scholarly journals What is multidisciplinary cancer care like in practice? a protocol for a mixed-method study to characterise ambulatory oncology services in the Australian public sector

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031179
Author(s):  
Bróna Nic Giolla Easpaig ◽  
Gaston Arnolda ◽  
Yvonne Tran ◽  
Mia Bierbaum ◽  
Klay Lamprell ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Multidisciplinary Care ◽  
Outpatient Clinics ◽  
Local Health ◽  
Outpatient Services ◽  
Or Efficiency ◽  
Ambulatory Oncology ◽  
Patient Reported ◽  
Roll Out

IntroductionAn understanding of the real-world provision of oncology outpatient services can help maintain service quality in the face of escalating demand and tight budgets, by informing the design of interventions that improve the effectiveness or efficiency of provision. The aims of this study are threefold. First, to develop an understanding of cancer services in outpatient clinics by characterising the organisation and practice of multidisciplinary care (MDC). Second, to explore the key areas of: (a) clinical decision-making and (b) engagement with patients’ supportive needs. Third, to identify barriers to, and facilitators of, the delivery of quality care in these settings.Methods and analysisA suite of mixed-methods studies will be implemented at six hospitals providing cancer outpatient clinics, with a staged roll-out. In Stage One, we will examine policies, use unstructured observations and undertake interviews with key health professionals to characterise the organisation and delivery of MDC. In Stage Two, observations of practice will continue, to deepen our understanding, and to inform two focused studies. The first will explore decision-making practices and the second will examine how staff engage with patients’ needs; both studies involve interviews, to complement observation. As part of the study of supportive care, we will examine the implications of an introduction of patient-reported measures (PRMs) into care, adding surveys to interviews before and after PRMs roll-out. Data analysis will account for site-specific and cross-site issues using an adapted Qualitative Rapid Appraisal, Rigorous Analysis approach. Quantitative data from clinician surveys will be statistically analysed and triangulated with the related qualitative study findings.Ethics and disseminationEthical approval was granted by South Eastern Sydney Local Health District Human Research Ethics Committee (no. 18/207). Findings will be shared with participating hospitals and widely disseminated through publications and presentations.

Between a logic of disruption and a logic of continuation: Negotiating the legitimacy of algorithms used in automated clinical decision-making

2021 ◽  
pp. 136345932199674
Author(s):  
Rikke Torenholt ◽  
Henriette Langstrup
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Patient Reported Outcomes ◽  
Patient Involvement ◽  
Clinical Decision Making ◽  
Diagnostic Procedures ◽  
Clinical Decision ◽  
Patient Reported ◽  
Pro Tools

In both popular and academic discussions of the use of algorithms in clinical practice, narratives often draw on the decisive potentialities of algorithms and come with the belief that algorithms will substantially transform healthcare. We suggest that this approach is associated with a logic of disruption. However, we argue that in clinical practice alongside this logic, another and less recognised logic exists, namely that of continuation: here the use of algorithms constitutes part of an established practice. Applying these logics as our analytical framing, we set out to explore how algorithms for clinical decision-making are enacted by political stakeholders, healthcare professionals, and patients, and in doing so, study how the legitimacy of delegating to an algorithm is negotiated and obtained. Empirically we draw on ethnographic fieldwork carried out in relation to attempts in Denmark to develop and implement Patient Reported Outcomes (PRO) tools – involving algorithmic sorting – in clinical practice. We follow the work within two disease areas: heart rehabilitation and breast cancer follow-up care. We show how at the political level, algorithms constitute tools for disrupting inefficient work and unsystematic patient involvement, whereas closer to the clinical practice, algorithms constitute a continuation of standardised and evidence-based diagnostic procedures and a continuation of the physicians’ expertise and authority. We argue that the co-existence of the two logics have implications as both provide a push towards the use of algorithms and how a logic of continuation may divert attention away from new issues introduced with automated digital decision-support systems.

scholarly journals Management of Pulp Canal Obliteration—Systematic Review of Case Reports

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1237
Author(s):  
Alexandra Vinagre ◽  
Catarina Castanheira ◽  
Ana Messias ◽  
Paulo J. Palma ◽  
João C. Ramos
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Watchful Waiting ◽  
Case Reports ◽  
Intervention Strategy ◽  
Permanent Teeth ◽  
Clinical Approach ◽  
Treatment Pathways ◽  
Patient Reported

Background and Objectives: This systematic review aimed to assess the literature focusing on the clinical management of traumatized teeth with Pulp Canal Obliteration (PCO) and propose an updated clinical decision-making algorithm. The present review follows the PRISMA guidelines and was registered on PROSPERO database (CRD42020200656). Materials and Methods: An electronic search strategy was performed in Pubmed, EBSCOhost and LILACS from inception to March 2021. Only anterior permanent teeth with PCO due to dental trauma were included. Regarding clinical approaches, only teeth managed with a “watchful waiting” approach, tooth bleaching or root canal treatment (RCT) were included. Quality assessment was performed using the JBI Critical Appraisal Tool for Case Reports. Results: Twenty case reports were selected, resulting in a total of 27 patients. The number of traumatized teeth diagnosed with PCO was 33. The “watchful waiting” approach was the most implemented clinical strategy. Discolored non-symptomatic PCO teeth were mostly managed with external bleaching. The prevalence of pulp necrosis (PN) was 36.4%. For teeth diagnosed with PN, non-surgical RCT was performed in 10 teeth and surgical RCT in one tooth. Guided endodontic technique was performed in six of those teeth. Conclusions: For discolored non-symptomatic PCO teeth, external bleaching is advocated and the RCT approach should not be implemented as a preventive intervention strategy. Symptomatic PCO teeth should follow regular endodontic treatment pathways. Clinical approach of teeth with PCO should follow a decision-making algorithm incorporating clinical and radiographic signs and patient-reported symptoms.

scholarly journals Call for action: how to improve use of patient-reported outcomes to guide clinical decision making in rheumatoid arthritis

2018 ◽  
Vol 38 (6) ◽  
pp. 935-947 ◽  
Author(s):  
Bruno Fautrel ◽  
Rieke Alten ◽  
Bruce Kirkham ◽  
Inmaculada de la Torre ◽  
Frederick Durand ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Making ◽  
Patient Reported Outcomes ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Patient Reported

Elucidation of qualitative patient-reported outcome (PRO) data using latent dirichlet allocation (LDA) in patients (pts) undergoing radical cystectomy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18245-e18245
Author(s):  
Thomas Michael Atkinson ◽  
Bruce D. Rapkin ◽  
Elizabeth Schofield ◽  
Bernard H. Bochner ◽  
Yuelin Li
Keyword(s):  
Decision Making ◽  
Clinical Trials ◽  
Radical Cystectomy ◽  
Clinical Decision Making ◽  
Routine Care ◽  
Free Text ◽  
Post Surgery ◽  
Patient Reported ◽  
Latent Topics ◽  
Prospective Longitudinal

e18245 Background: As PROs become commonplace in clinical trials and routine care, we must identify efficient analytic methods to better understand and ultimately integrate this information into clinical decision-making. While PROs are often captured via qualitative methods to provide context and pt voice to traditional objective and/or quantitative assessments, the current analytic standard is resource intensive and impractical for timely delivery of this information to clinicians and trialists. To address this problem, we propose the use of LDA, a natural language processing technique that automates the distillation of vast amounts of free-text data into underlying topics. Methods: As part of a prospective longitudinal trial of pts ( N = 200; M age = 63.8; 20% female; 46%) undergoing radical cystectomy (52% stage T2-T4) and urinary diversion (49% continent) for bladder cancer (ClinicalTrials.gov identifier NCT00745355), pts completed 30 minute interviews at baseline and 6-months post-surgery where they were asked to characterize their quality of life with respect to goals or milestones they would like to reach, problems they would like to solve, situations they would like to prevent, things they would like to remain the same, and commitments they would be willing to let go. LDA was used to extract latent topics and themes, stratified by time. Results: LDA extracted 7 latent topics and showed shifting patient priorities. At baseline, pt primary concerns were related to surgery and recovery. Six months post-surgery, pt goals transitioned toward themes related to concerns about cancer recurrence, regaining a sense of normalcy, return to work, enjoyment of life and increased appreciation of friends and family. Conclusions: LDA was used as an automated tool to illustrate a shift in pt goals and concerns as they transition into survivorship. This novel data analytic technique offers the possibility of significantly reducing the resources required to summarize qualitative PRO data. As such, this information may now be more readily available for immediate inclusion in the decision-making process as part of routine care and clinical trials. Clinical trial information: NCT00745355.

scholarly journals Patient reported distress can aid clinical decision making in idiopathic pulmonary fibrosis: analysis of the PROFILE cohort

2018 ◽  
Author(s):  
Iain Stewart ◽  
Tricia McKeever ◽  
Rebecca Braybrooke ◽  
Eunice Oballa ◽  
Juliet K Simpson ◽  
...  
Keyword(s):  
Decision Making ◽  
Lung Function ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Disease Progression ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Risk Of Death ◽  
Patient Reported ◽  
Incident Cases

AbstractIdiopathic pulmonary fibrosis is a progressive and fatal interstitial lung disease. We aimed to determine if patient response to a palliative assessment survey could predict disease progression or death.We undertook a cross-sectional study in a UK clinical cohort of incident cases. Rasch-based methodology provided a disease distress value from an abridged 11 item model of the original 45 item survey. Distress values were compared with measures of lung function. Disease progression or mortality alone was predicted at twelve months from survey completion, with risk of death assessed at three, six and twelve months.Disease distress values were negatively correlated with lung function (r=-0.275 percent predicted DLCO). Expected survey scores computed from distress values could distinguish disease progression, 8.8 (p=0.004), and people who died, 10.2 (p=0.002), from those who did not progress, 6.9. Actual survey scores predicted disease progression and mortality with an area under the curve of 0.60 and 0.64, respectively. Each point increment in actual score increased risk of twelve-month mortality by 10%, almost 43% of people scoring above 18 did not survive beyond 105 days.We define a short questionnaire that can score disease distress and predict prognosis, assisting clinical decision making in progressive fibrosis.

scholarly journals Pharmacogenetic testing in outpatient mental health clinics

2017 ◽  
Author(s):  
◽  
Tammie Gainey
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Outpatient Clinics ◽  
Future Research ◽  
Mental Health Clinicians ◽  
Pharmacogenetic Testing ◽  
Mental Health Clinics ◽  
Outpatient Mental Health ◽  
Health Clinics

The purpose of this study was to evaluate mental health clinicians' perceived knowledge regarding pharmacogenetic testing; their attitude, receptivity towards, and confidence in pharmacogenetic testing; and how pharmacogenetic testing is being implemented to support decision making in outpatient clinics. This study was guided by Rogers' Diffusion of Innovation (DOI) Theory. An exhausted literature search was conducted to find studies on mental health clinicians' knowledge, perceived attitudes, and implementation of pharmacogenetic testing. The subject population included 28 mental health clinicians who are actively utilizing pharmacogenetic testing in outpatient mental health clinics. Participants responded to semi-structured open-ended prompts regarding knowledge, perceptions and implementation of pharmacogenetic testing in mental health outpatient clinics. Data were analyzed using a qualitative descriptive approach. Five relevant themes emerged related to the perceptions of pharmacogenetic testing, impact on clinical decision-making, associated concerns of pharmacogenetic testing, knowledge gaps among clinicians, and policy challenges. Overall, clinicians perceived pharmacogenetic testing beneficial to guide dosing and medication selection to decrease the risk of side effects and increase tolerability of psychotropic medications. This study will lead to future research to support shared decision-making around pharmacogenetics testing, medication adherence and tolerability, and setting guidelines for pharmacogenetics testing in mental health clinics.

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