The Netherlands
| | - Kon-Siong G Jie
- Zuyderland Medical Center Sittard-Geleen, Heerlen, The Netherlands; Research Centre for Integrative Patient Centred Health Care, Zuyd Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Anna Jhm Beurskens
- Research Centre for Autonomy and Participation for Persons with a Chronic Illness, Zuyd Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands; Maastricht University, CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Maastricht, The Netherlands
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Bombard Y, Baker GR, Orlando E, Fancott C, Bhatia P, Casalino S, Onate K, Denis JL, Pomey MP. Engaging patients to improve quality of care: a systematic review. Implement Sci 2018; 13:98. [PMID: 30045735 PMCID: PMC6060529 DOI: 10.1186/s13012-018-0784-z] [Citation(s) in RCA: 484] [Impact Index Per Article: 80.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/20/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To identify the strategies and contextual factors that enable optimal engagement of patients in the design, delivery, and evaluation of health services. METHODS We searched MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, PsychINFO, Social Science Abstracts, EBSCO, and ISI Web of Science from 1990 to 2016 for empirical studies addressing the active participation of patients, caregivers, or families in the design, delivery and evaluation of health services to improve quality of care. Thematic analysis was used to identify (1) strategies and contextual factors that enable optimal engagement of patients, (2) outcomes of patient engagement, and (3) patients' experiences of being engaged. RESULTS Forty-eight studies were included. Strategies and contextual factors that enable patient engagement were thematically grouped and related to techniques to enhance design, recruitment, involvement and leadership action, and those aimed to creating a receptive context. Reported outcomes ranged from educational or tool development and informed policy or planning documents (discrete products) to enhanced care processes or service delivery and governance (care process or structural outcomes). The level of engagement appears to influence the outcomes of service redesign-discrete products largely derived from low-level engagement (consultative unidirectional feedback)-whereas care process or structural outcomes mainly derived from high-level engagement (co-design or partnership strategies). A minority of studies formally evaluated patients' experiences of the engagement process (n = 12; 25%). While most experiences were positive-increased self-esteem, feeling empowered, or independent-some patients sought greater involvement and felt that their involvement was important but tokenistic, especially when their requests were denied or decisions had already been made. CONCLUSIONS Patient engagement can inform patient and provider education and policies, as well as enhance service delivery and governance. Additional evidence is needed to understand patients' experiences of the engagement process and whether these outcomes translate into improved quality of care. REGISTRATION N/A (data extraction completed prior to registration on PROSPERO).
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Affiliation(s)
- Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Elaina Orlando
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
- Niagara Health System, 1200 Fourth Avenue, St. Catharines, Ontario, L2S 0A9, Canada
| | - Carol Fancott
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Pooja Bhatia
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Selina Casalino
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Kanecy Onate
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Jean-Louis Denis
- Professor of Health Policy and Management, School of Public Health, Université de Montréal-CRCHUM & Canada Research Chair in Health System Design and Adaptation, 900, Saint Denis Street, Pavillion R, Montreal, Quebec, H2X 0A9, Canada
| | - Marie-Pascale Pomey
- Départment de Gestion, d'Évaluation et de Politique de Santé, École de santé Publique, Université de Montréal, Centre de recherche du CHUM, Carrefour de l'innovation et de l'évaluation en santé, 850 rue Saint-Denis, Montréal, Quebec, H2X 0A9, Canada
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Pype P, Mertens F, Belche J, Duchesnes C, Kohn L, Sercu M, Deveugele M. Experiences of hospital-based multidisciplinary team meetings in oncology: An interview study among participating general practitioners. Eur J Gen Pract 2018; 23:155-163. [PMID: 28554220 PMCID: PMC5774280 DOI: 10.1080/13814788.2017.1323081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Cancer care has become complex, requiring healthcare professionals to collaborate to provide high-quality care. Multidisciplinary oncological team (MDT) meetings in the hospital have been implemented to coordinate individual cancer patients’ care. General practitioners (GPs) are invited to join, but their participation is minimal. Objectives: Aim of this study is to explore participating GPs’ perceptions of their current role and to understand their preferences towards effective role execution during MDT meetings. Methods: In May to June 2014, semi-structured interviews (n = 16) were conducted involving GPs with MDT experience in Belgium. The analysis was done according to qualitative content analysis principles. Results: Attendance of an MDT meeting is perceived as part of the GP’s work, especially for complex patient care situations. Interprofessional collaborative relationships and the GP’s perceived benefit to the MDT meeting discussions are important motivators to participate. Enhanced continuity of information flow and optimized organizational time management were practical aspects triggering the GP’s intention to participate. GPs valued the communication with the patient before and after the meeting as an integral part of the MDT dynamics. Conclusion: GPs perceive attendance of the MDT meeting as an integral part of their job. Suggestions are made to enhance the efficiency of the meetings.
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Affiliation(s)
- Peter Pype
- a Department of Family Medicine and Primary Healthcare , Ghent University , Ghent , Belgium
| | - Fien Mertens
- a Department of Family Medicine and Primary Healthcare , Ghent University , Ghent , Belgium
| | - Jeanluc Belche
- b Département Universitaire de Médecine Générale, Faculté de Médecine , Université de Liège , Liege , Belgium
| | - Christiane Duchesnes
- b Département Universitaire de Médecine Générale, Faculté de Médecine , Université de Liège , Liege , Belgium
| | - Laurence Kohn
- c Belgian Health Care Knowledge Centre (KCE) , Brussels , Belgium
| | - Marij Sercu
- a Department of Family Medicine and Primary Healthcare , Ghent University , Ghent , Belgium
| | - Myriam Deveugele
- a Department of Family Medicine and Primary Healthcare , Ghent University , Ghent , Belgium
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Cancer Nurses Can Bridge the Gap Between the Specialist Cancer Care and Primary Care Settings to Facilitate Shared-Care Models. Cancer Nurs 2018; 41:89-90. [PMID: 29462073 DOI: 10.1097/ncc.0000000000000583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lyu KX, Zhao J, Wang B, Xiong GX, Yang WQ, Liu QH, Zhu XL, Sun W, Jiang AY, Wen WP, Lei WB. Smartphone Application WeChat for Clinical Follow-up of Discharged Patients with Head and Neck Tumors: A Randomized Controlled Trial. Chin Med J (Engl) 2017; 129:2816-2823. [PMID: 27900995 PMCID: PMC5146789 DOI: 10.4103/0366-6999.194635] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Nowadays, social media tools such as short message service, Twitter, video, and web-based systems are more and more used in clinical follow-up, making clinical follow-up much more time- and cost-effective than ever before. However, as the most popular social media in China, little is known about the utility of smartphone WeChat application in follow-up. In this study, we aimed to investigate the feasibility and superiority of WeChat application in clinical follow-up. Methods: A total of 108 patients diagnosed with head and neck tumor were randomized to WeChat follow-up (WFU) group or telephone follow-up (TFU) group for 6-month follow-up. The follow-ups were delivered by WeChat or telephone at 2 weeks, 1, 2, 3, and 6 months to the patients after being discharged. The study measurements were time consumption for follow-up delivery, total economic cost, lost-to-follow-up rate, and overall satisfaction for the follow-up method. Results: Time consumption in WFU group for each patient (23.36 ± 6.16 min) was significantly shorter than that in TFU group (42.89 ± 7.15 min) (P < 0.001); total economic cost in WFU group (RMB 90 Yuan) was much lower than that in TFU group (RMB 196 Yuan). Lost-to-follow-up rate in the WFU group was 7.02% (4/57) compared with TFU group, 9.80% (5/51), while no significance was observed (95% confidence interval [CI]: 0.176–2.740; P = 0.732). The overall satisfaction rate in WFU group was 94.34% (50/53) compared with 80.43% (37/46) in TFU group (95% CI: 0.057–0.067; P = 0.034). Conclusions: The smartphone WeChat application was found to be a viable option for follow-up in discharged patients with head and neck tumors. WFU was time-effective, cost-effective, and convenient in communication. This doctor-led follow-up model has the potential to establish a good physician-patient relationship by enhancing dynamic communications and providing individual health instructions. Trial Registration: Chinese Clinical Trial Registry, ChiCTR-IOR-15007498; http://www.chictr.org.cn/ showproj.aspx?proj=12613.
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Affiliation(s)
- Ke-Xing Lyu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Jing Zhao
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Bin Wang
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Guan-Xia Xiong
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Wei-Qiang Yang
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China
| | - Qi-Hong Liu
- Department of Otorhinolaryngology, Affiliated Futian Hospital of Guangdong Medical College, Shenzhen, Guangdong 518033, China
| | - Xiao-Lin Zhu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Wei Sun
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Ai-Yun Jiang
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Wei-Ping Wen
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Wen-Bin Lei
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
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Abstract
PURPOSE Surveillance after colorectal cancer (CRC) treatment is routine, but intensive follow-up may offer little-to-no overall survival benefit. Given the growing population of CRC survivors, we aimed to systematically evaluate the literature for the patient perspective on two questions: (1) How do CRC patients perceive routine surveillance following curative treatment and what do they expect to gain from their surveillance testing or visits? (2) Which providers (specialists, nursing, primary care) are preferred by CRC survivors to guide post-treatment surveillance? METHODS Systematic searches of PubMed MEDLINE, Embase, the CENTRAL Register of Controlled Trials, CINAHL, and PsycINFO were conducted. Studies were screened for inclusion by two reviewers, with discrepancies adjudicated by a third reviewer. Data were abstracted and evaluated utilizing validated reporting tools (CONSORT, STROBE, CASP) appropriate to study design. RESULTS Citations (3691) were screened, 91 full-text articles reviewed, and 23 studies included in the final review: 15 quantitative and 8 qualitative. Overall, 12 studies indicated CRC patients perceive routine surveillance positively, expecting to gain reassurance of continued disease suppression. Negative perceptions described in six studies included anxiety and dissatisfaction related to quality of life or psychosocial issues during follow-up. Although 5 studies supported specialist-led care, 9 studies indicated patient willingness to have follow-up with non-specialist providers (primary care or nursing). CONCLUSIONS Patients' perceptions of follow-up after CRC are predominantly positive, although unmet needs included psychosocial support and quality of life. IMPLICATIONS FOR CANCER SURVIVORS Survivors perceived follow-up as reassuring, however, surveillance care should be more informative and focused on survivor-specific needs.
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The role of the general practitioner in cancer care: a survey of the patients’ perspective. J Cancer Res Clin Oncol 2017; 143:895-904. [DOI: 10.1007/s00432-017-2343-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/10/2017] [Indexed: 02/06/2023]
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„Der spielt im Moment nicht mehr ganz die Rolle“. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 60:55-61. [DOI: 10.1007/s00103-016-2478-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Høeg BL, Bidstrup PE, Allerslev Horsboel T, Dalton SO, Saltbaek L, Karlsen RV, Andersen KK, Johansen C. Follow-up strategies following completion of primary cancer treatment in adult cancer survivors. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Beverley Lim Høeg
- Danish Cancer Society Research Center; Survivorship Unit; Strandboulevarden 49 Copenhagen Central Denmark Region Denmark 2100
| | - Pernille Envold Bidstrup
- Danish Cancer Society Research Center; Survivorship Unit; Strandboulevarden 49 Copenhagen Central Denmark Region Denmark 2100
| | - Trine Allerslev Horsboel
- Danish Cancer Society Research Center; Survivorship Unit; Strandboulevarden 49 Copenhagen Central Denmark Region Denmark 2100
| | - Susanne Oksbjerg Dalton
- Danish Cancer Society Research Center; Survivorship Unit; Strandboulevarden 49 Copenhagen Central Denmark Region Denmark 2100
| | - Lena Saltbaek
- Danish Cancer Society Research Center; Survivorship Unit; Strandboulevarden 49 Copenhagen Central Denmark Region Denmark 2100
| | - Randi Valbjørn Karlsen
- Danish Cancer Society Research Center; Survivorship Unit; Strandboulevarden 49 Copenhagen Central Denmark Region Denmark 2100
| | - Klaus Kaae Andersen
- Danish Cancer Society Research Center; Statistics, Bioinformatics and Registry Unit; Copenhagen Denmark
| | - Christoffer Johansen
- Copenhagen University Hospital; Department of Oncology; Blegdamsvej 9 Copenhagen Central Denmark Region Denmark 2100
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Tomasone JR, Brouwers MC, Vukmirovic M, Grunfeld E, O'Brien MA, Urquhart R, Walker M, Webster F, Fitch M. Interventions to improve care coordination between primary healthcare and oncology care providers: a systematic review. ESMO Open 2016; 1:e000077. [PMID: 27843639 PMCID: PMC5070279 DOI: 10.1136/esmoopen-2016-000077] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 12/22/2022] Open
Abstract
Coordination of patient care between primary care and oncology care providers is vital to care quality and outcomes across the cancer continuum, yet it is known to be challenging. We conducted a systematic review to evaluate current or new models of care and/or interventions aimed at improving coordination between primary care and oncology care providers for patients with adult breast and/or colorectal cancer. MEDLINE, EMBASE, CINAHL, Cochrane Library Database of Systematic Reviews, and the Centre for Reviews and Dissemination were searched for existing English language studies published between January 2000 and 15 May 2015. Systematic reviews, meta-analyses, randomised controlled trials (RCTs) and non-randomised studies were included if they evaluated a specific model/intervention that was designed to improve care coordination between primary care and oncology care providers, for any stage of the cancer continuum, for patients with adult breast and/or colorectal cancer. Two reviewers extracted data and assessed risk of bias. Twenty-two studies (5 systematic reviews, 6 RCTs and 11 non-randomised studies) were included and varied with respect to the targeted phase of the cancer continuum, type of model or intervention tested, and outcome measures. The majority of studies showed no statistically significant changes in any patient, provider or system outcomes. Owing to conceptual and methodological limitations in this field, the review is unable to provide specific conclusions about the most effective or preferred model/intervention to improve care coordination. Imprecise results that lack generalisability and definitiveness provide limited evidence to base the development of future interventions and policies. TRIAL REGISTRATION NUMBER CRD42015025006.
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Affiliation(s)
- Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Melissa C Brouwers
- Department of Oncology, McMaster University & the Escarpment Cancer Research Institute, Hamilton, Ontario, Canada
| | - Marija Vukmirovic
- Department of Oncology, McMaster University & the Escarpment Cancer Research Institute, Hamilton, Ontario, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melanie Walker
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Fiona Webster
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Margaret Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Lund AS, Lund L, Jønler M, Graversen P, Bro F, Borre M. Shared care in prostate cancer: a three-year follow-up. Scand J Urol 2016; 50:346-51. [PMID: 27420767 DOI: 10.1080/21681805.2016.1206618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to investigate 3 year follow-up in patients with stable prostate cancer (PCa) managed in a shared care program by general practitioners (GPs) in collaboration with urological departments. PCa patients who have undergone curative treatment or endocrine therapy require long-term follow-up. Until recently, follow-up has primarily been managed by urologists at hospital-based outpatient clinics. However, new organizational strategies are needed to meet the needs of the growing number of elderly, comorbid cancer patients. These new organizational strategies target patients, GPs and specialists as joint stakeholders in the care and management of PCa. MATERIALS AND METHODS In this 3 year follow-up to a Danish shared care PCa trial, 530 patients, out of a total of 2585 patients, were outsourced to the GPs. Strict evaluation criteria were selected to assess compliance according to individually agreed follow-up and re-referral plans for patients and GPs, respectively. RESULTS This study included 426 (80.4%) out of the 530 PCa patients. Among these, 196 patients had initially undergone curative-intended treatment, whereas 230 patients underwent non-curative treatment. Ninety-one deaths occurred during the study period. Among the 425 patients who were alive, 335 (78.8%) gave consent for their medical records to be accessed. Overall, patient compliance was successfully met in 390 (91.5%) of the cases, while GP compliance was successfully met in 393 (92.3%) of the cases. CONCLUSION The shared care regimen for patient follow-up between the departments of urology and the local GPs had a high rate of patient and GP compliance.
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Affiliation(s)
| | - Lars Lund
- b Urology Department , Odense University Hospital , Odense , Denmark
| | - Morten Jønler
- c Urology Department , Aalborg University Hospital , Aalborg , Denmark
| | - Peder Graversen
- d Urology Department , Holstebro Hospital , Holstebro , Denmark
| | - Flemming Bro
- e Research Section for General Practice , Aarhus University , Aarhus , Denmark
| | - Michael Borre
- a Urology Department , Aarhus University Hospital , Aarhus , Denmark
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Winpenny EM, Miani C, Pitchforth E, King S, Roland M. Improving the effectiveness and efficiency of outpatient services: a scoping review of interventions at the primary-secondary care interface. J Health Serv Res Policy 2016; 22:53-64. [PMID: 27165979 PMCID: PMC5482389 DOI: 10.1177/1355819616648982] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives Variation in patterns of referral from primary care can lead to inappropriate overuse or underuse of specialist resources. Our aim was to review the literature on strategies involving primary care that are designed to improve the effectiveness and efficiency of outpatient services. Methods A scoping review to update a review published in 2006. We conducted a systematic literature search and qualitative evidence synthesis of studies across five intervention domains: transfer of services from hospital to primary care; relocation of hospital services to primary care; joint working between primary care practitioners and specialists; interventions to change the referral behaviour of primary care practitioners and interventions to change patient behaviour. Results The 183 studies published since 2005, taken with the findings of the previous review, suggest that transfer of services from secondary to primary care and strategies aimed at changing referral behaviour of primary care clinicians can be effective in reducing outpatient referrals and in increasing the appropriateness of referrals. Availability of specialist advice to primary care practitioners by email or phone and use of store-and-forward telemedicine also show potential for reducing outpatient referrals and hence reducing costs. There was little evidence of a beneficial effect of relocation of specialists to primary care, or joint primary/secondary care management of patients on outpatient referrals. Across all intervention categories there was little evidence available on cost-effectiveness. Conclusions There are a number of promising interventions which may improve the effectiveness and efficiency of outpatient services, including making it easier for primary care clinicians and specialists to discuss patients by email or phone. There remain substantial gaps in the evidence, particularly on cost-effectiveness, and new interventions should continue to be evaluated as they are implemented more widely. A move for specialists to work in the community is unlikely to be cost-effective without enhancing primary care clinicians’ skills through education or joint consultations with complex patients.
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Affiliation(s)
- Eleanor M Winpenny
- 1 Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Céline Miani
- 1 Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Emma Pitchforth
- 1 Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Sarah King
- 1 Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Martin Roland
- 2 RAND Professor of Health Services Research, Cambridge Centre for Health Services Research, University of Cambridge, UK
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Winpenny E, Miani C, Pitchforth E, Ball S, Nolte E, King S, Greenhalgh J, Roland M. Outpatient services and primary care: scoping review, substudies and international comparisons. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04150] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AimThis study updates a previous scoping review published by the National Institute for Health Research (NIHR) in 2006 (Roland M, McDonald R, Sibbald B.Outpatient Services and Primary Care: A Scoping Review of Research Into Strategies For Improving Outpatient Effectiveness and Efficiency. Southampton: NIHR Trials and Studies Coordinating Centre; 2006) and focuses on strategies to improve the effectiveness and efficiency of outpatient services.Findings from the scoping reviewEvidence from the scoping review suggests that, with appropriate safeguards, training and support, substantial parts of care given in outpatient clinics can be transferred to primary care. This includes additional evidence since our 2006 review which supports general practitioner (GP) follow-up as an alternative to outpatient follow-up appointments, primary medical care of chronic conditions and minor surgery in primary care. Relocating specialists to primary care settings is popular with patients, and increased joint working between specialists and GPs, as suggested in the NHS Five Year Forward View, can be of substantial educational value. However, for these approaches there is very limited information on cost-effectiveness; we do not know whether they increase or reduce overall demand and whether the new models cost more or less than traditional approaches. One promising development is the increasing use of e-mail between GPs and specialists, with some studies suggesting that better communication (including the transmission of results and images) could substantially reduce the need for some referrals.Findings from the substudiesBecause of the limited literature on some areas, we conducted a number of substudies in England. The first was of referral management centres, which have been established to triage and, potentially, divert referrals away from hospitals. These centres encounter practical and administrative challenges and have difficulty getting buy-in from local clinicians. Their effectiveness is uncertain, as is the effect of schemes which provide systematic review of referrals within GP practices. However, the latter appear to have more positive educational value, as shown in our second substudy. We also studied consultants who held contracts with community-based organisations rather than with hospital trusts. Although these posts offer opportunities in terms of breaking down artificial and unhelpful primary–secondary care barriers, they may be constrained by their idiosyncratic nature, a lack of clarity around roles, challenges to professional identity and a lack of opportunities for professional development. Finally, we examined the work done by other countries to reform activity at the primary–secondary care interface. Common approaches included the use of financial mechanisms and incentives, the transfer of work to primary care, the relocation of specialists and the use of guidelines and protocols. With the possible exception of financial incentives, the lack of robust evidence on the effect of these approaches and the contexts in which they were introduced limits the lessons that can be drawn for the English NHS.ConclusionsFor many conditions, high-quality care in the community can be provided and is popular with patients. There is little conclusive evidence on the cost-effectiveness of the provision of more care in the community. In developing new models of care for the NHS, it should not be assumed that community-based care will be cheaper than conventional hospital-based care. Possible reasons care in the community may be more expensive include supply-induced demand and addressing unmet need through new forms of care and through loss of efficiency gained from concentrating services in hospitals. Evidence from this study suggests that further shifts of care into the community can be justified only if (a) high value is given to patient convenience in relation to NHS costs or (b) community care can be provided in a way that reduces overall health-care costs. However, reconfigurations of services are often introduced without adequate evaluation and it is important that new NHS initiatives should collect data to show whether or not they have added value, and improved quality and patient and staff experience.FundingThe NIHR Health Services and Delivery Research programme.
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Affiliation(s)
| | | | | | | | - Ellen Nolte
- RAND Europe, Cambridge, UK
- European Observatory on Health Systems and Policies, London School of Economics and Political Science and London School of Hygiene and Tropical Medicine, London, UK
| | | | - Joanne Greenhalgh
- Faculty of Education, Social Sciences and Law, University of Leeds, Leeds, UK
| | - Martin Roland
- Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Abstract
A significant proportion of men suffer side effects and are acknowledged to have unmet physical, functional and psychological needs after prostate cancer treatment. A nurse-led survivorship programme was implemented at Newcastle upon Tyne Hospitals NHS Foundation Trust for men with prostate cancer. This article describes implementation of the model and presents the results of an early evaluation to assess its impact. In the first 6 months 169 men (90% of those invited) engaged in the survivorship programme. Holistic needs assessments in particular were found to be invaluable for addressing individual men's needs and signposting them to relevant services. Collaboration between existing organisations and initiatives across primary and secondary care resulted in the establishment of a comprehensive network of services available to men on the programme. The nurse-led Newcastle survivorship model has been able to deliver individualised survivorship care with a high satisfaction rating within routine NHS practice.
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Affiliation(s)
- Jill Ferguson
- Prostate Cancer UK, Prostate Cancer Survivorship Nurse Specialist, Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust
| | - Jonathan Aning
- Consultant Urological Surgeon, Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust
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Coindard G, Barrière J, Vega A, Patrikidou A, Saldanha-Gomes C, Arnould P, Combessie P, Ourabah R. What role does the general practitioner in France play among cancer patients during the initial treatment phase with intravenous chemotherapy? A qualitative study. Eur J Gen Pract 2016; 22:96-102. [PMID: 26799829 DOI: 10.3109/13814788.2015.1126821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND France's ethical and legal principles place general practitioners (GPs) at the forefront of cancer patient management, coordination, and follow-up. The objective of this study was to determine the actual role of GPs in the follow-up phase as well as patient perspectives on their GPs. METHOD A multidisciplinary group of researchers conducted this qualitative study based on in-depth interviews of 50 patients managed at two cancer centres. A content analysis method was used to analyse the study data. RESULTS According to the patients interviewed for this study, their GPs were relatively ineffective at managing medical problems related to cancer by comparison with their oncologists. Nonetheless, the patients had all consulted their GPs during the interval between the diagnosis and our interview. Reasons given for consulting their GPs included administrative matters, psychological support, reassurance, and advice, but also to a lesser extent, medical management. CONCLUSION Patients' perspectives called attention to two aspects of the role of GPs in the French healthcare system: (a) the importance of GPs within an effective system for managing cancer patients, and (b) for some patients, GPs' relative lack of medical skill compared to oncologists.
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Affiliation(s)
- Guillaume Coindard
- a Department of General Practice , Université Paris-Sud , Le Kremlin-Bicêtre , France ;,b Université Paris Ouest , Sophiapol (LASCO) , Nanterre , France
| | - Jérôme Barrière
- c Department of Medical Oncology , Centre Antoine Lacassagne, Nice , France
| | - Anne Vega
- b Université Paris Ouest , Sophiapol (LASCO) , Nanterre , France
| | - Anna Patrikidou
- d Department of Cancer Medicine , Gustave Roussy , Villejuif , France
| | | | - Pascale Arnould
- a Department of General Practice , Université Paris-Sud , Le Kremlin-Bicêtre , France
| | | | - Rissane Ourabah
- a Department of General Practice , Université Paris-Sud , Le Kremlin-Bicêtre , France
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Ngune I, Jiwa M, McManus A, Hughes J. Do patients with long-term side effects of cancer treatment benefit from general practitioner support? A literature review. Int J Integr Care 2015; 15:e023. [PMID: 26150761 PMCID: PMC4491325 DOI: 10.5334/ijic.1987] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 04/07/2015] [Accepted: 04/24/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Alongside specialist cancer clinics, general practitioners have an important role in cancer patients' follow-up care, yet no literature summarises the nature, extent and impact of their involvement. This paper addresses this issue through a review of the literature. METHODS Studies were sourced from six academic databases - AustHealth (n = 202), CINAHL (n = 500), the Cochrane Library (reviews and trials; n = 200), Embase (n = 368), PHCRIS (n = 132) and PubMed/Medline (n = 410). Studies that focused on interventions designed for patients receiving follow-up care and reported cancer care provided by a general practitioner delivered alongside specialist care were reviewed. RESULTS A total of 19 papers were identified as relevant for this review (3 randomised control trials; 4 cross-sectional, 5 cohort and 3 qualitative studies, and 3 systematic reviews). The reviewed studies indicated that providing general practitioner-led supportive interventions for post-treatment care of cancer patients is feasible and acceptable to patients. General practitioner involvement resulted in improved physical and psychosocial well-being of patients and continuity of care, especially for patients with concomitant health conditions. CONCLUSION Involving general practitioners in post-treatment cancer care is beneficial to patients. However, proactive initiatives that encourage and facilitate patients to consult their general practitioner about their needs or symptoms of recurrence should be considered.
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Affiliation(s)
- Irene Ngune
- Curtin University, Faculty of Health Sciences, Bentley, Perth, WA, Australia
| | - Moyez Jiwa
- Curtin University, Medical Education, Bentley, Perth, WA, Australia
| | - Alexandra McManus
- Curtin University, Faculty of Health Sciences, Bentley, Perth, WA, Australia
| | - Jeff Hughes
- Curtin University, School of Pharmacy, Bentley, Perth, WA, Australia
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Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Optimizing cancer care through mobile health. Support Care Cancer 2015; 23:2183-8. [PMID: 25649121 DOI: 10.1007/s00520-015-2627-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/22/2015] [Indexed: 01/07/2023]
Abstract
The survival rates for patients living with cancer are increasing, due to recent advances in detection, prevention and treatment. It has been estimated that there were 28 million cancer survivors around the world in 2012. In the UK, for patients diagnosed in 2007, it is predicted that more than half of them will survive their cancer for 5 years or more. A large majority of cancer survivors report unmet supportive care needs and distressing symptoms and adverse long-term consequences related to their cancer. Cancer management could be optimized to better meet patients demand through technology, including mobile health (m-Health). m-Health is defined as the use of mobile communications and network technologies for health care. m-Health can help both patients and health-care professionals and play an important part in managing and delivering cancer care including managing side effects, supporting drug adherence, providing cancer information, planning and follow up and detecting and diagnosing cancer. Health authorities have already published guidelines regulating m-Health to insure patient safety and improve the accountability of its applications.
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Affiliation(s)
- Bassel Odeh
- Drug Discovery, Delivery and Patient Care (DDDPC) Centre, School of Pharmacy and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, Surrey, KT1 2EE, UK,
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Halkett GKB, Jiwa M, Lobb EA. Patients' perspectives on the role of their general practitioner after receiving an advanced cancer diagnosis. Eur J Cancer Care (Engl) 2014; 24:662-72. [PMID: 25132066 DOI: 10.1111/ecc.12224] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2014] [Indexed: 11/28/2022]
Abstract
The aim of this study was to explore patients' perspectives on the role of their general practitioner (GP) after an advanced cancer diagnosis. A qualitative research approach was used. Semi-structured interviews were conducted and data were analysed using a constant comparative methodology. Participants were eligible if they were diagnosed with advanced cancer and referred for palliative radiotherapy. Data saturation was achieved after 21 interviews. Key themes included (1) obtaining diagnosis and referral for advanced cancer treatment; (2) preference for specialist oncology care; (3) a preference for GP to act as an advocate; and (4) obtaining ongoing routine care from their GP. GP involvement in the patients' management was dependent on: time since diagnosis, GP's involvement in diagnosis and referral, doctor/patient relationship, additional chronic conditions requiring management, frequency of seeing oncologist and specialist recommendation to involve GP. Patients want GPs to have varying levels of involvement following an advanced cancer diagnosis. Not all communication between GPs and patients was positive suggesting communication skills training may be a priority. Patients wished to maintain continunity of care for their non-cancer related issues and healthcare of their family members. Future research needs to focus on working with GPs to increase their role in the management of advanced cancer.
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Affiliation(s)
- G K B Halkett
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - M Jiwa
- Department of Medical Education, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - E A Lobb
- Calvary Health Care Sydney and Cunningham Centre for Palliative Care, Sydney, NSW, Australia.,School of Medicine, University of Notre Dame, Sydney, NSW, Australia
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Dickinson R, Hall S, Sinclair JE, Bond C, Murchie P. Using technology to deliver cancer follow-up: a systematic review. BMC Cancer 2014; 14:311. [PMID: 24885758 PMCID: PMC4101828 DOI: 10.1186/1471-2407-14-311] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 04/17/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND People with cancer receive regular structured follow up after initial treatment, usually by a specialist in a cancer centre. Increasing numbers of cancer survivors prompts interest in alternative structured follow-up models. There is worldwide evidence of increasing interest in delivering cancer follow-up using technology. This review sough evidence supporting the use of technology in cancer follow-up from good quality randomised controlled trials. METHOD A search strategy was developed to identify randomised controlled trials and reviews of randomised trials of interventions delivering some aspect of structured cancer follow-up using new technologies. Databases searched were: All EBM Reviews; Embase; Medline (No Revisions); Medline (Non-Indexed Citations), and CAB Abstracts. Included articles were published in English between 2000 and 2014. Key words were generated by the research question. Papers were read independently and appraised using a standardised checklist by two researchers, with differences being resolved by consensus [J Epidemiol Community Health, 52:377-384, 1998]. Information was collected on the purpose, process, results and limitations of each study. All outcomes were considered, but particular attention paid to areas under consideration in the review question. RESULTS The search strategy generated 22879 titles. Following removal of duplicates and abstract review 17 full papers pertaining to 13 randomised controlled studies were reviewed. Studies varied in technologies used and the elements of follow-up delivered, length of follow-up, tumour type and numbers participating. Most studies employed only standard telephone follow-up. Most studies involved women with breast cancer and included telephone follow-up. Together the results suggest that interventions comprising technology had not compromised patient satisfaction or safety, as measured by symptoms, health related quality of life or psychological distress. There was insufficient evidence to comment on the cost effectiveness of technological cancer follow-up interventions. CONCLUSIONS Modern technology could deliver cancer follow-up that is acceptable and safe. More research is required to develop cancer follow-up systems which exploit modern technology, which should be assessed using randomised trials, with consistent outcomes, so that evidence on the acceptability, safety, cost effectiveness and impact in quality of life of technological follow-up can accumulate and be made available to patients, professionals and policy makers.
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Affiliation(s)
- Rebekah Dickinson
- Wednesbury Malling Health Practice, High Bullen, Wednesbury, West Midlands WS10 7HP, UK
| | - Susan Hall
- Division of Applied Health Science, Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Jenny E Sinclair
- Division of Applied Health Science, Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Christine Bond
- Division of Applied Health Science, Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Peter Murchie
- Division of Applied Health Science, Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
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Auckland R, Wassell P, Hall S, Nicolson MC, Murchie P. Exploring patterns of recurrent melanoma in Northeast Scotland to inform the introduction a digital self-examination intervention. BMC DERMATOLOGY 2014; 14:4. [PMID: 24612627 PMCID: PMC3984711 DOI: 10.1186/1471-5945-14-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 02/27/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Melanoma incidence is growing and more people require follow-up to detect recurrent melanoma quickly. Those detecting their own recurrent melanoma appear to have the best prognosis, so total skin self examination (TSSE) is advocated, but practice is suboptimal. A digital intervention to support TSSE has potential but it is not clear which patient groups could benefit most. The aim of this study was to explore cutaneous melanoma recurrence patterns between 1991 and 2012 in Northeast Scotland. The objectives were to: determine how recurrent melanomas were detected during the period; explore factors potentially predictive of mode of recurrence detection; identify groups least likely to detect their own recurrent melanoma and with most potential to benefit from digital TSSE support. METHODS Pathology records were used to identify those with a potential recurrent melanoma of any type (local, regional and distant). Following screening of potential cases available secondary care-held records were subsequently scrutinised. Data was collected on demographics and clinical characteristics of the initial and recurrent melanoma. Data were handled in Microsoft Excel and transported into SPSS 20.0 for statistical analysis. Factors predicting detection at interval or scheduled follow-up were explored using univariate techniques, with potentially influential factors combined in a multivariate binary logistic model to adjust for confounding. RESULTS 149 potential recurrences were identified from the pathology database held at Aberdeen Royal Infirmary. Reliable data could be obtained on 94 cases of recurrent melanoma of all types. 30 recurrences (31.9%) were found by doctors at follow-up, and 64 (68.1%) in the interval between visits, usually by the patient themselves. Melanoma recurrences of all types occurring within one-year were significantly more likely to be found at follow-up visits, and this remained so following adjustment for other factors that could be used to target digital TSSE support. CONCLUSIONS A digital intervention should be offered to all newly diagnosed patients. This group could benefit most from optimal TSSE practice.
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Affiliation(s)
| | | | - Susan Hall
- Centre of Academic Primary Care - Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
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Choi KH, Park SM, Lee K, Kim KH, Park JS, Han SH. Prevalence, Awareness, Control, and Treatment of Hypertension and Diabetes in Korean Cancer Survivors: A Cross-Sectional Analysis of the Fourth and Fifth Korea National Health and Nutrition Examination Surveys. Asian Pac J Cancer Prev 2013; 14:7685-92. [DOI: 10.7314/apjcp.2013.14.12.7685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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