scholarly journals Patient-Reported Quality of Supportive Care Among Patients With Colorectal Cancer in the Veterans Affairs Health Care System

2014 ◽  
Vol 32 (8) ◽  
pp. 809-815 ◽  
Author(s):  
Michelle van Ryn ◽  
Sean M. Phelan ◽  
Neeraj K. Arora ◽  
David A. Haggstrom ◽  
George L. Jackson ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Supportive Care ◽  
Cancer Care ◽  
Quality Measurement ◽  
Veterans Affairs ◽  
Health Administration ◽  
Patient Centered ◽  
Patient Reported ◽  
The Impact

Purpose High-quality supportive care is an essential component of comprehensive cancer care. We implemented a patient-centered quality of cancer care survey to examine and identify predictors of quality of supportive care for bowel problems, pain, fatigue, depression, and other symptoms among 1,109 patients with colorectal cancer. Patients and Methods Patients with new diagnosis of colorectal cancer at any Veterans Health Administration medical center nationwide in 2008 were ascertained through the Veterans Affairs Central Cancer Registry and sent questionnaires assessing a variety of aspects of patient-centered cancer care. We received questionnaires from 63% of eligible patients (N = 1,109). Descriptive analyses characterizing patient experiences with supportive care and binary logistic regression models were used to examine predictors of receipt of help wanted for each of the five symptom categories. Results There were significant gaps in patient-centered quality of supportive care, beginning with symptom assessment. In multivariable modeling, the impact of clinical factors and patient race on odds of receiving wanted help varied by symptom. Coordination of care quality predicted receipt of wanted help for all symptoms, independent of patient demographic or clinical characteristics. Conclusion This study revealed substantial gaps in patient-centered quality of care, difficult to characterize through quality measurement relying on medical record review alone. It established the feasibility of collecting patient-reported quality measures. Improving quality measurement of supportive care and implementing patient-reported outcomes in quality-measurement systems are high priorities for improving the processes and outcomes of care for patients with cancer.

Creation of a Tool to Evaluate Supportive Care: Experiences from Socioesthetics

2021 ◽  
Author(s):  
Damien Giacchero ◽  
Guillaume Buiret ◽  
Cecile Grosjean ◽  
CHARLES TAIEB ◽  
Mahasti Saghatchian ◽  
...  
Keyword(s):  
Supportive Care ◽  
External Validation ◽  
Care Patient ◽  
Patient Reported Outcome ◽  
Measurement Properties ◽  
Research Teams ◽  
Patient Reported ◽  
The Impact ◽  
Published Research

Abstract The absence of a specific tool to evaluate the impact of Supportive care in general and socioesthetics in particular as a rendered medical service is undoubtedly at the origin of the lack of published research based on scientific standards.In this context, we developed one supportive-care patient-reported outcome [PRO] using the multistep methods following COSMIN recommendations. Its construction followed all recommended steps: elaboration of the questionnaire, measurement properties of the questionnaire, internal and external validation, test-retest validation and translation, cross-cultural adaptation and cognitive debriefing. In total, our questionnaire includes11 items. It is scored by adding each VAS, making it range from 0 to 110, with a higher benefit when the score is higher. The Cronbach’s α coefficient is 0.88 for the entire questionnaire. The questionnaire thus constructed is a reflection of the patient's feelings, and it is quite natural that the name The “patient centricity questionnaire” (PCQ) was retained and validated by the Scientific Committee. The PCQ correlated negatively and moderately with the PSS, positively and moderately with the mental dimension of the and poorly with the WB12, the physical dimension of the SF-12 and the satisfaction EVA. Constructed according to the recommendations, the PCQ meets the prerequisite for this type of questionnaire. Its short format (11 questions) and simplicity of use allow it to be used by a large number of people and provides an pragmatic answer by making available to research teams a simple, reliable, easy-to-use and validated tool. It makes possible randomized studies to prove the impact on quality of life of the Supportive care in general and socioesthetics" in particular.

Colorectal cancer survivors’ quality of life: a qualitative study of unmet need

2020 ◽  
pp. bmjspcare-2020-002190
Author(s):  
Amanda Drury ◽  
Sheila Payne ◽  
Anne-Marie Brady
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Supportive Care ◽  
Cancer Survivors ◽  
Unmet Needs ◽  
Unmet Need ◽  
Safety Net ◽  
The Impact

ObjectiveCancer survivors’ perceptions of healthcare have been identified as a predictor of quality of life (QoL) outcomes. This study aims to explore colorectal cancer (CRC) survivors’ perceptions of how cancer-related healthcare affects their QoL.MethodsSemistructured interviews were conducted with 22 CRC survivors receiving follow-up care between 1 and 5 years post diagnosis. Interviews were recorded, transcribed and analysed thematically.ResultsFive themes described the impact of healthcare experiences on CRC survivors’ QoL. While cancer survivors spoke positively of their relationships with healthcare professionals, many experienced a range of unmet information and supportive care needs. Participants described a range of positive and negative experiences, as power dynamics and navigation of healthcare systems had implications for their QoL. Where negative healthcare events aligned, survivors’ autonomy, dignity and confidence were undermined, and survivorship issues could be inadequately addressed. To address persistent unmet needs, survivors developed a safety net(work) of supports to bridge the gap of unmet needs in healthcare with varying outcomes.ConclusionsCancer survivors’ experience of follow-up and healthcare can positively or negatively affect their QoL. Preparation for cancer survivorship must be incorporated into the acute phase of diagnosis and treatment and interlinked with clear pathways of survivorship care and accessible supportive care, which support survivors to be equal partners in their healthcare. Understanding cancer survivors’ knowledge, expertise and mastery of their condition is essential to ensure delivery of person-centred supportive care that adequately addresses the survivor’s unmet needs.

An international patient-centered outcome measurement set for colorectal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 753-753
Author(s):  
Harvey J. Mamon ◽  
Jessica A. Zerillo ◽  
Maartje Gisele Schouwenburg ◽  
Annelotte van Bommel ◽  
Caleb Stowell ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Focus Group ◽  
Clinical Outcomes ◽  
Working Group ◽  
Outcome Measurement ◽  
Clinical Expertise ◽  
Patient Centered ◽  
Patient Reported ◽  
Acute Complications

753 Background: While there are tools to measure outcomes relevant to patients with colorectal cancer, none is universally accepted and none incorporates components of long-term clinical outcomes, acute complications, and patient-reported outcomes (PROs). Methods: The International Consortium for Health Outcomes Measurement convened an international multidisciplinary working group to develop a comprehensive patient-centered outcome measurement set for patients with all stages of colorectal cancer. The working group utilized a literature review, patient focus group and their own clinical expertise to reach consensus on outcomes and case mix factors through a modified Delphi process. Measurement tools were selected by International Society of Quality of Life Research standards. The final list of PROs was validated through a patient survey. Results: The 29 members of the working group included patient representatives and palliative care, nursing, pathology, medical oncology, colorectal surgery and radiation oncology specialists from academic and nonacademic practices in Europe, Australia, Asia and the USA. The international focus group included 11 patients with colorectal cancer treated with palliative and curative intents. The working group defined four clinical outcomes applicable to all and eight specific to subgroups, such as presence of ostomy for patients with rectal cancer and hospital admission in the last 30 days of life for patients with advanced disease. An algorithm for documenting acute complications was developed. The working group defined 11 PROs applicable to all and eight specific to subgroups, such as erectile dysfunction for patients who received radiotherapy/surgery and neuropathy for those who received chemotherapy. 276 colorectal cancer patients completed the validation survey. Conclusions: Through use of extensive patient input, the international multidisciplinary group developed a patient-centered outcome measurement set incorporating clinical outcomes, acute complications and PROs for patients with colorectal cancer. This comprehensive measurement set allows for standardized international comparison on quality of care outcomes and will be revised annually.

The quality of CT surveillance in resected colorectal cancer survivors at Veterans Health Administration facilities.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 525-525
Author(s):  
Amikar Sehdev ◽  
Eric A Sherer ◽  
Sui Hui ◽  
Jingwei Wu ◽  
David Andrew Haggstrom
Keyword(s):  
Colorectal Cancer ◽  
Univariate Analysis ◽  
Secondary Analysis ◽  
Organizational Characteristics ◽  
Ct Scans ◽  
Health Administration ◽  
Primary Analysis ◽  
Lower Stage ◽  
The Impact

525 Background: Annual CT scan for three years is the current standard for post-treatment surveillance of colorectal cancer (CRC) survivors following curative treatment. We conducted a retrospective study with the primary aim to assess the patient, physician & organizational characteristics associated with quality of CT surveillance at Veterans Administration (VA) facilities. Methods: The Department of Veterans Affairs Central Cancer Registry was used to identify patients with stage I-III CRC between 2001 & 2009. Patient (age, race, marital status, income, priority status, year of diagnosis, stage, comorbidity), provider (primary care, specialist, other) & facility (region & organizational survey) characteristics were measured. In the primary analysis, we analyzed the impact of the 2005 ASCO update in CRC surveillance guidelines. In the secondary analysis, we included only patients diagnosed after 2005 to avoid any bias due to change in guidelines. Overuse (OU) was defined as > 1 CT/12 months, whereas underuse (UU) was defined as < 1 CT/12 months. The Wald test was used for univariate analysis & logistic regression models, for multivariate analysis. Results: The primary analysis demonstrated no change in the receipt of CT scans before & after the 2005 guideline update, as there was an increasing trend favoring more CT scans in general.In the secondary analysis, there were a total of 2,263 patients. Overall, UU (19.44% patients) occurred more often than OU (15% patients). In univariate analyses, age, stage, insurance status, provider type & facility region were significant in both OU & UU analyses (p <.001). Comorbidity was associated with OU only (p =.02). Different organizational characteristics were significant for OU & UU cohorts. Multivariate analyses showed younger age [AOR = 2.17 (1.65 - 2.86)] & higher stage [AOR =.71 (.59 -.85)] were associated with OU at p <.001. Older age [AOR = 1.89 (1.54 - 3.10)], lower stage [AOR =.63 (.49 -.81)] at p <.001 & facility region [AOR = 1.84 (1.01 - 3.35)] at p =.04 were associated with UU. Conclusions: While present, there did not appear to be substantial rates of UU or OU among CRC survivors in the VA. Age & cancer stage were associated with the quality of CT surveillance.

scholarly journals Ovarian Cancer Epidemiology, Healthcare Access and Disparities (ORCHiD): methodology for a population-based study of black, Hispanic and white patients with ovarian cancer

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e052808
Author(s):  
Tomi Akinyemiju ◽  
April Deveaux ◽  
Lauren Wilson ◽  
Anjali Gupta ◽  
Ashwini Joshi ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Supportive Care ◽  
Racial Differences ◽  
Structural Equation Models ◽  
Healthcare Access ◽  
Cancer Epidemiology ◽  
Patient Reported ◽  
The Impact ◽  
White Patients

IntroductionLess than 40% of patients with ovarian cancer (OC) in the USA receive stage-appropriate guideline-adherent surgery and chemotherapy. Black patients with cancer report greater depression, pain and fatigue than white patients. Lack of access to healthcare likely contributes to low treatment rates and racial differences in outcomes. The Ovarian Cancer Epidemiology, Healthcare Access and Disparities study aims to characterise healthcare access (HCA) across five specific dimensions—Availability, Affordability, Accessibility, Accommodation and Acceptability—among black, Hispanic and white patients with OC, evaluate the impact of HCA on quality of treatment, supportive care and survival, and explore biological mechanisms that may contribute to OC disparities.Methods and analysisWe will use the Surveillance Epidemiology and Ends Results dataset linked with Medicare claims data from 9744 patients with OC ages 65 years and older. We will recruit 1641 patients with OC (413 black, 299 Hispanic and 929 white) from cancer registries in nine US states. We will examine HCA dimensions in relation to three main outcomes: (1) receipt of quality, guideline adherent initial treatment and supportive care, (2) quality of life based on patient-reported outcomes and (3) survival. We will obtain saliva and vaginal microbiome samples to examine prognostic biomarkers. We will use hierarchical regression models to estimate the impact of HCA dimensions across patient, neighbourhood, provider and hospital levels, with random effects to account for clustering. Multilevel structural equation models will estimate the total, direct and indirect effects of race on treatment mediated through HCA dimensions.Ethics and disseminationResult dissemination will occur through presentations at national meetings and in collaboration with collaborators, community partners and colleagues across othercancer centres. We will disclose findings to key stakeholders, including scientists, providers and community members. This study has been approved by the Duke Institutional Review Board (Pro00101872). Safety considerations include protection of patient privacy. All disseminated data will be deidentified and summarised.

scholarly journals Care for a Patient With Cancer As a Project: Management of Complex Task Interdependence in Cancer Care Delivery

2016 ◽  
Vol 12 (11) ◽  
pp. 1101-1113 ◽  
Author(s):  
Julia R. Trosman ◽  
Ruth C. Carlos ◽  
Melissa A. Simon ◽  
Debra L. Madden ◽  
William J. Gradishar ◽  
...  
Keyword(s):  
Project Management ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Early Stage ◽  
Care Delivery ◽  
Task Interdependence ◽  
Patient Centered ◽  
Patient Reported ◽  
Future Patient

Cancer care is highly complex and suffers from fragmentation and lack of coordination across provider specialties and clinical domains. As a result, patients often find that they must coordinate care on their own. Coordinated delivery teams may address these challenges and improve quality of cancer care. Task interdependence is a core principle of rigorous teamwork and is essential to addressing the complexity of cancer care, which is highly interdependent across specialties and modalities. We examined challenges faced by a patient with early-stage breast cancer that resulted from difficulties in understanding and managing task interdependence across clinical domains involved in this patient’s care. We used team science supported by the project management discipline to discuss how various task interdependence aspects can be recognized, deliberately designed, and systematically managed to prevent care breakdowns. This case highlights how effective task interdependence management facilitated by project management methods could markedly improve the course of a patient’s care. This work informs efforts of cancer centers and practices to redesign cancer care delivery through innovative, practical, and patient-centered approaches to management of task interdependence in cancer care. Future patient-reported outcomes research will help to determine optimal ways to engage patients, including those who are medically underserved, in managing task interdependence in their own care.

Concordance between patient and family caregiver reports of quality of colorectal cancer care.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 187-187
Author(s):  
Rachel D. Havyer ◽  
Michelle van Ryn ◽  
Patrick Wilson ◽  
Joan M. Griffin
Keyword(s):  
Colorectal Cancer ◽  
Quality Of Care ◽  
Family Caregiver ◽  
Cancer Care ◽  
Patient Reports ◽  
Lower Stage ◽  
Care Assessment ◽  
Significant Difference ◽  
Patient Reported

187 Background: Patient-reported evaluations of interpersonal quality of care are essential elements of quality of cancer care assessment. At times, patients may be unable to report themselves on their care experience and systems may rely on proxy reports. The validity of this approach is dependent on the degree to which family caregiver assessments are concordant with patient assessments. Methods: A VA cohort of colorectal cancer (CRC) patients and their caregivers both completed a self-administered questionnaire on the quality of VA cancer care in 3 specific domains: surgery, chemotherapy overall and chemotherapy nursing care, all measured on a 5-point Likert scale. Because the kappa statistic penalizes skewed distributions which are commonly seen in patient satisfaction reports, agreement between patients and caregivers on perceptions of quality care were measured using Gwet’s AC2 statistic. Stratified analyses on caregiver burden, race, education, and age as well as patient’s stage of disease were used to assess variation in agreement. Results: 417 caregiver-patient dyads completed the survey (70% response rate), of whom 362 (86.8%) had surgery and 195 (46.8%) had chemotherapy. Overall agreement was high for the 3 quality of care domains: AC2 (95% CI): 0.870 (0.838, 0.903) for surgery, 0.835 (0.786, 0.884) for chemotherapy overall and 0.906 (0.868, 0.944) for chemotherapy nurses. Stratified analyses of agreement showed particular populations of higher or lower agreement; however the findings were inconsistent across the three domains and most were not statistically significant. Patients with lower stage (I-II) had higher agreement than higher stages (III-IV) (AC2: 0.967 and 0.879 respectively, P = 0.006) but only in the chemotherapy nurses domain. For the surgery domain, age was the only significant difference in agreement (0.816, 0.912, and 0.838 for < 50, 51-65, and > 65 respectively, P = 0.03). Conclusions: Family caregiver reports on the quality of CRC care were highly concordant with patient reports. Therefore, family caregivers may be able to provide reasonable proxy report on measures of quality of cancer care when patient reports are unavailable.

The Impact of Patient-Physician Relationships on the Quality of Colorectal Cancer Care

2013 ◽  
Vol 179 (2) ◽  
pp. 192
Author(s):  
A.M. Morris ◽  
C. Gamble ◽  
S.T. Hawley ◽  
J.J. Griggs ◽  
P. Abrahamse ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Care ◽  
The Impact
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