An integrated family orientated cancer care program: The report of a pilot project in the socio-emotional management of chronic disease

Effective community-based chronic disease management requires general practice engagement and ongoing improvement in care models. This article outlines a case study on contributing factors to insufficient participant recruitment through general practice for an evidence-based diabetes care pilot project. Key stakeholder semi-structured interviews and focus groups were undertaken at cessation of the pilot project. Participants (15 GPs, five practice nurses, eight diabetes educators) were healthcare providers engaged in patient recruitment. Through descriptive analysis, common themes were identified. Four major themes were identified: (1) low perceived need for intervention; (2) communication of intervention problematic; (3) translation of research into practice not occurring; and (4) the service providing the intervention was not widely viewed as a partner in chronic disease care. Engaging GPs in new initiatives is challenging, and measures facilitating uptake of new innovations are required. Any new intervention needs to: be developed with GPs to meet their needs; have considerable lead-in time to develop rapport with GPs and raise awareness; and ideally, have dedicated support staff within practices to reduce the demand on already-overburdened practice staff. Feasible and effective mechanisms need to be developed to facilitate uptake of new innovations in the general practice setting.

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Choosing a Value-Based Cancer Care Program For Your Practice

Default Digital Object Group ◽

10.1200/adn.20.200031 ◽

2020 ◽

Keyword(s):

Cancer Care ◽

Care Program ◽

A Value

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Pilot program of fast-track germline genetic analyses as part of integrated breast, ovarian, or gastrointestinal personalized cancer care program.

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.15_suppl.1546 ◽

2010 ◽

Vol 28 (15_suppl) ◽

pp. 1546-1546

Author(s):

O. Caron ◽

B. Bressac-de-Paillerets ◽

D. Malka ◽

A. Remenieras ◽

C. Bourgier ◽

...

Keyword(s):

Cancer Care ◽

Fast Track ◽

Care Program ◽

Pilot Program ◽

Genetic Analyses ◽

Personalized Cancer

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Standardizing quality breast cancer care throughout all New York university facilities.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.160 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 160-160

Author(s):

Anna C. Pavlick ◽

Freya Ruth Schnabel ◽

Amy Tiersten ◽

Matthew Volm ◽

Jennifer J. Wu ◽

...

Keyword(s):

Breast Cancer ◽

New York ◽

Cost Effectiveness ◽

Cancer Care ◽

Treatment Algorithm ◽

Care Program ◽

Cancer Center ◽

Breast Cancer Care ◽

New York University ◽

Provider Satisfaction

160 Background: NYU physicians provide breast cancer care (BCC) at several locations throughout New York. The NYU Clinical Cancer Center (NYUCCC) is a private, university-based facility while Bellevue and Woodhull Hospitals are city hospitals. The diversity of BCC provided to patients (pts) in city hospitals can vary greatly from that of private centers and intra-center physician variability also diversifies care. This variability can impact on pt satisfaction and outcomes. Breast cancer (Br Ca) pts make up the greatest number of pts seen and treated at all NYU affiliated sites, therefore, a "Br Ca Quality of Care Program" will be incorporated into the electronic medical record (EMR) at all facilities. A treatment algorithm based on the pt’s stage and a simple "drop-down menus" will simplify use. It will encompass diagnostic imaging, pathology, biopsy procedures, surgery, radiation, chemo, and hormonal therapy as well as survivorship guidelines for maintaining wellness. Methods: Leaders of each Br Ca program have identified potential barriers to care and rectifiable issues. Algorithms and “drop down menus” in the EMR will be presented to the NYUCCC Br Ca physicians for feedback. This tool will then be refined and launched at NYUCCC. After evaluating this program at NYUCCC, the data will be presented to the all NYUCCC faculty. Achieving the city hospitals to adopt this EMR program will be the ultimate success and standardized quality care will be the result. Results: An assessment of the endpoints of physician adherence to guidelines, cost effectiveness and pt/provider satisfaction will be conducted 6 months later. Random audits of breast cancer pt charts will evaluate provider compliance. A cost analysis of this care will be done and compared to a random sampling of previously treated pt charts. Review and analysis of this data would be presented to the NYUCCC faculty, then programs launched at both city-hospitals. Conclusions: If the endpoints of quality standardized care, cost effectiveness and pt/provider satisfaction are met, incorporation of similar programs into other high volume oncologic disease entities seen at all NYU facilities would be developed.

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Improving quality of cancer care by rapid adoption of new scientific evidence.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.62 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 62-62

Author(s):

Joanne Schottinger ◽

Violeta Rabrenovich ◽

David Campen ◽

Dean Fredriks

Keyword(s):

Cancer Care ◽

Scientific Evidence ◽

Care Program ◽

Evidence Based ◽

Clinical Expertise ◽

Patient Centered ◽

Chemotherapy Administration ◽

Inpatient Settings ◽

New Evidence

62 Background: The goal of the Kaiser Permanente (KP) Cancer Care Program is to provide patient-centered, evidence-based, safe care for all KP oncology patients. Multiple processes and information technology tools support KP’s clinicians in delivering the best care to our patients. Prior to 2008, chemotherapy ordering and administration across KP was paper-based, and the standardization of chemotherapy regimens was driven by prescribers’ preferences. KP Oncologists used more than 1,400 chemotherapy protocols. Pharmacy had varying systems for dosing alerts, and reliable chemotherapy administration data was not available for clinical quality improvement. Methods: By 2012, all KP regions had implemented the KP HealthConnect Beacon (KPHCB) system, which incorporates chemotherapy ordering, alerting, verifying, dispensing, and administration in ambulatory and inpatient settings. Important outcomes of the KPHCB implementation include: 1) our success in gaining agreements on standardization of chemotherapy protocols across the Program, and 2) implementation of a rapid process for adoption of new scientific evidence. Our approach includes an evaluation of the quality of the relevant scientific literature and an assessment of a particular treatment. The KP multidisciplinary team discusses and integrates the scientific evidence and clinical expertise of KP clinicians into KPHCB chemotherapy protocols. The new evidence-based protocols with supporting literature references are imbedded as a web link at the end of the each protocol and are available to clinicians within days following the publishing of new evidence. Results: An example of a rapid dissemination and adoption of evidence is the 2010 Pfizer’s and FDA’s announcement that the sale of Mylotarg would be voluntarily discontinued due to a fatal liver veno-occlusive disease. Within 48 hours, we identified 12 patients who received Mylotarg in 2010, and the treating oncologists were individually contacted and provided with the new information to discuss with patients, as appropriate. Conclusions: The benefits of KP’s rapid adoption of new evidence methodology are reaching over 40,000 cancer patients, receiving over 250,000 chemotherapy treatments annually.

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Safety and effectiveness of medical cannabis as a complementary option for supportive cancer care: Results from the Cannabis Pilot Project.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.12106 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 12106-12106

Author(s):

Antonio Vigano ◽

Saro Aprikian ◽

Popi Kasvis ◽

Virginie Bacis ◽

Amna Al Harrasi ◽

...

Keyword(s):

Cancer Care ◽

Symptom Relief ◽

Symptom Control ◽

Health Centre ◽

Brief Pain Inventory ◽

Symptom Assessment ◽

Pilot Project ◽

Assessment System ◽

Medical Cannabis ◽

Supportive Cancer Care

12106 Background: Access to medical cannabis (MC) is a common request by patients and caregivers in supportive cancer care (SCC). However, healthcare professionals require more evidence on MC safety and effectiveness. Methods: The Cannabis Pilot Project (CPP) was implemented at the Cedars Cancer Centre of the McGill University Health Centre to evaluate MC as a complementary option for symptom control in SCC. Referral to the CPP was reserved for patients who were receiving SCC but had not obtained adequate symptom relief. An interdisciplinary team (physician, nurse and research coordinator) was established to systematically assess patients, prescribe and monitor MC treatments and record data on their safety and effectiveness. Patients were enrolled in the CPP between February 2018 and December 2019 and reassessed at intervals of one to six months. Results: Ninety-six cancer patients (mean age 60.0y (±13.9); 41 (42.7%) males) had at least one follow-up (FUP) and were included in the study. The main cancer types were breast (19.8%), lung (9.4%) and colorectal (9.4%). Adverse events (top three: drowsiness, low energy and nausea) were reported in 28% of patients, with 9% having to stop MC. Mean Brief Pain Inventory scores significantly improved between baseline, FUP-2 and FUP-3 for worst pain (5.4± SEM 0.3 vs 4.3±0.3 and 3.7±0.4) and average pain severity (4.2±0.2 vs 3.2±0.3 and 3.2±0.4). Anorexia improved (3.4±0.3 vs 2.2±0.4 and 1.7±0.4), as measured via the revised Edmonton Symptom Assessment System (ESAS-r). ESAS-r wellbeing improved significantly between baseline and FUP-1 (4.4±0.2 vs 3.7±0.2). Between baseline and each FUP, approximately a third of patients dropped their use of concurrent medications (including analgesics, antidepressants and anxiolytics), as measured by the Medication Quantification Scale. Conclusions: The CPP data support the safety and effectiveness of MC as a complementary option for improving pain control, appetite and quality of life in SCC.

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Evaluation of an Australian primary care telephone cognitive behavioural therapy pilot

Australian Journal of Primary Health ◽

10.1071/py12111 ◽

2014 ◽

Vol 20 (1) ◽

pp. 62 ◽

Cited By ~ 6

Author(s):

Bridget Bassilios ◽

Jane Pirkis ◽

Kylie King ◽

Justine Fletcher ◽

Grant Blashki ◽

...

Keyword(s):

Mental Health ◽

Cognitive Behavioural Therapy ◽

Mental Health Professionals ◽

Health Professionals ◽

Care Program ◽

Pilot Project ◽

Behavioural Therapy ◽

Face To Face ◽

Cognitive Behavioural ◽

Minimum Dataset

A telephone-based cognitive behavioural therapy pilot project was trialled from July 2008 to June 2010, via an Australian Government-funded primary mental health care program. A web-based minimum dataset was used to examine level of uptake, sociodemographic and clinical profile of consumers, precise nature of services delivered, and consumer outcomes. Key informant interviews with 22 project officers and 10 mental health professionals elicited lessons learnt from the implementation of the pilot. Overall, 548 general practitioners referred 908 consumers, who received 6607 sessions (33% via telephone). The sessions were delivered by 180 mental health professionals. Consumers were mainly females with an average age of 37 years and had a diagnosis of depressive and/or anxiety disorders. A combination of telephone and face-to-face sessions of 1 h in duration were conducted, delivering behavioural and cognitive interventions, usually with no cost to consumers. Several implementation issues were identified by project officers and mental health professionals. Although face-to-face treatment is preferred by providers and consumers, the option of the telephone modality is valued, particularly for consumers who would not otherwise access psychological services. Evidence in the form of positive consumer outcomes supports the practice of multimodal service delivery.

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Does Clinical Presentation Predict Response to a Nonsurgical Chronic Disease Management Program for Endstage Hip and Knee Osteoarthritis?

The Journal of Rheumatology ◽

10.3899/jrheum.131475 ◽

2014 ◽

Vol 41 (11) ◽

pp. 2223-2231 ◽

Cited By ~ 14

Author(s):

Jillian P. Eyles ◽

Barbara R. Lucas ◽

Jillian A. Patterson ◽

Matthew J. Williams ◽

Kate Weeks ◽

...

Keyword(s):

Chronic Disease ◽

Disease Management ◽

Knee Osteoarthritis ◽

Disease Management Program ◽

Chronic Disease Management ◽

Care Program ◽

Management Program ◽

Knee Oa ◽

Predictors Of Response ◽

High Level

Objective.To identify baseline characteristics of participants who will respond favorably following 6 months of participation in a chronic disease management program for hip and knee osteoarthritis (OA).Methods.This prospective cohort study assessed 559 participants at baseline and following 6 months of participation in the Osteoarthritis Chronic Care Program. Response was defined as the minimal clinically important difference of an 18% and 9-point absolute improvement in the Western Ontario and McMaster Universities Arthritis Index global score. Multivariate logistic regression modeling was used to identify predictors of response.Results.Complete data were available for 308 participants. Those who withdrew within the study period were imputed as nonresponders. Three variables were independently associated with response: signal joint (knee vs hip), sex, and high level of comorbidity. Index joint and sex were significant in the multivariate model, but the model was not a sensitive predictor of response.Conclusion.Strong predictors of response to a chronic disease management program for hip and knee OA were not identified. The significant predictors that were found should be considered in future studies.

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