Improving Quality and Value of Cancer Care for Older Adults

2017 ◽  
pp. 383-393
Author(s):  
Erika E. Ramsdale ◽  
Valerie Csik ◽  
Andrew E. Chapman ◽  
Arash Naeim ◽  
Beverly Canin
Keyword(s):  
Older Adults ◽  
Cancer Care ◽  
Functional Independence ◽  
Models Of Care ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Bundled Payment ◽  
Processes Of Care ◽  
Patients With Cancer ◽  
History Of

The concepts of quality and value have become ubiquitous in discussions about health care, including cancer care. Despite their prominence, these concepts remain difficult to encapsulate, with multiple definitions and frameworks emerging over the past few decades. Defining quality and value for the care of older adults with cancer can be particularly challenging. Older adults are heterogeneous and often excluded from clinical trials, severely limiting generalizable data for this population. Moreover, many frameworks for quality and value focus on traditional outcomes of survival and toxicity and neglect goals that may be more meaningful for older adults, such as quality of life and functional independence. A history of quality and value standards and an evaluation of some currently available standards and frameworks elucidate the potential gaps in application to older adults with cancer. However, narrowing the focus to processes of care presents several opportunities for improving the care of older adults with cancer now, even while further work is ongoing to evaluate outcomes and efficiency. New models of care, including the patient-centered medical home, as well as new associated bundled payment models, would be advantageous for older adults with cancer, facilitating collaboration, communication, and patient-centeredness and minimizing the fragmentation that impairs the current provision of cancer care. Advances in information technology support the foundation for these models of care; these technologies facilitate communication, increase available data, support shared decision making, and increase access to multidisciplinary specialty care. Further work will be needed to define and to continue to tailor processes of care to achieve relevant outcomes for older patients with cancer to fulfill the promise of quality and value of care for this vulnerable and growing population.

Comprehensive Geriatric Assessment for Older Patients With Cancer

2007 ◽  
Vol 25 (14) ◽  
pp. 1824-1831 ◽  
Author(s):  
Martine Extermann ◽  
Arti Hurria
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Cancer Care ◽  
Older Patients ◽  
Morbidity And Mortality ◽  
Psychological State ◽  
Future Research ◽  
Oncology Patient ◽  
Patients With Cancer

Purpose During the last decade, oncologists and geriatricians have begun to work together to integrate the principles of geriatrics into oncology care. The increasing use of a comprehensive geriatric assessment (CGA) is one example of this effort. A CGA includes an evaluation of an older individual's functional status, comorbid medical conditions, cognition, nutritional status, psychological state, and social support; and a review of the patient's medications. This article discusses recent advances on the use of a CGA in older patients with cancer. Methods In this article, we provide an update on the studies that address the domains of a geriatric assessment applied to the oncology patient, review the results of the first studies evaluating the use of a CGA in developing interventions to improve the care of older adults with cancer, and discuss future research directions. Results The evidence from recent studies demonstrates that a CGA can predict morbidity and mortality in older patients with cancer. Accumulating data show the benefits of incorporating a CGA in the evaluation of older patients with cancer. Prospective trials evaluating the utility of a CGA to guide interventions to improve the quality of cancer care in older adults are justified. Conclusion Growing evidence demonstrates that the variables examined in a CGA can predict morbidity and mortality in older patients with cancer, and uncover problems relevant to cancer care that would otherwise go unrecognized.

Research and Design Trends for Exam Room Computing to Enhance Patient Centeredness

2021 ◽  
Vol 65 (1) ◽  
pp. 196-200
Author(s):  
Jason J. Saleem ◽  
Laura G. Militello ◽  
Onur Asan ◽  
Jacob M. Read ◽  
Enid Montague
Keyword(s):  
Patient Communication ◽  
Patient Centeredness ◽  
Patient Centered ◽  
History Of Research ◽  
Room Design ◽  
Exam Room ◽  
History Of ◽  
Recent Trends ◽  
Research And Design ◽  
Improve Patient

While there is an extensive and established history of research that demonstrates the unfortunate capacity of exam room computing and electronic health records (EHRs) to negatively impact provider-patient communication and interaction, recent trends in exam room computing are promising in that there may be an opportunity for the EHR to improve patient engagement. The logical evolution of this research is to flip the narrative to understand strategies for using exam room computing as a mediator or facilitator of provider-patient communication and interaction, rather than simply establishing ways to mitigate the documented barriers. Panelists will present and discuss their latest research and experiences that may contribute to the evolution of using exam room computing as a tool to enhance provider-patient communication and interaction. We will also discuss how a thoughtful exam room design with patient-centered exam room computing technologies and practices may positively impact specific human factors, safety, and bias outcomes.

scholarly journals Patient Centeredness from a Perspective of History of the Present: A Genealogical Analysis

2020 ◽  
Vol 7 ◽  
pp. 233339362095024
Author(s):  
Eleni Siouta ◽  
Ulf Olsson
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Policy Documents ◽  
Policy Issues ◽  
History Of ◽  
Transnational Discourse ◽  
Historical Discourses ◽  
Historical Periods

The overall aim of this study, performed in Sweden, was to problematize the contemporary national and transnational discourse on patient centeredness, which during recent decades has become a given, having become established as a dogma in conversations, writing, and thinking about patients and health care. We did that by showing that ideas such as patient centeredness can be seen differently from the way they are depicted in contemporary discourses about health care. In the presented analysis, we drew on Foucault’s concepts of governmentality, ‘history of the present’ and genealogy. This means that we reflected on contemporary conceptions of how phenomena, such as the care seeker, have been constructed within other discourses about health care. Empirically, we used different health policy documents—government reports from three different historical periods. The analysis showed that contemporary narratives about centeredness are neither more, nor less, care seeker-centered than the narratives of yesteryear. Rather, the phenomenon of the care seeker is given different frames and meanings within the framework of different economic and historical discourses about health care. Our analysis raised questions about the contemporary construction of patient centeredness. In a world with such huge economic differences between nations, as well as between citizens within most nations, the contemporary discourse may be limited as it does not problematize structural issues in the same way as previous discourses had done. Perhaps what is needed today are national and international patient-centered or person-centered discourses which also discuss policies and practices that are population- and social group-centered. In the final discussion of the analysis, we identified a new patient-centered discourse, which views the patient as a resource among other resources. The most important limitation of this type of study is that it is only about discourses and policy issues and not about daily practical activities.

Including Family Members in Caring for the Patient with Cancer

2021 ◽  
pp. 723-728
Author(s):  
Douglas S. Rait
Keyword(s):  
Family Relationships ◽  
Well Being ◽  
Models Of Care ◽  
Mental Health Consultation ◽  
Patient Centered ◽  
Patients With Cancer ◽  
Systems Model ◽  
Collaborative Models ◽  
The Family ◽  
Family Centered

The assumption that family relationships play an important role in the care and well-being of the cancer patient may be overlooked simply because it is so universal. At the same time, the elevated role of the family as a primary unit of care in oncology settings is now beginning to receive proper attention in medical and psychiatric circles, and growing evidence supports the efficacy of family interventions for patients with cancer. Family-centered, collaborative models of mental health consultation for patients with cancer are consistent with, and offer an expansion to, current patient-centered models of care in oncology settings. Normative couple and family responses to stages of cancer and its treatment are described, and premises of the family-systems model for assessment and consultation are presented. A case example illustrates how the dimensions of family development, family history, family relationships, and the family’s relationship with providers contribute to a family-centered assessment and consultation.

scholarly journals Community-Based Supports and Services for Older Adults: A Primer for Clinicians

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Eugenia L. Siegler ◽  
Sonam D. Lama ◽  
Michael G. Knight ◽  
Evelyn Laureano ◽  
M. Carrington Reid
Keyword(s):  
United States ◽  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
The United States ◽  
Models Of Care ◽  
Community Based ◽  
Half Century ◽  
History Of ◽  
Primary Care Clinicians

Although 20% of adults 60 years and older receive community-based supports and services (CBSS), clinicians may have little more than a vague awareness of what is available and which services may benefit their patients. As health care shifts toward more creative and holistic models of care, there are opportunities for CBSS staff and primary care clinicians to collaborate toward the goal of maintaining patients’ health and enabling them to remain safely in the community. This primer reviews the half-century history of these organizations in the United States, describes the most commonly used services, and explains how to access them.

scholarly journals Taking care of our own: A narrative review of cancer care services-led models of care providing emergent care to patients with cancer

2019 ◽  
Vol 40 ◽  
pp. 85-97 ◽  
Author(s):  
Sarah Northfield ◽  
Elise Button ◽  
David Wyld ◽  
Nicole Claire Gavin ◽  
Gillian Nasato ◽  
...  
Keyword(s):  
Cancer Care ◽  
Models Of Care ◽  
Narrative Review ◽  
Patients With Cancer ◽  
Care Services ◽  
Taking Care

Predictors of Depression at One Year Post-stroke in Older Adults

2013 ◽  
Vol 14 (3) ◽  
pp. 381-391 ◽  
Author(s):  
Shirley G. Hosking ◽  
Nigel V. Marsh
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Cognitive Functioning ◽  
Verbal Memory ◽  
Daily Living ◽  
Depression Scale ◽  
Functional Independence ◽  
Post Stroke ◽  
Previous Stroke ◽  
History Of

The prevalence and determinates of depression in 67 older adults were assessed at 1 year post-stroke. The sample had an average age of 74 years (SD = 7, range = 60–87 years) at the time of their stroke and 52% were female. The relative contribution of demographic (gender, age), medical (history of previous stroke, hemispheric location of stroke), two measures of functional independence (Barthel Activities of Daily Living (ADL) Index and Nottingham Extended ADL Index) and aspects of cognitive functioning (IQ, attention, verbal memory and verbal fluency) to depression (Geriatric Depression Scale) was investigated. Results indicated that 51% of patients had impairment in activities of daily living, and 33% reported clinically significant levels of depression. Prevalence of cognitive impairment ranged from 28% on a measure of basic cognitive functioning through to 87% on a measure of complex attention. The results from a hierarchical multiple regression analysis showed that the combination of variables explained 40% of the variance in depression scores. In addition, the two individual variables of history of previous stroke and functional independence made significant unique contributions to the variance in depression scores. These results demonstrate the wide variety of factors involved and provide support for a biopsychosocial model of post-stroke depression.

Interdisciplinary Therapy Assessments for the Older Adult

2012 ◽  
Vol 17 (1) ◽  
pp. 11-16
Author(s):  
Lynn Chatfield ◽  
Sandra Christos ◽  
Michael McGregor
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Standardized Testing ◽  
Health Care Providers ◽  
Outcome Measurement ◽  
Care Providers ◽  
Patient Centered ◽  
Screening Process ◽  
Evidenced Based ◽  
Changing Economy

In a changing economy and a changing industry, health care providers need to complete thorough, comprehensive, and efficient assessments that provide both an accurate depiction of the patient's deficits and a blueprint to the path of treatment for older adults. Through standardized testing and observations as well as the goals and evidenced-based treatment plans we have devised, health care providers can maximize outcomes and the functional levels of patients. In this article, we review an interdisciplinary assessment that involves speech-language pathology, occupational therapy, physical therapy, and respiratory therapy to work with older adults in health care settings. Using the approach, we will examine the benefits of collaboration between disciplines, an interdisciplinary screening process, and the importance of sharing information from comprehensive discipline-specific evaluations. We also will discuss the importance of having an understanding of the varied scopes of practice, the utilization of outcome measurement tools, and a patient-centered assessment approach to care.

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