1
|
Davis RA, Sine K, Burguera-Couce E, Ahmad J, Oliver BJ. Diversity in Combating Complex, Chronic, and Costly Conditions Using a Learning Health System Approach: A Scoping Review. Perm J 2024; 28:245-261. [PMID: 39113492 PMCID: PMC11404638 DOI: 10.7812/tpp/24.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
INTRODUCTION The purpose of this scoping review was to investigate in the literature how a learning health system (LHS) can be implemented in cases of complex, costly, chronic (3C) conditions. METHODS A scoping review of literature published in English since 2007 was conducted using Medline, Cumulative Index to Nursing and Allied Health Literature, and Scopus. Two authors screened the resulting articles and two authors extracted study details on the structure, process, and outcome of each LHS. Eligibility criteria included studies of LHSs that focused on populations experiencing a complex chronic health condition. A narrative synthesis of data was conducted using deductive qualitative methods. RESULTS Application of the authors' search strategy resulted in 656 publications that were analyzed for this review. The authors included 17 studies that focused on 13 LHSs. The structure of the LHSs had many components, and many included data from either patient surveys or patient charts. The processes varied widely, from engaging patients in the process to exclusively analyzing the data. The outcomes were largely patient-reported, though several clinical outcomes were also used to benchmark the success of the LHS. DISCUSSION Our review shows that LHS definitions, structures, processes, and outcomes in 3C applications vary widely. Many have shown substantial potential to be implemented and improve care in 3C populations. To deliver on this goal, future work will need to focus on better specification, formalization, and definition of LHS approaches, as well as better design of their structures, processes, and outcomes to fit the needs of the intended population.
Collapse
Affiliation(s)
- Rebekah A Davis
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kathryn Sine
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Jabeen Ahmad
- Chronic Health Improvement Research Program at Dartmouth Health, Department of Community & Family Medicine, Dartmouth Health, Lebanon, NH, USA
| | - Brant J Oliver
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Chronic Health Improvement Research Program at Dartmouth Health, Department of Community & Family Medicine, Dartmouth Health, Lebanon, NH, USA
- Department of Psychiatry, Dartmouth Health, Lebanon, NH, USA
- Office of Care Experience, the Value Institute, Dartmouth Health, Lebanon, NH, USA
| |
Collapse
|
2
|
Banks LC, Kapphahn K, Das M, Patel MI. Randomized Trial of a Volunteer-Led Symptom Assessment Intervention on Documentation, Patient-Reported Outcomes, and Health Care Use Among Veterans With Lung Cancer. JCO Oncol Pract 2024; 20:419-428. [PMID: 38207246 DOI: 10.1200/op.23.00557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/03/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE Identification and documentation of Veterans' symptoms are crucial for optimal lung cancer care delivery. The objective of this study was to determine whether a volunteer-led proactive telephone symptom assessment intervention could improve comprehensive symptom documentation. METHODS Veterans with lung cancer were randomly assigned to usual care (control group) or usual care with proactive symptom assessment in which a peer volunteer made weekly phone calls to assess patient symptoms under nurse practitioner supervision. The primary outcome was oncologist documentation of symptoms in the electronic health record at all clinical visits within 6 months after enrollment. Secondary outcomes included patient satisfaction with decision, patient activation, health-related quality of life (HRQOL), and symptom burden, measured at baseline, and 3, 6, and 9 months after enrollment, and acute care use within 9 months after enrollment. RESULTS Among 60 Veterans randomly assigned, median (range) age was 70.2 (50-86) years; 57 (95.0%) were male. More intervention participants had oncologist documentation of symptoms than control group participants (24 [77.4%] v seven [24.1%], respectively; odds ratio, 16.46 [95% CI, 4.58 to 59.16]). Intervention group participants had greater improvements over time in HRQOL (expected mean difference, 25.3 [95% CI, 15.00 to 35.70]) and patient activation (expected mean difference, 13.6 [95% CI, 3.79 to 23.39]), lower symptom burden (expected mean difference, -6.39 [95% CI, -15.21 to -2.46]), lower rates of emergency room visits (incidence rate ratio, 0.48 [95% CI, 0.30 to 0.75]), and hospitalizations (incidence rate ratio, 0.47 [95% CI, 0.28 to 0.77]) than control group participants. CONCLUSION This symptom assessment intervention is an effective strategy for Veterans with lung cancer.
Collapse
Affiliation(s)
| | - Kris Kapphahn
- Quantitative Sciences Unit, Stanford School of Medicine, Stanford, CA
| | - Millie Das
- Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA
- Division of Oncology, Stanford School of Medicine, Stanford, CA
| | - Manali I Patel
- Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA
- Division of Oncology, Stanford School of Medicine, Stanford, CA
| |
Collapse
|
3
|
Bakker L, Aarts J, Uyl-de Groot C, Redekop K. How can we discover the most valuable types of big data and artificial intelligence-based solutions? A methodology for the efficient development of the underlying analytics that improve care. BMC Med Inform Decis Mak 2021; 21:336. [PMID: 34844594 PMCID: PMC8628451 DOI: 10.1186/s12911-021-01682-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Much has been invested in big data and artificial intelligence-based solutions for healthcare. However, few applications have been implemented in clinical practice. Early economic evaluations can help to improve decision-making by developers of analytics underlying these solutions aiming to increase the likelihood of successful implementation, but recommendations about their use are lacking. The aim of this study was to develop and apply a framework that positions best practice methods for economic evaluations alongside development of analytics, thereby enabling developers to identify barriers to success and to select analytics worth further investments. METHODS The framework was developed using literature, recommendations for economic evaluations and by applying the framework to use cases (chronic lymphocytic leukaemia (CLL), intensive care, diabetes). First, the feasibility of developing clinically relevant analytics was assessed and critical barriers to successful development and implementation identified. Economic evaluations were then used to determine critical thresholds and guide investment decisions. RESULTS When using the framework to assist decision-making of developers of analytics, continuing development was not always feasible or worthwhile. Developing analytics for progressive CLL and diabetes was clinically relevant but not feasible with the data available. Alternatively, developing analytics for newly diagnosed CLL patients was feasible but continuing development was not considered worthwhile because the high drug costs made it economically unattractive for potential users. Alternatively, in the intensive care unit, analytics reduced mortality and per-patient costs when used to identify infections (- 0.5%, - €886) and to improve patient-ventilator interaction (- 3%, - €264). Both analytics have the potential to save money but the potential benefits of analytics that identify infections strongly depend on infection rate; a higher rate implies greater cost-savings. CONCLUSIONS We present a framework that stimulates efficiency of development of analytics for big data and artificial intelligence-based solutions by selecting those applications of analytics for which development is feasible and worthwhile. For these applications, results from early economic evaluations can be used to guide investment decisions and identify critical requirements.
Collapse
Affiliation(s)
- Lytske Bakker
- Erasmus School of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University, Rotterdam, The Netherlands.
| | - Jos Aarts
- Erasmus School of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Carin Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University, Rotterdam, The Netherlands
| | - Ken Redekop
- Erasmus School of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University, Rotterdam, The Netherlands
| |
Collapse
|
4
|
Platt JE, Raj M, Wienroth M. An Analysis of the Learning Health System in Its First Decade in Practice: Scoping Review. J Med Internet Res 2020; 22:e17026. [PMID: 32191214 PMCID: PMC7118548 DOI: 10.2196/17026] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 12/20/2022] Open
Abstract
Background In the past decade, Lynn Etheredge presented a vision for the Learning Health System (LHS) as an opportunity for increasing the value of health care via rapid learning from data and immediate translation to practice and policy. An LHS is defined in the literature as a system that seeks to continuously generate and apply evidence, innovation, quality, and value in health care. Objective This review aimed to examine themes in the literature and rhetoric on the LHS in the past decade to understand efforts to realize the LHS in practice and to identify gaps and opportunities to continue to take the LHS forward. Methods We conducted a thematic analysis in 2018 to analyze progress and opportunities over time as compared with the initial Knowledge Gaps and Uncertainties proposed in 2007. Results We found that the literature on the LHS has increased over the past decade, with most articles focused on theory and implementation; articles have been increasingly concerned with policy. Conclusions There is a need for attention to understanding the ethical and social implications of the LHS and for exploring opportunities to ensure that these implications are salient in implementation, practice, and policy efforts.
Collapse
Affiliation(s)
- Jodyn E Platt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Minakshi Raj
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Matthias Wienroth
- School of Geography, Politics & Sociology, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
5
|
Asan O, Nattinger AB, Gurses AP, Tyszka JT, Yen TWF. Oncologists' Views Regarding the Role of Electronic Health Records in Care Coordination. JCO Clin Cancer Inform 2019; 2:1-12. [PMID: 30652555 DOI: 10.1200/cci.17.00118] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Electronic health records (EHRs) play a significant role in complex health care processes, especially in information transfer with patients and care coordination among providers. EHRs may also generate unintended consequences, introducing new patient safety risks. To date, little investigation has been performed in oncology settings, despite the need for quality provider-patient communication and information transfer during oncology visits. In this qualitative study, we focused on oncology providers' perceptions of EHRs for supporting communication with patients and coordination of care with other providers. METHODS We conducted semistructured interviews with oncologists from an urban academic medical center to learn their perceptions of the use of EHRs before, during, and after clinic visits with patients. Our interview guide was developed on the basis of the work system model. We coded transcripts using inductive content analysis. RESULTS Data analysis yielded four main themes regarding oncologists' practices in using the EHR and perceptions about EHRs: (1) EHR use for care coordination (eg, timeliness of receiving information, SmartSet documentation); (2) EHR use in the clinic visit (eg, educating patients, using as a reinforcement tool); (3) safety hazards in care coordination associated with EHRs (eg, incomplete documentation, error propagating, no filtering mechanism to capture errors); and (4) suggestions for improvements (eg, improved SmartSet functionalities, simplification of user interface). CONCLUSION Current EHRs do not adequately support teamwork of oncology providers, which could lead to potential hazards in the care of patients with cancer. Redesigning EHR features that are tailored to support oncology care and addressing the concerns regarding information overload, improved organization of flagging abnormal results, and documentation-related workload are needed to minimize potential safety hazards.
Collapse
Affiliation(s)
- Onur Asan
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
| | - Ann B Nattinger
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
| | - Ayse P Gurses
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
| | - Jeanne T Tyszka
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
| | - Tina W F Yen
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
6
|
McLachlan S, Dube K, Johnson O, Buchanan D, Potts HW, Gallagher T, Fenton N. A framework for analysing learning health systems: Are we removing the most impactful barriers? Learn Health Syst 2019; 3:e10189. [PMID: 31641685 PMCID: PMC6802533 DOI: 10.1002/lrh2.10189] [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: 10/01/2018] [Revised: 02/01/2019] [Accepted: 03/05/2019] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Learning health systems (LHS) are one of the major computing advances in health care. However, no prior research has systematically analysed barriers and facilitators for LHS. This paper presents an investigation into the barriers, benefits, and facilitating factors for LHS in order to create a basis for their successful implementation and adoption. METHODS First, the ITPOSMO-BBF framework was developed based on the established ITPOSMO (information, technology, processes, objectives, staffing, management, and other factors) framework, extending it for analysing barriers, benefits, and facilitators. Second, the new framework was applied to LHS. RESULTS We found that LHS shares similar barriers and facilitators with electronic health records (EHR); in particular, most facilitator effort in implementing EHR and LHS goes towards barriers categorised as human factors, even though they were seen to carry fewer benefits. Barriers whose resolution would bring significant benefits in safety, quality, and health outcomes remain.LHS envisage constant generation of new clinical knowledge and practice based on the central role of collections of EHR. Once LHS are constructed and operational, they trigger new data streams into the EHR. So LHS and EHR have a symbiotic relationship. The implementation and adoption of EHRs have proved and continues to prove challenging, and there are many lessons for LHS arising from these challenges. CONCLUSIONS Successful adoption of LHS should take account of the framework proposed in this paper, especially with respect to its focus on removing barriers that have the most impact.
Collapse
Affiliation(s)
- Scott McLachlan
- Electrical Engineering and Computer ScienceQueen Mary University of LondonLondonUK
| | - Kudakwashe Dube
- Fundamental SciencesMassey UniversityPalmerston NorthNew Zealand
| | | | - Derek Buchanan
- Fundamental SciencesMassey UniversityPalmerston NorthNew Zealand
| | - Henry W.W. Potts
- Institute of Health InformaticsUniversity College LondonLondonUK
| | | | - Norman Fenton
- Electrical Engineering and Computer ScienceQueen Mary University of LondonLondonUK
| |
Collapse
|
7
|
McLachlan S, Potts HWW, Dube K, Buchanan D, Lean S, Gallagher T, Johnson O, Daley B, Marsh W, Fenton N. The Heimdall Framework for Supporting Characterisation of Learning Health Systems. JOURNAL OF INNOVATION IN HEALTH INFORMATICS 2018; 25:77-87. [PMID: 30398449 DOI: 10.14236/jhi.v25i2.996] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/08/2018] [Accepted: 03/27/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Learning Health Systems (LHS) can focus population medicine and Evidence Based Practice; smart technology delivering the next generation of improved healthcare described as Precision Medicine, and yet researchers in the LHS domain presently lack the ability to recognise their relevant works as falling within this domain. OBJECTIVE To review LHS literature and develop a framework describing the domain that can be used as a tool to analyse the literature and support researchers to identify health informatics investigations as falling with the domain of LHS. METHOD A scoping review is used to identify literature on which analysis was performed. This resolved the ontology and framework. The ontology was applied to quantify the distribution of classifications of LHS solutions. The framework was used to analyse and characterise the various works within the body of LHS literature. RESULTS The ontology and framework developed was shown to be easily applicable to the literature, consistently describing and representing the goals, intentions and solutions of each LHS investigation in the literature. More proposed or potential solutions are described in the literature than implemented LHS. This suggests immaturity in the domain and points to the existence of barriers preventing LHS realisation. CONCLUSION The lack of an ontology and framework may have been one of the causes for the failure to describe research works as falling within the LHS domain. Using our ontology and framework, LHS research works could be easily classified, demonstrating the comprehensiveness of our approach in contrast to earlier efforts.
Collapse
|
8
|
Irby-Shasanmi A, Leech TGJ. 'Because I Don't know': uncertainty and ambiguity in closed-ended reports of perceived discrimination in US health care. ETHNICITY & HEALTH 2017; 22:458-479. [PMID: 27741709 DOI: 10.1080/13557858.2016.1244659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective Surveys often ask respondents to assess discrimination in health care. Yet, patients' responses to one type of widely used measure of discrimination (single-item, personally mediated) tend to reveal prevalence rates lower than observational studies would suggest. This study examines the meaning behind respondents' closed-ended self-reports on this specific type of measure, paying special attention to the frameworks and references used within the medical setting. Design Twenty-nine respondents participated in this study. They were asked the widely used question: 'Within the past 12 months, when seeking health care do you feel your experiences were worse than, the same as, or better than people of other races?' We then conducted qualitative interviews focusing on their chosen response and past experiences. Descriptive analyses focus on both the quantitative and qualitative data, including a comparison of conveyed perceived discrimination according to the different sources of data. Results To identify discrimination, respondents drew upon observations of dynamics in the waiting room or the health providers' communication style. Our respondents were frequently ambivalent and uncertain about how their personal treatment in health care compared to people of other races. When participants were unable to make observable comparisons, they tended to assume equal treatment and report 'same as' in the close-ended reports. Conclusion Respondents' responses to single-item, closed-ended questions may be influenced by characteristics specific to the health care realm. An emphasis on privacy and assumptions about the health care field (both authority and benevolence of providers) may limit opportunities for comparison and result in assumptions of racial parity in treatment.
Collapse
Affiliation(s)
- Amy Irby-Shasanmi
- a Department of Social and Behavioral Sciences , Indiana University Purdue University, Indianapolis (IUPUI) , Indianapolis , IN , USA
| | - Tamara G J Leech
- a Department of Social and Behavioral Sciences , Indiana University Purdue University, Indianapolis (IUPUI) , Indianapolis , IN , USA
| |
Collapse
|
9
|
Honein-AbouHaidar GN, Stuart-McEwan T, Waddell T, Salvarrey A, Smylie J, Dobrow MJ, Brouwers MC, Gagliardi AR. How do organisational characteristics influence teamwork and service delivery in lung cancer diagnostic assessment programmes? A mixed-methods study. BMJ Open 2017; 7:e013965. [PMID: 28235969 PMCID: PMC5337676 DOI: 10.1136/bmjopen-2016-013965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Diagnostic assessment programmes (DAPs) can reduce wait times for cancer diagnosis, but optimal DAP design is unknown. This study explored how organisational characteristics influenced multidisciplinary teamwork and diagnostic service delivery in lung cancer DAPs. DESIGN A mixed-methods approach integrated data from descriptive qualitative interviews and medical record abstraction at 4 lung cancer DAPs. Findings were analysed with the Integrated Team Effectiveness Model. SETTING 4 DAPs at 2 teaching and 2 community hospitals in Canada. PARTICIPANTS 22 staff were interviewed about organisational characteristics, target service benchmarks, and teamwork processes, determinants and outcomes; 314 medical records were reviewed for actual service benchmarks. RESULTS Formal, informal and asynchronous team processes enabled service delivery and yielded many perceived benefits at the patient, staff and service levels. However, several DAP characteristics challenged teamwork and service delivery: referral volume/workload, time since launch, days per week of operation, rural-remote population, number and type of full-time/part-time human resources, staff colocation, information systems. As a result, all sites failed to meet target benchmarks (from referral to consultation median 4.0 visits, median wait time 35.0 days). Recommendations included improved information systems, more staff in all specialties, staff colocation and expanded roles for patient navigators. Findings were captured in a conceptual framework of lung cancer DAP teamwork determinants and outcomes. CONCLUSIONS This study identified several DAP characteristics that could be improved to facilitate teamwork and enhance service delivery, thereby contributing to knowledge of organisational determinants of teamwork and associated outcomes. Findings can be used to update existing DAP guidelines, and by managers to plan or evaluate lung cancer DAPs. Ongoing research is needed to identify ideal roles for navigators, and staffing models tailored to case volumes.
Collapse
Affiliation(s)
| | - Terri Stuart-McEwan
- Gattuso Rapid Diagnosis Centre, University Health Network, Toronto, Ontario, Canada
| | - Tom Waddell
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Alexandra Salvarrey
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Jennifer Smylie
- Ages Cancer Assessment Clinic, Ottawa Hospital, Ottawa, Canada
| | - Mark J Dobrow
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Melissa C Brouwers
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Lewis-Patterson P, Palos GR, Dains J, Jackson TL. Cancer Prevention in the Survivorship Setting. Semin Oncol Nurs 2016; 32:291-305. [PMID: 27539283 DOI: 10.1016/j.soncn.2016.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe how nurses can use risk reduction and health promotion activities to facilitate surveillance of late effects and secondary cancers in long-term cancer survivors. DATA SOURCES Literature review on survivorship, nursing practice, cancer prevention, and survivorship; articles published in peer-reviewed scientific journals; and Web-based or professional organization resources. CONCLUSION Appropriate participation in screening activities, early detection of cancer, and further advances in treatment have contributed to the rise in cancer survivors. A demand for nurses with clinical experience and competence in survivorship care will follow. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses have an essential role in providing safe and high-quality care throughout the survivorship experience, which can contribute to better long-term outcomes.
Collapse
|
11
|
Erfani SS, Blount Y, Abedin B. The influence of health-specific social network site use on the psychological well-being of cancer-affected people. J Am Med Inform Assoc 2016; 23:467-76. [PMID: 26911816 DOI: 10.1093/jamia/ocv170] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 10/15/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We aimed to explore and examine how and in what ways the use of social network sites (SNSs) can improve health outcomes, specifically better psychological well-being, for cancer-affected people. METHODS Qualitative semi-structured interviews were conducted with users of the Ovarian Cancer Australia Facebook page (OCA Facebook), the exemplar SNS used in this study. Twenty-five women affected by ovarian cancer who were users of OCA Facebook were interviewed. A multi-theory perspective was employed to interpret the data. RESULTS Most of the study participants used OCA Facebook daily. Some users were passive and only observed created content, while other users actively posted content and communicated with other members. Analysis showed that the use of this SNS enhanced social support for users, improved the users' experiences of social connectedness, and helped users learn and develop social presence, which ultimately improved their psychological well-being. DISCUSSION The strong theoretical underpinning of our research and empirically derived results led to a new understanding of the capacity of SNSs to improve psychological well-being. Our study provides evidence showing how the integration of these tools into existing health services can enhance patients' psychological well-being. This study also contributes to the body of knowledge on the implications of SNS use for improving the psychological well-being of cancer-affected people. CONCLUSION This research assessed the relationship between the use of SNSs, specifically OCA Facebook, and the psychological well-being of cancer-affected people. The study confirmed that using OCA Facebook can improve psychological well-being by demonstrating the potential value of SNSs as a support service in the healthcare industry.
Collapse
Affiliation(s)
| | - Yvette Blount
- Faculty of Business and Economics, Macquarie University, North Ryde 2109 Australia,
| | - Babak Abedin
- Faculty of Engineering and IT, University of Technology Sydney, Ultimo 2007, Australia,
| |
Collapse
|
12
|
Sicotte C, Lapointe J, Clavel S, Fortin MA. Benefits of improving processes in cancer care with a care pathway-based electronic medical record. Pract Radiat Oncol 2016; 6:26-33. [DOI: 10.1016/j.prro.2015.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/25/2015] [Accepted: 08/29/2015] [Indexed: 11/28/2022]
|
13
|
Stover A, Irwin DE, Chen RC, Chera BS, Mayer DK, Muss HB, Rosenstein DL, Shea TC, Wood WA, Lyons JC, Reeve BB. Integrating Patient-Reported Outcome Measures into Routine Cancer Care: Cancer Patients' and Clinicians' Perceptions of Acceptability and Value. EGEMS (WASHINGTON, DC) 2015; 3:1169. [PMID: 26557724 PMCID: PMC4636110 DOI: 10.13063/2327-9214.1169] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Despite growing interest in integrating patient-reported outcome (PRO) measures of symptoms and functional status into routine cancer care, little attention has been paid to patients' and clinicians' perceptions of acceptability and value. METHODS A two-phase qualitative study was conducted to develop a web-based PRO screening system with 21 items assessing symptoms (e.g., nausea) and functional status. Phase 1 involved cognitive interviews with 35 cancer outpatients (n=9 breast chemotherapy, radiation for prostate (n=8) or head and neck cancer (n=10), and n=8 bone marrow transplant [BMT]). In Phase 2, we evaluated the acceptability and perceived value of reviewing a PRO measure during real-time clinical encounters with 39 additional outpatients (n=10 breast, n=9 head and neck, n=10 prostate, n=10 BMT) and 12 clinicians (n=3 breast, n=2 head and neck, n=4 prostate, n=3 BMT). At least 20% of patients were ≥60 years, African American, or ≤ high school. RESULTS Patients felt that their PRO summary of symptoms and functional status was helpful in discussing health issues with clinicians (92%), wanted to review their results with clinicians during future visits (82%), and would recommend it to other patients (87%). Clinicians found the PRO summary to be easy to interpret (83%), most helpful for documenting the Review of Symptoms (92%), and would recommend it to future patients (92%). Over 90% of clinicians reported that consultation time did not increase. CONCLUSION Both cancer patients and clinicians reported that discussing a PRO summary of symptoms and functional status during an outpatient visit was useful, acceptable, and feasible.
Collapse
|
14
|
Hsu W, Gonzalez NR, Chien A, Pablo Villablanca J, Pajukanta P, Viñuela F, Bui AAT. An integrated, ontology-driven approach to constructing observational databases for research. J Biomed Inform 2015; 55:132-42. [PMID: 25817919 DOI: 10.1016/j.jbi.2015.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 02/14/2015] [Accepted: 03/19/2015] [Indexed: 11/28/2022]
Abstract
The electronic health record (EHR) contains a diverse set of clinical observations that are captured as part of routine care, but the incomplete, inconsistent, and sometimes incorrect nature of clinical data poses significant impediments for its secondary use in retrospective studies or comparative effectiveness research. In this work, we describe an ontology-driven approach for extracting and analyzing data from the patient record in a longitudinal and continuous manner. We demonstrate how the ontology helps enforce consistent data representation, integrates phenotypes generated through analyses of available clinical data sources, and facilitates subsequent studies to identify clinical predictors for an outcome of interest. Development and evaluation of our approach are described in the context of studying factors that influence intracranial aneurysm (ICA) growth and rupture. We report our experiences in capturing information on 78 individuals with a total of 120 aneurysms. Two example applications related to assessing the relationship between aneurysm size, growth, gene expression modules, and rupture are described. Our work highlights the challenges with respect to data quality, workflow, and analysis of data and its implications toward a learning health system paradigm.
Collapse
Affiliation(s)
- William Hsu
- Department of Radiological Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, United States.
| | - Nestor R Gonzalez
- Department of Radiological Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, United States; Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Aichi Chien
- Department of Radiological Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - J Pablo Villablanca
- Department of Radiological Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Päivi Pajukanta
- Department of Human Genetics, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Fernando Viñuela
- Department of Radiological Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Alex A T Bui
- Department of Radiological Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| |
Collapse
|