EPOCK study protocol: a mixed-methods research program evaluating cancer care coordination nursing occupations in France as a complex intervention

280 Background: Effective care coordination (CC) is a critical component of high-quality cancer care; however, efforts to improve cancer care coordination are hampered by limited patient-centered measures. This mixed-methods research reports on patients’ feedback and the utility of a novel care coordination instrument (CCI) designed to assess cancer care coordination. Methods: 7 focus group discussions were conducted with 68 cancer patients receiving active therapy to evaluate validity of the CCI. Subsequently, the CCI was modified and administered to additional 200 cancer patients derived from community-based private and hospital clinics. The CCI is a 29-item, multiple-choice questionnaire and includes subscales that evaluate CC in 3 domains (Communication, Navigation, Operational) across 4 areas of CC (patient-physician; between providers; during inpatient-to-ambulatory care transitions; during transitions across phases of care). Results: Qualitative analysis of focus group discussions demonstrated that the CCI has good face and content validity. Content analysis identified the following themes: Survey, Education/Knowledge, Navigator, Communication, Support, Access, Providers, and Team. Questions with unclear wording or high proportions of not applicable or missing responses were refined or removed. Results of the revised survey indicated that the CCI is able to distinguish patient- and practice characteristics associated with optimal/poor CC. Specifically, cancer types (leukemia, myeloma) and having a patient navigator predicted high overall patients’ ratings of CC ( p < .05). Marginally significant differences were found for practice setting ( p = .085). A multiple regression model with all predictors entered simultaneously revealed that the presence of a family/friend caregiver significantly predicted better CC ( p < .001); however, the benefits of a patient navigator were no longer significant. Conclusions: This study demonstrates the utility of the CCI for assessing patients’ perspectives of cancer CC. Use and integration of this instrument in oncology practices/clinics can identify areas of potential interventions for CC improvement and lead to a better quality of care.

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Mixed-methods research to assess care coordination experiences among NCORP clinical trial participants.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.168 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 168-168

Author(s):

Izumi Okado ◽

Ian Pagano ◽

Anamalia Su'esu'e ◽

Kevin Cassel ◽

Jessica Rhee ◽

...

Keyword(s):

Clinical Trial ◽

Mixed Methods ◽

Focus Group ◽

Care Coordination ◽

Cancer Care ◽

Additional Benefit ◽

Cancer Clinical Trial ◽

Focus Group Discussions ◽

Group Discussions ◽

Trial Participants

168 Background: According to the Institute of Medicine, care coordination (CC) is a critical component of high-quality cancer care; however, many patients with cancer continue to experience fragmented care. CC experiences among cancer clinical trial (CT) participants are relatively unknown. Using mixed methods, we examined perceptions of CC among patients enrolled on therapeutic CTs conducted through the Hawaii Minority/Underserved NCI Community Oncology Research Program (NCORP). Methods: Forty-five CT participants completed the validated Care Coordination Instrument (CCI). The CCI assesses cancer patients’ perceptions of CC overall and across Communication, Navigation, and Operational domains. Data from 45 non-CT participants matched by age, gender, cancer type (breast, GI, other), and clinical stage from our prior studies served as a control group. Paired t-tests were used to compare the CCI scores between the two groups. Three semi-structured focus group interviews were conducted with 14 CT participants in 2020 and 2021. Results: The mean age of CT participants was 61.7 ( SD = 9.4), with the majority being female (67%) and Asian (56%). The most common cancer disease sites were breast (27%) and GI (16%). CT participants reported significantly higher total CC scores than non-participants ( p =.0008). Similar trends were found for Navigation ( p =.007) and Operational ( p =.001) domain scores. 56% of CT participants reported receiving moderate to high-intensity CC assistance from their clinical research professionals (CRPs). Content analysis of focus group discussions revealed that the majority of CT participants’ comments aligned with CC domains; 42% Communication, 30% Navigation, and 28% Operational. Nearly half of focus group discussions centered on CRPs (47%), including CC support provided by CRPs (26%). Other key themes that emerged from the focus groups included general CT experiences (22%) and CRP involvement as an additional benefit to CT participation (15%). Conclusions: Clinical trial participants perceive better CC than non-CT participants, partly attributed to CC support provided by CRPs. Our findings highlight a generally unrecognized yet integral role of CRPs as part of a cancer clinical trial care team. CRP involvement may be an additional benefit of CT participation and contribute to improved quality and value for patient-centered cancer care.

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Validity, reliability and feasibility of commercially available activity trackers in physical therapy for people with a chronic disease: a study protocol of a mixed methods research

Pilot and Feasibility Studies ◽

10.1186/s40814-017-0200-5 ◽

2017 ◽

Vol 3 (1) ◽

Cited By ~ 4

Author(s):

Emmylou Beekman ◽

Susy M. Braun ◽

Darcy Ummels ◽

Kim van Vijven ◽

Albine Moser ◽

...

Keyword(s):

Mixed Methods ◽

Chronic Disease ◽

Physical Therapy ◽

Study Protocol ◽

Mixed Methods Research ◽

Activity Trackers

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Care–physical activity initiatives in the neighbourhood: study protocol for mixed-methods research on participation, effective elements, impact, and funding methods

BMC Public Health ◽

10.1186/s12889-018-5715-z ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Annemarie Wagemakers ◽

Lisanne S. Mulderij ◽

Kirsten T. Verkooijen ◽

Stef Groenewoud ◽

Maria A. Koelen

Keyword(s):

Physical Activity ◽

Mixed Methods ◽

Study Protocol ◽

Mixed Methods Research

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Status of Cancer Care at Network Sites of the Nation’s Academic Cancer Centers

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7656 ◽

2021 ◽

Vol 19 (6) ◽

pp. 726-732

Author(s):

Stanton L. Gerson ◽

Kate Shaw ◽

Louis B. Harrison ◽

Randall F. Holcombe ◽

Laura Hutchins ◽

...

Keyword(s):

Mixed Methods ◽

Rural Communities ◽

Clinical Research ◽

Care Coordination ◽

Cancer Care ◽

Quality Measures ◽

The United States ◽

Cancer Centers ◽

Patient Navigators ◽

Main Center

Background: Cancer care coordination across major academic medical centers and their networks is evolving rapidly, but the spectrum of organizational efforts has not been described. We conducted a mixed-methods survey of leading cancer centers and their networks to document care coordination and identify opportunities to improve geographically dispersed care. Methods: A mixed-methods survey was sent to 91 cancer centers in the United States and Canada. We analyzed the number and locations of network sites; access to electronic medical records (EMRs); clinical research support and participation at networks; use of patient navigators, care paths, and quality measures; and physician workforce. Responses were collected via Qualtrics software between September 2017 and December 2018. Results: Of the 69 responding cancer centers, 74% were NCI-designated. Eighty-seven percent of respondents were part of a matrix health system, and 13% were freestanding. Fifty-six reported having network sites. Forty-three respondents use navigators for disease-specific populations, and 24 use them for all patients. Thirty-five respondents use ≥1 types of care path. Fifty-seven percent of networks had complete, integrated access to their main center’s EMRs. Thirty-nine respondents said the main center provides funding for clinical research at networks, with 22 reporting the main center provides all funding. Thirty-five said the main center provided pharmacy support at the networks, with 15 indicating the main center provides 100% pharmacy support. Certification program participation varied extensively across networks. Conclusions: The data show academic cancer centers have extensive involvement in network cancer care, often extending into rural communities. Coordinating care through improved clinical trial access and greater use of patient navigation, care paths, coordinated EMRs, and quality measures is likely to improve patient outcomes. Although it is premature to draw firm conclusions, the survey results are appropriate for mapping next steps and data queries.

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