The Role of Physical Cues in Co-located and Remote Casework

Across the world, large swaths of society closed in response to the COVID-19 (C-19) pandemic, transforming the provision of government services, including welfare. The shift to remote work afforded a glimpse of what a future digitized public sector might look like. In Denmark, employment assistance went fully remote in spring 2020 to prevent the spread of C-19. Caseworkers assessed unemployed individuals' needs for welfare benefits over the phone instead of at the physical job center. With this change, caseworkers could no longer rely on nonverbal communication, such as physical cues (e.g., the appearance of an unemployed individual), in their assessment practice. Although they are not explicitly described in the formal work process, caseworkers report that such cues influence their assessment of an individual's challenges related to their unemployment. Taking a qualitative approach, we conducted 60 telephone interviews with 6 caseworkers across 3 Danish job centers during the first wave of the pandemic. Later, during the second wave of the pandemic (August 2020-June 2021), we conducted observational studies (22.5 h) including on-site interviews in two job centers where caseworkers had returned to work having consultations with unemployed individuals both remotely and co-located. During this second-wave period we also conducted new interviews (n = 18) with the caseworkers from the first part of the study. The contribution of this paper is an empirical description of how casework changes when it shifts from co-located to remote consultations, focused on two factors: (1) the role of physical cues and how caseworkers rely on these cues to communicate with and assess the individual, and (2) documentation practices, and how earlier documentation became more important when caseworkers lacked access to physical cues. We contribute to CSCW research by showing that although implicit information about the individual is valuable for caseworkers, it is not problem-free, and therefore we argue that there is a need to find new ways to assess individuals, in particular interpreting implicit or un-spoken information, as the complicated use of physical cues can tip over to become a matter of bias.

Study protocol for OptimalTTF-2: enhancing Tumor Treating Fields with skull remodeling surgery for first recurrence glioblastoma: a phase 2, multi-center, randomized, prospective, interventional trial

BACKGROUND

OptimalTTF-2 is a randomized, comparative, multi-center, investigator-initiated, interventional study aiming to test skull remodeling surgery in combination with Tumor Treating Fields therapy (TTFields) and best physicians choice medical oncological therapy for first recurrence in glioblastoma patients. OptimalTTF-2 is a phase 2 trial initiated in November 2020. Skull remodeling surgery consists of five burrholes, each 15 mm in diameter, directly over the tumor resection cavity. Preclinical research indicates that this procedure enhances the effect of Tumor Treating Fields considerably. We recently concluded a phase 1 safety/feasibility trial that indicated improved overall survival and no additional toxicity. This phase 2 trial aims to validate the efficacy of the proposed intervention.

METHODS

The trial is designed as a comparative, 1:1 randomized, minimax two-stage phase 2 with an expected 70 patients to a maximum sample size of 84 patients. After 12-months follow-up of the first 52 patients, an interim futility analysis will be performed. The two trial arms will consist of either a) TTFields therapy combined with best physicians choice oncological treatment (control arm) or b) skull remodeling surgery, TTFields therapy and best practice oncology (interventional arm). Major eligibility criteria include age ≥ 18 years, 1st recurrence of supratentorial glioblastoma, Karnofsky performance score ≥ 70, focal tumor, and lack of significant co-morbidity. Study design aims to detect a 20% increase in overall survival after 12 months (OS12), assuming OS12 = 40% in the control group and OS12 = 60% in the intervention group. Secondary endpoints include hazard rate ratio of overall survival and progression-free survival, objective tumor response rate, quality of life, KPS, steroid dose, and toxicity. Toxicity, objective tumor response rate, and QoL will be assessed every 3rd month. Endpoint data will be collected at the end of the trial, including the occurrence of suspected unexpected serious adverse reactions (SUSARs), unacceptable serious adverse events (SAEs), withdrawal of consent, or loss-to-follow-up.

DISCUSSION

New treatment modalities are highly needed for first recurrence glioblastoma. Our proposed treatment modality of skull remodeling surgery, Tumor Treating Fields, and best practice medical oncological therapy may increase overall survival significantly.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT0422399 , registered 13. January 2020.