Harnessing AI for health equity in oncology research and practice.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 67-67
Author(s):  
Alexandra Urman ◽  
Ching-Kun Wang ◽  
Irene Dankwa-Mullan ◽  
Ethan Scheinberg ◽  
Michael J. Young
Keyword(s):  
Clinical Practice ◽  
Health Equity ◽  
Cancer Susceptibility ◽  
Care Delivery ◽  
Diagnostic Errors ◽  
Ethical Challenges ◽  
Ethical Implications ◽  
Oncology Research ◽  
Oncology Care ◽  
The Impact

67 Background: Recent advances in artificial intelligence (AI) carry underexplored practical and ethical implications for the practice of clinical oncology. As oncologic applications of AI proliferate, a framework for guiding their ethical implementations and equitable distribution will be crucial. Methods: We reviewed the current landscape of AI applications in oncology research and clinical practice by reviewing the current body of evidence in PubMed and Medline. Key ethical challenges and opportunities to address health equity are critically evaluated and highlighted. Ethical implications for patients, clinicians and society at large are delineated, with particular focus on the impact and ramifications of AI with respect to healthcare disparities and equity of oncology care delivery. Results: Growing concerns that AI may widen disparities in oncologic care by virtue of lack of affordability, inconsistent accessibility and biased machine-learning models are addressed. Although there is potential for AI to widen disparities in oncology care, using foresight in application, AI has the potential to (1) democratize access to specialized clinical knowledge, (2) improve the accuracy of predicting cancer susceptibility, recurrence and mortality, (3) prevent diagnostic errors in under-resourced settings, (4) minimize unintended bias and (5) enable access to tailored therapeutic options including clinical trials if appropriately deployed. Separately, AI can be harnessed to identify areas of underserved needs and optimize systems of health-information sharing and reimbursements as blockchain technology converges with AI. As AI advances it will have a larger presence in oncology research and clinical practice. Conclusions: A strategic framework integrating ethical standards and emphasizing equitable implementation can help ensure that the potential of AI to address disparities in oncology are maximally captured and its perils averted. Further work is being done on exploring these challenges and will be submitted as a manuscript.

The Impact of Industry on Oncology Research and Practice

2015 ◽  
pp. 130-137 ◽  
Author(s):  
Beverly Moy ◽  
Reshma Jagsi ◽  
Richard B. Gaynor ◽  
Mark J. Ratain
Keyword(s):  
Conflicts Of Interest ◽  
Ethical Challenges ◽  
Patients With Cancer ◽  
Direct To Consumer ◽  
Professional Societies ◽  
Oncology Research ◽  
Public Scrutiny ◽  
Oncology Practice ◽  
Direct To Consumer Advertising ◽  
The Impact

Public scrutiny has increased over potential conflicts of interest among oncology researchers and providers. Given the increased prevalence and complexity of industry relationships, oncologists are increasingly faced with ethical challenges when navigating their financial relationships with industry. Oncologists are continually dealing with changing conflict of interest policies within academic centers and professional societies. With the recent passage of The Sunshine Act, oncologists are beginning to understand the repercussions of this new law. The consequences of the increasing use of direct-to-consumer advertising on patients with cancer are also unclear. Finally, industry's perspective on the evolution of these relationships is not clearly understood. This manuscript discusses issues related to industry's influence on oncology practice and research.

The History and Ethics of the Therapeutic Relationship

2020 ◽  
Author(s):  
Ulrich Koch ◽  
Kelso Cratsley
Keyword(s):  
Clinical Practice ◽  
Therapeutic Relationship ◽  
Ethical Analysis ◽  
Ethical Challenges ◽  
Ethical Implications ◽  
Relational Practices ◽  
Societal Influences

This chapter reviews past and present debates about the therapeutic relationship in order to draw out the ethical implications of relational practices in psychotherapy. The therapeutic relationship has been understood differently across psychotherapeutic approaches, with each tradition responding to the attendant ethical challenges in distinctive ways. Aside from practitioners’ theoretical and practical commitments, the therapeutic relationship has also been, and continues to be, shaped by broader societal influences. The chapter discusses the shifting ethical implications of relational practices, then, as situated in their theoretical and historical contexts. The historical variability of concerns raised by the therapeutic relationship requires continued ethical analysis in order to confront the diversity and complexity of contemporary clinical practice.

scholarly journals From outcome measurement to improving health outcomes following lower limb amputation - making outcome measurement work from a clinical practice perspective

2020 ◽  
Author(s):  
Chantel Ostler ◽  
Helen Scott ◽  
Imad Sedki ◽  
Sisary Kheng ◽  
Maggie Donovan-Hall ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Health Outcomes ◽  
Lower Limb ◽  
Care Delivery ◽  
Outcome Measurement ◽  
Narrative Review ◽  
Successful Outcome ◽  
Prosthetic Rehabilitation ◽  
Clinical Narrative ◽  
The Impact

Background: Outcome measurement is essential to understand the impact of clinical interventions and the performance of services. Despite national and professional encouragement outcome measurement has failed to become embedded in clinical practice and its value continues to be questioned. Objectives: To address the outcome measurement debate within lower limb prosthetic rehabilitation and provide a critical synthesis of the evidence surrounding the discussion applied within the clinical context of the UK National Health Service (NHS).Study Design: Narrative review Methods: The authors drew on over 20 years clinical experience in prosthetic rehabilitation to synthesise and critique the outcome literature across a breadth of healthcare services. A narrative review methodology was selected to give voice to the clinical narrative thread.Results: This review addresses why we should measure health outcomes, the health care delivery and organisational scenarios in which outcome measurement can be beneficial and explores where lessons can be learnt for prosthetic rehabilitation from approaches in different specialities. The current outcome measurement literature within prosthetic rehabilitation is critiqued and we discuss the issues facing this field in the future.Conclusions: The dilemma of successful outcome measurement in clinical practice is multifaceted. Understanding and embedding value at every step is key to success. Addressing the questions of `why’, `what’ and `how’ we measure outcome will move us closer to a national consensus. Routine outcome measurement implementation at the clinical level must ensure data collection is valuable to clinical practice, makes use of IT solutions and has all important organisational buy in.

scholarly journals Hospital ethics reflection groups: a learning and development resource for clinical practice

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
H. Bruun ◽  
L. Huniche ◽  
E. Stenager ◽  
C. B. Mogensen ◽  
R. Pedersen
Keyword(s):  
Clinical Practice ◽  
General Hospital ◽  
Positive Impact ◽  
Reflection Group ◽  
Ethical Challenge ◽  
Ethical Challenges ◽  
Reflection Groups ◽  
Patient Admissions ◽  
The Impact ◽  
Ethics Reflection

Abstract Background An ethics reflection group (ERG) is one of a number of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the significance of ERGs in psychiatric and general hospital departments in Denmark. Methods This is a qualitative action research study, including systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Short written descriptions of the ethical challenges presented in the ERGs also informed the analysis of significance. Results A recurring ethical challenge for clinicians, in a total of 63 cases described and assessed in 3 ethical reflection groups, is to strike a balance between respect for patient autonomy, paternalistic responsibility, professional responsibilities and institutional values. Both in psychiatric and general hospital departments, the study participants report a positive impact of ERG, which can be divided into three categories: 1) Significance for patients, 2) Significance for clinicians, and 3) Significance for ward managers. In wards characterized by short-time patient admissions, the cases assessed were retrospective and the beneficiaries of improved dialogue mainly future patients rather than the patients discussed in the specific ethical challenge presented. In wards with longer admissions, the patients concerned also benefitted from the dialogue in the ERG. Conclusion This study indicates a positive significance and impact of ERGs; constituting an interdisciplinary learning resource for clinicians, creating significance for themselves, the ward managers and the organization. By introducing specific examples, this study indicates that ERGs have significance for the patients discussed in the specific ethical challenge, but mostly indirectly through learning among clinicians and development of clinical practice. More research is needed to further investigate the impact of ERGs seen from the perspectives of patients and relatives.

Health Equity in Artificial Intelligence and Primary Care Research: Protocol for a Scoping Review (Preprint)

2021 ◽  
Author(s):  
Jonathan Xin Wang ◽  
Sulaiman Somani ◽  
Jonathan H Chen ◽  
Sara Murray ◽  
Urmimala Sarkar
Keyword(s):  
Artificial Intelligence ◽  
Primary Care ◽  
Health Equity ◽  
Scoping Review ◽  
Underserved Populations ◽  
Care Delivery ◽  
Data Extraction ◽  
Cochrane Library ◽  
Preventative Care ◽  
The Impact

BACKGROUND Though artificial intelligence (AI) has potential to augment the patient-physician relationship in primary care, bias in intelligent healthcare systems has the potential to differentially impact vulnerable patient populations. OBJECTIVE The purpose of this scoping review is to summarize the extent to which AI systems in primary care examine the inherent bias towards or against vulnerable populations and appraise how these systems have mitigated the impact of such biases during their development. METHODS We will conduct a search update from an existing scoping review to identify AI and primary care articles in the following databases: Medline-OVID,Embase,CINAHL, Cochrane Library, Web of Science, Scopus, IEEE Xplore, ACM Digital Library, MathSciNet, AAAI, and arXiv. Two screeners will independently review all abstracts, titles and full-texts. The team will extract data using structured data extraction form and synthesize the results according to PRISMA-Scr guidelines. RESULTS This review will provide an assessment of the current state of healthcare equity within AI for primary care. Specifically, we will identify the degree to which vulnerable patients have been included, assess how bias is interpreted and documented, and understand the extent harmful biases are addressed. As of October 2020, the scoping review is in the title and abstract screening stage. The results are expected to be submitted for publication in fall of 2021. CONCLUSIONS AI applications in primary care are becoming an increasingly common tool in health care delivery, including in preventative care efforts for underserved populations. This scoping review aims to understand to what extent AI-primary care studies employ a health equity lens and take steps to mitigate bias.

scholarly journals Development of a Rural Family Practice Rotation in an Athletic Training Residency Program

2017 ◽  
Vol 12 (3) ◽  
pp. 188-194
Author(s):  
Forrest Q. Pecha ◽  
Lucas A. Bahnmaier ◽  
Jefferson J. Wetherington ◽  
Alejandro A. Homaechevarria ◽  
Jon Schott
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Athletic Training ◽  
Family Practice ◽  
Health Care Delivery ◽  
Interprofessional Collaboration ◽  
Care Delivery ◽  
Athletic Training Education ◽  
Rural Family ◽  
The Impact

Context: Postprofessional residency (PPR) programs continue to gain popularity as athletic training education prepares for a paradigm shift. The Commission on Accreditation of Athletic Training Education has established didactic and clinical infrastructure for PPRs seeking accreditation. Accredited programs provide athletic trainers (ATs) with an advanced level of knowledge in a focused area of clinical practice. Objective: A case study report to introduce a novel PPR general medical rotation to illustrate the skills and knowledge of ATs, evaluate the impact of the athletic training residents in the rural family practice (FP) setting, and to discuss how employing an AT in this setting aligns with the triple aim of the Affordable Care Act (ACA). Background: Currently, there is very little literature regarding PPRs. Additionally, very little research exists describing how ATs function within the ACA model of health care delivery. Description: The PPR developed a rotation for a rural FP outpatient clinic. Athletic training residents completed 3-week rotations in this setting working with multiple providers. Learning objectives were created to emphasize the evaluation, diagnosis, and management of general medical conditions. Objectives were assessed at the conclusion of the rotation. Finally, data were collected to evaluate the impact of athletic training residents in the ACA model of health care delivery. Clinical Advantage(s): The athletic training residents improved their clinical evaluation and diagnosis skills in a FP clinic through this educational opportunity. This rotation cultivated and fostered interdisciplinary education and interprofessional collaboration. Finally, the observational findings of this rotation revealed the impact of ATs appear to align with the objectives of the ACA health care model, supporting the use of ATs in this role. Conclusion(s): This rotation highlights an area of clinical practice future ATs could pursue. Accredited PPR programs must consider the evolution in health care delivery and the shift in athletic training education standards to develop strong PP programs.

scholarly journals Ethical considerations of phone-based interviews from three studies of COVID-19 impact in Bihar, India

2021 ◽  
Vol 6 (Suppl 5) ◽  
pp. e005981
Author(s):  
Karima Khalil ◽  
Priya Das ◽  
Rochana Kammowanee ◽  
Deepika Saluja ◽  
Priyanjali Mitra ◽  
...  
Keyword(s):  
Digital Data ◽  
Active Listening ◽  
Emotional States ◽  
Health Providers ◽  
Ethical Challenges ◽  
Ethical Considerations ◽  
Ethical Implications ◽  
Institutional Review ◽  
Women's Lives ◽  
The Impact

Phone-based interviews present a range of ethical challenges, including how to ensure informed consent and privacy and maintain confidentiality. Our paper presents conceptual and practical ethical considerations taken into account across three telephone studies on the impact of COVID-19 conducted following India’s nationwide lockdown imposed in March 2020. Two studies captured COVID-19 response impact on primary-level Reproductive Maternal Neonatal and Child Health (RMNCH) services and on provider wellness, respectively. The third study focused on how the gendered experience of COVID-19 and the state’s response to control transmission impacted women’s lives, focusing on health services, livelihood, entitlements and social change, by interviewing individual women. The ethical challenges as well as the advantages of digital data collection are presented with recommendations for low-resource settings. Ethical considerations included the above challenges as well as avoiding posing unreasonable time burden on the respondents, framing questions with a gendered lens, considering emotional states given contagion concerns and economic uncertainties, and redressing pandemic-induced distress. Using scripted Hindi was challenging in consent-taking, as was protecting household respondents’ privacy and confidentiality during lockdown. Unanticipated positive ethical implications of using a telephone approach included providing respondents privacy and catharsis, respondents choosing convenient interview times and affording health providers more privacy than institutional inperson interviews. Internalising empathy, respect and appreciative enquiry are key to establishing rapport in the absence of prior relationships. Institutional Review Board (IRB) time limits on call duration need to be flexible to allow for ‘active listening’ and empathetic enquiry in surveys on the impact of COVID-19.

scholarly journals De-Implementing Ineffective and Low-value Clinical Practices: Research and Practice Opportunities in Community Oncology Settings

2021 ◽  
Author(s):  
Wynne E Norton ◽  
Worta McCaskill-Stevens ◽  
David A Chambers ◽  
Philip J Stella ◽  
Otis W Brawley ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
Implementation Strategies ◽  
Clinical Practices ◽  
National Network ◽  
Oncology Research ◽  
Community Oncology ◽  
Practice Opportunities ◽  
Oncology Care ◽  
Study Designs

Abstract Patients, practitioners, and policymakers are increasingly concerned about the delivery of ineffective or low-value clinical practices in cancer care settings. Research is needed on how to effectively de-implement these types of practices from cancer care. In this commentary, we spotlight the National Cancer Institute (NCI) Community Oncology Research Program (NCORP), a national network of community oncology practices, and elaborate on how it is an ideal infrastructure for conducting rigorous, real-world research on de-implementation. We describe key, multi-level issues that affect de-implementation and also serve as a guidepost for developing strategies to drive de-implementation. We describe optimal study designs for testing de-implementation strategies and elaborate on how and why the NCORP network is uniquely positioned to conduct rigorous and impactful de-implementation trials. The number and diversity of affiliated community oncology care sites, coupled with the overall objective of improving cancer care delivery, make the NCORP an opportune infrastructure for advancing de-implementation research while simultaneously improving the care of millions of cancer patients nationwide.

The future delivery of oncology care: Thoughts on the impact of quality improvement, personalized medicine, and integrating interprofessional collaboration.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 19-19
Author(s):  
Caroline Osborne Robinson ◽  
Maziar Abdolrasulnia ◽  
Holder Nevins ◽  
John E. Ruggiero
Keyword(s):  
Quality Improvement ◽  
Personalized Medicine ◽  
Qualitative Analysis ◽  
Care Delivery ◽  
Patient Specific ◽  
Care Providers ◽  
Interprofessional Teams ◽  
Oncology Care ◽  
The Impact

19 Background: A significant thrust within recent innovation has been focused on improving the quality of diagnostics and system adherence to guidelines; equally important are attempts to improve patient-specific therapy plans, or personalized medicine. These two approaches—quality improvement and personalized medicine—have equally laudable goals toward improving cancer care and outcomes, yet have not been fully examined for their concomitant impacts, particularly among and within interprofessional teams, in which a mix of health care providers present varied foci within the oncology care delivery process. Methods: Twenty phone-based qualitative interviews were facilitated with community-based medical oncologists in active practice in July 2012. Transcripts of the interview sessions were examined through grounded qualitative analysis, and overall findings are presented. Results: Oncologists hold varied definitions of personalized medicine, yet share understanding of the central nature of the patient within personalized medicine care delivery. More varied are oncologists’ perceptions of the goals and value of implementation of quality improvement initiatives, which range from those focused on pragmatic concerns of the oncology clinic, such as patient flow, to the quality of clinical decision-making and outcomes. Oncologists value well-functioning and clearly defined roles within interprofessional teams within oncology practices, both among other clinicians and allied team members. However, functional and perceptional gaps remain in the practical application of quality improvement objectives within interprofessional teams and within the implementation of personalized oncology care delivery. Conclusions: This exploratory qualitative analysis approach provides grounded identification of practicing oncologists’ definitions of quality improvement, personalized medicine, interprofessional care delivery, and the practical interrelationships between these domains, enabling a framework for future research and quality initiatives.

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