scholarly journals Survivorship for Individuals Living with Advanced and Metastatic Cancers: National Cancer Institute Meeting Report

2021 ◽  
Author(s):  
Michelle A Mollica ◽  
Ashley Wilder Smith ◽  
Emily Tonorezos ◽  
Kathleen Castro ◽  
Kelly K Filipski ◽  
...  
Keyword(s):  
Subject Matter ◽  
National Cancer Institute ◽  
Metastatic Cancer ◽  
Quality Care ◽  
Healthcare Delivery ◽  
Evidence Base ◽  
Meeting Report ◽  
Subject Matter Experts ◽  
Policy And Practice ◽  
Care Needs

Abstract An important and often overlooked subpopulation of cancer survivors is individuals who are diagnosed with or progress to advanced or metastatic cancer. Living longer with advanced or metastatic cancer often comes with a cost of burdensome physical and psychosocial symptoms and complex care needs, however research is limited on this population. Thus, in May 2021, the National Cancer Institute convened subject matter experts, researchers, clinicians, survivors, and advocates a for a 2-day virtual meeting. The purpose of this report is to provide a summary of the evidence gaps identified by subject matter experts and attendees and key opportunities identified by NCI in five research areas: epidemiology and surveillance, symptom management, psychosocial research, healthcare delivery, and health behaviors. Identified gaps and opportunities include the need to develop new strategies to estimate the number of individuals living with advanced and metastatic cancers, understand and address emerging symptom trajectories, improve prognostic understanding and communication between providers, patients, and caregivers, develop and test models of comprehensive survivorship care tailored to these populations, and assess patient and provider preferences for health behavior discussions throughout the survivorship trajectory. To best address the needs of individuals living with advanced and metastatic cancer and to deliver comprehensive evidence-based quality care, research is urgently needed to fill evidence gaps, and it is essential to incorporate the survivor perspective. Developing such an evidence base is critical to inform policy and practice.

Evolving best practice for take-home cancer drugs in Ontario.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 246-246
Author(s):  
Aliya Pardhan ◽  
Kathy Vu ◽  
Daniela Gallo-Hershberg ◽  
Leta Marie Forbes ◽  
Scott Gavura ◽  
...  
Keyword(s):  
Subject Matter ◽  
Best Practice ◽  
Task Force ◽  
Quality Care ◽  
Standard Setting ◽  
Subject Matter Experts ◽  
Cancer Drugs ◽  
Caregiver Education ◽  
Modified Delphi ◽  
Routine Monitoring

246 Background: Take-home cancer drugs (THCD) have become a standard treatment for many cancers and present opportunities and challenges for patients, providers and administrators. Ontario’s system has been described as two-tiered, with intravenous cancer drugs (IVCD) viewed as more comprehensive, organized, safer, and more patient-centred. Cancer Care Ontario (CCO) is the Ontario government’s principal cancer advisor. In April 2017, CCO established an Oncology Pharmacy Task Force to develop consensus-based recommendations on best practices for THCD to ensure that all patients are receiving consistent high-quality care regardless of the method of delivery of treatment. Methods: The Task Force included 34 members with representation from patient advocacy groups, pharmacy and pharmacist associations, regulatory and standard setting organizations, and subject matter experts. Standards, guidelines and recommendations from leading authorities were extracted by CCO’s Evidence Search and Review Service and synthesized by a core working group to develop 29 statements. The consensus process included a three-step modified Delphi method with two electronic surveys and a face-to-face meeting. Seventy percent agreement was required to include a recommendation. Thereafter, an extensive review process was conducted with relevant CCO programs and committees as well as subject matter experts, stakeholders and standard setting bodies at the local-regional and national levels. Results: Sixteen consensus-based recommendations were developed: training and education for providers (2); drug access (1); prescribing (4); patient, family/caregiver education (3); communication (1); dispensing (3); monitoring for adherence, identification and management of symptoms/adverse effect (1); and incident reporting (1) . This guidance will have most relevance for patients receiving THCD that require routine monitoring and for clinicians involved in delivering systemic treatment, and associated medications. Conclusions: Through the rigorous use of the Delphi technique, the Task Force developed a robust set of recommendations for THCD delivery in Ontario. Further work will be required to understand implementation enablers and barriers

Clinical Skills in Children's Nursing

2010 ◽  
Keyword(s):  
Nursing Students ◽  
Clinical Skills ◽  
Quality Care ◽  
Student Nurses ◽  
Thinking Skills ◽  
Evidence Base ◽  
Critical Thinking Skills ◽  
Family Needs ◽  
Online Resource ◽  
Key Terms

Children's Nurses require excellent clinical skills to provide high quality care to children and young people across a range of different ages. After the first year of their training, children's nursing students must master skills of increasing complexity whilst developing clinical judgement and confidence. Therefore, it is vital that links are made to children's biology and development, family needs, legal issues and problem solving but until now, it has been hard to find all this in one place. Clinical Skills for Children's Nursing is designed for children's and general nursing students in second year onwards to facilitate the transition from closely supervised beginners, to qualified professionals. By clearly explaining essential principles, evidence and special considerations, this text helps students to build up their confidence, not just in performing skills, but also in decision-making in readiness for registration and beyond. Step-by-step guides to performing core and advanced procedures are presented in tables for easy comprehension and revision, illustrated by photographs and drawings. Each skill draws on the available evidence base, which is updated regularly on the accompanying Online Resource Centre. Uniquely, this text develops students' critical thinking skills and ability to deliver child centred care by providing clear links to anatomical, physiological and child development milestones as well as regular nursing alerts which help prevent readers from making common mistakes. Clearly reflecting the Nursing and Midwifery Council's Essential Skills Clusters for registration and beyond, Clinical Skills for Children's Nursing is designed to support student nurses develop into competent practitioners. Supported by a dedicated Online Resource Centre with up-to-date evidence, realistic scenarios, and a wealth of other tools. On the Online Resource Centre: For registered lecturers and mentors: - Figures from the book, ready to download and use in teaching material For students: - Evidence, guidelines and protocols, reviewed and updated every 6 months - Over 40 interactive scenarios - Active web links provide a gateway to the articles cited in the book - Flashcard glossary to help learn key terms

scholarly journals The importance of soft skills development in a hard data world: learning from interviews with healthcare leaders

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Traci H. Abraham ◽  
Greg L. Stewart ◽  
Samantha L. Solimeo
Keyword(s):  
Leadership Training ◽  
Soft Skills ◽  
Quality Care ◽  
Healthcare Delivery ◽  
Care Staff ◽  
Patient Centered ◽  
Data Infrastructure ◽  
Hard Data ◽  
Formal Leadership ◽  
Healthcare Leaders

Abstract Background Learning healthcare systems have invested heavily in training primary care staff to provide care using patient-centered medical home models, but less is known about how to effectively lead such teams to deliver high quality care. Research is needed to better understand which healthcare leadership skills are most utilized or in need of development through additional training. Method Semi-structured telephone interviews with healthcare leaders familiar with Patient-Aligned Care Teams (PACT) implementation in the U.S. Department of Veterans Affairs (VA). We interviewed sixteen (N = 16) physician, nursing, and administrative leaders at VA facilities located in the upper Midwestern United States. Content analysis of interviews transcripts using template techniques. Results Participants described instrumental challenges that they perceived hindered leadership effectiveness, including the supervisory structure; pace of change; complexity of the clinical data infrastructure; an over-reliance on technology for communication; and gaps in available leadership training. Factors perceived as facilitating effective leadership included training in soft skills, face-to-face communication, and opportunities for formal training and mentorship. A cross-cutting theme was the importance of developing “soft skills” for effective PACT leadership. Conclusions Although formal leadership training and development were perceived as beneficial, healthcare leaders familiar with PACT implementation in the VA described a mismatch between the skills and knowledge PACT leaders need to succeed and the training available to them. Closing this gap could improve retention of skilled and knowledgeable healthcare leaders, thereby reducing the costs associated with training and leading to improvements in healthcare delivery.

Development of an Instrument for Assessing Trauma Team Performance

2007 ◽  
Vol 51 (11) ◽  
pp. 678-682 ◽  
Author(s):  
Barbara Kuenzle Haake ◽  
Yan Xiao ◽  
Colin Mackenzie ◽  
F. Jacob Seagull ◽  
Thomas Grissom ◽  
...  
Keyword(s):  
Team Performance ◽  
Performance Feedback ◽  
Subject Matter ◽  
Clinical Performance ◽  
Trauma Team ◽  
Ease Of Use ◽  
Initial Assessment ◽  
Subject Matter Experts ◽  
Real Patient ◽  
Widespread Application

Teamwork training is critical for patient safety and has been advocated for widespread application in many settings. A key challenge for evaluating teamwork training is measurement. Despite much effort, the team performance instruments reported thus far suffer from a variety shortcomings that prevent their wide application in assessing teams in real settings. Based on review of video recorded trauma team activities in real patient care, a multi-disciplinary research team developed an instrument based on observable behaviors (UMTOP). A set of video clips were reviewed by 6 subject matter experts who were requested to provide “descriptors” about the observed team activities. The 167 collated descriptors were combined to a reduced list, which was then sent to the subject matter experts for revision. The revised list was then categorized into 5 areas of team performance (task and clinical performance, leadership organization, teamwork organization, social environment, sterile precaution). UMTOP was developed to be a tradeoff among four criteria: ease of use, reliability, usefulness for team performance feedback, and speed of scoring. An initial assessment of reliability was conducted with surgeon and nursing reviewers.

Barriers to High Quality End of Life Care in the Surgical Intensive Care Unit

2020 ◽  
pp. 104990912096997
Author(s):  
Ricardo Diaz Milian
Keyword(s):  
Intensive Care ◽  
End Of Life ◽  
Conflicts Of Interest ◽  
Quality Care ◽  
Surgical Intensive Care Unit ◽  
Care Needs ◽  
Surgical Intensive Care ◽  
Quality Reporting ◽  
Number Of Patients ◽  
Hospice And Palliative Care

End of life discussions frequently take place in surgical intensive care units, as a significant number of patients die while admitted to the hospital, and surgery is common during the last month of life. Multiple barriers exist to the initiation of these conversations, including: miscommunication between clinicians and surrogates, a paternalistic approach to surgical patients, and perhaps, conflicts of interest as an unwanted consequence of surgical quality reporting. Goal discordant care refers to the care that is provided to a patient that is incapacitated and that is not concordant to his/her wishes. This is a largely unrecognized medical error with devastating consequences, including inappropriate prolongation of life and non-beneficial therapy utilization. Importantly, hospice and palliative care needs to be recognized as quality care in order to deter the incentives that might persuade clinicians from offering these services.

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