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McLeod M, Torode J, Leung K, Bhoo-Pathy N, Booth C, Chakowa J, Gralow J, Ilbawi A, Jassem J, Parkes J, Mallafré-Larrosa M, Mutebi M, Pramesh CS, Sengar M, Tsunoda A, Unger-Saldaña K, Vanderpuye V, Yusuf A, Sullivan R, Aggarwal A. Quality indicators for evaluating cancer care in low-income and middle-income country settings: a multinational modified Delphi study. Lancet Oncol 2024; 25:e63-e72. [PMID: 38301704 DOI: 10.1016/s1470-2045(23)00568-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 02/03/2024]
Abstract
This Policy Review sourced opinions from experts in cancer care across low-income and middle-income countries (LMICs) to build consensus around high-priority measures of care quality. A comprehensive list of quality indicators in medical, radiation, and surgical oncology was identified from systematic literature reviews. A modified Delphi study consisting of three 90-min workshops and two international electronic surveys integrating a global range of key clinical, policy, and research leaders was used to derive consensus on cancer quality indicators that would be both feasible to collect and were high priority for cancer care systems in LMICs. Workshop participants narrowed the list of 216 quality indicators from the literature review to 34 for inclusion in the subsequent surveys. Experts' responses to the surveys showed consensus around nine high-priority quality indicators for measuring the quality of hospital-based cancer care in LMICs. These quality indicators focus on important processes of care delivery from accurate diagnosis (eg, histologic diagnosis via biopsy and TNM staging) to adequate, timely, and appropriate treatment (eg, completion of radiotherapy and appropriate surgical intervention). The core indicators selected could be used to implement systems of feedback and quality improvement.
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Affiliation(s)
- Megan McLeod
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Julie Torode
- Institute of Cancer Policy, Centre for Cancer, Society and Public Health, King's College London, London, UK
| | - Kari Leung
- Guy's and St Thomas' NHS Trust, London, UK
| | - Nirmala Bhoo-Pathy
- Department of Clinical Epidemiology, Universiti Malaya Medical Centre, Kuala Lampar, Malaysia
| | - Christopher Booth
- Department of Medical Oncology, Queen's University, Kingston, ON, Canada
| | | | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, VA, USA
| | | | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Jeannette Parkes
- Division of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Merixtell Mallafré-Larrosa
- City Cancer Challenge, Geneva, Switzerland; Department of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - C S Pramesh
- Department of Thoracic Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Audrey Tsunoda
- Department of Gynecologic Oncology, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | | | - Verna Vanderpuye
- National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Aasim Yusuf
- Department of Gastroenterology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar, Pakistan
| | - Richard Sullivan
- Institute of Cancer Policy, Centre for Cancer, Society and Public Health, King's College London, London, UK; Global Oncology Group, Centre for Cancer, Society and Public Health, King's College London, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Gimenez L, Grosclaude P, Druel V, Costa N, Delpierre C, Molinier L, Delord JP, Rougé Bugat ME. Study protocol of the CREDO randomised controlled trial: evaluation of a structured return home consultation for patients suffering from metastaticcancer. BMJ Open 2023; 13:e062219. [PMID: 36717134 PMCID: PMC9887714 DOI: 10.1136/bmjopen-2022-062219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Patients suffering from cancer are often managed by multiple health professionals. General practitioners with specific skills in oncology could facilitate care coordination between hospital and general practice in the management of these patients. To explore this hypothesis, we run a randomised clinical trial, called 'Concertation de REtour à DOmicile, CREDO'. The main objective is to explore the effectiveness of a 'return home' consultation compared with standard care. The number of unscheduled visits to care centres is used to evaluate the effectiveness of the treatment. METHODS AND ANALYSIS CREDO is a multicentre, randomised, open-label, prospective trial. It takes place in two specialised cancer care centres in southern France (Occitania region). Patient inclusion criteria are: be over 18 years old; be treated with a first cycle of metastatic chemotherapy in a specialised cancer care centre; have a metastatic solid cancer and be returning home after treatment. Patients are randomised in two arms: standard-arm (conventional management) or intervention-arm (CREDO management). In the intervention arm, a 'return home' consultation is carried out in three steps. First, the investigating GP (GP with specific skills in oncology) from the specialised care centre collects information about the patient and patient's management choices. Then, the investigating GP conducts an interview with the patient's referring GP to quickly communicate and discuss information about the patient. Finally, the investigating GP summarises these exchanges and transmits this information to the care centres chosen by the patient.All the patients are followed for 1 year.Statistical and medicoeconomic analysis are planned. ETHICS AND DISSEMINATION This clinical trial is registered under ClinicalTrials.gov identifier and was approved by the ethics committee of South-Western French Committee for the Protection of Persons (number: 2016-A01587-44) and from the French National Drug Safety Agency (ANSM, number: 2016111500034).An international publication of the final results and conference presentations will be planned. TRIAL REGISTRATION NUMBER NCT02857400.
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Affiliation(s)
- Laëtitia Gimenez
- Département Universitaire de Médecine Générale - Université Toulouse III Paul Sabatier, Toulouse, France
- UMR 1295 INSERM - Université Toulouse III Paul Sabatier, Toulouse, France
- Maison de Santé Pluriprofessionnelle Universitaire La Providence, Toulouse, France
| | - Pascale Grosclaude
- UMR 1295 INSERM - Université Toulouse III Paul Sabatier, Toulouse, France
- Institut Universitaire du Cancer Toulouse - Oncopole (IUCT-O), Toulouse, France
| | - Vladimir Druel
- Département Universitaire de Médecine Générale - Université Toulouse III Paul Sabatier, Toulouse, France
| | - Nadège Costa
- UMR 1295 INSERM - Université Toulouse III Paul Sabatier, Toulouse, France
- Service d'Economie de la santé - CHU de Toulouse, Toulouse, France
| | - Cyrille Delpierre
- UMR 1295 INSERM - Université Toulouse III Paul Sabatier, Toulouse, France
| | - Laurent Molinier
- UMR 1295 INSERM - Université Toulouse III Paul Sabatier, Toulouse, France
- Service d'Economie de la santé - CHU de Toulouse, Toulouse, France
| | - Jean-Pierre Delord
- Institut Universitaire du Cancer Toulouse - Oncopole (IUCT-O), Toulouse, France
| | - Marie-Eve Rougé Bugat
- Département Universitaire de Médecine Générale - Université Toulouse III Paul Sabatier, Toulouse, France
- UMR 1295 INSERM - Université Toulouse III Paul Sabatier, Toulouse, France
- Maison de Santé Pluriprofessionnelle Universitaire La Providence, Toulouse, France
- Institut Universitaire du Cancer Toulouse - Oncopole (IUCT-O), Toulouse, France
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Gimenez L, Druel V, Bonnet A, Delpierre C, Grosclaude P, Rouge-Bugat ME. Experimental system of care coordination for the home return of patients with metastatic cancer: a survey of general practitioners. BMC Prim Care 2022; 23:283. [PMID: 36396990 PMCID: PMC9673376 DOI: 10.1186/s12875-022-01891-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND To promote improved coordination between general practice and hospital, the French clinical trial CREDO ("Concertation de REtour à DOmicile") is testing an innovative experimental consultation for patients with metastatic cancer who are returning home. This consultation involves the patient, the patient's referring GP (GPref) and a GP with specific skills in oncology (GPonc) in a specialized care center. The objective of our study is to explore the satisfaction of GPsref about this consultation, in the phase of interaction between GPonc and GPref. METHODS This observational, cross-sectional, multicenter study explored the satisfaction of GPsref who had participated in this type of consultation, via a telephone survey. RESULTS One Hundred GPsref responded to the questionnaire between April and September 2019 (overall response rate: 55%). 84.5% were satisfied with the consultation, and the majority were satisfied with its methods. Half of the GPsref learned new information during the consultation, three-quarters noted an impact on their practice, and 94.4% thought that this type of coordination between the GPref and the oncology specialist could improve general practice - hospital coordination. CONCLUSIONS For GPs, the CREDO consultation seems to be practical and effective in improving the coordination between general medicine and hospital. GPs would benefit from such coordination for all patients with cancer, several times during follow-up and at each occurrence of a medically significant event.
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Affiliation(s)
- Laëtitia Gimenez
- Département Universitaire de Médecine Générale - Université Toulouse III Paul Sabatier, 133 Route de Narbonne, 31062, Toulouse Cedex, France.
- Faculté de médecine, CERPOP - UMR 1295 INSERM - Université Toulouse III Paul Sabatier, 37 allées Jules Guesde -, 31000, Toulouse, France.
- Maison de Santé Pluriprofessionnelle Universitaire La Providence, 1 avenue Louis Blériot -, 31500, Toulouse, France.
| | - Vladimir Druel
- Département Universitaire de Médecine Générale - Université Toulouse III Paul Sabatier, 133 Route de Narbonne, 31062, Toulouse Cedex, France
| | - Anastasia Bonnet
- Département Universitaire de Médecine Générale - Université Toulouse III Paul Sabatier, 133 Route de Narbonne, 31062, Toulouse Cedex, France
| | - Cyrille Delpierre
- Faculté de médecine, CERPOP - UMR 1295 INSERM - Université Toulouse III Paul Sabatier, 37 allées Jules Guesde -, 31000, Toulouse, France
| | - Pascale Grosclaude
- Faculté de médecine, CERPOP - UMR 1295 INSERM - Université Toulouse III Paul Sabatier, 37 allées Jules Guesde -, 31000, Toulouse, France
- Institut Universitaire du Cancer Toulouse - Oncopole, 1, avenue Irène Joliot-Curie -, 31059, Toulouse Cedex 9, France
| | - Marie-Eve Rouge-Bugat
- Département Universitaire de Médecine Générale - Université Toulouse III Paul Sabatier, 133 Route de Narbonne, 31062, Toulouse Cedex, France
- Faculté de médecine, CERPOP - UMR 1295 INSERM - Université Toulouse III Paul Sabatier, 37 allées Jules Guesde -, 31000, Toulouse, France
- Maison de Santé Pluriprofessionnelle Universitaire La Providence, 1 avenue Louis Blériot -, 31500, Toulouse, France
- Institut Universitaire du Cancer Toulouse - Oncopole, 1, avenue Irène Joliot-Curie -, 31059, Toulouse Cedex 9, France
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Honaker SM, Gopalkrishnan A, Brann M, Wiehe S, Clark AA, Chung A. “It made all the difference”: a qualitative study of parental experiences with pediatric obstructive sleep apnea detection. J Clin Sleep Med 2022; 18:1921-1931. [PMID: 35499142 PMCID: PMC9340584 DOI: 10.5664/jcsm.10024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess parental experience of their child's obstructive sleep apnea (OSA) detection process and inform the development of interventions and health communication strategies to improve OSA detection. METHODS Semistructured interviews were conducted with 30 parents of children (ages 3-14) who snored and were referred for an overnight polysomnogram (PSG). Parents (60.0% Black race, 93.3% mothers) described how their child was referred for PSG and their perceptions and feelings throughout the detection process. Parents also completed an OSA knowledge measure. Interview data were analyzed using a descriptive approach and thematic analysis was conducted using the NVivo 12 software system. RESULTS Twenty-one themes were identified across 5 categories (first steps; PSG facilitators and barriers; health information; health care experiences; parent experiences). Respondents experienced multiple pathways to OSA detection, with more than half of referrals initiated by parental concerns (vs. screening efforts). Parents reported a willingness to take any necessary steps to help their child. Both barriers and facilitators to completing a PSG were described. Parents observed both nighttime and daytime symptoms related to OSA in their child but often did not connect the symptoms to each other until later in the process. Participants had varying degrees of OSA knowledge, with a mean knowledge score of 56% correct (range 10%-90% correct). CONCLUSIONS Parental experiences highlight aspects of the health care system that are both effective and ineffective in detecting children with OSA. Implications include a need for strategies to promote timely detection and to provide parents with accurate information about pediatric OSA. CITATION Honaker SM, Gopalkrishnan A, Brann M, Wiehe S, Clark AA, Chung A. "It made all the difference": a qualitative study of parental experiences ith pediatric obstructive sleep apnea detection. J Clin Sleep Med. 2022;18(8):1921-1931.
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Affiliation(s)
- Sarah M. Honaker
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Akila Gopalkrishnan
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch
| | - Maria Brann
- Department of Communication Studies, Indiana University Purdue University Indianapolis
| | - Sarah Wiehe
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Ann A. Clark
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Alicia Chung
- Center for Early Childhood Health and Development, Department of Population Health, New York University Grossman School of Medicine
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Druel V, Gimenez L, Tachousin P, Boussier N, Bauvin E, Pascale G, Beyne-Rauzy O, Rougé Bugat ME. Adapting patients' oncological treatment through remote participation of general practitioners in multi-disciplinary consultation meetings: A feasibility study. Eur J Gen Pract 2022; 28:15-22. [PMID: 35179084 PMCID: PMC8865098 DOI: 10.1080/13814788.2021.2003775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The general practitioner (GP) is central to managing patients with cancer, whose numbers are increasing worldwide. The GP’s involvement requires better coordination between involved partners, in particular oncologists and GPs. Objectives To conduct a feasibility study of remote participation of GPs in multi-disciplinary consultation meetings (MCMs). We analysed participation, participants’ satisfaction, and their impact on therapeutic decisions. Methods We conducted a feasibility study in the regional cancer centre of Toulouse, France. All patient cases discussed in the MCMs for myelodysplasia from 1 January to 31 March 2016 were included. Cases of patients aged over 18 years, with a diagnosis of myelodysplasia and registered with a GP were included if patients gave informed consent. One investigator collected the data provided by GPs during three telephone or video calls: before, during, and after the MCM, respectively. Results Of 86 patient cases discussed during three months of MCMs, 44 were eligible for GP participation; 27 GPs participated in discussions of 27 patient cases. The GP’s participation in the MCM led to a change in management in five cases, with four times treatment intensifications and once de-intensification. Medical, social, family-related, and psychological domains were discussed with input from the GPs. Overall, all participants were satisfied with the MCMs. Conclusion Remote participation of GPs in MCMs is feasible and may result in adapting oncological and haematological management for patients. This patient-centred approach requires a specific organisation that, when implemented, satisfies the needs of all participants.
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Affiliation(s)
- Vladimir Druel
- Department of Primary Care, University of Toulouse, Toulouse, France.,Oncology Unit, Auch Hospital, Auch, France.,Paul Sabatier University-Toulouse III, Toulouse, France
| | - Laetitia Gimenez
- Department of Primary Care, University of Toulouse, Toulouse, France.,Paul Sabatier University-Toulouse III, Toulouse, France.,Faculty of Medicine, Inserm U1027, Toulouse, France
| | | | | | - Eric Bauvin
- Onco-Occitanie, Réseau Régional de Cancérologie, Toulouse, France
| | | | - Odile Beyne-Rauzy
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Marie-Eve Rougé Bugat
- Department of Primary Care, University of Toulouse, Toulouse, France.,Paul Sabatier University-Toulouse III, Toulouse, France.,Faculty of Medicine, Inserm U1027, Toulouse, France.,Onco-Occitanie, Réseau Régional de Cancérologie, Toulouse, France.,Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
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