The relationship between older cancer survivors’ reports of depression, anxiety and pain to health providers’ findings and mortality

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8597-8597
Author(s):  
P. H. Seo ◽  
R. Sloane ◽  
S. S. Ingram ◽  
D. Misra ◽  
E. C. Clipp ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Karnofsky Performance Status ◽  
Depression Scale ◽  
Primary Care Providers ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Health Providers ◽  
Care Providers ◽  
Pain Anxiety

8597 Background: Older cancer survivors may experience psychological distress due to their cancer experience and aging health. This study aimed to compare primary care and specialty providers’ inquiries of pain, depression and anxiety to older cancer survivors’ questionnaire responses. Methods: 153 patients seen in oncology clinics at the Veterans Affairs Medical Center (Durham, NC) from November 1999 until April 2000 completed the Hospital Anxiety and Depression Scale and a pain thermometer questionnaire. Blinded chart review examined health provider inquiries of pain, anxiety and depression. Cox proportional hazards survival analyses were performed on subjective pain, anxiety and depression with comorbidities and Karnofsky performance status (KPS) added in controlled models. Results: Patients were on average aged 68, had 5.4 comorbidities, 87.4% KPS, and were 3.1 years from a cancer diagnosis. Health providers missed 17 of 94 patients with significant levels of self-reported pain (sensitivity 0.82). Although 28 (20.6%) and 33 (25.8%) patients screened positively for depression and anxiety respectively, providers asked 7 patients about anxiety (sensitivity 0.15) and 16 patients about depression (sensitivity 0.25). The overall three year mortality was 37.9%. Pain was not associated with mortality. Patients screening for depression [HR 2.03 (95% CI: 1.03, 4.01)] and anxiety [HR 2.02 (95% CI: 1.01, 4.04)] had lower 3 year survival. KPS and comorbidities diminished these effects. Conclusions: In older cancer survivors, anxiety and depression may have an association with mortality. To improve detection, oncology and primary care providers should routinely inquire about mood and aim to intervene with pharmacologic or supportive treatments. No significant financial relationships to disclose.

scholarly journals Mental Health and Primary Care: Contributing to Mental Health System Transformation in Canada

2017 ◽  
Vol 36 (4) ◽  
pp. 33-67 ◽  
Author(s):  
Nick Kates
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Health Providers ◽  
Care Providers ◽  
System Transformation ◽  
Mental Health Systems ◽  
Care Systems

For 20 years mental health and primary care providers across Canada have been working collaboratively together to improve access to care, provider skills, and patient experience. The new strategic plan of the Mental Health Commission of Canada (MHCC) offers many opportunities for collaborative care to play a role in the transformation of Canada’s mental health systems. To assist the plan, this paper presents principles underlying successful projects and ways that mental health and primary care services can work together more collaboratively, including integrating mental health providers in primary care. It integrates these concepts into a Canadian Model for Collaborative Mental Health Care that can guide future expansion of these approaches, and suggests ways in which better collaboration can address wider issues facing all of Canada’s health care systems.

Cancer survivorship algorithms as clinical tools for primary care providers.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 100-100
Author(s):  
Guadalupe R. Palos ◽  
Katherine Ramsey Gilmore ◽  
Paula A. Lewis-Patterson ◽  
Maria Alma Rodriguez
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Primary Care Providers ◽  
Cell Transplant ◽  
Care Providers ◽  
Coordinated Care ◽  
Major Barrier ◽  
Site Specific ◽  
The Impact

100 Background: Clinical decision tools (CDTs) such as survivorship algorithms may be valuable resources for primary care providers who provide post-treatment care for cancer survivors. Our objective was to assess providers’ perceptions, adoption, and satisfaction with clinical practice algorithms tailored to site-specific cancer survivorship clinics. Methods: Eligible providers were those assigned to one of 9 site-specific survivorship clinics, (breast, colorectal, genitourinary, gynecology, head and neck, lymphoma, melanoma, stem cell transplant, and thyroid). Potential respondents were invited to participate by emails. Voluntary return of the survey indicated a provider’s informed consent. Providers had the choice to participate by clicking on a link embedded in an email. Once the link was activated, the user was taken to a 10-item survey with questions asking about the usability, awareness, and satisfaction with the algorithms specific to their clinic. Descriptive statistics (i.e. frequencies and percentages) were used to summarize the responses. Results: Of 35 providers assigned in the survivorship clinics, 18 responded resulting in a 51% response rate. The majority of respondents (94.4%) were aware of the survivorship algorithms specific to their clinic. Over 75% reported using the algorithms occasionally (16.7%), frequently (33%) and always (33.3%). The major barrier to using the algorithms was a lack of awareness on to access the algorithms. Over half of the providers (55.6%) preferred using the digital versions of the algorithms. 68% strongly agreed the algorithms were practical to use and implement in their clinical setting. The majority of providers’ reported being satisfied (62.5%) or very satisfied (25.0%) with the algorithms tailored to their site specific clinic. Conclusions: Survivorship practice algorithms were perceived as useful clinical resources to deliver coordinated care to cancer survivors with diverse cancer diagnoses. Future work is needed to determine the impact of the algorithms on providers’ practice with cancer survivors.

The role of annual personal health visits (APHV) on patients' with cancer knowledge and perceptions of the harms of continued smoking.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 152-152
Author(s):  
Delaram Farzanfar ◽  
Lin Lu ◽  
Jie Su ◽  
Devon Alton ◽  
Rahul Mohan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Cancer Survivors ◽  
Cancer Patients ◽  
Primary Care Providers ◽  
Smoking History ◽  
Care Providers ◽  
Risk Of Death ◽  
Increase Risk

152 Background: With improvements in cancer detection and therapies, important secondary prevention measures in survivorship include smoking cessation. Primary care providers have an opportunity to discuss these measures with cancer survivors at APHV. We evaluated whether having a recent APHV is associated with cancer patients’ awareness and perceptions of the harms of continued smoking. Methods: Cancer survivors were surveyed from April 2014 to May 2016 with respect to their smoking history, knowledge and perceptions of the harms of continued smoking along with the date of their most recent APHV (term changed from annual health physical examination in 2013). Multivariable logistic regression analyses assessed the association of having an APHV with knowledge and perceptions of the harms of continued smoking. Results: Of 985 cancer patients, 23% smoked at diagnosis; 34% quit > 1 year prior to diagnosis; 55% had tobacco-related cancers; 77% received curative therapy. From a knowledge viewpoint, over 52% reported being unaware that smoking negatively impacts cancer outcomes; despite this, most perceived smoking to negatively influence quality of life (75%), survival (76%), and fatigue (73%). Within the last year, 48% had an APHV, while 84% had an APHV at any time in the past; 18 (2%) reported not having a family doctor. Patients who had an APHV in the last year were more likely to be aware that continued smoking can increase risk of death (adjusted odds ratio (aOR)=1.49, 95% CI [1.13-1.96], P=0.004), and more likely to perceive smoking to negatively impact quality of life (aOR=1.37 [0.94-1.99], P=0.10), survival (aOR=1.60 [0.95-2.71], P=0.08), and fatigue (aOR=1.63 [1.11-2.39], P=0.01). Those ever having an APHV were more likely aware that smoking can increase risk of death (aOR=1.61 [1.07-2.43], P=0.02) and second primaries (aOR=1.53 [1.02-2.33], P=0.04). Conclusions: Having a recent APHV was associated with improved awareness and perceptions of the harms of continued smoking, but it is unclear whether this is related to provider counseling or a healthy bias effect. APHV may be an appropriate time for primary care providers to treat tobacco addiction in their cancer survivors.

Factors influencing the use of electronic health record systems to provide follow-up care to cancer survivors.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 182-182
Author(s):  
Guadalupe R. Palos ◽  
Maria Alma Rodriguez ◽  
Paula A. Lewis-Patterson ◽  
Rachel Harris ◽  
Lewis E. Foxhall
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Clinical Information ◽  
Primary Care Providers ◽  
Self Report ◽  
Care Providers ◽  
Convenience Sample ◽  
Major Barrier ◽  
Care Plans ◽  
Electronic Health

182 Background: One of the expected benefits of electronic health records (EHRs) is their interoperability to remotely access and exchange clinical information across systems and clinicians. Cancer survivors’ treatment summaries (TSs) and care plans (CPs) are documents that can be electronically transferred from oncologists to primary care providers. We conducted a needs assessment to identify factors which influenced EHRs in meeting these expectations in rural and underserved primary care settings. Methods: Clinicians from 2 family practice health care systems, located in central and northeast Texas were surveyed. REDCap, a web-based system, was used to develop, manage, and distribute the survey to a convenience sample of clinical staff from both settings. Survey questions focused on respondents’ demographic and clinical practice characteristics, current experience with TSs and CPs, and type of EHR used. Results: A total of 26 surveys were included in this analysis. Respondents were primarily physicians (73%). Overall 61.5% reported that ≤ 25% of their patients were diagnosed with cancer or currently had cancer. A patient’s self-report was the primary method used by majority of respondents to determine if a patient had a history of cancer. 80.8% indicated they would be interested in learning more about the use and development of TSs and CPs. Barriers reported towards the use of EHRs to deliver TSs and CPs included: EHRs interference with workflow (60%); limited knowledge on how to develop TSs and CPs (48%), inadequate access to IT resources (48%), and inefficient EHR systems (44%). In these settings, EHRs used were: Epic (61.6%), Aria (30.8%), and Medit (7.7%). Respondents’ comments on EHRs weaknesses included: “the two systems…do not completely communicate with each other” or “no place where a cancer treatment summary or survivorship plan is documented”. Conclusions: Primary care providers identified limitations in EHR operability as a major barrier to retrieving health information required for TSs and CPs. Clinicians in rural or underserved regions may benefit from education and retraining in EHR systems.

scholarly journals Shared care involving cancer specialists and primary care providers - What do cancer survivors want?

2017 ◽  
Vol 20 (5) ◽  
pp. 1081-1087 ◽  
Author(s):  
Sharon Lawn ◽  
Julia Fallon-Ferguson ◽  
Bogda Koczwara
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Primary Care Providers ◽  
Shared Care ◽  
Care Providers ◽  
Cancer Specialists

scholarly journals NÍVEL DE DOR, ANSIEDADE E DEPRESSÃO EM PACIENTES COM DOR LOMBAR ATENDIDOS EM UM CENTRO DE FISIOTERAPIA

2018 ◽  
Vol 10 (Especial 5) ◽  
pp. 89-94
Author(s):  
Silas de Oliveira Damasceno ◽  
José Henrique Piedade Cardoso ◽  
Raíssa Puzzi Ladvig ◽  
Luana Martins de Paula ◽  
Renilton José Pizzol ◽  
...  
Keyword(s):  
Analogue Scale ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Low Back ◽  
Depression And Anxiety ◽  
Hospital Anxiety ◽  
Cross Sectional ◽  
Pain Anxiety ◽  
Disability Questionnaire ◽  
Mri Score

Pain, anxiety, and depression are symptoms that need attention in physiotherapeutic practice, once they influence the functionality of patients, so understanding them becomes an important tool. The aim of the study was to verify the levels of pain, depression, and anxiety in patients attended at a physiotherapy center. A cross-sectional clinical study in which a sociodemographic questionnaire was applied, the Visual Analogue Scale (VAS), the Hospital Anxiety and Depression Scale (HADS) and the Roland Morris Disability Questionnaire (MRQ). Seven patients participated and presented a MRI score of 18.57 ± 2.63 points, HADS in the topic anxiety 12.71 ± 5.43 points, HADS depression 9.57 ± 5.22 points and the resting VAS presented an average of 4 , 42 ± 3.9 pain points and in motion showed 8.71 ± 0.95. It is concluded that the population with low back pain has high intensity of pain, probable anxiety and possible level of depression.

scholarly journals Availability, functionality and access of blood pressure machines at the points of care in public primary care facilities in Tororo district, Uganda

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Innocent K. Besigye ◽  
Vicent Okuuny ◽  
Mari Armstrong-Hough ◽  
Anne R. Katahoire ◽  
Nelson K. Sewankambo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Point Of Care ◽  
Primary Care Providers ◽  
Health Facilities ◽  
Health Providers ◽  
Care Providers ◽  
Tororo District ◽  
Key Informant ◽  
Care Facilities

Background: Early diagnosis of hypertension prevents a significant number of complications and premature deaths. In resource-variable settings, diagnosis may be limited by inadequate access to blood pressure (BP) machines. We sought to understand the availability, functionality and access of BP machines at the points of care within primary care facilities in Tororo district, Uganda.Methods: This was an explanatory sequential mixed-methods study combining a structured facility checklist and key informant interviews with primary care providers. The checklist was used to collect data on availability and functionality of BP machines within their organisational arrangements. Key informant interviews explored health providers’ access to BP machines.Results: The majority of health facilities reported at least one working BP machine. However, Health providers described limited access to machines because they are not located at each point of care. Health providers reported borrowing amongst themselves within their respective units or from other units within the facility. Some health providers purchase and bring their own BP machines to the health facilities or attempted to restore the functionality of broken ones. They are motivated to search the clinic for BP machines for some patients but not others based on their perception of the patient’s risk for hypertension.Conclusion: Access to BP machines at the point of care was limited. This makes hypertension screening selective based on health providers’ perception of the patients’ risk for hypertension. Training in proper BP machine use and regular maintenance will minimise frequent breakdowns.

Nurse navigation: The key to a seamless transition.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 84-84
Author(s):  
Joy M. Fulbright ◽  
Wendy McClellan ◽  
Gary C. Doolittle ◽  
Hope Krebill ◽  
Robin Ryan ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Cancer Survivorship ◽  
Childhood Cancer Survivors ◽  
Primary Care Providers ◽  
Survivorship Care ◽  
Care Providers ◽  
Nurse Navigator ◽  
Seamless Transition

84 Background: Children's Mercy (CM) established a cancer survivorship clinic that cares for approximately 180 survivors a year. A third of the survivors are 18 years or older requiring transition to adult care. The importance of transitioning childhood cancer survivors from pediatric oncology care to adult primary care has been acknowledged in literature, but obstacles remain. Barriers include patient and provider anxiety, difficulty navigating the complex health care system and lack of knowledge regarding late effects. CM and The University of Kansas Cancer Center (KUCC) collaborated to decrease barriers to transition for childhood cancer survivors. Methods: The work group met for 2 years to develop the clinic at KUCC. Models and delivery of survivorship care, including the breast cancer survivorship clinic at KUCC, were reviewed. A shared nurse navigator was identified as an essential component to a seamless transition. Philanthropic support was obtained and job description was developed. Contracts were negotiated to allow the navigator to be present at both institutions. Results: The Survivorship Transition Clinic (STC) at KUCC launched July 2014, with a navigator supporting patients at CM as they begin their transition. The same navigator then meets with the patient at KUCC STC as they initiate care. The navigator provides treatment summaries, patient education and navigates the referral services for survivors. Since clinic launch, 16 survivors out of 16 have successfully transitioned from pediatric to adult survivorship care. Positive feedback was received from patient satisfaction surveys that were administered. A common theme showed a relief from anxiety due to having a contact person to facilitate communication among providers in a complex healthcare system. Conclusions: The nurse navigator has minimized anxiety about transition for patients and parents as she establishes a relationship with patients at CM, and then is able to provide continuity as they transition to the STC at KUMC. The navigator also improves communication between pediatric providers, adult primary care providers and sub-specialists caring for the patients. Overall, our transition process has been effective and is now serving as a model across both institutions.

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