Piloting breast cancer survivorship care planning in a safety net hospital.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 65-65
Author(s):  
Sofia F. Garcia ◽  
Katy Wortman ◽  
Yanina Guevara ◽  
Elizabeth A. Hahn ◽  
Maria E. Corona ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Self Efficacy ◽  
Safety Net ◽  
Care Staff ◽  
Health Care Staff ◽  
Survivorship Care ◽  
Safety Net Hospital ◽  
Patient Reported

65 Background: Survivorship care plans (SCPs) include treatment summaries and follow-up care recommendations intended to improve patient care and well-being after cancer treatment. Limited research has yielded mixed results regarding SCPs' impact on patient and system outcomes, but emphasized provider burden as an implementation barrier. We created a patient-centered SCP template and implemented its delivery at a safety net hospital that serves primarily racial/ethnic minority patients. Methods: In a single-arm feasibility study, oncologists and advanced practice nurses used the template to deliver SCPs to post-treatment breast cancer survivors (BCS) in consultation visits. We assessed changes in patient-reported outcomes from baseline (pre-SCP) to a 3-month follow-up, as well as provider time burden. Results: Female BCS participants (n = 75; mean age = 58.5 years) were primarily African-American (73%) and had high school/GED education or less (61%). Average time since diagnosis was 3.7 years (SD = 3.8); all received surgery; most received radiation (84%), hormone (77%), and/or chemotherapy treatment (73%). At follow-up, a majority rated their SCPs as good to excellent (92%), easy or very easy to understand (84%), a good to excellent summary of their treatment (92%) and as motivation for healthy lifestyles (88%). BCS follow-up scores improved significantly from baseline on breast cancer knowledge (p = .02), self-efficacy (p = .03), the QLQ-INFO25 (p < .01), and the FACIT TS-PS satisfaction with health care staff communication subscale (p < .01). No significant differences between baseline and follow-up scores (p < .05) were found for overall treatment satisfaction, health behaviors, and health-related quality of life. Preparing and delivering SCPs took providers considerable time (M = 54 & 22 minutes, respectively). Conclusions: This pilot study is limited by a single-arm design, but results suggest that SCPs may be related to improved survivor knowledge, information, self-efficacy and communication with health care staff. The individualized, comprehensive SCPs were well received by BCS in a safety net hospital but delivery was time-intensive. These findings will inform future research trials and clinical care initiatives.

How Involuntary Admission Might Have Been Avoided: An Interview Study of Referring General Practitioners

2017 ◽  
Vol 41 (S1) ◽  
pp. S150-S151 ◽  
Author(s):  
K. Røtvold ◽  
R. Wynn
Keyword(s):  
Health Care ◽  
General Practitioners ◽  
Care Staff ◽  
Health Care Staff ◽  
Involuntary Admission ◽  
Central Question ◽  
Home Care Nursing ◽  
Main Factors ◽  
Care Nursing

IntroductionThe legal criteria for involuntary admission in Norway are that the patient has a serious psychiatric disorder (i.e. psychosis) and is in need of admission to secure needed treatment or that there is a risk of danger. While there have been some studies focusing on coercion in hospitals, less is known about the processes leading up to involuntary admission and the reasoning of referring doctors. In Norway, it is primarily general practitioners (GPs) that refer patients.AimsTo study which factors that GPs who had recently referred patients to involuntary admission thought might have made their latest referral unnecessary.MethodsSeventy-four GPs were interviewed by phone. They had all recently referred patients involuntarily to a major Norwegian university psychiatric hospital. One central question concerned how their latest involuntary referral might have been avoided.ResultsThese are the main factors that the GPs thought could have been of importance in avoiding involuntary referral of their patients:– that the patient took the prescribed medication (28%);– that they personally had the opportunity to closely follow up the patient in the following days (22%);– that other health care staff could follow up the patient closely in the patient's own home (i.e. home care nursing, etc.) (19%);– that a family member of the patient could help the patient (8%).ConclusionsThe GPs suggested that an increased availability of resources and more assistance from other parts of the health service were some of the factors that could be of importance in reducing involuntary admissions.

scholarly journals Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma for Health Care Staff Working During COVID-19: Exploratory Pilot Study With Nurses (Preprint)

2021 ◽  
Author(s):  
Laura Singh ◽  
Marie Kanstrup ◽  
Katherine Depa ◽  
Ann-Charlotte Falk ◽  
Veronica Lindström ◽  
...  
Keyword(s):  
Health Care ◽  
Pilot Study ◽  
Data Collection ◽  
Mixed Method ◽  
Traumatic Events ◽  
Psychological Trauma ◽  
Care Staff ◽  
Health Care Staff ◽  
Intrusive Memories

BACKGROUND The COVID-19 pandemic has accelerated the worldwide need for simple remotely delivered (digital) scalable interventions that can also be used preventatively to protect the mental health of health care staff exposed to psychologically traumatic events during their COVID-19–related work. We have developed a brief behavioral intervention that aims to reduce the number of intrusive memories of traumatic events but has only been delivered face-to-face so far. After digitalizing the intervention materials, the intervention was delivered digitally to target users (health care staff) for the first time. The adaption for staff’s working context in a hospital setting used a co-design approach. OBJECTIVE The aims of this mixed method exploratory pilot study with health care staff who experienced working in the pandemic were to pilot the intervention that we have digitalized (for remote delivery and with remote support) and adapted for this target population (health care staff working clinically during a pandemic) to explore its ability to reduce the number of intrusive memories of traumatic events and improve related symptoms (eg, posttraumatic stress) and participant’s perception of their functioning, and to explore the feasibility and acceptability of both the digitalized intervention and digitalized data collection. METHODS We worked closely with target users with lived experience of working clinically during the COVID-19 pandemic in a hospital context (registered nurses who experienced intrusive memories from traumatic events at work; N=3). We used a mixed method design and exploratory quantitative and qualitative analysis. RESULTS After completing the digitalized intervention once with remote researcher support (approximately 25 minutes) and a brief follow-up check-in, participants learned to use the intervention independently. All 3 participants reported zero intrusive memories during week 5 (primary outcome: 100% digital data capture). Prior to study inclusion, two or more intrusions in the week were reported preintervention (assessed retrospectively). There was a general pattern of symptom reduction and improvement in perceived functioning (eg, concentration) at follow-up. The digitalized intervention and data collection were perceived as feasible and rated as acceptable (eg, all 3 participants would recommend it to a colleague). Participants were positive toward the digital intervention as a useful tool that could readily be incorporated into work life and repeated in the face of ongoing or repeated trauma exposure. CONCLUSIONS The intervention when delivered remotely and adapted for this population during the pandemic was well received by participants. Since it could be tailored around work and daily life and used preventatively, the intervention may hold promise for health care staff pending future evaluations of efficacy. Limitations include the small sample size, lack of daily intrusion frequency data in the week before the intervention, and lack of a control condition. Following this co-design process in adapting and improving intervention delivery and evaluation, the next step is to investigate the efficacy of the digitalized intervention in a randomized controlled trial.

Improving patient participation in a breast cancer survivorship program at a safety net hospital.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 60-60
Author(s):  
Shakuntala Shrestha ◽  
Pam Khosla ◽  
Janos Molnar ◽  
Maria Eugenia Corona ◽  
Sofia M Garcia
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Breast Cancer Survivors ◽  
Safety Net ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Breast Cancer Survivorship ◽  
Safety Net Hospital

60 Background: To provide comprehensive services and meet Commission on Cancer (CoC) accreditation requirements, we developed and evaluated a customized breast cancer SCP template and delivery model. Objective: To implement and pilot test survivorship care plan (SCP) delivery for breast cancer survivors. Methods: Clinicians at a safety net hospital partnered with investigators at an academic institution to start a breast cancer survivorship care program. We developed an SCP template that is CoC-complaint and responsive to input gathered in 2 focus groups with breast cancer survivors (n = 12) and interviews with staff (n = 8). Oncologists and nurses identified and referred English-speaking women who had completed breast cancer treatment. Participants completed baseline measures prior to receiving individualized SCPs in a survivorship consultation visit with a dedicated APN. In response to high no-show rates, we expanded clinic scheduling to harmonize with participants' other medical appointments. Interim feasibility results for our ongoing study are presented here. Results: A total of 154 patients were screened to reach target enrollment (n= 80) within 20 months. Participant median age was 60 ± 11; 71% were African American, 14% Hispanic; 11% Non-Hispanic White and 92% had household incomes < $20,000. Average times were: 30 ± 13.4 minutes for abstracting patient clinical information in preparation for the survivorship visit; 25 ± 16 minutes for completing individual SCPs; 22±7.65 minutes to review / deliver the SCPs with patients. The difference in no-show rate between first 3-month recruitment period (clinic limited to one day/week) and next 17 months (clinic appointment expanded to accommodate patients' schedule) was statistically significant, p = 0.028. Conclusions: Tailoring SCP templates and delivery models to the needs of a safety net hospital aided the sustainability of a new survivorship clinic. Patient non-adherence to scheduled visits was significantly improved by expanding clinic hours. Significant clinician time was spent preparing SCPs and a level 4 visit (25 minutes) does not adequately reflect this effort. This study is funded by the American Cancer Society, Illinois Division (Grant# 254698).

Breast cancer patients on adjuvant chemotherapy report a wide range of problems not identified by health-care staff

2006 ◽  
Vol 103 (2) ◽  
pp. 185-195 ◽  
Author(s):  
Mogens Groenvold ◽  
Peter M. Fayers ◽  
Morten Aagard Petersen ◽  
Mirjam A. G. Sprangers ◽  
Neil K. Aaronson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Care Staff ◽  
Health Care Staff ◽  
Breast Cancer Patients ◽  
Wide Range

Evaluating Survivorship Care Plans: Results of a Randomized, Clinical Trial of Patients With Breast Cancer

2011 ◽  
Vol 29 (36) ◽  
pp. 4755-4762 ◽  
Author(s):  
Eva Grunfeld ◽  
Jim A. Julian ◽  
Gregory Pond ◽  
Elizabeth Maunsell ◽  
Douglas Coyle ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Patient Reported Outcomes ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Event Scale ◽  
Care Plans ◽  
Patient Reported ◽  
Secondary Outcomes ◽  
The Impact

Purpose An Institute of Medicine report recommends that patients with cancer receive a survivorship care plan (SCP). The trial objective was to determine if an SCP for breast cancer survivors improves patient-reported outcomes. Patients and Methods Women with early-stage breast cancer who completed primary treatment at least 3 months previously were eligible. Consenting patients were allocated within two strata: less than 24 months and ≥ 24 months since diagnosis. All patients were transferred to their own primary care physician (PCP) for follow-up. In addition to a discharge visit, the intervention group received an SCP, which was reviewed during a 30-minute educational session with a nurse, and their PCP received the SCP and guideline on follow-up. The primary outcome was cancer-related distress at 12 months, assessed by the Impact of Event Scale (IES). Secondary outcomes included quality of life, patient satisfaction, continuity/coordination of care, and health service measures. Results Overall, 408 survivors were enrolled through nine tertiary cancer centers. There were no differences between groups on cancer-related distress or on any of the patient-reported secondary outcomes, and there were no differences when the two strata were analyzed separately. More patients in the intervention than control group correctly identify their PCP as primarily responsible for follow-up (98.7% v 89.1%; difference, 9.6%; 95% CI, 3.9 to 15.9; P = .005). Conclusion The results do not support the hypothesis that SCPs are beneficial for improving patient-reported outcomes. Transferring follow-up to PCPs is considered an important strategy to meet the demand for scarce oncology resources. SCPs were no better than a standard discharge visit with the oncologist to facilitate transfer.

Breast cancer diagnosis and treatment in a safety net setting: Differences between insured and uninsured patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6566-6566
Author(s):  
N. J. Farrell ◽  
C. J. Bradley ◽  
L. M. Schickle
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Health Insurance ◽  
Adjuvant Chemotherapy ◽  
Breast Cancer Diagnosis ◽  
Safety Net ◽  
Cancer Center ◽  
Hospital System ◽  
Safety Net Hospital ◽  
Chemotherapy Initiation

6566 Background: Despite the safety net system and many other means of providing free or low cost care to women with breast cancer, disparities in health outcomes between uninsured and insured women with breast cancer exist. In this study, we evaluate the role of health insurance on breast cancer treatments at a large safety net hospital system. Methods: From the patient population at the Massey Cancer Center at Virginia Commonwealth University Health Care System (a large regional safety net provider), we selected women ages 21 to 64 diagnosed with breast cancer between January 1999 and March 2006 (n=1,381). We used billing records to identify health insurance status of these patients. First, we compared the stage of disease and tumor size at diagnosis for women with and without insurance. Next, we compared the number of days between diagnosis and surgery and the number of days between surgery and chemotherapy initiation. Finally, we estimated the number of days it took these groups of women to complete a common adjuvant chemotherapy regimen of doxorubicin plus cyclophosphamide (AC) or doxorubicin plus cyclophosphamide followed by paclitaxel (ACT). Results: Our analysis shows that women without insurance were more likely to have more advanced cancers and correspondingly larger tumors. Uninsured women experienced considerable delays from the date of diagnosis to surgery and from surgery to chemotherapy initiation compared with insured women (21.5 and 22 days longer, respectively). Uninsured women also took significantly longer to complete adjuvant chemotherapy regimens relative to insured women (4 and 26 days for AC and ACT, respectively). Conclusions: To understand the disparities that exist in breast cancer outcomes among women with and without health insurance, we must understand the different experiences these groups of women have with treatment. In this study, uninsured women had more advanced cancers, and experienced considerable delays receiving and completing treatment relative to insured women. Our study demonstrates the value of health insurance in the timely provision of health care even in a safety net setting where care is guaranteed. No significant financial relationships to disclose.

scholarly journals Re-Engage: A Novel Nurse-Led Program for Survivors of Childhood Cancer Who Are Disengaged From Cancer-Related Care

2020 ◽  
Vol 18 (8) ◽  
pp. 1067-1074
Author(s):  
Christina Signorelli ◽  
Claire E. Wakefield ◽  
Karen A. Johnston ◽  
Joanna E. Fardell ◽  
Jordana K McLoone ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Self Efficacy ◽  
Empirical Work ◽  
Trial Registration ◽  
Survivorship Care ◽  
Physical And Mental Health ◽  
Patient Reported ◽  
Health Related ◽  
Survivors Of Childhood Cancer

Background: Survivors of childhood cancer often experience treatment-related chronic health conditions. Survivorship care improves survivors’ physical and mental health, yet many are disengaged from care. Innovative models of care are necessary to overcome patient-reported barriers to accessing survivorship care and to maximize survivors’ health. Methods: We piloted a novel survivorship program, called “Re-engage,” a distance-delivered, nurse-led intervention aiming to engage, educate, and empower survivors not receiving any cancer-related care. Re-engage involves a nurse-led consultation delivered via telephone/online to establish survivors’ medical history and needs. Participants completed questionnaires at baseline, 1 month postintervention, and 6-month follow-up. Results: A total of 27 survivors who had not accessed survivorship care in the last 2 years participated (median age, 31 years; interquartile range [IQR], 27–39 years); of which, 82% were at high-risk for treatment-related complications. Participation in Re-engage was high (75%) and there was no attrition once survivors enrolled. At 1 month postintervention, 92% of survivors reported that Re-engage was “beneficial,” which all survivors reported at 6-month follow-up. Survivors’ overall satisfaction with their care increased from 52% before Re-engage to 84% at 1 month postintervention. Survivors’ mean self-efficacy scores remained similar from baseline to 1 month postintervention (b = −0.33, 95% CI, −1.31 to 0.65), but increased significantly from baseline to 6-month follow-up (b = 1.64, 95% CI, 0.28–3.00). At 6-month follow-up, 73% of survivors showed an increase in health-related self-efficacy compared with baseline. Conclusions: Re-engage is a highly acceptable and feasible intervention and promotes health-related self-efficacy, which is integral to survivors being advocates for their own health. Further empirical work is needed to evaluate the long-term efficacy of Re-engage.Trial registration: ACTRN12618000194268

scholarly journals Strengthening Screening and Detection Services for Breast Cancer in Vietnam

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 52s-52s
Author(s):  
C. Jenkins ◽  
T.T. Ngan ◽  
N.B. Ngoc ◽  
T.B. Phuong ◽  
L. Lohfeld ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Health System ◽  
District Level ◽  
Care Staff ◽  
Health Care Staff ◽  
Opportunistic Screening ◽  
Specific Training ◽  
Cancer Services ◽  
Depth Interviews

Background: The incidence of breast cancer has increased consistently in Vietnam over the past two decades. Data from 2012 indicates an increase from an age-standardized rate of 16.2 per 100,000 in 2002, to 23.0 per 100,000 in 2012. Despite this, and consistent studies indicating late diagnosis, there has been a lack of empirical studies on what breast cancer services exist and how they function across different levels of the Vietnamese health system. Aim: Our project sought to examine the accessibility, affordability, and appropriateness of breast cancer services in Vietnam with the objective of making recommendations to strengthen service delivery. Methods: The project used a mixed-methods approach, collecting data through self-administered questionnaires (n=69) and in-depth interviews (n=23) with health professionals working at facilities across all four levels of the Vietnamese health system (national, provincial, district, & commune). We completed in-depth interviews with women (n=12) diagnosed with breast cancer, focusing on their experiences of accessing and using services. Our study was located across three provinces, representing the northern, central, and southern regions of the country. Results: Our results show that screening activities for breast cancer in the community are not systematically organized or provided. There are no stand-alone screening campaigns for breast cancer and facility-based opportunistic screening is limited. There is scope for strengthening the primary and secondary levels of the Vietnamese health system to detect, diagnose and treat breast cancer. Increased autonomy and support for commune-level health stations to conduct screening activities, the systematic incorporation of opportunistic screening, and the extension of breast cancer-specific training for commune and district level health care staff are potential areas for strengthening. Conclusion: Our study suggests that there should be concerted efforts to implement the Ministry of Health's strategic objectives to decentralise and strengthen commune and district levels of the health system in relation to detection, diagnosis and treatment of breast cancer. No studies have been conducted that pilot interventions to provide systematic and comprehensive breast cancer services at the lower levels of the health system. Specific attention should be given to increasing autonomy and support for commune level health stations to conduct screening activities; for the systematic incorporation of opportunistic screening; and the extension of breast cancer-specific training for commune and district level health care staff.

Making it work: Breast cancer survivorship care at Johns Hopkins.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 61-61 ◽  
Author(s):  
Elissa Thorner Bantug ◽  
Kimberly S. Peairs ◽  
Lillie D. Shockney ◽  
Nelli Zafman ◽  
Carol D. Riley ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Cancer Treatment ◽  
Cancer Survivorship ◽  
Care Coordination ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Breast Cancer Survivorship

61 Background: Breast cancer survivor numbers are increasing due to population aging and improved treatment outcomes but many of their long-term health care needs are unmet. Integrated follow-up care strategies that enhance care coordination, education, and access to survivorship resources are needed to provide patients with evidence-based care that addresses medical and psychosocial needs after cancer treatment. Methods: In 2008, we established the Johns Hopkins Breast Cancer Survivorship Program with representation from the Schools of Nursing, Public Health, and Medicine to address the needs of patients completing initial cancer treatment and transitioning to long-term follow-up. Patient educational resources were created within an interactive website ( http://bit.ly/hZfzFi ) including > 35 patient/provider educational video clips, blogs and social media. Activities including provider educational events, educational folders, and trainee curriculum additions have been ongoing. Starting May 2011, Hopkins patients were offered a one-time transition visit with a nurse practitioner focusing on individualized treatment summary/survivorship care plan activities (e.g., cancer screening/surveillance, medical intervention, psychosocial support, and care coordination with non-cancer providers). Results: Our website is averaging 3,000 hits monthly. We have participated in 22 provider/trainee formal educational presentations. In the pilot phase of these transition visits (n=40), age/race breakdown of participants were representative of our breast cancer population (median age 51, range 34-69; 17% African Americans). Our post-visit survey (n=37), 97% found the survivorship visit beneficial and all reported that this one-time consultation helped with transitioning away from treatment. Conclusions: A multidisciplinary patient-centered approach to breast cancer survivorship allowed us to develop comprehensive clinical and educational service models to benefit patients and their cancer/non-cancer providers. This program aims to enhance education, overcome the fragmentation of the health care system, and improve overall health and wellness of breast cancer survivors as they transition to long-term survivorship.

Patient-reported sources of breast cancer survivorship care four years after diagnosis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20511-e20511
Author(s):  
Christopher Ryan Friese ◽  
Sarah T. Hawley ◽  
Jennifer J. Griggs ◽  
Ann S. Hamilton ◽  
John Graff ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Cancer Survivorship ◽  
White Women ◽  
Disease Stage ◽  
Survivorship Care ◽  
Breast Cancer Survivorship ◽  
Catchment Areas ◽  
Patient Reported

e20511 Background: Breast cancer survivors remain “lost in transition” after active treatment due to changing needs and fragmented care. We sought to describe the patterns of breast cancer survivorship care in a diverse sample to identify factors associated with receipt of survivorship care by medical oncologists (med onc). Methods: We conducted a mailed survey to 2,290 women who resided in the Los Angeles and Detroit SEER registry catchment areas with a confirmed invasive breast cancer case from 6/05-2/07. Women were then surveyed approximately 4 years after diagnosis (n=1,536). On the follow-up survey, women were asked to identify their main provider of breast cancer follow up care: med onc, surgeon, primary care physician (PCP)/other physician. We examined the relationship between report of med onc as main provider of survivor care and: age, race/ethnicity, insurance, tumor stage, receipt of chemotherapy, and care by med onc reported on the baseline survey. Bivariate analyses and logistic regression were used to examine med onc-led survivorship care and the factors above. Results were weighted to account for sample selection and non-response. Results: 858 women had invasive disease at time of diagnosis: 65.2% reported med oncs as the main provider of survivorship care, followed by PCP/other physicians (24.3%) and surgeons (10.5%). Of the women who did not receive chemotherapy, 56% reported med onc-led survivorship care, compared with 79% of chemotherapy recipients. In multivariable logistic regression, black women were less likely than white women to report med onc-led survivorship care (OR 0.49, 95% CI 0.34-0.71). Privately-insured patients were more likely than Medicaid recipients to report med onc-led care (OR 2.00, 95% CI 1.16-3.45). Women with higher disease stage, those who received chemotherapy, and those who saw a med onc at baseline were significantly more likely to report med onc-led survivorship care. Conclusions: The oncology workforce shortage compels the identification of optimal and efficient survivorship care models. A mismatch may exist between chemotherapy receipt and med onc-led care. Our data suggest clear guidelines are needed to direct patients to the providers most appropriate to manage their care.

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