scholarly journals Development of Health Pathways to Standardize Cancer Care Pathways Informed by Patient-Reported Outcomes and Clinical Practice Guidelines

2018 ◽  
pp. 1-13 ◽  
Author(s):  
Afaf Girgis ◽  
Ivana Durcinoska ◽  
Eng-Siew Koh ◽  
Weng Ng ◽  
Anthony Arnold ◽  
...  

Purpose High-quality symptom management and supportive care are essential components of comprehensive cancer care. We aimed to describe the development of an evidence-based automated decisional algorithm for patients with cancer that had specific, actionable, clinical, evidence-based recommendations to improve patient care, communication, and management. Methods We reviewed existing literature and clinical practice guidelines to identify priority domains of patient care and potential clinical recommendations. Two multidisciplinary clinical advisory groups used a two-stage consensus decision-making approach to determine domains of care and patient-reported outcome (PRO) measures and subsequently developed automated algorithms with clear clinical recommendations amendable to intervention in clinical settings. Results Algorithms were developed to inform management of patient symptoms, distress, and unmet needs. Three PRO measures were chosen: Distress Thermometer and problem checklist, Edmonton Symptom Assessment Scale, and the Supportive Care Needs Survey–Screening Tool 9. PRO items were mapped to five domains of patient well-being: physical, emotional, practical, social and family, and maintenance of well-being. A total of 15 actionable clinical recommendations tailored to specific issues of concern were established. Conclusion Using automated algorithms and clinical recommendations provides a platform for streamlining and systematizing the use of PROs to inform risk-stratified guideline-informed care. The series of algorithms, which set out systematized care pathways for the clinical care of patients with cancer, can be used to potentially inform patient-centered care.

2021 ◽  
pp. 205715852110069
Author(s):  
Åsa Falchenberg ◽  
Ulf Andersson ◽  
Birgitta Wireklint Sundström ◽  
Anders Bremer ◽  
Henrik Andersson

Emergency care nurses (ECNs) face several challenges when they assess patients with different symptoms, signs, and conditions to determine patients’ care needs. Patients’ care needs do not always originate from physical or biomedical dysfunctions. To provide effective patient-centred care, ECNs must be sensitive to patients’ unique medical, physical, psychological, social, and existential needs. Clinical practice guidelines (CPGs) provide guidance for ECNs in such assessments. The aim of this study was to evaluate the quality of CPGs for comprehensive patient assessments in emergency care. A quality evaluation study was conducted in Sweden in 2017. Managers from 97 organizations (25 emergency medical services and 72 emergency departments) were contacted, covering all 20 Swedish county councils. Fifteen guidelines were appraised using the validated Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. The results revealed that various CPGs are used in emergency care, but none of the CPGs support ECNs in performing a comprehensive patient assessment; rather, the CPGs address parts of the assessment primarily related to biomedical needs. The results also demonstrate that the foundation for evidence-based CPGs is weak and cannot confirm that an ECN has the prerequisites to assess patients and refer them to treatment, such as home-based self-care. This may indicate that Swedish emergency care services utilize non-evidence-based guidelines. This implies that ECN managers and educators should actively seek more effective ways of highlighting and safeguarding patients’ various care needs using more comprehensive guidelines.


2018 ◽  
Vol 29 ◽  
pp. iv96-iv110 ◽  
Author(s):  
M. Aapro ◽  
Y. Beguin ◽  
C. Bokemeyer ◽  
M. Dicato ◽  
P. Gascón ◽  
...  

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