Cost of Cancer Care: Issues and Implications

2007 ◽  
Vol 25 (2) ◽  
pp. 180-186 ◽  
Author(s):  
Neal J. Meropol ◽  
Kevin A. Schulman
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Clinical Practice ◽  
Cancer Care ◽  
Medical Technology ◽  
Clinical Medicine ◽  
Scientific Progress ◽  
Medical Spending ◽  
Cost Of Health Care

Medical technology is increasingly costly in most fields of clinical medicine. Oncology has not been spared from issues related to cost, in part resulting from the tremendous scientific progress that has lead to new tools for diagnosis, treatment, and follow-up of our patients. The increasing cost of health care in general (and cancer care in particular) raises complex questions related to its effects on our economy and the citizens of our society. This article reviews the macroeconomic principles and individual behaviors that govern medical spending, and examines how cost disproportionately affects various populations. Our overall goal is to frame debate about health policy concerns that influence the clinical practice of oncology.

Acceptance and commitment therapy (ACT)-enhanced communication skills: development and evaluation of a novel training programme

2021 ◽  
pp. bmjspcare-2020-002786
Author(s):  
Nicholas J Hulbert-Williams ◽  
Lee Hulbert-Williams ◽  
Pandora Patterson ◽  
Sahil Suleman ◽  
Lesley Howells
Keyword(s):  
Clinical Practice ◽  
Acceptance And Commitment Therapy ◽  
Cancer Care ◽  
Psychological Flexibility ◽  
Training Programme ◽  
Free Text ◽  
Evaluation Data ◽  
Commitment Therapy ◽  
Acceptance And Commitment

BackgroundPsychological suffering is ubiquitous with cancer and frequently presents as an unmet supportive care need. In clinical practice, distress-related needs are often addressed by nurses and non-psychologist allied healthcare professionals who may have limited training in psychological therapeutic frameworks, particularly more recently developed interventions such as Acceptance and Commitment Therapy (ACT).AimsWe developed a single-day training programme for professionals working in supportive and palliative cancer care settings to change the nature of clinical communication about psychological distress and suffering towards an ACT-consistent approach.MethodWe report on experiences of training delivery, and evaluation data about training satisfaction and intention to apply the training to clinical practice, from three training iterations in British and Australian, government-funded and charitable sectors. One hundred and sixteen cancer care professionals participated in the training. Evaluation data were collected from 53 participants (at either 2-week or 3-month follow-ups, or both) using self-report survey, including both quantitative and free-text questions.ResultsAt 2 week follow-up, 73% of trainees rating our course as having relevance to their work, and at 3 month follow-up, 46% agreed that they were better placed to provide improved clinical services. Qualitative feedback supported the inclusion of experiential learning and theoretical explanations underpinning ACT techniques. Undertaking this training did not significantly increase trainees’ stress levels, nor did implementation of this new way of working negatively affect staff well-being. Positive, ACT-consistent, changes in communication behaviours and attitudes were reported, however there was a lack of significant change in psychological flexibility.DiscussionAcceptability and applicability of this training to supportive and palliative healthcare is positive. The lack of change in psychological flexibility suggests a potential need for more experiential content in the training programme. Logistical challenges in one training group suggests the need for more robust train-the-trainer models moving forward.

scholarly journals Clinical Practice Guidelines: who needs them?

1995 ◽  
Vol 19 (7) ◽  
pp. 403-406 ◽  
Author(s):  
Sarah Marriott
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Medical Technology ◽  
Indirect Costs ◽  
Routine Practice ◽  
Direct And Indirect Costs ◽  
Health Community

Clinical Practice Guidelines (CPGs) are systematically developed statements to assist practitioner and patient in clinical decisions about appropriate health care for specific clinical circumstances. The Royal College of Psychiatrists CPG Programme aims to develop clinical guidelines which are scientifically valid and acceptable to those affected by them. At the same time, CPGs must be responsive to advances in knowledge, and versatile enough for the demands of routine practice. Their development involves a number of stages and a variety of methods, built into a cycle of evaluation and review. The Programme has established priorities for clinical topics for CPG development through consultation with the mental health community. Well-developed CPGs would benefit clinicians, patients and purchasers of care. It Is now important to appraise their ability to change clinical practice, the associated direct and indirect costs, and their value as a medical technology. The clinical professions are in the strongest position to co-ordinate their development, and guide their evaluation.

scholarly journals Sexual Health as Part of Gynecologic Cancer Care: What Do Patients Want?

2018 ◽  
Vol 28 (9) ◽  
pp. 1737-1742 ◽  
Author(s):  
Casey M. Hay ◽  
Heidi S. Donovan ◽  
Erin G. Hartnett ◽  
Jeanne Carter ◽  
Mary C. Roberge ◽  
...  
Keyword(s):  
Health Care ◽  
Sexual Health ◽  
Sexual Activity ◽  
Cancer Patients ◽  
Cancer Care ◽  
Gynecologic Cancer ◽  
Relationship Status ◽  
Cancer Type ◽  
Sexual Health Care

ObjectiveSexual health is important to quality of life; however, the sexual health of gynecologic cancer patients is infrequently and inadequately addressed. We sought to understand patient experiences and preferences for sexual health care to help inform strategies for improvement.Methods/MaterialsAn anonymous, cross-sectional survey of outpatient gynecologic cancer patients at a large academic medical center was performed as part of a larger study examining patient and caregiver needs. The survey explored patient-provider discussions about sexuality across 3 domains (experiences, preferences, barriers) and 4 phases of cancer care (diagnosis, treatment, treatment completion, follow-up). Age, relationship status, sexual activity, and cancer type were recorded.ResultsMean age was 63 years. Most patients had ovarian cancer (38%) or endometrial cancer (32%). Thirty-seven percent received treatment within the last month, 55% were in a relationship, and 35% were sexuality active. Thirty-four percent reported sexuality as somewhat or very important, whereas 27% felt that it was somewhat or very important to discuss. Importance of sexuality was associated with age, relationship status, and sexual activity but not cancer type. Fifty-seven percent reported never discussing sexuality. Age was associated with sexuality discussions, whereas relationship status, sexual activity, and cancer type were not. The most common barrier to discussion was patient discomfort. Follow-up was identified as the best time for discussion. Sexuality was most often discussed with a physician or advanced practice provider and usually brought up by the provider.ConclusionsDemographic predictors of importance of sexuality to the patient are age, relationship status, and sexual activity. Providers primarily use age as a proxy for importance of sexuality; however, relationship status and sexual activity may represent additional ways to screen for patients interested in discussing sexual health. Patient discomfort with discussing sexuality is the primary barrier to sexual health discussions, and awareness of this is key to developing effective approaches to providing sexual health care.

Patient safety in Danish cancer care: Results from complementary studies.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 216-216
Author(s):  
Janne Lehmann Knudsen ◽  
Henriette Lipzack ◽  
Cecilie Sperling ◽  
Mette Sandager
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Health Care Professionals ◽  
Cancer Care ◽  
Critical Evaluation ◽  
Cancer Society ◽  
Safety Database ◽  
The Past ◽  
Patient Reported

216 Background: Cancer care has been a top political priority in Danish health care for the past 12 years, but there has been no specific attention towards patient safety. During the past three years, the Danish Cancer Society has carried out several studies, and in 2011 a National working group with all central stakeholders was established together with the Multidisciplinary Cancer Groups. The aim is to provide an overview of safety hazards during the cancer journey based on four different studies addressing the perspective of the health care professionals as well as the patients, and to outline the challenges in the monitoring safety in cancer based on these. Methods: Data from four studies will be presented: (1) 2,429 cancer related adverse event reports from the national Danish Patient Safety Database; (2) retrospective chart review identifying harm in 572 patient records in five inpatients cancer settings using the Global Trigger Tool; (3) errors experienced by 4,262 patients participating in a nationwide survey addressing needs and experiences with healthcare from first contact until completion of primary treatment; (4) errors experienced by the same group of patients during follow-up and rehabilitation two years after diagnosis. Results: The hazards measured varies from according to the methods used; The cancer specific AE reports were primarily related to medication, clinical, process documentation, and clinical administration. Physical harm using GTT was identified in 28% of admissions related to clinical processes, infections, and medication. 10% of the patient reported errors during contact with GP, 15% during diagnostic at hospital and 25 % during treatment. Delay, insufficient information, medication errors, and logistic errors were the most dominant errors. The results adressing patient experienced errors during follow-up and rehablitation are being analyzed. Conclusions: There are specific and serious safety challenges in cancer care and systematic monitoring is needed. Asking the patients add new knowledge. There is a need for critical evaluation of which methods to use for measuring.

scholarly journals A Review of Clinical Practice Guidelines and Treatment Recommendations for Cancer Care in the COVID-19 Pandemic

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2452 ◽  
Author(s):  
Alberto Zaniboni ◽  
Michele Ghidini ◽  
Francesco Grossi ◽  
Alice Indini ◽  
Francesca Trevisan ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cancer Care ◽  
English Language ◽  
Cooperative Groups ◽  
Cancer Centers ◽  
Practice Recommendations ◽  
Group Position ◽  
Health Authorities ◽  
Systemic Therapies

The COVID-19 pandemic has inevitably caused those involved in cancer care to change clinical practice in order to minimize the risk of infection while maintaining cancer treatment as a priority. General advice during the pandemic suggests that most patients continue with ongoing therapies or planned surgeries, while follow-up visits may instead be delayed until the resolution of the outbreak. We conducted a literature search using PubMed to identify articles published in English language that reported on care recommendations for cancer patients during the COVID-19 pandemic from its inception up to 1st June 2020, using the terms “(cancer or tumor) AND (COVID 19)”. Articles were selected for relevance and split into five categories: (1) personal recommendations of single or multiple authors, (2) recommendations of single authoritative centers, (3) recommendations of panels of experts or of multiple regional comprehensive centers, (4) recommendations of multicenter cooperative groups, (5) official guidelines or recommendations of health authorities. Of the 97 included studies, 10 were personal recommendations of single or multiple independent authors, 16 were practice recommendations of single authoritative cancer centers, 35 were recommendations provided by panel of experts or of multiple regional comprehensive centers, 19 were cooperative group position papers, and finally, 17 were official guidelines statements. The COVID-19 pandemic is a global emergency, and has rapidly modified our clinical practice. Delaying unnecessary treatment, minimizing toxicity, and identifying care priorities for surgery, radiotherapy, and systemic therapies must be viewed as basic priorities in the COVID-19 era.

scholarly journals Paradigm shift, metamorphosis of medical ethics, and the rise of bioethics

1999 ◽  
Vol 15 (suppl 1) ◽  
pp. S15-S25 ◽  
Author(s):  
José Luiz Telles de Almeida ◽  
Fermin Roland Schramm
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Medical Practice ◽  
Paradigm Shift ◽  
Medical Technology ◽  
Moral Dilemma ◽  
Ethical Practice ◽  
Ethical Theories ◽  
Philosophical Debate ◽  
The 1960S

Both the increasing incorporation of medical technology and new social demands (including those for health care) beginning in the 1960s have brought about significant changes in medical practice. This situation has in turn sparked a growth in the philosophical debate over problems pertaining to ethical practice. These issues no longer find answers in the Hippocratic ethical model. The authors believe that the crisis in Hippocratic ethics could be described as a period of paradigm shift in which a new set of values appears to be emerging. Beginning with the bioethics movement, the authors expound on the different ethical theories applied to medical practice and conclude that principlism is the most appropriate approach for solving the new moral dilemma imposed on clinical practice.

The Changing Legal and Conceptual Shape of Health Care Privacy

2004 ◽  
Vol 32 (4) ◽  
pp. 680-691 ◽  
Author(s):  
Roger S. Magnusson
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Medical Care ◽  
Health Inequalities ◽  
Medical Technology ◽  
Clinical Settings ◽  
Social Forces ◽  
Health Law ◽  
Stage Of Development ◽  
Professional Codes

The contributions of Professor Bernard Dickens to health law and bioethics span the era in which these fields have emerged as distinct domains of teaching, scholarship and professional and public conversation. Neither field exists in a vacuum. The concerns of bioethics, like the content of health law, are a product of social forces. The bureaucratization of medical care, the possibilities and uncertainties created by developments in medical technology, not to mention glaring health inequalities, have been destabilizing forces in medicine. Writing in 1974, American sociologist Renée Fox noted that medicine had reached “a stage of development characterized by diffuse ethical and existential self-consciousness.” This new medical introspection was evidenced by intense engagement with issues of biomedical regulation, and with the growth of professional codes and processes for resolving value-laden issues within clinical settings.While sometimes described as a process or site for discussion and “engagement,” bioethics evolved rapidly into a domain of governance, with direct implications for clinical practice.

scholarly journals Current Literature Summary

2011 ◽  
Vol 6 (2) ◽  
pp. 121-123
Author(s):  
Jennifer Doherty-Restrepo
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Athletic Training ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Health Care Decisions ◽  
Reform Legislation ◽  
Cost Of Health Care ◽  
The Cost

Evidence-based practice collectively involves research evidence, clinician expertise, and patient preference while making health care decisions. Due to health care reform legislation, there is greater emphasis on evidence-based practice as a means for improving the quality, and lowering the cost, of health care. Principles of evidence-based practice must be integrated into athletic training curricula for students to develop the skill set of accessing, understanding, and evaluating research to appropriately apply evidence–based procedures in clinical practice. We will provide brief synopses of current research related to teaching evidence-based practice and discuss possible applications to athletic training.

scholarly journals библиоVirtual reality (VR) in clinical medicine: international and Russian experience

2021 ◽  
Vol 7 (3) ◽  
pp. 7-20
Author(s):  
M.M. Zelensky ◽  
◽  
S.A. Reva ◽  
A.I. Shaderkina ◽  
◽  
...  
Keyword(s):  
Health Care ◽  
Virtual Reality ◽  
Clinical Practice ◽  
Medical Staff ◽  
Clinical Medicine ◽  
Surgical Interventions ◽  
Wide Range ◽  
Innovative Tool ◽  
Technological Methods ◽  
Medicine Education

Introduction. This article reviews an application of highly technological methods of virtual reality (VR) in clinical practice based on various studies and experiments of foreign and Russian researchers in recent years. The aim of this review is to demonstrate application of virtual reality technologies for further transformation of classical medicine into digital one. Materials and methods. There is significant growth of interest in the use of VR in medicine. Particularly, only in PubMed library such dynamics can be traced by using key words «VR technology in medicine»: in 2017 year there were 58 articles, in 2018 – 65, in 2019 – 106, in 2020 – 127, and currently in the first half of 2021 year there are already 145 articles. For this paper 37 articles from international journals and 28 from Russian ones were selected. The accent was made on the usage of VR technologies in different fields of clinical medicine, education of medical staff and patients. Results. In this paper we described wide range of experiments on using VR technologies during various medical manipulations such as diagnosis, planning of surgical interventions, cognitive therapy, pain management, preventing medicine and conservative treatment. Examples of successful clinical management of patients during rehabilitation and health maintaining were shown. Medical fields where VR is currently widely used were chosen, promising directions for further research were indicated. We also described opportunities of VR application for teaching medical staff. Conclusion. Nearly all researchers who applied virtual reality (VR) in clinical practice have come to similar conclusion. This innovative tool is a breakthrough in medicine and it has high potential for using it by physicians, patients and health care organizers. Authors have articulated issues which should be managed for further successful introduction VR technologies into modern clinical practice.

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