“How I kept track of it of course was my business”: Cancer patient self-monitoring as self-stylized work

2013 ◽  
Vol 12 (5) ◽  
pp. 355-361 ◽  
Author(s):  
Carol J. Hermansen-Kobulnicky ◽  
Mary Anne Purtzer
Keyword(s):  
Cancer Patient ◽  
Cancer Patients ◽  
Cancer Center ◽  
Structured Interviews ◽  
Patient Centered ◽  
Work Lives ◽  
Self Monitoring ◽  
Centered Care ◽  
Cancer Experience ◽  
Present Opportunity

AbstractObjectives:Self-monitoring behaviors of cancer patients benefit patients, caregivers, and providers, and yet the phenomenon of self-monitoring from the cancer-patient perspective has not been studied. We examined cancer patients' self-monitoring preferences and practices, focusing on the meaning of self-monitoring within the cancer experience.Methods:Semi-structured interviews were conducted among adult cancer patients who had been seen at least once at a rural United States cancer center. Questions sought out the meaning of self-monitoring and its practical aspects. Qualitative data were analyzed by adapting the four-stepped method by Giorgi for empirical phenomenological analysis.Results:Twenty participants were interviewed (11 women and 9 men). Transcribed interviews revealed that cancer patient self-monitoring is self-stylized work that ranges from simple to complex, while being both idiosyncratic and routine. Participants reported using tools with systems for use that fit their distinctive lives for the purpose of understanding and using information they deemed to be important in their cancer care. Three conceptual categories were discerned from the data that help to elucidate this self-stylized work as fitting their individual priorities and preferences, reflecting their identities, and being born of their work lives.Significance of results:Findings highlight patients' unique self-monitoring preferences and practices, calling into question the assumption that the sole use of standardized tools are the most effective approach to engaging patients in this practice. Self-monitoring efforts can be validated when providers welcome or adapt to patients' self-stylized tools and systems. Doing so may present opportunity for improved communications and patient-centered care.

scholarly journals Awareness and perceptions among members of a Japanese cancer patient advocacy group concerning the financial relationships between the pharmaceutical industry and physicians: a mixed-methods analysis of survey data

2021 ◽  
Author(s):  
Anju Murayama ◽  
Yuki Senoo ◽  
Kayo Harada ◽  
Yasuhiro Kotera ◽  
Hiroaki Saito ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Cancer Patients ◽  
Conflicts Of Interest ◽  
Patient Advocacy ◽  
Patient Centered Care ◽  
Advocacy Group ◽  
Undue Influence ◽  
Patient Centered ◽  
Centered Care ◽  
Patient Advocacy Group

Abstract Objectives Financial conflicts of interest (FCOI) between pharmaceutical companies (Pharma) and healthcare domains may unduly influence physician-led clinical practice and patient-centered care. However, the extent of awareness and perceptions of FCOI among Japanese cancer patients remains unclear. This study aimed to assess these factors and their impacts on physician trustworthiness among Japanese cancer patients. Methods A cross-sectional study using self-administered surveys was conducted on a Japanese cancer patient advocacy group with 800 registered members from January to February 2019. Main outcome measures included awareness and perceptions of physician-Pharma interactions, their impact on physician trustworthiness, and attitudes towards FCOI among professions. We also performed thematic analyses on additional comments responders provided in the surveys. Results Among the 524 invited members, 96 (18.3%) completed the questionnaire. Of these, 69 (77.5%) were cancer patients. The proportion of participants aware of such interactions ranged from 2.1% to 65.3%, depending on the interaction type. Participants were generally neutral on how the interactions would affect physician trustworthiness. A large proportion of participants agreed that these interactions were unethical, could influence physicians' prescribing behavior leading to unnecessary prescriptions, and negatively affect physician trustworthiness. Qualitative responses (n=56) indicated that patients expected physicians to use sound ethical judgment and avoid accepting incentives. Participants were also concerned about their treatment and the undue influence of FCOI on physicians. Conclusion Most participants were aware of at least one FCOI between Pharma and physicians and perceived them negatively. Further efforts to regulate FCOI appear necessary to protect patient-centered care.

scholarly journals Reframing the Medication Experience in Pharmacy Using Seminal Concepts of Patient-Centered Care—Implications for Practice

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 9
Author(s):  
Brian Isetts ◽  
Anthony Olson ◽  
Jon Schommer
Keyword(s):  
Therapeutic Relationship ◽  
Secondary Analysis ◽  
Patient Centered Care ◽  
National Sample ◽  
Patient Specific ◽  
Structured Interviews ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care ◽  
Medication Experience

Team-based, Patient-Centered Care is essential to chronic disease prevention and management but there are differing ideas about the concept’s meaning across healthcare populations, settings and professions. This commentary’s objective is to empirically evaluate the theoretical relationships of the [a] Medication Experience, [b] Patient-Centeredness and other relevant component concepts from pharmaceutical care (i.e., [c] Therapeutic Relationship, [d] Patient-specific preferences for achieving goals of therapy and resolving drug therapy problems) so as to provide practice-based insights. This is achieved using a secondary analysis of 213 excerpts generated from in-depth semi-structured interviews with a national sample of pharmacists and patients about Patient-Centeredness in pharmacist practice. The four component concepts (i.e., a–d) related to the objective were examined and interpreted using a novel 3-archetype heuristic (i.e., Partner, Client and Customer) revealing common practice-based themes related to care preferences and expectations in collaborative goal setting, enduring relationships, value co-creation and evolving patient expectations during challenging medical circumstances. Most practice-based insights were generated within the Partner archetype, likely reflecting high congruence with pharmacist and patient responses related to the Medication Experience and Therapeutic Relationship. The practice-based insights may be especially useful for new practitioners and students accelerating their advancement in providing effective and efficient Patient-Centered Care.

Understanding the interaction between physicians and pharmacists as a method of quality improvement.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 90-90
Author(s):  
Jessica Lynn Fontaine Calder ◽  
Vivian Choy ◽  
Denise Kwan ◽  
Sophia Li ◽  
Melissa Lo ◽  
...  
Keyword(s):  
Health Information System ◽  
Oral Chemotherapy ◽  
Professional Communication ◽  
Cancer Center ◽  
Patient Centered ◽  
System A ◽  
Medication Delivery ◽  
Centered Care ◽  
Pharmacy Technicians ◽  
Physician Order Entry

90 Background: Pharmacists and pharmacy technicians are essential to safe medication delivery. Filling prescriptions can be time consuming when the prescription is not complete or clear and requires inter-professional communication. To improve the quality and efficiency of dispensing medication we performed an audit of callbacks to physicians in the outpatient pharmacy associated with our cancer center with a focus on oral chemotherapy. Methods: The Princess Margaret is one of the largest cancer centers in the world, with an outpatient pharmacy on the premises that fills over 70,000 prescriptions a year. The pharmacists have access to the hospital’s Health Information System and chemotherapy prescribing system. A Prescription Audit Form was developed to track the mode of oral chemotherapy prescription (handwritten, preprinted, computerized physician order entry (CPOE), verbal) and reason for callback. The form was implemented from February 10th until March 7th, 2014 with coded data collection. The form was incorporated into the normal workflow of the outpatient pharmacy and concurrently used to document pharmacy interactions for billing purposes. Results: A total of 5,546 prescriptions were filled with 1,166 prescriptions for oral chemotherapy. Nine percent of prescriptions for oral chemotherapy required a callback to a physician and accounted for 32% of the total callbacks made to physicians. Of the 1,166 oral chemotherapy prescriptions; 39% were refills, 34% were handwritten, 22% were CPOE, 4% were verbal, 1% were preprinted, and 1% were not documented. The top two reasons for callbacks were; drug interaction (32%) and incorrect dose (24%). In the 9% of cases where the physician was contacted to clarify a prescription, the prescription was changed 43% of the time. Conclusions: Understanding the reasons for callbacks can be used to determine optimal data fields required in oral chemotherapy prescribing. Ensuring that prescriptions are appropriately completed will reduce the number of callbacks to physicians - significantly impacting the workflow and efficiency of the pharmacy. Reducing unnecessary callbacks will allow the pharmacy team to deliver timely, safe and effective patient centered care.

scholarly journals How do I keep myself safe? Patient perspectives on including reason for use information on prescriptions and medication labels: a qualitative thematic analysis

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Colin Whaley ◽  
Ashley Bancsi ◽  
Joanne Man-Wai Ho ◽  
Catherine M. Burns ◽  
Kelly Grindrod
Keyword(s):  
Patient Adherence ◽  
Patient Centered Care ◽  
Modern Medicine ◽  
Structured Interviews ◽  
Patient Centered ◽  
Patient Decision Making ◽  
Qualitative Thematic Analysis ◽  
Patient Decision ◽  
Interview Guide ◽  
Centered Care

Abstract Background Medications are crucial for maintaining patient wellness and improving health in modern medicine, but their use comes with risks. Helping patients to understand why they are taking medications is important for patient-centered care and facilitates patient adherence to prescribed medications. One strategy involves enhancing communication between patients, physicians, and pharmacists through the sharing of reason for use (RFU) information or the indication for medications. Methods Semi-structured interviews were conducted with 20 patients in Ontario, Canada, to gain perspectives on how patients currently store their medication information and benefits and disadvantages of adding RFU to prescriptions and medication labels. An interview guide was used by the two interviewers, and the interviews were recorded, transcribed, and thematically coded. Results The analysis yielded three main themes: patient decision making with RFU, RFU in modern, patient-centered care, and logistical aspects of communicating RFU. The patients that were interviewed expressed the value of having RFU when deciding if a medication was effective or to stop taking the medication. Patients felt comfortable with RFU being added to prescriptions and acknowledged the value in adding RFU to medication labels, helping patients and others identify and distinguish medications. Patients generally expressed interest in having RFU written in lay language and identified strengths and weaknesses of having access to RFU via a website or app. Conclusions Patients rated the importance of knowing RFU very highly, identified the value in sharing RFU with pharmacists on prescriptions, and in having RFU on medication labels. These results can be used to inform policy on the addition of RFU on prescriptions and medication labels and support improved communication between patients, pharmacists, and physicians about RFU.

Assessing patient values first: Creating a platform for advance care planning (ACP) in the adult oncology population.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 99-99
Author(s):  
Sabrina Q. Mikan ◽  
Cynthia Taniguchi ◽  
J. Russell Hoverman ◽  
Susan Ash-Lee ◽  
Deb Harrison ◽  
...  
Keyword(s):  
Metastatic Cancer ◽  
Healthcare Providers ◽  
Cancer Center ◽  
Extensive Literature ◽  
Major Step ◽  
Patient Centered ◽  
Cross Sectional ◽  
Centered Care ◽  
Patient Values ◽  
Eol Care

99 Background: Patients, families and healthcare providers can be apprehensive about having end-of-life (EOL) conversations. However, asking patients about personal values regarding their healthcare goals may create a platform for more in depth conversations. A quantitative instrument to assess patient values and ACP readiness was developed and validated to complement a process for identifying patients appropriate for ACP. Methods: Recruitment was conducted at seven cancer center sites in The US Oncology Network over a 90-day pilot study period. Of 871 identified patients, 301 Texas Oncology patients engaged in ACP. A cross-sectional descriptive design was used in 301 metastatic cancer patients. Sixty-three participants completed the questionnaire. The 13-item instrument was created after an extensive literature review regarding EOL choices and interventions using a 5-point Likert scale. Descriptive statistics were examined, in addition to analysis of the relationships between items using Pearson’s r correlations. Results: Participants were primarily female (59%) and Caucasian (95%); with a mean age of 66 years. Sixty-eight percent reported it "Very Important" to be told they were dying. There was a significant association between willingness to discuss feelings about dying and being told by their physician when dying, (r= 0.373, p<0.01). Sixty-two percent reported it "Very Important" to be able to choose their EOL care location. EOL care location and level of burden for caregivers were significantly associated (r= 0.315, p<0.05). Also, 76% reported being able to select the person who makes EOL decisions for them as "Very Important." Conclusions: Recent studies have shown the importance of assessment of patient healthcare values in the metastatic oncology population. The values and readiness instrument allows healthcare providers to understand the patient’s wishes early in the course of care. ACP can be guided through review of the validated instrument in the adult metastatic population. This provides appropriate weight to both sides of the care equation and is a major step toward creating patient-centered care. Further development of the instrument is needed in this population.

Identifying barriers to oncologist referral to palliative care: A dual approach.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 121-121 ◽  
Author(s):  
Kyle Whelan
Keyword(s):  
Palliative Care ◽  
Literature Review ◽  
End Of Life ◽  
Cancer Patients ◽  
Tertiary Hospital ◽  
Cancer Center ◽  
Structured Interviews ◽  
Dual Approach ◽  
Wide Range ◽  
Specific Barriers

121 Background: Longitudinal palliative care has demonstrated benefits for cancer patients, and the American Society for Clinical Oncology recommends that palliative care be used along with standard anti-cancer therapy at the diagnosis of serious disease. However, studies have shown that oncologists still often refer to palliative care within days of the end of life, or not at all. This indicates that oncologists face barriers, systems-based or self-imposed, to palliative care referral. This study aims to identify specific barriers that prevent oncologists from referring cancer patients to palliative care services. Methods: Barriers to referral were identified via a dual approach. A literature review was performed using a PubMed search of articles published since 2012, when the ASCO provisional opinion was issued. This was narrowed down to 27 articles that meaningfully commented on barriers that oncologists face in referring to palliative care. Additionally, a qualitative analysis of semi-structured interviews of five practicing oncologists was performed. Oncologists interviewed for the study practice in a cancer center affiliated with an academic tertiary hospital. Results: 20 distinct barriers to referral, both systems-based and at the individual provider level, were enumerated from the literature review and interview analysis. Conclusions: Oncologists face a wide range of specific barriers that prevent appropriate referral to palliative care, related both to the logistics of the healthcare system and to providers’ preconceptions about palliative care. A significant barrier at the oncologist level is a tendency to associate palliative care exclusively with the end of life, despite demonstrated benefits earlier in the course of disease.

The Commission on Cancer’s survivorship care plan standard: Implementation is underway.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 72-72
Author(s):  
Nina S. Miller
Keyword(s):  
Cancer Patients ◽  
Patient Centered Care ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Psychosocial Needs ◽  
Patient Centered ◽  
Cancer Program ◽  
Centered Care

72 Background: The American College of Surgeons Commission on Cancer established a patient-centered standard regarding the delivery of a survivorship care plan to cancer patients. In response to recommendations from the 2006 National Academy of Sciences, Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition, a working group developed a set of Continuum of Care standards to address the psychosocial needs of cancer patients. In 2009 Commission on Cancer members had met to discuss a strategic plan for addressing a major shift in accreditation standards from process to patient-centered care with a focus on patient outcomes. According to Cancer Program Standards: Ensuring Patient-Centered Care, the cancer program must implement a process to disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing cancer treatment. Programs are in full implementation mode and surveys monitoring this Survivorship Care Plan Standard have begun this year. The care plan provides guidance and recommendations for survivors and their healthcare providers to address the medical and psychosocial problems that may arise post-treatment. By delivering a plan, the patient is empowered with information about the treatment they have received, the recommendations for their care going forward, and recommended resources. Methods: Programs submit documentation to describe their process for delivery of care through an electronic activity report. Documentation of this standard includes method of delivery, identification of eligible patients, implementation process and tracking. This presentation will summarize program submissions for 2015-2016 and include an analysis of the details of the standard compliance as reported by accredited programs. Results: This analysis will include responses from all Commission on Cancer accredited programs reporting on this standard. The analysis will provide information about the trends in program implementation and compliance with the standard. Conclusions: This analysis will inform future decisions about the content of plans, the value of plan delivery to the provider and to the patient and summarize current practice.

Early discussion of patients’ values by oncology nurses.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 3-3
Author(s):  
Andrew S. Epstein ◽  
Kimberly Chow ◽  
Kelley Anderson ◽  
Molly Okpako ◽  
Camila Bernal ◽  
...  
Keyword(s):  
Cancer Patients ◽  
High Volume ◽  
Clinical Situation ◽  
Oncology Nurses ◽  
Medical Decision ◽  
Cancer Center ◽  
Newly Diagnosed ◽  
Structured Interviews ◽  
Oncology Nurse ◽  
Patient Values

3 Background: Optimal advance care planning allows patients to articulate their values as an affirmation of personhood and a touchstone for medical decision-making. Ideally, it occurs when patients are well enough to express themselves thoughtfully, with opportunities for iteration as the clinical situation unfolds. We piloted a novel program of systematic, oncology nurse-led values discussions with patients soon after diagnosis, testing feasibility, and acceptability in high-volume clinics in a dedicated cancer center. Methods: Within an institutional initiative integrating primary and specialist palliative care from diagnosis for all cancer patients regardless of stage or prognosis, specialists trained oncology nurses (90 minutes) to use specific questions ( re living well, hopes, fears, sources of strength, abilities essential for acceptable quality of life) and an empathic communication framework to discuss health-related values with newly-diagnosed patients over two consecutive clinic visits. Nurses summarized discussions on a template for patient verification, oncologist review, and EMR documentation. Documentation was re-reviewed with the patient quarterly (sooner on patient or clinician request). Feasibility and acceptability were evaluated in three clinics for patients with hematologic or gastrointestinal (GI) cancers. Results: Oncology nurses conducted a total of 83 discussions (part 1=38, part 2=29, template review=16) with 15 and 23 newly-diagnosed hematologic and GI cancer patients, respectively. No patient declined participation. Discussions averaged 8 minutes; summaries were reviewed in 4 minutes, and all were verified by patients. Clinic workflow and volume (about 20 patients/clinic day) were maintained. Of 12 patients, all reported feeling comfortable with the process, 92% considered it helpful, 92% would recommend it to others. In structured interviews, patients, families, and clinicians strongly endorsed this process. Conclusions: Early, nurse-led discussions of patient values are feasible and acceptable in high-volume outpatient oncology clinics. Next steps include optimization of EMR accessibility, scalability, and evaluation of impact on other patient-focused and utilization outcomes.

scholarly journals Uptake and usage of an online prostate cancer treatment decision aid in Dutch clinical practice: A quantitative analysis from the Prostate Cancer Patient Centered Care trial

2018 ◽  
Vol 25 (4) ◽  
pp. 1498-1510 ◽  
Author(s):  
Maarten Cuypers ◽  
Romy ED Lamers ◽  
Paul JM Kil ◽  
Julia J van Tol-Geerdink ◽  
Cornelia F van Uden-Kraan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patient ◽  
Cancer Treatment ◽  
Decision Aid ◽  
Prostate Cancer Patient ◽  
Decision Aids ◽  
Treatment Decision ◽  
Patient Centered ◽  
Prostate Cancer Treatment ◽  
Centered Care

Implementation of patient’s decision aids in routine clinical care is generally low. This study evaluated uptake and usage of a novel Dutch web-based prostate cancer treatment decision aid within the Prostate Cancer Patient Centered Care trial. From an estimated total patient sample of 1006 patients, 351 received a decision aid (35% implementation rate; hospital ranges 16%–84%). After receipt of the decision aid, most patients accessed the decision aid, utilized most functions, although not completely, and discussed the decision aid summary in a subsequent consultation with their care provider. Including nurses for dissemination of decision aids seemed to positively affect decision aid uptake. Once received, patients seemed able to use the decision aid and engage in shared decision-making as intended; however, decision aid uptake and complete usage of all decision aid components should be further improved. Prior to the diagnosis consultation, handing out of the decision aid should be prepared.

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