Impact of COVID-19 on cancer service delivery: results from an international survey of oncology clinicians

ObjectivesTo report clinician-perceived changes to cancer service delivery in response to COVID-19.DesignMultidisciplinary Australasian cancer clinician survey in collaboration with the European Society of Medical Oncology.SettingBetween May and June 2020 clinicians from 70 countries were surveyed; majority from Europe (n=196; 39%) with 1846 COVID-19 cases per million people, Australia (AUS)/New Zealand (NZ) (n=188; 38%) with 267/236 per million and Asia (n=75; 15%) with 121 per million at time of survey distribution.ParticipantsMedical oncologists (n=372; 74%), radiation oncologists (n=91; 18%) and surgical oncologists (n=38; 8%).ResultsEighty-nine per cent of clinicians reported altering clinical practices; more commonly among those with versus without patients diagnosed with COVID-19 (n=142; 93% vs n=225; 86%, p=0.03) but regardless of community transmission levels (p=0.26). More European clinicians (n=111; 66.1%) had treated patients diagnosed with COVID-19 compared with Asia (n=20; 27.8%) and AUS/NZ (n=8; 4.8%), p<0.001. Many clinicians (n=307; 71.4%) reported concerns that reduced access to standard treatments during the pandemic would negatively impact patient survival. The reported proportion of consultations using telehealth increased by 7.7-fold, with 25.1% (n=108) of clinicians concerned that patient survival would be worse due to this increase. Clinicians reviewed a median of 10 fewer outpatients/week (including non-face to face) compared with prior to the pandemic, translating to 5010 fewer specialist oncology visits per week among the surveyed group. Mental health was negatively impacted for 52.6% (n=190) of clinicians.ConclusionClinicians reported widespread changes to oncology services, in regions of both high and low COVID-19 case numbers. Clinician concerns of potential negative impacts on patient outcomes warrant objective assessment, with system and policy implications for healthcare delivery at large.

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The qualitative experience of telehealth access and clinical encounters in Australian healthcare during COVID-19: implications for policy

Health Research Policy and Systems ◽

10.1186/s12961-021-00812-z ◽

2022 ◽

Vol 20 (1) ◽

Author(s):

Jennifer White ◽

Julie Byles ◽

Tom Walley

Keyword(s):

Healthcare Delivery ◽

Healthcare Services ◽

Tertiary Hospital ◽

Policy Implications ◽

Face To Face ◽

Individual Interviews ◽

Clinical Encounters ◽

Adaptive Models ◽

Hunter Region ◽

Depth Interviews

Abstract Background Adaptive models of healthcare delivery, such as telehealth consultations, have rapidly been adopted to ensure ongoing delivery of essential healthcare services during the COVID-19 pandemic. However, there remain gaps in our understanding of how clinicians have adapted to telehealth. This study aims to explore the telehealth experiences of specialists, based at a tertiary hospital in the Hunter Region, and general practitioners (GP), including barriers, enablers and opportunities. Methods An interpretative qualitative study involving in-depth interviews explored the telehealth experiences of specialists, based at a tertiary hospital in the Hunter Region of Australia, and GPs, including barriers, enablers and opportunities. Data were analysed using an inductive thematic approach with constant comparison. Results Individual interviews were conducted with 10 specialists and five GPs. Key themes were identified: (1) transition to telehealth has been valuable but challenging; (2) persisting telehealth process barriers need to be addressed; (3) establishing when face-to-face consults are essential; (4) changes in workload pressures and potential for double-up; (5) essential modification of work practices; and (6) exploring what is needed going forward. Conclusions While there is a need to rationalize and optimize health access during a pandemic, we suggest that more needs to be done to improve telehealth going forward. Our results have important policy implications. Specifically, there is a need to effectively train clinicians to competently utilize and be confident using this telehealth and to educate patients on necessary skills and etiquette.

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Telehealth is Face-to-Face Service Delivery

International Journal of Telerehabilitation ◽

10.5195/ijt.2017.6225 ◽

2017 ◽

Vol 9 (1) ◽

pp. 77-78 ◽

Cited By ~ 4

Author(s):

Jana Cason

Keyword(s):

Service Delivery ◽

Policy Implications ◽

Face To Face ◽

Important Policy ◽

Broad Interpretation ◽

Clinical Interactions

The Commentary contests the increasingly outdated and narrow use of the terminology ‘face-to-face’ (often abbreviated as F2F) to connote clinical interactions in which both the client and the practitioner are physically present in the same room or space. An expanded definition is necessary because when delivered synchronously via videoconferencing, telehealth also provides face-to-face services (i.e., the practitioner and the client view each other’s faces). Terminology that uses face-to-face to connote only in-person care is limiting and perpetuates language that is out of line with progressive US regulatory language and broad interpretation within existing regulatory language. It is this author’s hope that this commentary will raise awareness of the important policy implications associated with this seemingly minor distinction in terminology and impact the lingering misapplication of the term, face-to-face.

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Multiple Job Holding - A Working Option for Young People

Labour Employment and Work in New Zealand ◽

10.26686/lew.v0i0.1601 ◽

1970 ◽

Cited By ~ 1

Author(s):

Rebecca Osborne ◽

Julie Warren

Keyword(s):

Young People ◽

Social Life ◽

Occupational Group ◽

Policy Implications ◽

Positive Experience ◽

Face To Face ◽

Younger Workers ◽

Negative Impacts ◽

Work Arrangement

This paper considers the motivations and experiences of young people who are multiple jobholders. The research is based on structured face-to-face interviews with 73 people aged 18-34 years who worked in cafe/restaurant and/or creative occupations. Young people working in either occupational group were ambivalent about why they held multiple jobs: they reported wanting to work in this way and also having to, for financial and other reasons. However, whereas those in cafe/restaurant jobs often saw multiple job holding as a transitional work arrangement to support themselves and their lifestyle while they pursued other activities, those in creative occupations tended to view multiple job holding as a long-term working arrangement. Despite the negative impacts multiple job holding had on many aspects of their personal and social life, most young people described multiple job holding as a positive experience. These findings add to our understanding of the range of work options now taken by younger workers and point to some policy implications.

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New digital models of care in ophthalmology, during and beyond the COVID-19 pandemic

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317683 ◽

2021 ◽

pp. bjophthalmol-2020-317683

Author(s):

Yih-Chung Tham ◽

Rahat Husain ◽

Kelvin Yi Chong Teo ◽

Anna Cheng Sim Tan ◽

Annabel Chee Yen Chew ◽

...

Keyword(s):

Business Models ◽

Digital Health ◽

Models Of Care ◽

Clinical Practices ◽

Digital Models ◽

Face To Face ◽

Potential Barriers ◽

Digital Business Models ◽

Brick And Mortar ◽

Clinical Models

COVID-19 has led to massive disruptions in societal, economic and healthcare systems globally. While COVID-19 has sparked a surge and expansion of new digital business models in different industries, healthcare has been slower to adapt to digital solutions. The majority of ophthalmology clinical practices are still operating through a traditional model of ‘brick-and-mortar’ facilities and ‘face-to-face’ patient–physician interaction. In the current climate of COVID-19, there is a need to fuel implementation of digital health models for ophthalmology. In this article, we highlight the current limitations in traditional clinical models as we confront COVID-19, review the current lack of digital initiatives in ophthalmology sphere despite the presence of COVID-19, propose new digital models of care for ophthalmology and discuss potential barriers that need to be considered for sustainable transformation to take place.

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Parental Involvement Policies for Minors Seeking Abortion in the Southeast and Quality of Care

Sexuality Research and Social Policy ◽

10.1007/s13178-021-00539-0 ◽

2021 ◽

Author(s):

Kari White ◽

Subasri Narasimhan ◽

Sophie A. Hartwig ◽

Erin Carroll ◽

Alexandra McBrayer ◽

...

Keyword(s):

Quality Of Care ◽

Parental Involvement ◽

Service Delivery ◽

Quality Care ◽

Health Service Delivery ◽

Policy Implications ◽

Patient Centeredness ◽

Patient Centered ◽

Staff Members

Abstract Introduction Thirty-seven states require minors seeking abortion to involve a parent, either through notification or consent. Little research has examined how implementation of these laws affect service delivery and quality of care for those who involve a parent. Methods Between May 2018 and September 2019, in-depth interviews were conducted with 34 staff members involved in scheduling, counseling, and administration at abortion facilities in three Southeastern states. Interviews explored procedures for documenting parental involvement, minors’ and parents’ reactions to requirements, and challenges with implementation and compliance. Both inductive and deductive codes, informed by the Institute of Medicine’s healthcare quality framework, were used in the thematic analysis. Results Parental involvement laws adversely affected four quality care domains: efficiency, patient-centeredness, timeliness, and equity. Administrative inefficiencies stemmed from the extensive documentation needed to prove an adult’s relationship to a minor, increasing the time and effort needed to comply with state reporting requirements. If parents were not supportive of their minor’s decision, participants felt they had a duty to intervene to ensure the minor’s decision and needs remained centered. Staff further noted that delays to timely care accumulated as minors navigated parental involvement and other state mandates, pushing some beyond gestational age limits. Lower income families and those with complex familial arrangements had greater difficulty meeting state requirements. Conclusions Parental involvement mandates undermine health service delivery and quality for minors seeking abortion services in the Southeast. Policy Implications Removing parental involvement requirements would protect minors’ reproductive autonomy and support the provision of equitable, patient-centered healthcare.

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Citizen Awareness and Satisfaction Survey: The Case of Tumauini, Isabela Philippines

Psychology and Education Journal ◽

10.17762/pae.v58i1.2164 ◽

2021 ◽

Vol 58 (1) ◽

pp. 5478-5487

Author(s):

Renejoy M. Bulos

Keyword(s):

Local Government ◽

Service Delivery ◽

Local Governments ◽

The Philippines ◽

Public Works ◽

Face To Face ◽

Citizen Satisfaction ◽

Satisfaction Index ◽

The People ◽

Multi Stage

Local governments in the Philippines are the nearest service units to its citizens. They are expected to deliver quality services to their constituents. As recipients of the different services, citizens are deemed in better position to assess whether quality services are delivered by the different municipalities in the country. In order to address the need to gather citizens’ feedback on the service delivery performance of the local government units (LGU), the Department of Interior and Local Government developed the Citizen Satisfaction Index System (CSIS). The municipality of Tumauini in the province of Isabela is one of the selected LGUs to implement the CSIS project in the country to measure its performance in service delivery for 2018. This study assessed the awareness and satisfaction of the people in Tumauini, Isabela on the services for Public Works and Infrastructure delivered by the LGU. There were 150 respondents selected using the multi-stage probability sampling method. In gathering the data needed, face to face interview was used with the aid of survey questionnaire. Overall, results revealed that citizens of Tumauini are aware and satisfied with the different service indicators of the Public Works and Infrastructure programs. Results of the study may help local government officials in crafting policies and making management decisions to improve the performance of the local government of Tumauini in the provision and delivery of Public Works and Infrastructure services to its constituents.

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Indigenous knowledge of Vietnamese cultivation in the Mekong Delta

Science & Technology Development Journal - Social Sciences & Humanities ◽

10.32508/stdjssh.v4i4.579 ◽

2020 ◽

Vol 4 (4) ◽

pp. First

Author(s):

Ngo Thi-Thu Trang

Keyword(s):

Indigenous Knowledge ◽

Mekong Delta ◽

Interdisciplinary Approach ◽

Policy Implications ◽

Production Model ◽

Strong Impact ◽

Group Discussions ◽

Face To Face ◽

Current Production ◽

Near Future

Being passed from generation to generation, indigenous knowledge is unique and confined to a particular culture or society. This knowledge is generated and transmitted through communities, over time, in an effort to cope with their own agro-ecological and socio-economic environments (Fernandez, 1994). Vietnamese residents in the Mekong Delta during the development of cultivation activities have accumulated a lot of folk experiences, creating a large amount of indigenous knowledge in daily life and farming production. This knowledge has supported the Vietnamese people to adapt themselves to survive for several hundred years. However, throughout the time, under the strong impact of scientific knowledge, indigenous knowledge nowadays is no longer applied as much as before. In the context of increasing climate change, understanding and reevaluating the correct value of this knowledge, besides preserving, also contribute to public policy implications in environmental change adaptation strategies in the near future. With an interdisciplinary approach to geography and anthropology, via long fieldwork methods, face-to-face meetings with farmers and group discussions, 10 in-depth interviews were conducted on issues related to this current production model and production experience. Indigenous knowledge has been and is being applied in flooded areas with representatives being An Giang and Hau Giang provinces. The author has systematized the indigenous knowledge of Vietnamese people on cultivating to better adapt to nature.

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The complex geographies of telelactation and access to community breastfeeding support in the state of Ohio

PLoS ONE ◽

10.1371/journal.pone.0242457 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242457

Author(s):

Tony H. Grubesic ◽

Kelly M. Durbin

Keyword(s):

Information And Communication Technologies ◽

Community Support ◽

Communication Technologies ◽

The State ◽

Policy Implications ◽

Breastfeeding Initiation ◽

Breastfeeding Support ◽

Face To Face ◽

Support Resources ◽

Information And Communication

The availability of breastfeeding support resources, including those provided by Baby-Friendly Hospitals, International Board Certified Lactation Consultants, breastfeeding counselors and educators, and volunteer-based mother-to-mother support organizations, such as La Leche League, are critically important for influencing breastfeeding initiation and continuation for the mother-child dyad. In addition, the emergence of community support options via information and communication technologies such as Skype and Facetime, social media (e.g., Facebook), and telelactation providers are providing mothers with a new range of support options that can help bridge geographic barriers to traditional community support. However, telelactation services that use information and communication technologies to connect breastfeeding mothers to remotely located breastfeeding experts require reliable, affordable, high-quality broadband connections to facilitate interaction between mothers and their support resources. The purpose of this paper is to explore the complex spatial landscape of virtual and face-to-face breastfeeding support options for mothers in the state of Ohio (U.S.), identifying barriers to support. Using a range of spatial and network analytics, the results suggest that a divide is emerging. While urban areas in Ohio benefit from both a density of face-to-face breastfeeding support resources and robust broadband options for engaging in telelactation, many rural areas of the state are lacking access to both. Policy implications and several potential strategies for mitigating these inequities are discussed.

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Improving communication on medical ward rounds with patients who speak limited English with implementation of medical communication charts

BMJ Open Quality ◽

10.1136/bmjoq-2021-001389 ◽

2021 ◽

Vol 10 (3) ◽

pp. e001389

Author(s):

Amrita Naomi D'Souza ◽

Ana Canoso ◽

Laura-Jane Smith

Keyword(s):

Healthcare Delivery ◽

Physical Symptoms ◽

Ward Round ◽

Medical Ward ◽

Language Therapy ◽

College Hospital ◽

Medical Communication ◽

Face To Face ◽

High Satisfaction ◽

Ward Rounds

AimTo improve communication on the medical ward round with patients with limited English through implementation of a medical communication chart.Local problemKing’s College Hospital (KCH), London, is situated in Southwark in which 11% of households have no members that speak English as a first language, 4.1% of London’s population report they do not speak English well. Language barriers impair healthcare delivery including during daily ward rounds. This has been exacerbated by the need for PPE during the SARS-CoV2 pandemic. Effective communication between healthcare teams and patients is essential for high quality, patient-centred care. Communication tools commonly used include online, telephone and face-to-face translation services but these have limitations.MethodsFace-to-face patient questionnaires were conducted in the pre-QIP (baseline) group to assess communication on medical ward rounds. Medical communication charts were designed by adapting pre-existing aids commonly used by speech and language therapy. Charts were translated into commonly spoken languages among KCH inpatients. Patients with limited English were selected from both COVID-19 and non-Covid wards. Preintervention and postintervention questionnaires were completed in three Plan–Do–Study–Act (PDSA) cycles.ResultsAt baseline, patients agreed or strongly agreed that the ward round addressed physical symptoms (8/8), concerns or anxieties (7/8), ongoing needs (7/8). Only two of eight doctors felt they could communicate effectively with patients. In PDSA 1, four of five patients reported high satisfaction in communicating physical symptoms, anxieties or concerns preintervention with five of five postchart implementation. Five of five patients reported high satisfaction in communicating ongoing needs preintervention but only three of five postintervention. In PDSA 2, two of five patients reported increased satisfaction in communicating physical symptoms, concerns or anxieties with four of four doctors reporting improved satisfaction in communication in PDSA 2 and two of three doctors reporting higher satisfaction in communication in PDSA 3.ConclusionUsing communication charts in patients with limited English can improve bidirectional communication on medical ward rounds.

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Efforts and Challenges to Ensure Continuity of Mental Healthcare Service Delivery in a Low Resource Settings During COVID-19 Pandemic—A Case of a Kenyan Referral Hospital

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.588216 ◽

2021 ◽

Vol 11 ◽

Author(s):

Edith Kwobah ◽

Florence Jaguga ◽

Kiptoo Robert ◽

Elias Ndolo ◽

Jane Kariuki

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Service Delivery ◽

Mental Health Care ◽

Healthcare Service ◽

Healthcare Delivery ◽

Mental Healthcare ◽

Referral Hospital ◽

Number Of Patients

The rising number of patients with Covid-19 as well as the infection control measures have affected healthcare service delivery, including mental healthcare. Mental healthcare delivery in low and middle income countries where resources were already limited are likely to be affected more during this pandemic. This paper describes the efforts of ensuring mental healthcare delivery is continued in a referral hospital in Kenya, Moi Teaching and Referral hospital, as well as the challenges faced. These efforts are guided by the interim guidelines developed by the Kenyan ministry of health. Some of the adjustments described includes reducing number of patients admitted, shortening the stay in the inpatient setting, using outdoors for therapy to promote physical distancing, utilization of electronic platforms for family therapy sessions, strengthening outpatient services, and supporting primary care workers to deliver mental health care services. Some of the challenges include limited ability to move about, declining ability for patients to pay out of pocket due to the economic challenges brought about by measures to control Covid-19, limited drug supplies in primary care facilities, inability to fully implement telehealth due to connectivity issues and stigma for mental health which results in poor social support for the mentally ill patients. It is clear that current pandemic has jeopardized the continuity of usual mental healthcare in many settings. This has brought to sharp focus the need to decentralize mental health care and promote community based services. Meanwhile, there is need to explore feasible alternatives to ensure continuity of care.

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