Changing focus: Living with advanced cancer—Development of a palliative care transition project.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 152-152
Author(s):  
Paul Joseph Daeninck ◽  
Simone Stenekes ◽  
Tara Carpenter-Kellett ◽  
Jill Talylor-Brown ◽  
Mark Kristjanson ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Health Care Providers ◽  
Care Providers ◽  
Cancer Centre ◽  
Palliative Approach ◽  
Follow Up Care ◽  
Treatment Summary

152 Background: The improvement in cancer screening, detection and treatment is changing the illness trajectory and experience for patients. Many cancer patients are living longer with advanced disease as treatment options have expanded. Thus, accurate prognostication is becoming challenging and referral to palliative care programs is often delayed until close to death. This has made the transition to a predominantly palliative approach to care complex to navigate for the health care team, patient and family. Methods: CancerCare Manitoba has undertaken an innovative project “Changing Focus: Living with Advanced Cancer” to enhance communication with primary health care providers (HCPs) and assist patients and caregivers in the transition to a palliative approach to care. The project includes development of an individualized patient treatment summary that provides details of the patient’s cancer treatment and symptoms, identifies the role of the HCPs involved with the patient and family, as well as the expectations for follow up care at the cancer centre and in the community. The transition appointment includes discussion around the treatment summary, standardized follow up care plan, and written information about palliative care, decision making, symptom management, unique issues for caregivers and details about local supports and resources is provided. Results: This presentation will focus on the development and implementation of this project within the cancer centre and throughout the province. Evaluation of this approach is ongoing. Family members and patients will provide feedback using a standardized questionnaire, and ongoing improvement will be built into the evolution of this program. HCPs will also be engaged in evaluation from their perspective. Conclusions: We expect this intervention will allow patients and families better quality of life and possibly improve the interval between the termination of chemotherapy and death.

scholarly journals Resilience for family carers of advanced cancer patients—how can health care providers contribute? A qualitative interview study with carers

2018 ◽  
Vol 32 (8) ◽  
pp. 1410-1418 ◽  
Author(s):  
Ingebrigt Røen ◽  
Hans Stifoss-Hanssen ◽  
Gunn Grande ◽  
Anne-Tove Brenne ◽  
Stein Kaasa ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Health Care Providers ◽  
Support Needs ◽  
Care Providers ◽  
Family Carers ◽  
Advanced Cancer Patients ◽  
Qualitative Interview Study

Background: Caring for advanced cancer patients affects carers’ psychological and physical health. Resilience has been defined as “the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of threat.” Aim: The aim of this study was to explore factors promoting carer resilience, based on carers’ experiences with and preferences for health care provider support. Design: Qualitative, semi-structured, individual interviews with family carers of advanced cancer patients were performed until data saturation. The interviews were recorded, transcribed, and analyzed using systematic text condensation. Setting/participants: Carers ( n = 14) of advanced cancer patients, not receiving curative treatment, admitted to an integrated curative and palliative care cancer outpatient clinic or to a university hospital cancer clinic, were included. Results: 14 carers of advanced cancer patients were included; 7 men, 7 women, and mean age of 59 years; 3 were bereaved; 12 were partners; 5 had young and teenage children. Four main resilience factors were identified: (1) being seen and known by health care providers—a personal relation; (2) availability of palliative care; (3) information and communication about illness, prognosis, and death; and (4) facilitating a good carer–patient relation. Conclusion: Health care providers may enhance carers’ resilience by a series of simple interventions. Education should address carers’ support needs and resilience. Systematic assessment of carers’ support needs is recommended. Further investigation is needed into how health care providers can help carers and patients communicate about death.

Cancer Survivors’ Reported Discussions with Health Care Providers About Follow-Up Care and Receipt of Written Care Plans

2017 ◽  
Vol 33 (6) ◽  
pp. 1181-1188 ◽  
Author(s):  
Sarah C. Reed ◽  
Rod Walker ◽  
Rebecca Ziebell ◽  
Borsika Rabin ◽  
Stephanie Nutt ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Survivors ◽  
Health Care Providers ◽  
Care Providers ◽  
Care Plans ◽  
Follow Up Care

From common sense to evidence-based: An evaluation of survivorship planning.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 76-76
Author(s):  
Sam Gaster
Keyword(s):  
Health Care ◽  
Cancer Survivors ◽  
Health Care Providers ◽  
Common Sense ◽  
Care Providers ◽  
Care Plans ◽  
Follow Up Care ◽  
The Future ◽  
The Impact

76 Background: The Institute of Medicine’s (IOM; 2005) seminal report, From Cancer Patient to Cancer Survivor: Lost in Transition, recommended survivorship care plans (SCPs) as a common sense approach to improve the care of cancer survivors. The American Society of Clinical Oncology (ASCO; Mayer et al., 2014) reiterated the importance of these plans and provided strategic guidance for their implementation. The American College of Surgeons’ Commission on Cancer requires SCP delivery from accredited cancer programs as of 2015. Despite the push from these organizations, SCPs remain understudied (Mayer, Birken, Check, & Chen, 2014). The impact of SCPs on patient outcomes is poorly understood. Additionally, there is limited data on patients’ preferences for SCPs. This evaluation describes the use and assessment of SCPs at six regional cancer centers in the Midwest. Methods: Feedback was collected from 30 cancer survivors after receipt of a SCP. Responses were collected with 22-item questionnaire. Outcomes included survivors’ satisfaction with the clarity and detail of SCPs, likelihood to use SCPs in the future, intention to share SCPs with other health care providers, and perceived knowledge about treatment and follow-up care. Results: Over 75% (n = 23) of survivors agreed that SCPs were easy to understand. Ninety-three percent (n = 28) of survivors indicated that SCPs contained the right amount of information. Fifty-three percent (n = 16) of survivors are very likely to use their SCP in the future, whereas 47% (n = 14) are somewhat likely to use their SCP in the future. The majority (77%; n = 23) of survivors intend to share their SCP with another health care provider. Ninety-seven percent (n = 29) of survivors felt more knowledge about their treatment and follow-up car as a result of receiving a SCP. Conclusions: This evaluation highlights the many benefits of SCPs for cancer survivors. Results suggest that SCPs educate survivors about their treatment and follow-up care. Additionally, results indicate that many survivors intend to share SCPs, perhaps allowing for better coordination between oncology and primary care. Further research is warranted on the adoption of healthy lifestyle behaviors and receipt of routine health care after delivery of SCPs.

Monitoring the Physical Health of Cancer Survivors: A Survivorship-Focused Medical History

2006 ◽  
Vol 24 (32) ◽  
pp. 5105-5111 ◽  
Author(s):  
Patricia A. Ganz
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cancer Survivors ◽  
Medical History ◽  
Health Care Providers ◽  
Primary Care Physicians ◽  
Care Providers ◽  
Follow Up Care ◽  
Physical Effects

Cancer survivors frequently visit their primary-care physicians, as well as oncology specialists, for follow-up care. There is a need to monitor these survivors for the late physical effects of cancer, yet few health care providers have received training in how to do this. This article provides guidance on how to take a cancer survivor-directed medical history to facilitate the elicitation of relevant exposures, family history, and symptoms that may be related to the late effects of cancer therapy.

Palliative Care Consultation Trends Among Hospitalized Patients With Advanced Cancer in the United States, 2005 to 2014

2018 ◽  
Vol 36 (4) ◽  
pp. 294-301 ◽  
Author(s):  
Muni Rubens ◽  
Venkataraghavan Ramamoorthy ◽  
Anshul Saxena ◽  
Sankalp Das ◽  
Sandeep Appunni ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Health Care Providers ◽  
The United States ◽  
Hospitalized Patients ◽  
Care Providers ◽  
Do Not Resuscitate ◽  
Factors Associated

Background: Although palliative care services are increasing in the United States, disparities exist in access and utilization. Hence, we explored these factors in hospitalized patients with advanced cancers using the National Inpatient Sample (NIS). Methods: This was a retrospective analysis of NIS data, 2005 to 2014, and included patients ≥18 years with advanced cancers with and without palliative care consultations. Both χ2 and independent t tests were used for categorical and continuous variables. Multivariate logistic regressions were used for identifying factors associated with palliative care consultations. Results: Palliative care consultations were recorded in 9.9% of 4 732 172 weighted advanced cancer hospitalizations and increased from 3.0% to 15.5% during 2005 to 2014 (relative increase, 172.2%, Ptrend < .01). Factors associated with higher palliative care consultations were increasing age, ≥80 years (odds ratio [OR]: 1.47; 95% confidence interval [CI]: 1.38-1.56); black race (OR: 1.21; 95% CI: 1.14-1.28); private insurance coverage (OR: 1.10; 95% CI: 1.02-1.18); West region (OR: 1.15; 95% CI: 1.01-1.33); large hospitals (OR: 1.19; 95% CI: 1.02-1.34); high income (OR: 1.08; 95% CI: 1.08-1.17); do-not-resuscitate (dying patients) status (OR: 10.55; 95% CI: 10.14-10.99); and in-hospital radiotherapy (OR: 1.13; 95% CI: 1.06-1.21). Palliative care consultations were lower in patients with chemotherapy (OR: 0.71; 95% CI: 0.60-0.84). Conclusion: Many demographic, socioeconomic, health-care, and geographic disparities were identified in palliative care consultations. Additionally, palliative care resources were underutilized by hospitalized patients with advanced cancers and commonly utilized by patients who are dying. Health-care providers and policy makers should focus on these disparities in order to improve palliative care use.

scholarly journals Sexual assault survivors’ perspectives on clinical follow-up in the Eden District, South Africa: A qualitative study

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Gail Holton ◽  
Kate Joyner ◽  
Robert Mash
Keyword(s):  
Health Care ◽  
Sexual Assault ◽  
Health Care Providers ◽  
Care Providers ◽  
Sexual Assault Survivors ◽  
Care Services ◽  
Follow Up Care ◽  
Negative Perceptions ◽  
Assault Survivors

Background: Although effective follow-up of sexual assault survivors is linked to optimal recovery, attendance at follow-up consultations is poor. It is therefore essential that health care providers maximise the benefit of follow-up care for every sexual assault survivor.Aim: This study explored the personal experiences of sexual assault survivors to better understand the enablers of, and barriers to, attendance at follow-up consultations.Methods: This phenomenological qualitative study was conducted at the three hospitals which manage most sexual assault survivors within the Eden District. Using purposive sampling, 10 participants were selected. Consenting participants shared their experiencesduring semi-structured interviews with the researcher.Results: Authoritative, client-held documentation was a powerful enabler to accessing follow-up care. Individualised, patient-centred care further enhanced participants’ access to, and utilisation of, health care services. The failure of health care providers to integrate follow-up care for sexual assault survivors into established chronic care services was a missedopportunity in the continuum of care. Negative perceptions, based on others’ or personal prior experience of police, judicial and health care systems, were further barriers to follow-up care.Conclusion: This study highlights the need of survivors of sexual assault for integrated,patient-centred care, encompassing principles of good communication. Committed actions of all stakeholders are necessary to tackle negative perceptions that create barriers to follow-upcare. A simple practical strategy, the provision of a scheduled appointment on official stationery, is easy to effect at facility level. As a powerful enabler to follow-up care, this should be implemented as a priority intervention.

Using implementation science to initiate survivorship care plan practice change.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 175-175
Author(s):  
Betty Goracke Olguin ◽  
Lindsay L. Benes
Keyword(s):  
Health Care ◽  
Side Effects ◽  
Implementation Science ◽  
Health Care Providers ◽  
Care Coordination ◽  
Survivorship Care ◽  
Care Providers ◽  
Follow Up Care ◽  
Strongly Agree

175 Background: Failure to address coordination of cancer survivorship care can result in physical disability, emotional distress, and increased health care costs. The Institute of Medicine (IOM) recommended Survivorship Care Plans (SCPs) to improve care coordination among cancer survivors. Despite evidence supporting SCPs there remains limited implementation of SCPs. The use of implementation science, frameworks, and strategies that address contextual and process factors, could improve use of SCPs in oncology clinics (Selove et al., 2016). Methods: This innovation used the Quality Implementation Framework (QIF) (Meyers, Durlak, & Wandersman, 2012) to guide implementation. The QIF outlines steps and strategies for four phases of implementation; initial considerations regarding the host setting, creating a structure for implementation, ongoing structure once implementation begins, and improving future application. Results: During the project period (January 29, 2018 through April 23, 2018), 17 SCP visits were conducted; all 17 patients completed study surveys. In response to, “My health care providers work together as a team to ensure that my needs are met,” 65% reported strongly agree, 29% reported agree, 5% reported disagree, and 0% reported strongly disagree. When asked “My health care providers have informed me of what my follow-up care should be” 65% reported strongly agree and 35% reported agree. Of the 17 PCP surveys mailed, four were returned. In response to “For this patient the SCP helps me coordinate follow-up care,” three PCPs responded “agree.” When asked “For this patient, the SCP helps me provide better care,” three responded “strongly agree.” One PCP reported neutral feelings toward both statements. All PCPs reported SCP helped them better understand cancer treatment given and side effects. Conclusions: Successful SCP implementation, replicating outcomes of trials supporting SCPs, is attributable to the use of implementation science. Results from this project demonstrated SCPs achieved care coordination and patient satisfaction. SCPs enhanced PCPs’ understanding of cancer treatment and side effects which could increase likelihood PCPs discuss survivorship issues, as demonstrated in literature.

Barriers to goals of care discussion and early palliative care referral in patients with advanced cancer: A community oncology clinic survey.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19199-e19199
Author(s):  
Sandhya Maradana ◽  
Yugandhara Kate ◽  
Deepali Pandey ◽  
Masood Pasha Syed ◽  
Pruthvi Raj Velamala ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Health Care Providers ◽  
Family Members ◽  
Outpatient Setting ◽  
Care Providers ◽  
Goals Of Care ◽  
Early Palliative Care ◽  
Important Barrier

e19199 Background: Earlier discussion of end-of-life (EOL) preferences in patients with advanced cancer is associated with less aggressive EOL care. Most terminally-ill patients have not discussed their goals of care (GOC) with their healthcare providers before becoming acutely ill. Identifying various barriers in the outpatient setting might help improve GOC discussion and EOL experience for patients with advanced cancer. Methods: This cross sectional survey was designed after a thorough literature review and distributed to internal medicine residents, oncologists and oncology nurses involved in patient care in an outpatient cancer center at a community hospital. Barriers to GOC discussions and early palliative care (PC) referral were assessed on a 7-point Likert scale (1 = extremely unimportant; 7 = extremely important). Most important barrier was defined by people ranking it as very important or extremely important (6 or 7). A total of 33 health care providers were included in the final analysis. Trends were reported using descriptive statistics. Results: Patient/family related barriers were ranked the highest overall. 88% of respondents perceived patient’s difficulty in accepting prognosis as most important, followed by lack of agreement among family members (82%) and patient wanting to be 'aggressive' (82%). Among groups, 100% (6 of 6) oncologists perceived patient wanting to be ‘aggressive’ as the most important barrier, whereas disagreement among family members and patient’s difficulty in accepting poor prognosis was perceived as most important by 88% (7 of 8) nurses and 84% (16 of 19) residents respectively. Nurses also ranked patient's difficulty in understanding limitations of life sustaining treatments high. 67% of respondents, especially nurses and residents, perceived lack of training to have GOC conversations as the most important health care provider related barrier. Patient’s refusal for PC services was rated as the most important barrier for early PC referral by 61% of respondents, however, oncologists (100%) ranked lack of outpatient PC services the highest. Conclusions: These results emphasize the need for better resources to improve communication between health care providers and cancer patients in an outpatient setting. Initiatives such as formal training and targeted education in communication about GOC to health care providers can be instrumental in addressing these barriers. Integration of outpatient palliative care services into community-based oncology can be beneficial.

scholarly journals Concerns of Patients With Cancer on Accessing Cannabis Products in a State With Restrictive Medical Marijuana Laws: A Survey Study

2019 ◽  
Vol 15 (10) ◽  
pp. 531-538 ◽  
Author(s):  
Vinita Singh ◽  
Ali J. Zarrabi ◽  
Kimberly A. Curseen ◽  
Roman Sniecinski ◽  
Justine W. Welsh ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Providers ◽  
Medical Marijuana ◽  
Survey Study ◽  
Care Practice ◽  
Care Providers ◽  
Patients With Cancer ◽  
Medical Marijuana Laws ◽  
Source Of Information

PURPOSE: Several states, particularly in the Southeast, have restrictive medical marijuana laws that permit qualified patients to use specific cannabis products. The majority of these states, however, do not provide avenues for accessing cannabis products such as in-state dispensaries. METHODS: We conducted a survey of patients registered for medical marijuana (low tetrahydrocannabinol [THC] oil cards) in an ambulatory palliative care practice in Georgia (one of the states with restrictive medical marijuana laws). RESULTS: We had a total of 101 responses. Among our sample of patients who use cannabis as part of a state-approved low THC oil program, 56% were male and 64% were older than age 50 years. Advanced cancer was the most common reason (76%) for granting the patients access to a low THC oil card. Although patients reported cannabis products as being extremely helpful for reducing pain, they expressed considerable concerns about the legality issues (64%) and ability to obtain THC (68%). Several respondents were using unapproved formulations of cannabis products. For 48% of the patients, their physician was the source of information regarding marijuana-related products. Furthermore, they believed that their health care providers and family members were supportive of their use of cannabis (62% and 79%, respectively). CONCLUSION: Patients on Georgia’s medical marijuana program are most concerned about the legality of the product and their ability to obtain marijuana-related products. Therefore, we recommend that states with medical marijuana laws should provide safe and reliable access to cannabis products for qualifying patients.

TELE-MONITORING SYSTEM OF RISK IN RESPIRATORY PATIENTS

2021 ◽  
pp. 2150041
Author(s):  
Awad Al-Zaben ◽  
Lina M.K. Al-Ebbini ◽  
Badr Qatashah
Keyword(s):  
Health Care ◽  
Signal Processing ◽  
Health Care Providers ◽  
Mobile Phones ◽  
Model Parameters ◽  
Care Providers ◽  
Server Side ◽  
Respiration Signal ◽  
At Home

In many situations, health care professionals need to evaluate the respiration rate (RR) for home patients. Moreover, when cases are more than health care providers’ capacity, it is important to follow up cases at home. In this paper, we present a complete system that enables healthcare providers to follow up with patients with respiratory-related diseases at home. The aim is to evaluate the use of a mobile phone’s accelerometer to capture respiration waveform from different patients using mobile phones. Whereas measurements are performed by patients themselves from home, and not by professional health care personnel, the signals captured by mobile phones are subjected to many unknowns. Therefore, the validity of the signals has to be evaluated first and before any processing. Proper signal processing algorithms can be used to prepare the captured waveform for RR computations. A validity check is considered at different stages using statistical measures and pathophysiological limitations. In this paper, a mobile application is developed to capture the accelerometer signals and send the data to a server at the health care facility. The server has a database of each patient’s signals considering patient privacy and security of information. All the validations and signal processing are performed on the server side. The patient’s condition can be followed up over a few days and an alarm system may be implemented at the server-side in case of respiration deterioration or when there is a risk of a patient’s need for hospitalization. The risk is determined based on respiration signal features extracted from the received respiration signal including RR, and Autoregressive (AR) moving average (ARMA) model parameters of the signal. Results showed that the presented method can be used at a larger scale enabling health care providers to monitor a large number of patients.

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