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Petry SE, Lara L, Boucher NA. Older Caregivers: Who They Are and How to Support Them. J Aging Soc Policy 2024; 36:589-602. [PMID: 35290168 DOI: 10.1080/08959420.2022.2051683] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/12/2021] [Indexed: 10/18/2022]
Abstract
Caregivers play a crucial role in providing health and social supports to their family and friends. Older adults who take on caregiving roles are themselves uniquely vulnerable to negative health and financial effects due to their age and underlying health risks. Many caregivers do not receive adequate support - either formally or informally - exacerbating the strains of providing care. Racial and ethnic minority caregivers may be less likely to report receiving support in their role and face additional challenges. We describe these caregivers over 65 and the burdens they face. We recommend community health workers, direct compensation, and normalization of respite care to support these essential care workers in their role and as they age.
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Affiliation(s)
- Sarah E Petry
- Doctoral Student, Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Luz Lara
- Director of Senior Services, Union Settlement, New York, New York, USA
| | - Nathan A Boucher
- Doctoral Student, Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
- Health Research Specialist, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, North Carolina, USA
- Associate Professor, School of Medicine, Duke University, Durham, North Carolina, USA
- Core Faculty, Duke- Duke University, Durham, North Carolina, USA
- Senior Fellow, Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
- Associate Research Professor, Sanford School of Public Policy, Duke University, Durham, USA
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Heshmati R, Kheiriabad M, Azmoodeh S, Ghasemi A, Pfaltz M. Pathways Linking Parental Care and Control to Loneliness in Breast Cancer Patients with A History of Childhood Maltreatment: Exploring the Mediating Roles of Ambivalence Over Emotional Expression and Self-Discrepancy. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:2261-2289. [PMID: 38158727 DOI: 10.1177/08862605231218678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Childhood maltreatment is a risk factor for loneliness and is linked to breast cancer. Parental bonding experienced during one's childhood also plays a significant role in increasing or decreasing the risk of loneliness later in life. Previous research has highlighted the significance of ambivalence over emotional expression (AEE) and self-discrepancy in the psychological adaptation of breast cancer patients, particularly concerning the impact of parental care and control experienced by patients in their relationship with their parents during childhood. Nevertheless, previous studies have not examined the mediating effects of AEE and self-discrepancy on parental care and control, as well as loneliness, in breast cancer patients. This study aimed to investigate whether AEE and self-discrepancy mediate the association of childhood parental care and control with loneliness in breast cancer patients with a history of childhood maltreatment. One hundred and thirty-three breast cancer patients who were receiving chemotherapy within the first 3 months post-diagnosis were recruited from one private and three public hospitals in Tabriz, Iran, to complete questionnaires. Parental bonding, loneliness, AEE, and self-discrepancy were assessed using the Parental Bonding Instrument (PBI), University of California Los Angeles (UCLA) Loneliness Scale, Ambivalence over the Expression of Emotion Questionnaire (AEQ), and Self-Discrepancies Scale (S-DS). Mediation models were tested using structural equation modeling. Effects of parental care (β = -.17, p < .05) and control (β = .21, p < .001) on loneliness were significant. Furthermore, both AEE (β = .19, p < .05) and self-discrepancy (β = .23, p < .01) significantly predicted loneliness. The pathway between parental care and AEE was significant (β = -.21, p < .001), as was the direct effect of parental control on self-discrepancy (β = .19, p < .05). Bootstrapping results showed that AEE significantly mediated the relationship between parental care and loneliness (95% confidence interval [CI] [-0.09, -0.01]). In addition, there was a significant indirect effect from parental control to loneliness via self-discrepancy (95% CI [0.11, 0.01]). These findings suggest that AEE and self-discrepancy could potentially be utilized in preventing or addressing loneliness in breast cancer patients who have a history of childhood maltreatment. Future research could, for example, assess whether integrating psychosocial interventions focusing on these variables as part of medical care can improve the mental health status of this subgroup of breast cancer patients who have experienced childhood maltreatment.
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Varanasi AP, Burhansstipanov L, Dorn C, Gentry S, Capossela MA, Fox K, Wilson D, Tanjasiri S, Odumosu O, Saavedra Ferrer EL. Patient navigation job roles by levels of experience: Workforce Development Task Group, National Navigation Roundtable. Cancer 2024; 130:1549-1567. [PMID: 38306297 DOI: 10.1002/cncr.35147] [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: 02/04/2024]
Abstract
PLAIN LANGUAGE SUMMARY Cancer patient navigators work in diverse settings ranging from community-based programs to comprehensive cancer centers to improve outcomes in underserved populations by eliminating barriers to timely cancer prevention, early detection, diagnosis, treatment, and survivorship in a culturally appropriate and competent manner. This article clarifies the roles and responsibilities of Entry, Intermediate, and Advanced level cancer patient navigators. The competencies described in this article apply to patient navigators, nurse navigators, and social work navigators. This article provides a resource for administrators to create job descriptions for navigators with specific levels of expertise and for patient navigators to advance their oncology careers and attain a higher level of expertise.
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Affiliation(s)
| | | | - Carrie Dorn
- National Association of Social Workers, Washington, DC, USA
| | - Sharon Gentry
- Academy of Oncology Nurse and Patient Navigators (AONN+), Lewisville, North Carolina, USA
| | | | - Kyandra Fox
- Patient Navigation, Education and Training, Susan G. Komen Foundation, Allen, Texas, USA
| | - Donna Wilson
- HCA Henrico Doctors' Hospital/Virginia Cancer Patient Navigator Network (VaCPNN), Midlothian, Virginia, USA
| | - Sora Tanjasiri
- Department of Health, Society and Behavior, University of Irvine, Irvine, California, USA
| | | | - Elba L Saavedra Ferrer
- College of Education and Human Sciences, University of New Mexico, Albuquerque, New Mexico, USA
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Xue Z, Zhang Y, Gan W, Wang H, She G, Zheng X. Quality and Dependability of ChatGPT and DingXiangYuan Forums for Remote Orthopedic Consultations: Comparative Analysis. J Med Internet Res 2024; 26:e50882. [PMID: 38483451 PMCID: PMC10979330 DOI: 10.2196/50882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/04/2023] [Accepted: 01/30/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND The widespread use of artificial intelligence, such as ChatGPT (OpenAI), is transforming sectors, including health care, while separate advancements of the internet have enabled platforms such as China's DingXiangYuan to offer remote medical services. OBJECTIVE This study evaluates ChatGPT-4's responses against those of professional health care providers in telemedicine, assessing artificial intelligence's capability to support the surge in remote medical consultations and its impact on health care delivery. METHODS We sourced remote orthopedic consultations from "Doctor DingXiang," with responses from its certified physicians as the control and ChatGPT's responses as the experimental group. In all, 3 blindfolded, experienced orthopedic surgeons assessed responses against 7 criteria: "logical reasoning," "internal information," "external information," "guiding function," "therapeutic effect," "medical knowledge popularization education," and "overall satisfaction." We used Fleiss κ to measure agreement among multiple raters. RESULTS Initially, consultation records for a cumulative count of 8 maladies (equivalent to 800 cases) were gathered. We ultimately included 73 consultation records by May 2023, following primary and rescreening, in which no communication records containing private information, images, or voice messages were transmitted. After statistical scoring, we discovered that ChatGPT's "internal information" score (mean 4.61, SD 0.52 points vs mean 4.66, SD 0.49 points; P=.43) and "therapeutic effect" score (mean 4.43, SD 0.75 points vs mean 4.55, SD 0.62 points; P=.32) were lower than those of the control group, but the differences were not statistically significant. ChatGPT showed better performance with a higher "logical reasoning" score (mean 4.81, SD 0.36 points vs mean 4.75, SD 0.39 points; P=.38), "external information" score (mean 4.06, SD 0.72 points vs mean 3.92, SD 0.77 points; P=.25), and "guiding function" score (mean 4.73, SD 0.51 points vs mean 4.72, SD 0.54 points; P=.96), although the differences were not statistically significant. Meanwhile, the "medical knowledge popularization education" score of ChatGPT was better than that of the control group (mean 4.49, SD 0.67 points vs mean 3.87, SD 1.01 points; P<.001), and the difference was statistically significant. In terms of "overall satisfaction," the difference was not statistically significant between the groups (mean 8.35, SD 1.38 points vs mean 8.37, SD 1.24 points; P=.92). According to how Fleiss κ values were interpreted, 6 of the control group's score points were classified as displaying "fair agreement" (P<.001), and 1 was classified as showing "substantial agreement" (P<.001). In the experimental group, 3 points were classified as indicating "fair agreement," while 4 suggested "moderate agreement" (P<.001). CONCLUSIONS ChatGPT-4 matches the expertise found in DingXiangYuan forums' paid consultations, excelling particularly in scientific education. It presents a promising alternative for remote health advice. For health care professionals, it could act as an aid in patient education, while patients may use it as a convenient tool for health inquiries.
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Affiliation(s)
- Zhaowen Xue
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yiming Zhang
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wenyi Gan
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Huajun Wang
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Guorong She
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaofei Zheng
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Gonzalez JD, Martin L, Osmundsen B, Garg B, Gregory WT, Cichowski S. Understanding the Pursuit of Third-Line Therapies for Overactive Bladder: A Mixed Methods Study. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:188-196. [PMID: 38484231 DOI: 10.1097/spv.0000000000001442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Overactive bladder (OAB) affects millions of women in the United States, with negative effects in multiple domains that have an impact on quality of life. Third-line therapies for OAB are as effective or superior to lifestyle/behavior modification and medical management, yet few women access these treatments and often spend more than 36 months to reach these treatments after starting medication. Factors associated with time to reach third-line therapy are not well studied, and little is known about how patients progress through care pathways for OAB. OBJECTIVES The aim of the study was to determine factors associated with the time spent between second- and third-line therapy for OAB at an academic urogynecology and reconstructive pelvic surgery practice. We sought to identify demographic, treatment, clinical factors, and themes in barriers to receiving treatment for OAB. STUDY DESIGN This was a mixed methods study consisting of a retrospective cohort study followed by qualitative key informant interviews. RESULTS Eighty-five total participants were included in the analysis, and 42 (49.5%) spent more than 36 months between initiation of medical management and initial third-line therapy for OAB. No significant (P > 0.05) demographic, clinical, or treatment differences were found between groups. Facilitators and obstacles to receiving third-line therapy were identified among key informants, and a treatment decision framework was developed. CONCLUSIONS Women often spend more than 36 months to pursue third-line therapy for OAB. Existing objective variables are poor predictors of pursuit of third-line treatment, and leveraging known facilitators and obstacles can be used to develop improved care pathways for OAB.
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Affiliation(s)
| | | | | | - Bharti Garg
- From the Oregon Health and Science University
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Oetzel JG, Simpson M, Meha P, Cameron MP, Zhang Y, Nock S, Reddy R, Adams H, Akapita N, Akariri N, Anderson J, Clark M, Ngaia K, Hokowhitu B. Tuakana-teina peer education programme to help Māori elders enhance wellbeing and social connectedness. BMC Geriatr 2024; 24:114. [PMID: 38291380 PMCID: PMC10826274 DOI: 10.1186/s12877-024-04703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND There are significant inequities between Māori (Indigenous people) and non-Māori in ageing outcomes. This study used a strengths-based approach based on the key cultural concept of mana motuhake (autonomy and self-actualisation) to develop a tuakana-teina (literally older sibling-younger sibling) peer education programme to assist kaumātua (elders) in addressing health and social needs. The purpose of this study was to test the impact on those receiving the programme. Three aims identify the impact on outcomes, resources received and the cost effectiveness of the programme. METHODS Five Kaupapa Māori (research and services guided by Māori worldviews) iwi (tribe) and community providers implemented the project using a partnership approach. Tuakana (peer educators) had up to six conversations each with up to six teina (peer learners) and shared information related to social and health services. A pre- and post-test, clustered staggered design was the research design. Participants completed a baseline and post-programme assessment of health and mana motuhake measures consistent with Māori worldviews. Open-ended questions on the assessments, five focus groups, and four individual interviews were used for qualitative evaluation. FINDINGS A total of 113 kaumātua were recruited, and 86 completed the programme. The analysis revealed improvements in health-related quality of life, needing more help with daily tasks, life satisfaction, paying bills and housing problems. Qualitative results supported impacts of the programme on mana motuhake and hauora (holistic health) through providing intangible and tangible resources. Cost-effectiveness analysis showed that the intervention is cost effective, with a cost per QALY of less than the conventional threshold of three times GDP per capita. CONCLUSIONS A culturally-resonant, strengths-based programme developed through a participatory approach can significantly improve health and social outcomes in a cost-effective way. TRIAL REGISTRY Clinical trial registry: Trial registration: (ACTRN12620000316909). Prospectively registered 06/03/2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379302&isClinicalTrial=False .
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Grants
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
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Affiliation(s)
- John G Oetzel
- University of Waikato, Private Bag 3105, 3240, Hamilton, New Zealand.
| | - Mary Simpson
- University of Waikato, Private Bag 3105, 3240, Hamilton, New Zealand
| | - Pare Meha
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St, 3204, Hamilton, New Zealand
| | - Michael P Cameron
- University of Waikato, Private Bag 3105, 3240, Hamilton, New Zealand
| | | | - Sophie Nock
- University of Waikato, Private Bag 3105, 3240, Hamilton, New Zealand
| | - Rangimahora Reddy
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St, 3204, Hamilton, New Zealand
| | - Hariata Adams
- Te Korowai Hauora o Hauraki, 210 Richmond St, 3500, Thames, New Zealand
| | - Ngapera Akapita
- Ngāti Ruanui Whānau Ora, 96 Collins Street, 4610, Hawera, New Zealand
| | - Ngareo Akariri
- Tui Ora Limited, 36 Maratahu Street, 4342, New Plymouth, New Zealand
| | - Justina Anderson
- Tui Ora Limited, 36 Maratahu Street, 4342, New Plymouth, New Zealand
| | - Marama Clark
- Poutiri Trust, 35 Commerce Lane, 3119, Te Puke, New Zealand
| | - Kawarau Ngaia
- Te Korowai o Ngāruahine Trust, 4610, Hawera, PO Box 474, New Zealand
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Vuocolo B, Gutierrez AM, Robinson JO, Recinos AM, Desrosiers LR, Majumder MA, Bernini JC, Gill J, Griffin T, Tomlinson GE, Vallance K, McGuire AL, Parsons DW, Plon SE, Scollon S. Families' experiences accessing care after genomic sequencing in the pediatric cancer context: "It's just been a big juggle". J Genet Couns 2024. [PMID: 38225886 DOI: 10.1002/jgc4.1858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 11/30/2023] [Accepted: 12/27/2023] [Indexed: 01/17/2024]
Abstract
Access to genomic sequencing (GS) and resulting recommendations have not been well described in pediatric oncology. GS results may provide a cancer predisposition syndrome (CPS) diagnosis that warrants screening and specialist visits beyond cancer treatment, including testing or surveillance for family members. The Texas KidsCanSeq (KCS) Study evaluated implementation of GS in a diverse pediatric oncology population. We conducted semi-structured interviews (n = 20) to explore experiences of KCS patients' families around learning about a CPS diagnosis and following up on recommended care. We used qualitative content analysis to develop themes and subthemes across families' descriptions of their experiences accessing care and to understand which factors presented barriers and/or facilitators. We found participants had difficulty differentiating which follow-up care recommendations were made for their child's current cancer treatment versus the CPS. In families' access to follow-up care for CPS, organizational factors were crucial: travel time and distance were common hardships, while coordination of care to streamline multiple appointments with different providers helped facilitate CPS care. Financial factors also impacted families' access to CPS-related follow-up care: having financial assistance and insurance were facilitators for families, while costs and lack of insurance posed as barriers for patients who lost coverage during transitions from pediatric to adult care, and for adult family members who had no coverage. Factors related to beliefs and perceptions, specifically perceiving the risk as less salient to them and feeling overwhelmed with the patient's cancer care, presented barriers to follow-up care primarily for family members. Regarding social factors, competing life priorities made it difficult for families to access follow-up care, though having community support alleviated these barriers. We suggest interventions to improve coordination of cancer treatment and CPS-related care and adherence to surveillance protocols for families as children age, such as care navigators and integrating longitudinal genetic counseling into hereditary cancer centers.
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Affiliation(s)
- Blake Vuocolo
- Department of Molecular and Human Genetics, School of Health Professions, Baylor College of Medicine, Houston, Texas, USA
| | - Amanda M Gutierrez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Jill O Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Alva M Recinos
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Lauren R Desrosiers
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Mary A Majumder
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Juan Carlos Bernini
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Cancer and Hematology Clinic, Vannie E. Cook Clinic, McAllen, Texas, USA
| | - Jonathan Gill
- UT MD Anderson Cancer Center, Children's Cancer Hospital, Houston, Texas, USA
| | - Timothy Griffin
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Department of Pediatric Hematology-Oncology, Children's Hospital of San Antonio, San Antonio, Texas, USA
| | - Gail E Tomlinson
- UT Health Science Center, Greehey Children's Cancer Research Institute and Division of Pediatric Hematology-Oncology, San Antonio, Texas, USA
| | - Kelly Vallance
- Cook Children's Hematology and Oncology, Cook Children's Hospital, Forth Worth, Texas, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - D Williams Parsons
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Sharon E Plon
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Sarah Scollon
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
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Carr AL, Vinod N, Farha P, Lu T, Farha MJ, Graves KD. An exploration of facilitators and barriers to patient navigator core functions with breast cancer patients: Implications for the development of a human-centered mHealth app. PEC INNOVATION 2023; 3:100226. [PMID: 37859864 PMCID: PMC10583173 DOI: 10.1016/j.pecinn.2023.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
Objectives To understand the barriers to core functions and workflow among patient navigators (PN) who navigate people diagnosed with breast cancer (BC). To identify how a mobile health (mHealth) app could assist PNs in providing care to BC patients. Methods This qualitative research study used purposive sampling to recruit stakeholders (N = 33) from January to August 2021. We conducted individual semi-structured interviews with PNs (n = 11), oncology care providers (n = 12), and BC patients (n = 10). We used conventional content analysis to analyze the interview data. Results Participants identified the following sociotechnical systems barriers in PN workflows that negatively impact BC patient care: 1) resources, 2) insurance coverage, 3) communication challenges, and 4) impact of logistical tasks. Participants identified the user experience, app features, and interoperability customizations to enhance PNs' provision of patient care as important design elements to include in a mHealth app. Conclusion Feedback from stakeholders provided valuable insights into key design considerations, functions, and content areas for developing a mHealth app for PN use in BC care delivery. Innovation This is one of the first studies to incorporate the human-centered design and sociotechnical systems frameworks to understand barriers to PN workflow and provision of BC patient care across the cancer care continuum.
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Affiliation(s)
- Alaina L. Carr
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Naomi Vinod
- Department of Psychology, Howard University, Washington, DC, USA
| | | | - Tan Lu
- Avident Health LLC, Baltimore, MD, USA
- Department of Surgery, MedStar Union Memorial and Good Samaritan Hospitals, Baltimore, MD, USA
| | - Maen J. Farha
- Avident Health LLC, Baltimore, MD, USA
- Department of Surgery, MedStar Union Memorial and Good Samaritan Hospitals, Baltimore, MD, USA
| | - Kristi D. Graves
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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陶 文, 文 进, 李 为. [Utilizing Patient Navigation Model in the Whole-Process Management of Lung Cancer in the Context of Medical Consortiums in China: Insights and Reflections]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:1288-1293. [PMID: 38162072 PMCID: PMC10752780 DOI: 10.12182/20231160301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Indexed: 01/03/2024]
Abstract
Patient navigation is an effective intervention measure to promote the integration of medical systems and services. By providing individualized, coordinated, and continuous care, patient navigation offers a way to address the problem of fragmented services across institutions and levels of care in the whole-process management of lung cancer, providing assistance to patients with complex healthcare needs. Herein, we reviewed the origin, the development, the models, and the application status of patient navigation in China and other countries. We also analyzed the considerations regarding introducing patient navigation in the whole-process management of lung cancer against the background of medical consortiums in China, discussing why patient navigation should be introduced, how to introduce patient navigation, as well as potential challenges and coping strategies. Patient navigation meets the current needs for equitable, accessible, systematic, continuous, and integrated prevention and treatment services for chronic diseases in the context of the Healthy China Strategy. It helps fill the gaps in the continuity and coordination of whole-process management of lung cancer patients in the context of medical consortiums. However, introducing patient navigation in medical consortiums involving multiple institutions and levels of care may face challenges, including incompatibility between the health information systems of different institutions, poor cross-institutional collaboration and communication, and limited resources. Further improvement is needed in medical informatization, coordination and communication mechanisms, and benefit distribution mechanisms within the medical consortiums. In this paper, we intend to provide insights and suggestions for developing patient navigation models that suit China's local characteristics and for promoting the implementation and development of whole-process management of lung cancer in the context of the medical consortium system.
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Affiliation(s)
- 文娟 陶
- 四川大学华西医院 医院管理研究所 (成都 610041)Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 进 文
- 四川大学华西医院 医院管理研究所 (成都 610041)Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 为民 李
- 四川大学华西医院 医院管理研究所 (成都 610041)Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China
- 四川大学华西医院 院长办公室 (成都 610041)President's Office, West China Hospital, Sichuan University, Chengdu 610041, China
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10
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Gallups SF, Demirci J, Nilsen ML, Burke J, Bender C, Rosenzweig MQ. Stakeholder perspectives on six identified interpersonal communication components of patient navigation in breast cancer care. Support Care Cancer 2023; 31:688. [PMID: 37947858 DOI: 10.1007/s00520-023-08121-7] [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: 06/30/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Although identified as a key competency domain and a needed area of professional development, interpersonal communication in breast cancer care patient navigation is understudied. Moreover, the patient-navigator relationship may be influenced by the interpersonal communication skills and behaviors of the patient navigator. This paper reports on the interpretation step of a concept mapping study, where key stakeholders shared their perspectives on six identified interpersonal communication components of breast cancer care patient navigation. METHODS This study utilized concept mapping, a community-engaged mixed method approach. After conducting brainstorming, sorting, and concept mapping analysis, a six-cluster concept map of interpersonal communication in breast cancer care patient navigation was identified. Interpretation sessions with each participant group (patients, patient navigators, administrators) allowed both naming and more in-depth exploration of the six clusters. The sessions were led by a facilitator, the PI, and were audio recorded and transcribed. RESULTS Six 2-h interpretation sessions were conducted with 21 participants, including patients with breast cancer, breast cancer patient navigators (lay or medically trained), and patient navigation administrators from Western Pennsylvania. Through a group consensus process, the six clusters were named. Participants identified that all six identified components were essential to patient navigation, but the ability to build patient-centered trust and relationships and maintain professional communication were the most impactful components of the patient-navigator relationship. CONCLUSION These findings validate the importance of interpersonal skills and behaviors of patient navigators in breast cancer care. These findings can inform the patient navigation role description, competencies, and the development of curriculum for training and metrics for evaluation.
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Affiliation(s)
- Sarah F Gallups
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA.
| | - Jill Demirci
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | | | - Jessica Burke
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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11
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Gallups SF, Demirci J, Nilsen M, Burke J, Bender C, Rosenzweig MQ. Using Concept Mapping to Explore Interpersonal Communication Components of Patient Navigation in Breast Cancer Care. Cancer Nurs 2023; 46:321-330. [PMID: 35439221 DOI: 10.1097/ncc.0000000000001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Research exploring the relational dimensions of patient navigation identifies interpersonal communication as fundamental to the patient navigator's (PN's) ability to reduce barriers to care and improve cancer care outcomes. Although interpersonal communication is a core competency for PNs, its key components are commonly understudied and overlooked. OBJECTIVE The purpose of this study was to identify the key interpersonal communication components of patient navigation in breast cancer care that patients, PNs, and PN administrators perceived to impact the patient-navigator relationship. METHODS This study used concept mapping, a community-engaged research method. Participants completed 3 concept mapping activities: brainstorming, sorting and rating, and interpretation. RESULTS A total of 31 persons participated in the study: 13 patients, 14 PNs, and 4 PN administrators. The concept mapping analysis produced a 6-cluster concept map, and each concept was named through a group consensus process. Among the 6 concepts, both patients and PNs emphasized the importance of "Empathetic, Comprehensive, and Compassionate Support," "Bridge to Clinical Education and Supportive Resources," and "Ongoing Individualized Coordination of Care" as the most important components for facilitating the patient-navigator relationship. CONCLUSION Patients, PNs, and PN administrators all emphasized the essential role of interpersonal communication in the PN-patient relationship and how it is woven into every aspect of the PN role. IMPLICATIONS FOR PRACTICE As a core competency, we need to work toward the development and testing of evidence-based training to support their professional development and ultimately promote positive cancer care outcomes.
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Affiliation(s)
- Sarah F Gallups
- Author Affiliations: School of Nursing, University of Alabama at Birmingham (Dr Gallups); School of Nursing, University of Pittsburgh (Drs Demirci, Nilsen, Bender, and Rosenzweig), Pennsylvania; and Graduate School of Public Health, University of Pittsburgh (Dr Burke), Pennsylvania
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12
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Zhu X, Zhang P, Kang H, Marla L, Robles Granda MI, Ebert-Allen RA, Stewart de Ramirez S, Oderwald T, McGee M, Handler JA. Derivation of a Unique, Algorithm-Based Approach to Cancer Patient Navigator Workload Management. JCO Clin Cancer Inform 2023; 7:e2200170. [PMID: 37207310 PMCID: PMC10569769 DOI: 10.1200/cci.22.00170] [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: 11/11/2022] [Revised: 02/05/2023] [Accepted: 03/15/2023] [Indexed: 05/21/2023] Open
Abstract
PURPOSE Cancer patient navigators (CPNs) can decrease the time from diagnosis to treatment, but workloads vary widely, which may lead to burnout and less optimal navigation. Current practice for patient distribution among CPNs at our institution approximates random distribution. A literature search did not uncover previous reports of an automated algorithm to distribute patients to CPNs. We sought to develop an automated algorithm to fairly distribute new patients among CPNs specializing in the same cancer type(s) and assess its performance through simulation on a retrospective data set. METHODS Using a 3-year data set, a proxy for CPN work was identified and multiple models were developed to predict the upcoming week's workload for each patient. An XGBoost-based predictor was retained on the basis of its superior performance. A distribution model was developed to fairly distribute new patients among CPNs within a specialty on the basis of predicted work needed. The predicted work included the week's predicted workload from a CPN's existing patients plus that of newly distributed patients to the CPN. Resulting workload unfairness was compared between predictor-informed and random distribution. RESULTS Predictor-informed distribution significantly outperformed random distribution for equalizing weekly workloads across CPNs within a specialty. CONCLUSION This derivation work demonstrates the feasibility of an automated model to distribute new patients more fairly than random assignment (with unfairness assessed using a workload proxy). Improved workload management may help reduce CPN burnout and improve navigation assistance for patients with cancer.
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Affiliation(s)
- Xiyitao Zhu
- University of Illinois at Urbana-Champaign, Champaign, IL
| | - Peng Zhang
- University of Illinois at Urbana-Champaign, Champaign, IL
| | - Hyojung Kang
- University of Illinois at Urbana-Champaign, Champaign, IL
| | - Lavanya Marla
- University of Illinois at Urbana-Champaign, Champaign, IL
| | | | | | - Sarah Stewart de Ramirez
- OSF HealthCare System, Peoria, IL
- University of Illinois College of Medicine at Peoria, Peoria, IL
| | | | | | - Jonathan A. Handler
- OSF HealthCare System, Peoria, IL
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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13
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Pomey MP, Paquette J, Iliescu-Nelea M, Vialaron C, Mourad R, Bouchard K, Normandin L, Côté MA, Desforges M, Pomey-Carpentier P, Fortin I, Ganache I, Régis C, Rosberger Z, Charpentier D, Bélanger L, Dorval M, Ghadiri DP, Lavoie-Tremblay M, Boivin A, Pelletier JF, Fernandez N, Danino AM, de Guise M. Accompanying patients in clinical oncology teams: Reported activities and perceived effects. Health Expect 2023; 26:847-857. [PMID: 36704843 PMCID: PMC10010089 DOI: 10.1111/hex.13710] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Since 2018, four establishments in Quebec, Canada, have decided to implement the PAROLE-Onco programme, which introduced accompanying patients (APs) in healthcare teams to improve the experience of cancer patients. APs are patient advisors who have had a cancer treatment experience and who conduct consultations to complement the service offered by providing emotional, informational and educational support to patients undergoing treatments (e.g., radiotherapy, chemotherapy, surgery), mostly for breast cancer. We aimed to explore the evolution of APs' perspectives regarding their activities within the clinical oncology teams as well as the perceived effects of their intervention with patients, the clinical team and themselves. METHODS A qualitative study based on semistructured interviews and focus groups was conducted with APs at the beginning of their intervention (T1) and 2 years afterwards (T2). The themes discussed were APs' activities and the perceived effects of their interventions on themselves, on the patients and on the clinical team. RESULTS In total, 20 APs were interviewed. In T2, APs' activities shifted from listening and sharing experiences to empowering patients by helping them become partners in their care and felt generally more integrated into the clinical team. APs help patients feel understood and supported, alleviate stress and become partners in the care they receive. They also alleviate the clinical team's workload by offering a complementary service through emotional support, which, according to them, helps patients feel calmer and more prepared for their appointments with healthcare professionals. They communicate additional information about their patients' health journey, which makes the appointment more efficient for healthcare professionals. When APs accompany patients, they feel as if they can make a difference in patients' lives. Their activities are perceived by some as an opportunity to give back but also as a way of giving meaning to their own experience, in turn serving as a learning experience. CONCLUSION By mobilizing their experiential knowledge, APs provide emotional, informational, cognitive and navigational support, which allows patients to be more empowered in their care and which complements professionals' scientific knowledge, thereby helping to refine their sensitivity to the patients' experiences. PATIENT OR PUBLIC CONTRIBUTION Two patient-researchers have contributed to the study design, the conduct of the study, the data analysis and interpretation, as well as in the preparation and writing of this manuscript.
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Affiliation(s)
- Marie-Pascale Pomey
- Research Centre of the University of Montreal Hospital Centre, Montréal, Quebec, CA.,Centre d'excellence sur le partenariat avec les patients et le public, Montréal, Quebec, CA.,Department of Health Policy, Management and Evaluation, School of Public Health, University of Montréal, Montréal, Quebec, Canada
| | - Jesseca Paquette
- Research Centre of the University of Montreal Hospital Centre, Montréal, Quebec, CA
| | - Monica Iliescu-Nelea
- Research Centre of the University of Montreal Hospital Centre, Montréal, Quebec, CA
| | - Cécile Vialaron
- Research Centre of the University of Montreal Hospital Centre, Montréal, Quebec, CA
| | - Rim Mourad
- Research Centre of the University of Montreal Hospital Centre, Montréal, Quebec, CA
| | - Karine Bouchard
- Centre Hospitalier Universitaire-CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Louise Normandin
- Research Centre of the University of Montreal Hospital Centre, Montréal, Quebec, CA
| | - Marie-Andrée Côté
- Research Centre of the University of Montreal Hospital Centre, Montréal, Quebec, CA
| | - Mado Desforges
- Research Centre of the University of Montreal Hospital Centre, Montréal, Quebec, CA
| | | | - Israël Fortin
- Centre Intégré Universitaire de santé et services sociaux de l'Est-de-l'Île-de Montréal, Hôpital de Maisonneuve-Rosemont, Montréal, Québec, Canada
| | - Isabelle Ganache
- Institut national d'excellence en santé et services sociaux (INESSS), Montréal, Québec, Canada
| | - Catherine Régis
- Université de Montréal-Faculté de Droit, Montréal, Québec, Canada
| | - Zeev Rosberger
- Gerald Bronfman Department of Oncology, Lady Davis Institute for Medical Research, Jewish General Hospital & McGill University, Montréal, Québec, Canada
| | | | - Lynda Bélanger
- Centre Hospitalier Universitaire-CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Michel Dorval
- Centre Hospitalier Universitaire-CHU de Québec-Université Laval, Québec, Québec, Canada.,Université Laval-Faculté de pharmacie, Québec, Québec, Canada.,Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada.,Centre de recherche du CISSS Chaudière Appalaches, Lévis, Québec, Canada
| | | | - Mélanie Lavoie-Tremblay
- Faculté des sciences infirmières, Université de Montréal, Montréal, Québec, Canada.,Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
| | - Antoine Boivin
- Research Centre of the University of Montreal Hospital Centre, Montréal, Quebec, CA.,Centre d'excellence sur le partenariat avec les patients et le public, Montréal, Quebec, CA.,Department of Family and Emergency Medicine, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Jean-François Pelletier
- Centre intégré de santé et de services sociaux de la Montérégie-Ouest, St-Hubert, Québec, Canada.,Yale Program for Recovery & Community Health, New Haven, Connecticut, USA
| | - Nicolas Fernandez
- Department of Family and Emergency Medicine, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Alain M Danino
- Research Centre of the University of Montreal Hospital Centre, Montréal, Quebec, CA.,Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Québec, Canada
| | - Michèle de Guise
- Institut national d'excellence en santé et services sociaux (INESSS), Montréal, Québec, Canada
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14
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Anthonisen G, Luke A, MacNeill L, MacNeill AL, Goudreau A, Doucet S. Patient navigation programs for people with dementia, their caregivers, and members of the care team: a scoping review. JBI Evid Synth 2023; 21:281-325. [PMID: 36449660 PMCID: PMC10578521 DOI: 10.11124/jbies-22-00024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The main objective of this review was to map the literature on the characteristics of patient navigation programs for people with dementia, their caregivers, and members of the care team across all settings. The secondary objective was to map the literature on the barriers and facilitators for implementing and delivering such patient navigation programs. INTRODUCTION People with dementia have individualized needs that change according to the stage of their condition. They often face fragmented and uncoordinated care when seeking support to address these needs. Patient navigation may be one way to help people with dementia access better care. Patient navigation is a model of care that aims to guide people through the health care system, matching their unmet needs to appropriate resources, services, and programs. Organizing the available information on this topic will present a clearer picture of how patient navigation programs work. INCLUSION CRITERIA This review focused on the characteristics of patient navigation programs for people living with dementia, their caregivers, and the members of the care team. It excluded programs not explicitly focused on dementia. It included patient navigation across all settings, delivered in all formats, and administered by all types of navigators if the programs aligned with this review's definition of patient navigation. This review excluded case management programs. METHODS This review was conducted in accordance with JBI methodology for scoping reviews. MEDLINE, CINAHL, APA PsycINFO, Embase, and ProQuest Nursing and Allied Health databases were searched for published full-text articles. A gray literature search was also conducted. Two independent reviewers screened articles for relevance against the inclusion criteria. The results are presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram, and the extracted data are presented narratively and in tabular format. RESULTS Thirty-nine articles describing 20 programs were included in this review. The majority of these articles were published between 2015 and 2020, and based out of the United States. The types of sources included randomized controlled trials, quasi-experimental studies, and qualitative exploratory studies, among others. All programs provided some form of referral or linkage to other services or resources. Most dementia navigation programs included an interdisciplinary team, and most programs were community-based. There was no consistent patient navigator title or standard delivery method. Commonly reported barriers to implementing and delivering these programs were navigator burnout and a lack of coordination between stakeholders. Commonly reported facilitators were collaboration, communication, and formal partnerships between key stakeholders, as well as accessible and flexible program delivery models. CONCLUSIONS This review demonstrates variety and flexibility in the types of services patient navigation programs provided, as well as in the modes of service delivery and in navigator title. This information may be useful for individuals and organizations looking to implement their own programs in the future. It also provides a framework for future systematic reviews that seek to evaluate the effectiveness or efficacy of dementia navigation programs.
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Affiliation(s)
- Grailing Anthonisen
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, NB, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
| | - Alison Luke
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, NB, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, NB, Canada
| | - Lillian MacNeill
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, NB, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
| | - A. Luke MacNeill
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, NB, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
| | - Alex Goudreau
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, NB, Canada
- University of New Brunswick Libraries, Saint John, NB, Canada
| | - Shelley Doucet
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, NB, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, NB, Canada
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15
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Alsbury-Nealy K, Scodras S, Munce S, Colquhoun H, Jaglal SB, Salbach NM. Models for establishing linkages between healthcare and community: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3904-e3920. [PMID: 36317803 DOI: 10.1111/hsc.14096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/22/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Community-based programmes can support healthcare systems by delivering preventive services and health promotion. This study aimed to determine the nature, range, and extent of theoretical models that guide the development of linkages between healthcare settings and community programmes. A scoping review guided by the Joanna Briggs Institute methodology and the PRISMA-ScR was conducted. Four databases (MEDLINE, EMBASE, CINAHL and PsycINFO) were searched on August 8, 2020. Two reviewers independently screened articles by title and abstract and divided the remaining articles for full-text screening. Articles that described the development of a theoretical model to guide the establishment of linkages between healthcare settings and community programmes, were peer-reviewed, and in English, were included. Articles that solely applied linkage models were excluded. One reviewer extracted data on study and model characteristics (e.g. model purpose, model components and relationships between components from the included articles). Categorical data were summarised using frequencies and percentages. Conventional content analysis was used for variables that had lengthier descriptions and variable terminology. The search identified 8926 records. Six articles describing six unique models were included in the review. Of the four models that described intended users, three (75%) identified primary care. Healthcare settings were identified in all models, with three (50%) focusing on primary care. Models used two or more linkage strategies: (1) agreeing on sharing resources, staff, and information, (2) coordinating services and referral processes, (3) planning and evaluation, (4) leadership, policies, and funding, (5) boundary spanning and (6) brokering. All models used the linkage strategy of agreeing on sharing resources, staff, and information. Findings provide important considerations for healthcare and community programme providers planning linkages. Future research should investigate the role and characteristics of community programmes in linkages, and linkages with other types of healthcare settings.
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Affiliation(s)
- Kyla Alsbury-Nealy
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Scodras
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Colquhoun
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan B Jaglal
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nancy M Salbach
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Ver Hoeve ES, Simon MA, Danner SM, Washington AJ, Coples SD, Percac-Lima S, Whited EC, Paskett ED, Naughton MJ, Gray DM, Wenzel JA, Zabora JR, Hassoon A, Tolbert EE, Calhoun E, Barton DL, Friese CR, Titler MG, Hamann HA. Implementing patient navigation programs: Considerations and lessons learned from the Alliance to Advance Patient-Centered Cancer Care. Cancer 2022; 128:2806-2816. [PMID: 35579501 PMCID: PMC9261966 DOI: 10.1002/cncr.34251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 01/31/2022] [Accepted: 04/04/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Six multidisciplinary cancer centers were selected and funded by the Merck Foundation (2017-2021) to collaborate in the Alliance to Advance Patient-Centered Cancer Care ("Alliance"), an initiative to improve patient access, minimize health disparities, and enhance the quality of patient-centered cancer care. These sites share their insights on implementation and expansion of their patient navigation efforts. METHODS Patient navigation represents an evidence-based health care intervention designed to enhance patient-centered care and care coordination. Investigators at 6 National Cancer Institute-designated cancer centers outline their approaches to reducing health care disparities and synthesize their efforts to ensure sustainability and successful transferability in the management of patients with cancer and their families in real-world health care settings. RESULTS Insights are outlined within the context of patient navigation program effectiveness and supported by examples from Alliance cancer center sites: 1) understand the patient populations, particularly underserved and high-risk patients; 2) capitalize on the existing infrastructure and institutional commitment to support and sustain patient navigation; and 3) build capacity by mobilizing community support outside of the cancer center. CONCLUSIONS This process-level article reflects the importance of collaboration and the usefulness of partnering with other cancer centers to share interdisciplinary insights while undergoing intervention development, implementation, and expansion. These collective insights may be useful to staff at other cancer centers that look to implement, enhance, or evaluate the effectiveness of their patient navigation interventions.
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Affiliation(s)
| | - Melissa A. Simon
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
| | - Sankirtana M. Danner
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
| | | | - Susan D. Coples
- Georgia Cancer Center for Excellence at Grady Health System, Atlanta, Georgia
| | | | | | | | | | - Darrell M. Gray
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Jennifer A. Wenzel
- The Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - James R. Zabora
- The Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Ahmed Hassoon
- The Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Elliott E. Tolbert
- The Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | | | - Debra L. Barton
- The University of Michigan School of Nursing, Ann Arbor, Michigan
| | | | - Marita G. Titler
- The University of Michigan School of Nursing, Ann Arbor, Michigan
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17
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Wells KJ, Wightman P, Cobian Aguilar R, Dwyer AJ, Garcia-Alcaraz C, Saavedra Ferrer EL, Mohan P, Fleisher L, Franklin EF, Valverde PA, Calhoun E. Comparing clinical and nonclinical cancer patient navigators: A national study in the United States. Cancer 2022; 128 Suppl 13:2601-2609. [PMID: 35699618 DOI: 10.1002/cncr.33880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/08/2021] [Accepted: 07/30/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND A nationwide survey was conducted to examine differences between clinical and nonclinical oncology navigators in their service provision, engagement in the cancer care continuum, personal characteristics, and program characteristics. METHODS Using convenience sampling, 527 oncology navigators participated and completed an online survey. Descriptive statistics, χ2 statistics, and t tests were used to compare nonclinical (eg, community health worker) and clinical (eg, nurse navigators) navigators on the provision of various navigation services, personal characteristics, engagement in the cancer care continuum, and program characteristics. RESULTS Most participants were clinical navigators (76.1%). Compared to nonclinical navigators, clinical navigators were more likely to have a bachelor's degree or higher (88.6% vs 69.6%, P < .001), be funded by operational budgets (84.4% vs 35.7%, P < .001), and less likely to work at a community-based organization or nonprofit (2.0% vs 36.5%, P < .001). Clinical navigators were more likely to perform basic navigation (P < .001), care coordination (P < .001), treatment support (P < .001), and clinical trial/peer support (P = .005). Clinical navigators were more likely to engage in treatment (P < .001), end-of-life (P < .001), and palliative care (P = .001) navigation. CONCLUSIONS There is growing indication that clinical and nonclinical oncology navigators perform different functions and work in different settings. Nonclinical navigators may be more likely to face job insecurity because they work in nonprofit organizations and are primarily funded by grants.
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Affiliation(s)
- Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, California.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | | | | | | | - Cristian Garcia-Alcaraz
- Department of Psychology, San Diego State University, San Diego, California.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
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18
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Dwyer AJ, Wender RC, Weltzien ES, Dean MS, Sharpe K, Fleisher L, Burhansstipanov L, Johnson W, Martinez L, Wiatrek DE, Calhoun E, Battaglia TA. Collective pursuit for equity in cancer care: The National Navigation Roundtable. Cancer 2022; 128 Suppl 13:2561-2567. [PMID: 35699616 DOI: 10.1002/cncr.34162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/11/2021] [Accepted: 01/08/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The evidence continues to build in support of implementing patient navigation to reduce barriers and increase access to care. However, health disparities remain in cancer outcomes. The goal of the National Navigation Roundtable (NNRT) is to serve as a convener to help support the field of navigation to address equity. METHODS To examine the progress and opportunities for navigation, the NNRT submitted a collection of articles based on the results from 2 dedicated surveys and contributions from member organizations. The intent was to help inform what we know about patient navigation since the last dedicated examination in this journal 10 years ago. RESULTS The online survey of >700 people described navigators and examined sustainability and policy issues and the longevity, specific role and function, and impact of clinical and nonclinical navigators in addition to the role of training and supervision. In addition, a full examination of coronavirus disease 2019 and contributions from member organizations helped further define progress and future opportunities to meet the needs of patients through patient navigation. CONCLUSIONS To achieve equity in cancer care will demand the sustained action of virtually every component of the cancer care system. It is the hope and intent of the NNRT that the information presented in this supplement will be a catalyst for action in this collective action approach.
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Affiliation(s)
- Andrea J Dwyer
- Department of Community and Behavioral Health, The Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Richard C Wender
- Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elsa S Weltzien
- Department of Community and Behavioral Health, The Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Monica S Dean
- Academy of Oncology Nurse and Patient Navigators, Cranbury, New Jersey
| | | | - Linda Fleisher
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Wenora Johnson
- Fight Colorectal Cancer Patient Advocate, Springfield, Missouri
| | | | | | - Elizabeth Calhoun
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas
| | - Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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19
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Garcia-Alcaraz C, Roesch SC, Calhoun E, Wightman P, Mohan P, Battaglia TA, Cobian Aguilar R, Valverde PA, Wells KJ. Exploring classes of cancer patient navigators and determinants of navigator role retention. Cancer 2022; 128 Suppl 13:2590-2600. [PMID: 35699613 DOI: 10.1002/cncr.33908] [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: 01/17/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND In the current nationwide study, the authors used latent class analysis (LCA) to identify classes of cancer patient navigators (CPNs) and examined whether class membership and 12 indicators were related to navigator role retention. METHODS By using data from 460 CPNs in the United States, LCA identified classes (ie, homogenous subgroups) of CPNs with the following indicators: type of CPN (clinical vs nonclinical), education level, area(s) of the cancer care continuum in which the CPN provided patient navigation, region and urbanity where the CPN provided services, organizational work setting, and patient navigation program funding source. The associations of navigator retention with class membership and each indicator were examined using χ2 tests. RESULTS LCA identified 3 classes of CPNs. Classes 1 and 3 were conceptualized as distinct, homogeneous subgroups of clinical CPNs that appeared to differ mainly on their likelihood of engagement in outreach, survivorship, palliative care, and end-of-life patient navigation. Class 2 was conceptualized as a nonclinical CPN subgroup that was distinct primarily based on their high endorsement of employment in programs, which are at least partially funded by grants and engagement in earlier stages of patient navigation (eg, early detection). The provision of survivorship and treatment patient navigation was related to navigator role retention, with senior CPNs providing these patient navigation services more than novice CPNs. CONCLUSIONS The current study highlights 3 distinct classes of CPNs, provides initial information regarding determinants of navigator retention, and makes several recommendations for future patient navigation research.
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Affiliation(s)
- Cristian Garcia-Alcaraz
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.,Department of Psychology, San Diego State University, San Diego, California
| | - Scott C Roesch
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.,Department of Psychology, San Diego State University, San Diego, California
| | | | - Patrick Wightman
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Prashanthinie Mohan
- Center for Population Science and Discovery, University of Arizona, Tucson, Arizona
| | - Tracy A Battaglia
- Boston Medical Center and Boston University Schools of Medicine and Public Health, Boston, Massachusetts
| | | | | | - Kristen J Wells
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.,Department of Psychology, San Diego State University, San Diego, California
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20
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Noyes K, Zapf AL, Depner RM, Flores T, Huston A, Rashid HH, McNeal D, Constine LS, Fleming FJ, Wilding GE, Sahler OJZ. Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study. Cancer Treat Res Commun 2022; 31:100552. [PMID: 35358820 PMCID: PMC9106910 DOI: 10.1016/j.ctarc.2022.100552] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 05/13/2023]
Abstract
PURPOSE Cancer patients experience significant distress and burden of decision-making throughout treatment and beyond. These stressors can interfere with their ability to make reasoned and timely decisions about their care and lead to low physical and social functioning and poor survival. This pilot study examined the impact of offering Problem-Solving Skills Training (PSST) to adult cancer survivors to help them and their caregivers cope more successfully with post-treatment decision-making burden and distress. PATIENTS AND METHODS Fifty patients who completed their definitive treatment for colorectal, breast or prostate cancer within the last 6 months and reported distress (level > 2 on the National Comprehensive Cancer Network distress thermometer) were randomly assigned to either care as usual (CAU) or 8 weekly PSST sessions. Patients were invited to include a supportive other (n = 17). Patient and caregiver assessments at baseline (T1), end of intervention or 3 months (T2), and at 6 months (T3) focused on problem-solving skills, anxiety/depression, quality of life and healthcare utilization. We compared outcomes by study arm and interviewed participants about PSST burden and skill maintenance. RESULTS Trial participation rate was 60%; 76% of the participants successfully completed PSST training. PSST patients reported reduction in anxiety/depression, improvement in QoL (p < 0.05) and lower use of hospital and emergency department services compared to CAU patients (p = 0.04). CONCLUSIONS The evidence from this pilot study indicates that a remotely delivered PSST is a feasible and potentially effective strategy to improve mood and self-management in cancer survivors in community oncology settings.
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Affiliation(s)
- Katia Noyes
- University at Buffalo, Buffalo, NY, United States of America.
| | - Alaina L Zapf
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Rachel M Depner
- Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Tessa Flores
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Alissa Huston
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hani H Rashid
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Demetria McNeal
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Louis S Constine
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Fergal J Fleming
- University of Rochester Medical Center, Rochester, NY, United States of America
| | | | - Olle Jane Z Sahler
- University of Rochester Medical Center, Rochester, NY, United States of America
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21
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Passey D, Healy R, Qualls J, Hamilton CJ, Tilley E, Burningham Z, Sauer B, Halwani A. Development and implementation of a pharmacist-led telehealth medication management program for veterans receiving oral antineoplastic therapies through the MISSION Act. Am J Health Syst Pharm 2022; 79:835-843. [PMID: 35084462 DOI: 10.1093/ajhp/zxac023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Veterans prescribed oral antineoplastic therapies (OATs) by community providers outside the Veterans Health Administration (VA) may lack access to comprehensive medication management. To address this, our multidisciplinary team developed and implemented a pharmacist-led telehealth medication management program for veterans prescribed OATs by community providers. SUMMARY The program exclusively uses telehealth to connect veterans with a dedicated board-certified clinical oncology pharmacist who provides comprehensive medication management. The program is based on established pharmacy models found in the research literature. We developed a standard operating procedure, communication templates, patient education materials, and a suite of health information technology tools to help streamline pharmacy processes. The Consolidated Framework for Implementation Research was used to design implementation strategies to promote the adoption of the program. In the first year, 64 veterans from 3 VA medical centers were enrolled in the program. The oncology clinical pharmacist performed 342 encounters and 101 interventions. The program saved an estimated $200,724 in medication-related costs. The veterans we surveyed reported high levels of satisfaction with the pharmacy services provided by the program. CONCLUSION The delivery of comprehensive medication management through telehealth is feasible from a healthcare system perspective and beneficial for patients. The board-certified oncology clinical pharmacist provided remote pharmacy services to Veterans across three sites in a large and rural service area for the VA. The program realized several benefits, including positive clinical outcomes, high levels of patient satisfaction, and cost savings on medication-related costs.
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Affiliation(s)
- Deborah Passey
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Regan Healy
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Joshua Qualls
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Clayton J Hamilton
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Elizabeth Tilley
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, and George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Zach Burningham
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, and Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Brian Sauer
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, and Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ahmad Halwani
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT; and Huntsman Cancer Institute, Salt Lake City, UT, USA
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22
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Dwyer K, Anderson A, Doescher M, Campbell J, Wharton B, Nagykaldi Z. Provider Communication: The Key to Care Coordination Between Tribal Primary Care and Community Oncology Providers. Oncol Nurs Forum 2022; 49:21-35. [PMID: 34914677 PMCID: PMC10428662 DOI: 10.1188/22.onf.21-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore tribal primary care providers' and community oncology providers' experiences of caring for individuals with cancer to inform intervention development and improve cancer care coordination in this high-need population. PARTICIPANTS & SETTING 33 tribal primary care providers and 22 nontribal, community-based oncology providers. METHODOLOGIC APPROACH A qualitative, descriptive design was used, and 55 semistructured individual interviews were completed. Data were analyzed using conventional inductive content analysis to identify major themes. FINDINGS Effective care coordination for individuals with cancer was characterized by timely communication. Providers in both settings identified unhindered communication between providers as a key element of care coordination. Identification of points of contact in each setting enhanced information exchange. As patient needs related to cancer care intensified, care coordination increased in complexity. IMPLICATIONS FOR NURSING Evaluating strategies to enhance communication between tribal primary care providers and community oncology providers is an important next step in enhancing the coordination of care for tribal individuals with cancer.
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23
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Tan CE, Lau SCD, Latiff ZA, Lee CC, Teh KH, Sidik SM. Information needs of Malaysian parents of children with cancer: a qualitative study. Asia Pac J Oncol Nurs 2021; 9:143-152. [PMID: 35494095 PMCID: PMC9052854 DOI: 10.1016/j.apjon.2021.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Informational support is an important pillar of psychosocial care for parents of children with cancer. Understanding the information needs of these parents may improve the provision of family-centered informational support. This paper aims to explore the information needs of Malaysian parents whose children have cancer. Methods This qualitative study was conducted among 14 parents of children with cancer and 8 healthcare providers. The parents were recruited from two urban pediatric oncology centers in Malaysia. Healthcare providers were recruited from these centers, as well as from community-based palliative care providers. In-depth interviews were conducted based on semi-structured topic guides, audio-recorded, and transcribed for thematic analysis using elements of the grounded theory approach. Results Analysis revealed three themes of information needs, which were: “interaction with the healthcare system,” “care for the child at home” and “psychosocial support for parents”. Information needs on parents’ interaction with the healthcare system consisted of disease and treatment-related information, as well as health system navigation. Information needs on care for the child at home were represented by their caregiving for basic activities of daily living, medical caregiving, and psychosocial caregiving. Psychosocial support for parents included information on practical support and self-care. There were differences in priorities for information needs between parents and healthcare providers. Conclusions Meeting the information needs of parents is an important part of psychosocial care in pediatric cancer care. Informational support may empower parents in caregiving for their child. The development of suitable information resources will be invaluable for healthcare providers in supporting parents’ needs.
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24
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Enuaraq S, Gifford W, Ashton S, Al Awar Z, Larocque C, Rolfe D. Understanding culturally safe cancer survivorship care with inuit in an urban community. Int J Circumpolar Health 2021; 80:1949843. [PMID: 34219604 PMCID: PMC8259824 DOI: 10.1080/22423982.2021.1949843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 11/03/2022] Open
Abstract
Cancer is a leading cause of death among Inuit. A legacy of colonialism, residential schools, and systemic racism has eroded trust among Inuit and many do not receive culturally safe care. This study aimed to explore the meaning of culturally safe cancer survivorship care for Inuit, and barriers and facilitators to receiving it in an urban setting in Ontario Canada. As Inuit and Western researchers, we conducted a descriptive qualitative study. We held two focus groups (n = 27) with cancer survivors and family members, and semi-structured interviews (n = 7) with health providers. Data were analysed using thematic content analysis.Three broad themes emerged as central to culturally safe care: access to traditional ways of life, communication, and family involvement. Family support, patient navigators, and designated spaces were facilitators; lack of support for traditional ways, like country food, was a barrier. Participants were clear what constituted culturally safe care, but major barriers exist. Lack of direction at institutional and governmental levels contributes to the complexity of issues that prevent Inuit from engaging in and receiving culturally safe cancer care. To understand how to transform healthcare to be culturally safe, studies underpinned by Inuit epistemology, values, and principles are required.
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Affiliation(s)
| | - Wendy Gifford
- School of Nursing, University of Ottawa, Ottawa, Canada
| | | | - Zeina Al Awar
- School of Nursing, University of Ottawa, Ottawa, Canada
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25
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Yoo DW, Ernala SK, Saket B, Weir D, Arenare E, Ali AF, Van Meter AR, Birnbaum ML, Abowd GD, De Choudhury M. Clinician Perspectives on Using Computational Mental Health Insights From Patients' Social Media Activities: Design and Qualitative Evaluation of a Prototype. JMIR Ment Health 2021; 8:e25455. [PMID: 34783667 PMCID: PMC8663497 DOI: 10.2196/25455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/11/2021] [Accepted: 06/22/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Previous studies have suggested that social media data, along with machine learning algorithms, can be used to generate computational mental health insights. These computational insights have the potential to support clinician-patient communication during psychotherapy consultations. However, how clinicians perceive and envision using computational insights during consultations has been underexplored. OBJECTIVE The aim of this study is to understand clinician perspectives regarding computational mental health insights from patients' social media activities. We focus on the opportunities and challenges of using these insights during psychotherapy consultations. METHODS We developed a prototype that can analyze consented patients' Facebook data and visually represent these computational insights. We incorporated the insights into existing clinician-facing assessment tools, the Hamilton Depression Rating Scale and Global Functioning: Social Scale. The design intent is that a clinician will verbally interview a patient (eg, How was your mood in the past week?) while they reviewed relevant insights from the patient's social media activities (eg, number of depression-indicative posts). Using the prototype, we conducted interviews (n=15) and 3 focus groups (n=13) with mental health clinicians: psychiatrists, clinical psychologists, and licensed clinical social workers. The transcribed qualitative data were analyzed using thematic analysis. RESULTS Clinicians reported that the prototype can support clinician-patient collaboration in agenda-setting, communicating symptoms, and navigating patients' verbal reports. They suggested potential use scenarios, such as reviewing the prototype before consultations and using the prototype when patients missed their consultations. They also speculated potential negative consequences: patients may feel like they are being monitored, which may yield negative effects, and the use of the prototype may increase the workload of clinicians, which is already difficult to manage. Finally, our participants expressed concerns regarding the prototype: they were unsure whether patients' social media accounts represented their actual behaviors; they wanted to learn how and when the machine learning algorithm can fail to meet their expectations of trust; and they were worried about situations where they could not properly respond to the insights, especially emergency situations outside of clinical settings. CONCLUSIONS Our findings support the touted potential of computational mental health insights from patients' social media account data, especially in the context of psychotherapy consultations. However, sociotechnical issues, such as transparent algorithmic information and institutional support, should be addressed in future endeavors to design implementable and sustainable technology.
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Affiliation(s)
- Dong Whi Yoo
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Sindhu Kiranmai Ernala
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Bahador Saket
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Domino Weir
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Elizabeth Arenare
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Asra F Ali
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Anna R Van Meter
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Manhasset, NY, United States
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Michael L Birnbaum
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Manhasset, NY, United States
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Gregory D Abowd
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
- College of Engineering, Northeastern University, Boston, MA, United States
| | - Munmun De Choudhury
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
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26
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LeClair AM, Battaglia TA, Casanova NL, Haas JS, Freund KM, Moy B, Parsons SK, Ko NY, Ross J, Ohrenberger E, Mullikin KR, Lemon SC. Assessment of patient navigation programs for breast cancer patients across the city of Boston. Support Care Cancer 2021; 30:2435-2443. [PMID: 34767089 DOI: 10.1007/s00520-021-06675-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Healthcare systems contribute to disparities in breast cancer outcomes. Patient navigation is a widely cited system-based approach to improve outcomes among populations at risk for delays in care. Patient navigation programs exist in all major Boston hospitals, yet disparities in outcomes persist. The objective of this study was to conduct a baseline assessment of navigation processes at six Boston hospitals that provide breast cancer care in preparation for an implementation trial of standardized navigation across the city. METHODS We conducted a mixed methods study in six hospitals that provide treatment to breast cancer patients in Boston. We administered a web-based survey to clinical champions (n = 7) across six sites to collect information about the structure of navigation programs. We then conducted in-person workflow assessments at each site using a semi-structured interview guide to understand site-specific implementation processes for patient navigation programs. The target population included administrators, supervisors, and patient navigators who provided breast cancer treatment-focused care. RESULTS All sites offered patient navigation services to their patients undergoing treatment for breast cancer. We identified wide heterogeneity in terms of how programs were funded/resourced, which patients were targeted for navigation, the type of services provided, and the continuity of those services relative to the patient's cancer treatment. CONCLUSIONS The operationalization of patient navigation varies widely across hospitals especially in relation to three core principles in patient navigation: providing patient support across the care continuum, targeting services to those patients most likely to experience delays in care, and systematically screening for and addressing patients' health-related social needs. Gaps in navigation across the care continuum present opportunities for intervention. TRIAL REGISTRATION Clinical Trial Registration Number NCT03514433, 5/2/2018.
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Affiliation(s)
- Amy M LeClair
- Department of Medicine, Tufts Medical Center, Boston, MA, USA.
| | - Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.,Department of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Nicole L Casanova
- Department of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Karen M Freund
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Beverly Moy
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susan K Parsons
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Naomi Y Ko
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.,Department of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - JoEllen Ross
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Katelyn R Mullikin
- Department of General Internal Medicine, Boston Medical Center, Boston, MA, USA
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27
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Budde H, Williams GA, Winkelmann J, Pfirter L, Maier CB. The role of patient navigators in ambulatory care: overview of systematic reviews. BMC Health Serv Res 2021; 21:1166. [PMID: 34706733 PMCID: PMC8555047 DOI: 10.1186/s12913-021-07140-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 10/06/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patient navigators have been introduced across various countries to enable timely access to healthcare services and to ensure completion of diagnosis and follow-up of care. There is an increasing evidence on the the role of patient navigation for patients and healthcare systems. The aim of this study was to analyse the evidence on patient navigation interventions in ambulatory care and to evaluate their effects on individuals and health system outcomes. METHODS An overview of reviews was conducted, following a prespecified protocol. All patients in ambulatory care or transitional care setting were included in this review as long as it was related to the role of patient navigators. The study analysed patient navigators covering a wide range of health professionals such as physicians, nurses, pharmacists, social workers and lay health workers or community-based workers with no or very limited training. Studies including patient-related measures and health system-related outcomes were eligible for inclusion. A rigorous search was performed in multiple data bases. After reaching a high inter-rater agreement of 0.86, title and abstract screening was independently performed. Of an initial 14,248 search results and an additional 62 articles identified through the snowballing approach, a total of 7159 hits were eligible for title/abstract screening. 679 articles were included for full-text screening. RESULTS Eleven systematic reviews were included covering various patient navigation intervention in cancer care, disease screening, transitional care and for various chronic conditions and multimorbidity. Nine systematic reviews primarily tailored services to ethnic minorities or other disadvantaged groups. Patient navigators performed tasks such as providing education and counselling, translations, home visits, outreach, scheduling of appointments and follow-up. Eight reviews identified positive outcomes in expanding access to care, in particular for vulnerable patient groups. Two reviews on patient navigation in transitional care reported improved patient outcomes, hospital readmission rates and mixed evidence on quality of life and emergency department visits. Two reviews demonstrated improved patient outcomes for persons with various chronic conditions and multimorbidity. CONCLUSIONS Patient navigators were shown to expand access to screenings and health services for vulnerable patients or population groups with chronic conditions who tend to underuse health services.
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Affiliation(s)
- Hannah Budde
- London School of Economics and Political Science, Houghton St, London, WC2A 2AE, UK.
| | - Gemma A Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Juliane Winkelmann
- Department of Healthcare Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Laura Pfirter
- Maecenata Institut für Philanthropie und Zivilgesellschaft in Berlin, Rungestr. 17, D-10179, Berlin, Germany
| | - Claudia B Maier
- Department of Healthcare Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany.
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Relationships between health literacy, having a cancer care coordinator, and long-term health-related quality of life among cancer survivors. Support Care Cancer 2021; 29:7913-7924. [PMID: 34191127 DOI: 10.1007/s00520-021-06356-w] [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] [Received: 01/25/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Care coordination is a strategy to reduce healthcare navigation challenges for cancer patients. The objectives of this study were to assess the association between having a cancer care coordinator (CCC) and long-term health-related quality of life (HRQoL), and to evaluate whether this association differed by level of health literacy. METHODS A population-based sample of survivors diagnosed with breast, prostate, or colorectal cancer in 2015 from the Iowa Cancer Registry participated in an online survey conducted in 2017-2018 (N = 368). Chi-squared tests and logistic regression were used to model the association between patient characteristics and having a cancer care coordinator. Linear regression was used to model the association between patient perception of having a cancer care coordinator and post-treatment physical or mental HRQoL by differing levels of health literacy while controlling for sociodemographic and clinical factors. RESULTS Most survivors (81%) reported having one healthcare professional who coordinated their cancer care. Overall, patient perception of having a coordinator was not significantly associated with physical HRQoL (p = 0.118). However, participants with low health literacy (21%) who had a coordinator had significantly higher physical HRQoL scores compared to those who did not (adjusted mean difference 5.2, p = 0.010), while not so for medium (29%) or high (51%) health literacy (p = 0.227, and p = 0.850, respectively; test for interaction p = 0.001). Mental HRQoL was not associated with having a coordinator in our analyses. CONCLUSION Findings suggest that care coordinators improved post-treatment physical HRQoL, particularly for participants with low health literacy. Care coordinators may be beneficial to the most vulnerable patients struggling to navigate the complex healthcare system during cancer treatment. Future research should focus on the mechanisms by which care coordination may affect post-treatment HRQoL.
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29
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Pekala KR, Yabes JG, Bandari J, Yu M, Davies BJ, Sabik LM, Kahn JM, Jacobs BL. The centralization of bladder cancer care and its implications for patient travel distance. Urol Oncol 2021; 39:834.e9-834.e20. [PMID: 34162498 DOI: 10.1016/j.urolonc.2021.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/16/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the impact of centralized surgical and nonsurgical care (i.e., radiation and chemotherapy) on travel distances and survival outcomes for patients with advanced bladder cancer. Bladder cancer is a disease with high mortality for which treatment access is paramount and survival is superior in patients receiving surgery at high-volume centers. METHODS Using SEER-Medicare, we identified patients 66 years or older diagnosed with bladder cancer between 2004-2013. We categorized patients as treated with either surgical (i.e., radical cystectomy) or nonsurgical (i.e., radiation or chemotherapy) care. We fit a linear probability model to generate the predicted proportion of patients treated at the top quintile of volume over time and assessed travel distance, 1-year all-cause mortality, and 1-year bladder cancer-specific mortality over time. RESULTS A total of 6,756 and 10,383 patients underwent surgical and nonsurgical care, respectively. The percentage of patients treated at high-volume centers increased over the study period for both surgical care (53% to 62%) and nonsurgical care (47% to 55%), (both P< 0.001). Median travel distance increased (11.8 to 20.3 miles) for surgical care and (6.5 to 8.3 miles) for nonsurgical care, (both P < 0.001). The 1-year adjusted all-cause mortality and 1-year adjusted bladder-cancer specific mortality decreased significantly for both surgical and nonsurgical care (both P < 0.05). CONCLUSIONS Over time, centralization of surgical and nonsurgical care for bladder cancer patients increased, which was associated with increasing patient travel distance and decreased all-cause and bladder-cancer specific mortality.
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Affiliation(s)
| | - Jonathan G Yabes
- Center for Research on Health Care; Division of General Internal Medicine, Department of Medicine
| | | | | | | | - Lindsay M Sabik
- Center for Research on Health Care; Department of Health Policy and Management, Graduate School of Public Health
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Bruce L Jacobs
- Department of Urology; Center for Research on Health Care
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Perspectives of multisectoral community stakeholders on Arab American cancer patients' needs and suggested interventions. Support Care Cancer 2021; 29:5915-5925. [PMID: 33763724 DOI: 10.1007/s00520-021-06169-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/18/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Multilevel barriers can arise after a cancer diagnosis, especially in underserved racial/ethnic minority patient populations, raising the need for diverse and contextually adapted interventions. However, limited data exists on Arab American (ArA) cancer patients' needs, partly due to their racial/ethnic misclassification as Whites. This study leveraged the perspectives of cancer survivors and community stakeholders (i.e., healthcare and community leaders) to identify ArA cancer patients' needs, as well as their preferred intervention strategies to address them. METHODS Using a hybrid inductive-deductive content analysis approach, we analyzed qualitative data from interviews with 18 ArA community stakeholders recruited through community partners in Chicago. RESULTS Participants associated cancer stigma to ArA patients' concealment of their diagnosis and aversion to cancer support groups. Economic and language barriers to treatment were emphasized. A lack of resources for ArA cancer patients was also noted and was partly attributed to their misclassification as White. In response to these needs, participants suggested peer mentorship programs to overcome privacy concerns, hospital-based patient navigation to address language and economic barriers in healthcare, diversification of the healthcare workforce to overcome language barriers, and community coalitions to recognize ArA as an ethnic group and increase cancer support resources. Such advocacy will be essential to accurately characterize patients' cancer burden and obtain funding to support community programs and resources. CONCLUSION Our findings suggest that multilevel interventions at the patient, healthcare, and community levels are needed to address ArA cancer patients' needs.
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Ortiz AP, Soto-Salgado M, Calo WA, Hull P, Fernández ME, Colon-López V, Tortolero-Luna G. Elimination of cervical cancer in U.S. Hispanic populations: Puerto Rico as a case study. Prev Med 2021; 144:106336. [PMID: 33678233 DOI: 10.1016/j.ypmed.2020.106336] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 12/15/2022]
Abstract
Cervical cancer remains a major burden for women around the world. In 2018, the World Health Organization called for the elimination of cervical cancer worldwide (<4 cases per 100,000 women-years), within the 21st century. In the U.S., despite great progress toward this goal, existing disparities among racial/ethnic groups in cervical cancer raise concerns about whether elimination can be achieved for all women. We describe: 1) disparities in cervical cancer among Hispanics in the U.S. and factors that contribute to their increased risk, 2) prevention and control efforts to increase equity in the elimination of cervical cancer in this population, and 3) cervical cancer control efforts in Puerto Rico (PR), a U.S. territory, as a case study for cervical cancer elimination among a minority and underserved Hispanic population. Hispanics have the highest incidence rates of cervical cancer among all racial/ethnic groups in the U.S. Despite being more likely to complete HPV vaccination series, lower cervical cancer screening and access to treatment may lead to a higher cervical cancer mortality in Hispanics compared to non-Hispanic White women. These disparities are influenced by multiple individual-, sociocultural-, and system-level factors. To achieve the goal of cervical cancer elimination in the U.S., systematic elimination plans that consider the needs of Hispanic populations should be included within the Comprehensive Cancer Control Plans of each state. Because PR has implemented coordinated efforts for the prevention and control of cervical cancer, it represents a notable case study for examining strategies that can lead to cervical cancer elimination among Hispanics.
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Affiliation(s)
- Ana Patricia Ortiz
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America; Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America.
| | - Marievelisse Soto-Salgado
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America; Department of Biochemistry, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Pamela Hull
- University of Kentucky Markey Cancer Center, United States of America; Department of Behavioral Science, University of Kentucky College of Medicine, United States of America
| | - María E Fernández
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, Houston, TX, United States of America
| | - Vivian Colon-López
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America; Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Guillermo Tortolero-Luna
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America
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Guha C, Lopez-Vargas P, Ju A, Gutman T, Scholes-Robertson NJ, Baumgart A, Wong G, Craig J, Usherwood T, Reid S, Cullen V, Howell M, Khalid R, Teixeira-Pinto A, Wyburn K, Sen S, Smolonogov T, Lee VW, Rangan GK, Matus Gonzales A, Tong A. Patient needs and priorities for patient navigator programmes in chronic kidney disease: a workshop report. BMJ Open 2020; 10:e040617. [PMID: 33154061 PMCID: PMC7646342 DOI: 10.1136/bmjopen-2020-040617] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Patients with early chronic kidney disease (CKD) face challenges in accessing healthcare, including delays in diagnosis, fragmented speciality care and lack of tailored education and psychosocial support. Patient navigator programmes have the potential to improve the process of care and outcomes. The objective of this study is to describe the experiences of patients on communication, access of care and self-management and their perspectives on patient navigator programmes in early CKD. DESIGN, SETTING AND PARTICIPANTS We convened a workshop in Australia with 19 patients with CKD (all stages including CKD Stage 1 to 5 not on dialysis, 5D (dialysis), and 5T (transplant)) and five caregivers. All of them were over 18 years and English-speaking. Transcripts from the workshop were analysed thematically. RESULTS Four themes that captured discussions were: lost in the ambiguity of symptoms and management, battling roadblocks while accessing care, emotionally isolated after diagnosis and re-establishing lifestyle and forward planning. Five themes that focussed on patient navigator programmes were: trust and credibility, respecting patient choices and readiness to accept the programme, using accessible language to promote the programme, offering multiple ways to engage and communicate and maintaining confidentiality and privacy. Of the 17 features identified as important for a patient navigator programme, the top five were delivery of education, psychosocial support, lifestyle modification, communication and decision-making support and facilitating care. CONCLUSION Patient navigator services can address gaps in services around health literacy, communication, psychosocial support and coordination across multiple healthcare settings. In comparison to the existing navigator programmes, and other services that are aimed at addressing these gaps, credible, accessible and flexible patient navigator programmes for patients with early CKD, that support education, decision-making, access to care and self-management designed in partnership with patients, may be more acceptable to patients.
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Affiliation(s)
- Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital, Westmead, New South Wales, Australia
| | - P Lopez-Vargas
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital, Westmead, New South Wales, Australia
| | - Angela Ju
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital, Westmead, New South Wales, Australia
| | - Talia Gutman
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital, Westmead, New South Wales, Australia
| | - Nicole Jane Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital, Westmead, New South Wales, Australia
| | - Amanda Baumgart
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital, Westmead, New South Wales, Australia
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital, Westmead, New South Wales, Australia
| | - Jonathan Craig
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Tim Usherwood
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sharon Reid
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Vanessa Cullen
- Forward Thinking Design, Quakers Hill, New South Wales, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital, Westmead, New South Wales, Australia
| | - Rabia Khalid
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital, Westmead, New South Wales, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital, Westmead, New South Wales, Australia
| | - Kate Wyburn
- Collaborative Transplant Research Group, Royal Prince Alfred Hospital and Bosch Institute, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Shaundeep Sen
- Department of Renal Medicine, Concord Repatriation Hospital, Concord, New South Wales, Australia
| | - Tanya Smolonogov
- Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Vincent W Lee
- Centre for Kidney Research, The Children's Hospital, Westmead, New South Wales, Australia
| | - Gopala K Rangan
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Andrea Matus Gonzales
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital, Westmead, New South Wales, Australia
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Ramirez AG, Muñoz E, Long Parma D, Perez A, Santillan A. Quality of life outcomes from a randomized controlled trial of patient navigation in Latina breast cancer survivors. Cancer Med 2020; 9:7837-7848. [PMID: 32979042 PMCID: PMC7643682 DOI: 10.1002/cam4.3272] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Breast cancer survivorship is a life-long process involving challenges to health-care communities and individuals, especially Latinas. Patient Navigation has shown some success in meeting these challenges. The purpose of this study was to compare the effects of an enhanced Patient Navigation program (Intervention; PN+) vs Control (PN) over time on general cancer and breast cancer-specific quality of life (QoL) in Latina breast cancer survivors (BCS). METHODS We conducted a 2-year, two-arm randomized controlled trial of the "Staying Healthy" program among Latina BCS. The design compared PN+ vs PN over time. We recruited 60 patients into each study arm and randomized them by sequential numerical assignment. PN+ participants received culturally tailored educational materials and active, personalized Patient Navigation services, including phone calls, transportation, and care coordination. PN participants were navigated only upon request. Primary outcomes included general cancer (Functional Assessments of Cancer Therapy [FACTS]-G) and breast cancer-specific (FACT-B) QoL. RESULTS PN+ participants had significantly improved QoL measures compared to PN at 6-month follow-up on all subscales (P-values .007-.04) except physical well-being (PWB; P = .11). Intervention effect size coefficient (standard error) for FACT-G overall was 7.9 (3.1); P = .01. For FACT-B, it was 10.9 (3.9); P = .006. Again, all subscales showed significant effects [range 1.7-3.1 (0.8-1.2); P-values .006-.04], except for PWB [1.5 (1.0); P = .16] and social/family well-being (SWB) [2.1 (1.1); P = .06]. There were no differences between groups at baseline. DISCUSSION Multiple cultural, psychosocial, and socioeconomic variables contributing to these intervention effects will be addressed in future studies. As the national BCS population continues to increase, more Patient Navigation-focused partnerships among patients, health-care professionals, research groups, and community organizations are needed to improve BCS experiences. The Staying Healthy program has the potential to serve as a national survivorship care model for improving Latina BCS QoL.
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Affiliation(s)
- Amelie G. Ramirez
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
- The Mays Cancer CenterUT Health San Antonio MD Anderson Cancer CenterSan AntonioTXUSA
| | - Edgar Muñoz
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
| | - Dorothy Long Parma
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
- The Mays Cancer CenterUT Health San Antonio MD Anderson Cancer CenterSan AntonioTXUSA
| | - Arely Perez
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
| | - Alfredo Santillan
- Department of Population Health SciencesUT Health San AntonioSan AntonioTXUSA
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Andall-Brereton G, Bromfield B, Smith S, Spence D. Cancer care in the Commonwealth Caribbean in COVID times. Lancet Oncol 2020; 21:1007-1009. [PMID: 32758457 PMCID: PMC7398666 DOI: 10.1016/s1470-2045(20)30395-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 11/21/2022]
Affiliation(s)
| | | | - Steven Smith
- Jamaica Cancer Care and Research Institute, Kingston, Jamaica
| | - Dingle Spence
- Jamaica Cancer Care and Research Institute, Kingston, Jamaica; Hope Institute Hospital, Kingston, Jamaica
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Oetzel JG, Cameron MP, Simpson ML, Reddy R, Nock S, Greensill H, Meha P, Johnston K, Harding T, Shelford P, Smith LT, Hokowhitu B. Kaumātua Mana Motuhake: peer education intervention to help Māori elders during later-stage life transitions. BMC Geriatr 2020; 20:186. [PMID: 32471351 PMCID: PMC7260849 DOI: 10.1186/s12877-020-01590-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aotearoa/New Zealand has a population that is ageing and there are challenges to health and social outcomes related to related to key life transitions (e.g., retirement, change in health conditions, loss of spouse). Further, there are significant inequities between Māori (Indigenous people) and non-Māori in ageing outcomes. The purpose of this study was to test the impacts and cost effectiveness of a tuakana/teina (peer education) intervention on kaumātua (elders) receiving the intervention. This study was framed by a strengths-based approach based on the key cultural concept of mana motuhake (autonomy and self-actualisation). METHODS This study was grounded in principles of Kaupapa Māori and community-based participatory research to bring together a diverse group of stakeholders to co-develop and co-evaluate the intervention. The intervention had tuakana (peer educators) having conversations with up to six teina (recipients) and providing information related to health and social services. The research design was a pre- and post-test, clustered staggered design. Participants completed a baseline assessment of health and mana motuhake measures consistent with Māori worldviews along with two follow-up assessments (one after the first intervention group completed its activities and a second after the second intervention group completed its activities). Additionally, five focus groups and open-ended questions on the assessments were used to provide qualitative evaluation. FINDINGS A total of 180 kaumātua were recruited to the intervention with 121 completing it. The analysis revealed improvements over time in the expected direction on most of the variables. However, only three of the variables had statistically significant intervention effects: received support, tribal identity, and trouble paying bills. Qualitative results supported impacts of the intervention on mana motuhake, social connectedness, and tangible/information support related to services. Cost-effectiveness analysis showed that the intervention is cost effective, with a cost per QALY of less than the conventional threshold of three times gross domestic product per capita. CONCLUSIONS The findings support the relevancy and importance of kaumātua knowledge to create a strengths-based approach to improve health and social outcomes. This study demonstrates that a contextually based and culturally safe age-friendly environments can facilitate engagement and participation by kaumātua for kaumātua. TRIAL REGISTRY Australia New Zealand Clinical Trial Registry (ACTRN12617001396314); Date Registered: 3 October 2017 (retrospectively registered); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373733&isClinicalTrial=False.
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Affiliation(s)
- John G Oetzel
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | - Michael P Cameron
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Mary L Simpson
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Rangimahora Reddy
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St., Hamilton, 3204, New Zealand
| | - Sophie Nock
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | | | - Pare Meha
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St., Hamilton, 3204, New Zealand
| | - Kirsten Johnston
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St., Hamilton, 3204, New Zealand
| | - Truely Harding
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Pita Shelford
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | | | - Brendan Hokowhitu
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
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Corbett CM, Somers TJ, Nuñez CM, Majestic CM, Shelby RA, Worthy VC, Barrett NJ, Patierno SR. Evolution of a longitudinal, multidisciplinary, and scalable patient navigation matrix model. Cancer Med 2020; 9:3202-3210. [PMID: 32129946 PMCID: PMC7196067 DOI: 10.1002/cam4.2950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/06/2019] [Accepted: 02/02/2020] [Indexed: 12/12/2022] Open
Abstract
This Longitudinal patient navigation Matrix Model was developed to overcome barriers across the cancer care continuum by offering prepatients, patients, and their families with support services. The extraordinary heterogeneity of patient needs during cancer screening, risk assessment, treatment, and survivorship as well as the vast heterogeneity of oncology care settings make it nearly impossible to follow a static navigation model. Our model of patient cancer navigation is unique as it enhances the traditional model by being highly adaptable based on both patient and family needs and scalable based on institutional needs and resources (eg, clinical volumes, financial resources, and community‐based resources). This relatively new operational model for system‐wide and systematic navigation incorporates a carefully cultivated supportive care program that evolved over the last decade from a bottom up approach that identified patient and family needs and developed appropriate resources. A core component of this model includes shifting away from department‐centric operations. This model does not require a patient to opt in or independently be able to report their needs or ask for services—it is an opt out model. The multidisciplinary “cross‐training” model can also facilitate reimbursement and sustainability by clarifying the differentiating actions that define navigation services: identification of barriers to quality care and specific actions taken to overcome those barriers, across the full continue of cancer care from community engagement to survivorship or end‐of‐life care.
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Affiliation(s)
- Cheyenne M Corbett
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Christine M Nuñez
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.,Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Catherine M Majestic
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Valarie C Worthy
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Nadine J Barrett
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA.,Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Steven R Patierno
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Ozdemir S, Finkelstein EA. Cognitive Bias: The Downside of Shared Decision Making. JCO Clin Cancer Inform 2019; 2:1-10. [PMID: 30652609 DOI: 10.1200/cci.18.00011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This narrative review presents theoretical and empirical evidence of common cognitive biases that are likely to influence treatment choices of patients with cancer and other illnesses. We present an overview of common cognitive biases that result from how and when information is presented to patients. We supplement these descriptions with cancer-specific examples or those from other health fields if no cancer-specific examples are available. The results provide compelling evidence that patient treatment choices are subconsciously influenced by both known and unknown biases. Shared decision making is ideal in theory, but in reality, it is fraught with risks resulting from cognitive biases and undue influence of even the best-intentioned physicians and family members. Efforts should be made to minimize these concerns and to help patients to make decisions that their future selves are least likely to regret.
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Affiliation(s)
- Semra Ozdemir
- All authors: Duke-NUS Medical School Singapore, Singapore
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Nalepinski DC. NAVIGATING THE CANCER EXPERIENCE. Cancer 2019. [DOI: 10.1002/9781119645214.ch8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Spence D, Dyer R, Andall-Brereton G, Barton M, Stanway S, Argentieri MA, Bray F, Cawich S, Edwards-Bennett S, Fosker C, Gabriel O, Greaves N, Hanchard B, Hospedales J, Luciani S, Martin D, Nimrod M, Ragin C, Simeon D, Tortolero-Luna G, Wharfe G, Sarfati D. Cancer control in the Caribbean island countries and territories: some progress but the journey continues. Lancet Oncol 2019; 20:e503-e521. [PMID: 31395473 DOI: 10.1016/s1470-2045(19)30512-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/24/2022]
Abstract
Cancer causes a fifth of deaths in the Caribbean region and its incidence is increasing. Incidence and mortality patterns of cancer in the Caribbean reflect globally widespread epidemiological transitions, and show cancer profiles that are unique to the region. Providing comprehensive and locally responsive cancer care is particularly challenging in the Caribbean because of the geographical spread of the islands, the frequently under-resourced health-care systems, and the absence of a cohesive approach to cancer control. In many Caribbean countries and territories, cancer surveillance systems are poorly developed, advanced disease presentations are commonplace, and access to cancer screening, diagnostics, and treatment is often suboptimal, with many patients with cancer seeking treatment abroad. Capacity building across the cancer-control continuum in the region is urgently needed and can be accomplished through collaborative efforts and increased investment in health care and cancer control.
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Affiliation(s)
- Dingle Spence
- Hope Institute Hospital, Kingston, Jamaica; Jamaica Cancer Care and Research Institute, University of the West Indies, Mona, Jamaica.
| | - Rachel Dyer
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | | | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, University of New South Wales, NSW, Australia
| | | | - M Austin Argentieri
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK; Jamaica Cancer Care and Research Institute, University of the West Indies, Mona, Jamaica
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Shamir Cawich
- Department of Surgery, University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | | | - Christopher Fosker
- Bermuda Cancer and Health Centre and Bermuda Hospitals Board, Hamilton, Bermuda
| | - Owen Gabriel
- Department of Oncology Victoria Hospital, Castries, Saint Lucia
| | - Natalie Greaves
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Barrie Hanchard
- Department of Pathology, University of the West Indies, Kingston, Jamaica
| | | | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Damali Martin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marisa Nimrod
- Caribbean Association for Oncology and Hematology, Port of Spain, Trinidad and Tobago
| | | | - Donald Simeon
- Caribbean Centre for Health Systems Research and Development, University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - Guillermo Tortolero-Luna
- Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Centre, Puerto Rico
| | - Gilian Wharfe
- Department of Pathology, University of the West Indies, Mona, Jamaica
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
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Fung LC, Nguyen KH, Stewart SL, Chen MS, Tong EK. Impact of a cancer education seminar on knowledge and screening intent among Chinese Americans: Results from a randomized, controlled, community-based trial. Cancer 2019; 124 Suppl 7:1622-1630. [PMID: 29578592 DOI: 10.1002/cncr.31111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/10/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cancer is the leading cause of death for Asian Americans. The authors evaluated the status of cancer prevention for Chinese Americans in San Francisco, which has had years of cancer prevention efforts. METHODS Through a community-based clinic serving Chinese Americans, a randomized, controlled trial (n = 395) was conducted among participants who attended either a cancer prevention seminar or biospecimen education seminar. Changes in knowledge, attitudes, and screening completion/intent were measured across and between seminar groups. RESULTS Participants were mostly women who had low acculturation and education levels. Over two-thirds to almost all participants knew about modifiable risk factors for cancer and that screening tests were available, including for lung cancer. The majority of women had already completed mammography and Papanicolaou (Pap) tests. Approximately one-half reported having completed colorectal cancer screening, prostate screening, or hepatitis B screening. Most were nonsmokers, but about one-half "strongly agreed" that they would want a test for tobacco smoke exposure. After the cancer prevention seminar, significant increases within group were noted for knowledge (eating healthy foods, from 93.1% to 97.7% [P = .0002]; secondhand smoke causes cancer, from 66.3% to 74.8% [P = .04]) and for screening completion/intent (colorectal cancer, from 58.1% to 64.5% [P = .002] cervical cancer, from 72.9% to 75.5% [P = .04]) and there was a trend toward an increase for prostate cancer (from 50.0% to 61.1%; P = .10). There was a significant change between groups for eating healthy foods (P = .004). CONCLUSIONS The current reports documents the gains in cancer prevention among Cantonese-speaking Chinese Americans, fostered by academic, community, and public health efforts. A community-based seminar demonstrated improvement in some cancer knowledge or screening intent and opportunities for continued efforts. Cancer 2018;124:1622-30. © 2018 American Cancer Society.
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Affiliation(s)
- Lei-Chun Fung
- Chinatown Public Health Center, San Francisco Department of Public Health, San Francisco, California
| | - Kim H Nguyen
- Institute for Health Policy Studies, University of California-San Francisco, San Francisco, California
| | - Susan L Stewart
- Department of Public Health Sciences, University of California-Davis, Sacramento, California
| | - Moon S Chen
- Department of Internal Medicine, University of California-Davis, Sacramento, California
| | - Elisa K Tong
- Department of Internal Medicine, University of California-Davis, Sacramento, California
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Ishida K, Weiss E, Kee SA, Yingling CT. Increasing colorectal cancer screening orders using unlicensed assistive personnel. BMJ Open Qual 2019; 8:e000545. [PMID: 31321316 PMCID: PMC6606072 DOI: 10.1136/bmjoq-2018-000545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 05/02/2019] [Accepted: 06/01/2019] [Indexed: 11/29/2022] Open
Abstract
Background Colorectal cancer (CRC) is among the leading cancer diagnoses affecting both men and women worldwide. Prevention and early detection of CRC is possible by increasing access to and utilisation of screening tests. Although CRC screening is highly recommended, screening rates remain suboptimal in the USA, particularly among underserved populations. Our project site, an urban federally qualified health centre, was not meeting the national screening target of 80% of eligible adults. Objective The aim of this quality improvement project was to increase the number of orders for CRC screening to eligible patients by using unlicensed assistive personnel and automated telephone outreach calls to offer 100 patients CRC screening during an 8-week period. Methods 40 patients received outreach calls from care coordinators (CC). 40 patients received automated telephone call reminders to call a CC to obtain an order for CRC screening. 20 patients were offered CRC screening by a medical assistant (MA) as part of their scheduled office visits. We used two plan-do-study-act (PDSA) cycles to deliver these three screening interventions. Results A total of 100 patients received one of the interventions. Ten of those patients received an order for either colonoscopy or faecal immunochemical testing by the conclusion of the second PDSA cycle. The MA-offered screening resulted in the highest percentage of patients accepting CRC screenings and patients preferred this outreach approach compared with CC outreach or automated voice messages. CC outreach yielded a lower rate of accepted screenings. None of the patients who received the automated calls followed up to obtain a screening order. Conclusion Our project demonstrates that unlicensed assistive personnel have the potential to increase patient access to CRC screening.
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Affiliation(s)
- Kanako Ishida
- College of Nursing-Health Systems Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Erin Weiss
- College of Nursing-Health Systems Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Summer A Kee
- College of Nursing-Health Systems Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Charles T Yingling
- College of Nursing-Health Systems Science, University of Illinois at Chicago, Chicago, Illinois, USA
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Kelly KJ, Doucet S, Luke A. Exploring the roles, functions, and background of patient navigators and case managers: A scoping review. Int J Nurs Stud 2019; 98:27-47. [PMID: 31271977 DOI: 10.1016/j.ijnurstu.2019.05.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patient navigators and case managers are health care workers who aim to provide individualized assistance to patients facing significant health concerns. Although these roles emerged from distinct historical need, the terms are often used interchangeably in the literature and are described to have overlapping functions. Differences in the way that these roles are conceptualized across countries has led to a lack of clarity regarding the exact functions that each offer to patients, caregivers, and the health care system. OBJECTIVES To differentiate the functions and backgrounds of patient navigators and case managers across settings and disease contexts. DESIGN This review was guided based on the PRISMA extension for scoping reviews using a five-step review process: identify the research questions; search and identify relevant studies; select studies based on a priori criterion; chart the data; and collate, summarize and report the results. DATA SOURCES A search of the literature was undertaken in peer-reviewed databases (Medline, CINAHL, and PubMed) and the grey literature (Google and unpublished articles in online repositories). REVIEW METHODS Extracted data included information on patient navigators and/or case managers related to their reported background, training, and/or knowledge; roles and/or specific functions; clinical setting; and targeted condition or disease type. RESULTS The search strategy resulted in 10,523 articles. After applying the eligibility criteria during title and abstract evaluation, 468 full-text articles were reviewed, resulting in a total of 160 articles. Functions of patient navigators and case managers were organized into nine emerging categories: (1) advocacy; (2) care coordination; (3) case monitoring and patient needs assessment; (4) community engagement; (5) education; (6) administration and research activities; (7) psychosocial support; (8) navigation of services; and (9) reduction of barriers. The background and knowledge areas of each role were compared and contrasted, and three categories related to the practice context of each role were identified: (1) typical setting and care trajectory; (2) target patient population; and (3) mode of service delivery. CONCLUSIONS The current study identified important differences in the functions between patient navigators and case managers. However, there remains significant ambiguity between the functions of these two roles. Standardized definitions detailing scope of practice, and allowing for inherent flexibility across different settings, are needed to improve service delivery.
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Affiliation(s)
- K J Kelly
- University of New Brunswick Saint John, 100 Tucker Park Road, P.O. Box 5050, E2L 4L5, Saint John, New Brunswick, Canada.
| | - S Doucet
- University of New Brunswick Saint John, 100 Tucker Park Road, P.O. Box 5050, E2L 4L5, Saint John, New Brunswick, Canada.
| | - A Luke
- University of New Brunswick Saint John, 100 Tucker Park Road, P.O. Box 5050, E2L 4L5, Saint John, New Brunswick, Canada.
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Stupplebeen DA, Barnett-Sherrill AT, Sentell TL. Community Health Workers in Hawai'i: A Scoping Review and Framework Analysis of Existing Evidence. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2019; 78:6-14. [PMID: 31285962 PMCID: PMC6603885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Introduction: Community health workers (CHWs) play a vital role in health across Hawai'i, but the scope of this work is not comprehensively collated. This scoping review describes the existing evidence of the roles and responsibilities of CHWs in Hawai'i. Methods: Between May and October 2018, researchers gathered documents (eg, reports, journal articles) relevant to Hawai'i CHWs from health organizations, government entities, colleges/universities, and CHWs. Documents were reviewed for overall focus and content, then analyzed using the Centers for Disease Control and Prevention's 10 Essential Public Health Services as well as the Community Health Worker Core Consensus Project roles to identify workplace roles and gaps. Results: Of 92 documents received, 68 were included for review. The oldest document dated to 1995. Document types included curricula outlines, unpublished reports, and peer-reviewed articles. Documents discussed trainings, certification programs, CHWs' roles in interventions, and community-, clinical-, and/or patient-level outcomes. Cultural concordance parity between CHWs and patients, cost savings, and barriers to CHW work were noted. Most roles named by the Community Health Worker Core Consensus Project were mentioned in documents, but few were related to the roles of "community/policy advocacy" and "participation in research and evaluation." Workplace roles, as determined using the 10 Essential Public Health Services, focused more on "assuring workforce competency" and "evaluation," and less on "policy development," and "enforcing laws." Discussion: CHWs are an important part of Hawaii's health system and engage in many public health functions. Although CHW roles in Hawai'i mirrored those identified by the CHW Core Consensus Project and 10 Essential Public Health Services frameworks, there is a noticeable gap in Hawai'i CHW professional participation in research, evaluation, and community advocacy.
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Affiliation(s)
- David A Stupplebeen
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI (DAS, TLS)
| | - Alexis T Barnett-Sherrill
- Chronic Disease Prevention & Health Promotion Division, Hawai'i State Department of Health, Kapolei, HI (ATB-S)
| | - Tetine L Sentell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI (DAS, TLS)
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Teysir J, Gegechkori N, Wisnivesky JP, Lin JJ. Racial disparities in surveillance mammography among older breast cancer survivors. Breast Cancer Res Treat 2019; 176:461-467. [DOI: 10.1007/s10549-019-05250-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/20/2019] [Indexed: 12/16/2022]
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Lynch HT, Nustas R, Kassim T, Snyder C, Shaw T, Diab O. The benefits of a model of interval comprehensive assessments (MICA) in hereditary cancer Syndromes: Hereditary diffuse gastric cancer (HDGC) as an example. Cancer Genet 2019; 233-234:43-47. [DOI: 10.1016/j.cancergen.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 11/25/2018] [Accepted: 03/20/2019] [Indexed: 12/20/2022]
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Clark-Snow RA, Vidall C, Börjeson S, Jahn P. Fixed Combination Antiemetic: A Literature Review on Prevention of Chemotherapy-Induced Nausea and Vomiting Using Netupitant/Palonosetron. Clin J Oncol Nurs 2019; 22:E52-E63. [PMID: 29547597 DOI: 10.1188/18.cjon.e52-e63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prevention of chemotherapy-induced nausea and vomiting (CINV) can be improved with guideline-consistent use of antiemetics. However, adherence to antiemetic guidelines remains often insufficient. Therefore, new strategies that improve adherence are needed. OBJECTIVES To review the latest antiemetic guideline recommendations and provide an update on the use of NEPA, a fixed combination antiemetic composed of the neurokinin-1 receptor antagonist (RA) netupitant and the 5-hydroxytryptamine-3 RA palonosetron (Akynzeo®). METHODS Analysis of the literature was performed, including guidelines, published literature, congress data on NEPA, and relevant articles on CINV. FINDINGS Nurses are in a unique position to promote guideline-consistent antiemetic prophylaxis and are central in the education of patients and caregivers. Thus, nurses’ continuous education on antiemetic treatments is key for the prevention and management of CINV. NEPA offers a simplified antiemetic therapy with the potential to increase guideline adherence.
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Kaumātua Mana Motuhake: A study protocol for a peer education intervention to help Māori elders work through later-stage life transitions. BMC Geriatr 2019; 19:36. [PMID: 30732566 PMCID: PMC6367813 DOI: 10.1186/s12877-019-1041-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 01/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background The Aotearoa/New Zealand population is ageing and numerous studies demonstrate with this phenomenon comes increases in non-communicable diseases, injuries and healthcare costs among other issues. Further, significant inequities exist between Māori (Indigenous peoples of Aotearoa/New Zealand) and non-Māori around poor ageing and health. Most research addressing these issues is deficit oriented; however, the current research project takes a strengths-based approach that highlights the potential of kaumātua (elders) by asserting mana motuhake (autonomy, identity and self-actualisation). We believe that the esteem of elders in Māori culture signals transformative potential. Specifically, this project utilises a ‘tuakana-teina’ (older sibling/younger sibling) peer-educator model, where kaumātua work with other kaumātua in relation to health and wellbeing. The objectives of the project are (a) to develop the capacity of kaumātua as peer educators, whilst having positive impacts on their sense of purpose, health and wellbeing; and (b) to enhance the social and health outcomes for kaumātua receiving the intervention. Methods The research is grounded in principles of Kaupapa Māori and community-based participatory research, and brings together an Indigenous community of kaumātua, community health researchers, and academic researchers working with two advisory boards. The project intervention involves an orientation programme for tuakana peer educators for other kaumātua (teina). The research design is a pre- and post-test, clustered staggered design. All participants will complete a baseline assessment of health and wellbeing consistent with Māori worldviews (i.e., holistic model). The tuakana and teina participants will be divided into two groups with the first group completing the intervention during the first half of the project and the second group during the second half of the project. All participants will complete post-test assessments following both interventions allowing comparison of the two groups along with repeated measures over time. Discussion The findings will provide an evidence base for the importance and relevancy of kaumātua knowledge to create contextually based and culturally safe age-friendly environments that facilitate engagement and participation by kaumātua for kaumātua. If the model is effective, we will seek to facilitate the dissemination and scalability of the intervention. Trial registration Australia New Zealand Clinical Trial Registry (ACTRN12617001396314); Date Registered: 3 October 2017 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12877-019-1041-2) contains supplementary material, which is available to authorized users.
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Chalela P, Muñoz E, Gallion KJ, Kaklamani V, Ramirez AG. Empowering Latina breast cancer patients to make informed decisions about clinical trials: a pilot study. Transl Behav Med 2018; 8:439-449. [PMID: 29800408 DOI: 10.1093/tbm/ibx083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Minority representation in clinical trials is vital for researchers to assess differential effects in outcomes of therapies on biological and genetic characteristics among groups. This study assessed the effect of Choices, a bilingual multi-component intervention, on perceived understanding of clinical trials, agreement with stages of decision readiness and consideration of clinical trials as a treatment option, among Latina breast cancer patients. This randomized controlled pilot study compared Choices with a control condition providing general clinical trial information to eligible patients. Seventy-seven Latina breast cancer patients were randomly assigned to either Choices (n = 38) or the control (n = 39). Choices included three components: an educational interactive video, a low-literacy booklet, and care coordination by patient navigation (i.e., educational and psychosocial support, coordinating appointments, translating, interacting with the medical team). Choices was more effective than the control in improving perceived understanding of clinical trials (p = .033) and increasing consideration of clinical trials as a treatment option (p = .008). Additionally, intervention participants showed significant changes between baseline and post-intervention on agreement with stages of decision readiness statements (p < .002) than control participants (p > .05); the percentage of intervention women in agreement with preparation to action statements increased from 52.8% at baseline to 86.1% at post-intervention, and those in agreement with ready to action stages rose from 50.0% to 88.9%. Computer-based videos and care coordination provided by patient navigation-specifically tailored to Latinos-are effective strategies to successfully address awareness, and improved decision-making skills to make informed decisions about clinical trial participation.
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Affiliation(s)
- Patricia Chalela
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Edgar Muñoz
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Kipling J Gallion
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Virginia Kaklamani
- Cancer Therapy and Research Center, UT Health San Antonio, San Antonio, USA
| | - Amelie G Ramirez
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
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Broder-Fingert S, Qin S, Goupil J, Rosenberg J, Augustyn M, Blum N, Bennett A, Weitzman C, Guevara JP, Fenick A, Silverstein M, Feinberg E. A mixed-methods process evaluation of Family Navigation implementation for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:1288-1299. [PMID: 30404548 DOI: 10.1177/1362361318808460] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is growing interest in Family Navigation as an approach to improving access to care for children with autism spectrum disorder, yet little data exist on the implementation of Family Navigation. The aim of this study was to identify potential failures in implementing Family Navigation for children with autism spectrum disorder, using a failure modes and effects analysis. This mixed-methods study was set within a randomized controlled trial testing the effectiveness of Family Navigation in reducing the time from screening to diagnosis and treatment for autism spectrum disorder across three states. Using standard failure modes and effects analysis methodology, experts in Family Navigation for autism spectrum disorder (n = 9) rated potential failures in implementation on a 10-point scale in three categories: likelihood of the failure occurring, likelihood of not detecting the failure, and severity of failure. Ratings were then used to create a risk priority number for each failure. The failure modes and effects analysis detected five areas for potential "high priority" failures in implementation: (1) setting up community-based services, (2) initial family meeting, (3) training, (4) fidelity monitoring, and (5) attending testing appointments. Reasons for failure included families not receptive, scheduling, and insufficient training time. The process with the highest risk profile was "setting up community-based services." Failure in "attending testing appointment" was rated as the most severe potential failure. A number of potential failures in Family Navigation implementation-along with strategies for mitigation-were identified. These data can guide those working to implement Family Navigation for children with autism spectrum disorder.
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Affiliation(s)
| | - Sarah Qin
- 2 The Children's Hospital of Philadelphia, USA
| | | | | | | | | | | | | | | | | | | | - Emily Feinberg
- 1 Boston University School of Medicine, USA.,5 Boston University School of Public Health, USA
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Shahid S, Taylor EV, Cheetham S, Woods JA, Aoun SM, Thompson SC. Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: a comprehensive review. BMC Palliat Care 2018; 17:72. [PMID: 29739457 PMCID: PMC5938813 DOI: 10.1186/s12904-018-0325-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. Objectives To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples’ preferences, needs, opportunities and barriers to palliative care. Methods A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly’s hierarchy of evidence-for-practice in qualitative research. Results Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples’ experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. Conclusions The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas. Electronic supplementary material The online version of this article (10.1186/s12904-018-0325-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shaouli Shahid
- Centre for Aboriginal Studies (CAS), Curtin University, Kent Street, Bentley, WA, 6102, Australia. .,Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia.
| | - Emma V Taylor
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia
| | - Shelley Cheetham
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Perth, WA, 6102, Australia
| | - John A Woods
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, 3086, Australia.,Institute for Health Research, Notre Dame University, Fremantle, WA, 6160, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia
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