Perspectives on cancer care delivery from oncology patients who experienced unplanned acute care events.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 201-201
Author(s):  
Tara L. Kaufmann ◽  
Katharine A. Rendle ◽  
Erin Aakhus ◽  
Andrea Bilger ◽  
Peter Edward Gabriel ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Acute Care ◽  
Care Delivery ◽  
System Level ◽  
Self Management ◽  
Structured Interviews ◽  
Patient Factors ◽  
Management Interventions ◽  
High Level ◽  
Oncology Providers

201 Background: Unplanned acute care is debilitating and burdensome for patients with advanced cancer and their caregivers. There is a pressing need to understand how available evidence-based practices (EBPs) to reduce acute care 1) align with the needs and priorities of patients and 2) are best implemented within large health systems. We are conducting a mixed methods study to assess patient- provider- and system-level factors that shape the decision to seek acute care during active cancer treatment in order to select and adapt EBPs for implementation. Here we present data from patients’ perspectives. Methods: Purposive sampling approach to identify solid tumor cancer patients on active treatment with unplanned acute care events at a large health system from Aug 2018-Jan 2019. We conducted semi-structured interviews to elicit patients’ perspectives on factors that shape their decision to seek acute care and to inform intervention strategies. Results: Forty-nine patients participated in this study. We identify several patient factors that intersect with the decision to seek care: self-management behaviors, guilt, negative ED perception, safety concerns, and trust. Patients attempt self-management prior to contacting their oncology team, which introduces variability in the duration and severity of reported symptoms. Delay is related to patients’ guilt for burdening their oncology team and to provider accessibility. Patients describe a high symptom threshold to seek care that is often coupled with a negative perception of the ED, but do prefer in-person evaluation for new and distressing symptoms for safety. They express a high level of trust in the oncology team and relative distrust of non-oncology providers. Conclusions: Our data suggest a conceptual model for patient factors that drive unplanned acute care. Patients identify three areas for improvement: 1) enhanced peer support and education to manage uncertainty about cancer treatment; 2) accessible portals for patient-clinician communication; and 3) home or clinic-based after-hours oncology symptom management. Interventions to target these needs should address patients’ emotional concerns and be well integrated within the oncology team.

Patient factors that drive unplanned acute care utilization in oncology care.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18011-e18011
Author(s):  
Tara L. Kaufmann ◽  
Erin Aakhus ◽  
Andrea Bilger ◽  
Peter Edward Gabriel ◽  
Vivek Nimgaonkar ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Acute Care ◽  
Comparative Method ◽  
System Level ◽  
Self Management ◽  
Care Utilization ◽  
Patient Factors ◽  
Safety Concerns ◽  
Oncology Care ◽  
Acute Care Utilization

e18011 Background: There is a critical need to develop oncology care delivery models that help cancer patients avoid preventable acute hospital care. We are conducting a mixed methods study to assess patient- provider- and system-level factors that drive unplanned acute care utilization in order to implement evidence-based practices (EBPs) at a large health system. Here we present data from patient perspectives on the factors that influence their decision to seek acute care. Methods: We used a purposive sampling approach to identify cancer patients with solid tumors on active treatment with unplanned acute care events at an academic cancer center or its two affiliated community practices from August 2018-January 2019. We conducted semi-structured interviews designed to elicit patient factors that drive unplanned acute care utilization and to understand strategies patients use to manage unexpected symptoms at home. Interviews were analyzed using the constant comparative method to identify key themes. Results: Forty-three patients participated in this study. We identify several patient factors that intersect with the decision to seek care: self-management behaviors, guilt, negative ED perception, safety concerns, and trust. Patients attempt self-management prior to contacting their oncology team, which introduces variability in the duration and severity of reported symptoms. Delay is related to patients’ sense of guilt for burdening their oncology team and to differences in provider accessibility. Patients describe a high symptom threshold to seek care that is often coupled with a negative perception of the ED. However, due to safety concerns, patients do prefer in-person evaluation for new and distressing symptoms. They also express a high level of trust in the oncology team and relative distrust of non-oncology providers. Conclusions: Our data suggest a conceptual model for patient factors that drive unplanned acute care and identify the following targets for implementation of EBPs: 1) symptom management 2) provider accessibility 3) alternate triage pathways for in-person evaluation. Strategies to target these needs should address patients’ emotional concerns and be well integrated within the oncology team.

scholarly journals Barriers to the Delivery of Timely, Guideline-Adherent Adjuvant Therapy Among Patients With Head and Neck Cancer

2020 ◽  
Vol 16 (12) ◽  
pp. e1417-e1432
Author(s):  
Evan M. Graboyes ◽  
Chanita Hughes Halbert ◽  
Hong Li ◽  
Graham W. Warren ◽  
Anthony J. Alberg ◽  
...  
Keyword(s):  
Health Care ◽  
Head And Neck ◽  
Conceptual Model ◽  
Care Delivery ◽  
Care Transitions ◽  
Health Care Team ◽  
Organizational Level ◽  
Structured Interviews ◽  
Postoperative Radiation Therapy ◽  
Oncology Providers

PURPOSE: Delays initiating guideline-adherent postoperative radiation therapy (PORT) in head and neck squamous cell carcinoma (HNSCC) are common, contribute to excess mortality, and are a modifiable target for improving survival. However, the barriers that prevent the delivery of timely, guideline-adherent PORT remain unknown. This study aims to identify the multilevel barriers to timely, guideline-adherent PORT and organize them into a conceptual model. MATERIALS AND METHODS: Semi-structured interviews with key informants were conducted with a purposive sample of patients with HNSCC and oncology providers across diverse practice settings until thematic saturation (n = 45). Thematic analysis was performed to identify the themes that explain barriers to timely PORT and to develop a conceptual model. RESULTS: In all, 27 patients with HNSCC undergoing surgery and PORT were included, of whom 41% were African American, and 37% had surgery and PORT at different facilities. Eighteen clinicians representing a diverse mix of provider types from 7 oncology practices participated in key informant interviews. Five key themes representing barriers to timely PORT were identified across 5 health care delivery levels: (1) inadequate education about timely PORT, (2) postsurgical sequelae that interrupt the tight treatment timeline (both intrapersonal level), (3) insufficient coordination and communication during care transitions (interpersonal and health care team levels), (4) fragmentation of care across health care organizations (organizational level), and (5) travel burden for socioeconomically disadvantaged patients (community level). CONCLUSION: This study provides a novel description of the multilevel barriers that contribute to delayed PORT. Interventions targeting these multilevel barriers could improve the delivery of timely, guideline-adherent PORT and decrease mortality for patients with HNSCC.

80 An Exploration of What Stakeholders Reveal About the Behaviours and Personality of Registered Nurses Working in Older People’s Acute Care Settings and the Potential Influence on Nursing Care

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i25-i26
Author(s):  
H Day
Keyword(s):  
Older People ◽  
Personality Traits ◽  
Acute Care ◽  
Nursing Care ◽  
Nursing Staff ◽  
Positive Impact ◽  
Care Delivery ◽  
Structured Interviews ◽  
Authentic Self ◽  
Acute Care Settings

Abstract Background Concern around poor standards of nursing care for older people in hospital has been explored in relation to workload and operational pressures. What is less evident from existing literature is an explanation as to why nurses behave differently under the same pressures within the same concrete situations. Notions of personality and associated behaviours as possible influencers on nursing care delivery are variables that required consideration. Aim To critically explore the behaviours of registered nursing staff working in older people's acute care settings from the perspectives gathered from key stakeholders, and to identify whether there are any distinguishing personality traits that influence effective care delivery for older people. Methods A constructivist grounded theory methodology was used. Semi structured interviews were conducted to gather data from 12 stakeholder participants. Results Through the analysis of data gathered from stakeholders a rubric describing specific behaviours with associated traits emerged leading to the identification of two major types of nursing staff. One group of nurses who work with older people are perceived to have no real desire to do so and in turn their care behaviours are perceived as ‘cold’ and task based. The second group of nurses are perceived as having a true commitment to older people’s wellbeing and their behaviours lead to the delivery of care that is perceived as being highly skilled and compassionate. The proposed theoretical framework that was constructed from this data analysis identifies four key personality traits related to nursing behaviours: conscientiousness, sociability, integrity and coping under a core category heading of ‘the authentic self’. Whilst the authentic self is identified as being the direct influencer on how care is delivered which is defined as the consequence, the influence of context is also taken into account. Conclusions This research offers insights into the meaning of four key traits and the behavioral facets comprising them, the associated behaviors that are displayed and what effect these have on nursing care delivery. Implications for healthcare practice include the potential for further research that can inform the development of educational and recruitment strategies for older people’s nurses which will have a positive impact on the care of the older patient in hospital.

scholarly journals Building a Clinically Relevant Risk Model: Predicting Risk of a Potentially Preventable Acute Care Visit for Patients Starting Antineoplastic Treatment

2020 ◽  
pp. 275-289 ◽  
Author(s):  
Bobby Daly ◽  
Dmitriy Gorenshteyn ◽  
Kevin J. Nicholas ◽  
Alice Zervoudakis ◽  
Stefania Sokolowski ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Care ◽  
Web Application ◽  
Risk Model ◽  
Care Delivery ◽  
Statistical Significance ◽  
Patient Specific ◽  
Cancer Center ◽  
Management Interventions ◽  
Care Visit

PURPOSE To create a risk prediction model that identifies patients at high risk for a potentially preventable acute care visit (PPACV). PATIENTS AND METHODS We developed a risk model that used electronic medical record data from initial visit to first antineoplastic administration for new patients at Memorial Sloan Kettering Cancer Center from January 2014 to September 2018. The final time-weighted least absolute shrinkage and selection operator model was chosen on the basis of clinical and statistical significance. The model was refined to predict risk on the basis of 270 clinically relevant data features spanning sociodemographics, malignancy and treatment characteristics, laboratory results, medical and social history, medications, and prior acute care encounters. The binary dependent variable was occurrence of a PPACV within the first 6 months of treatment. There were 8,067 observations for new-start antineoplastic therapy in our training set, 1,211 in the validation set, and 1,294 in the testing set. RESULTS A total of 3,727 patients experienced a PPACV within 6 months of treatment start. Specific features that determined risk were surfaced in a web application, riskExplorer, to enable clinician review of patient-specific risk. The positive predictive value of a PPACV among patients in the top quartile of model risk was 42%. This quartile accounted for 35% of patients with PPACVs and 51% of potentially preventable inpatient bed days. The model C-statistic was 0.65. CONCLUSION Our clinically relevant model identified the patients responsible for 35% of PPACVs and more than half of the inpatient beds used by the cohort. Additional research is needed to determine whether targeting these high-risk patients with symptom management interventions could improve care delivery by reducing PPACVs.

scholarly journals Engaging with EPIO, a digital pain self-management program: A qualitative study

2021 ◽  
Author(s):  
Katrine Bostrøm ◽  
Cecilie Varsi ◽  
Hilde Eide ◽  
Elin Børøsund ◽  
Olof B Kristjansdottir ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Intervention Program ◽  
Management Program ◽  
Cognitive Behavioral ◽  
Phone Call ◽  
Self Management ◽  
Structured Interviews ◽  
Management Intervention ◽  
Management Interventions ◽  
Chronic Pain Conditions

Abstract Background:Chronic pain conditions entail significant personal and societal burdens and improved outreach of evidence-based pain self-management programs are needed. Digital cognitive-behavioral self-management interventions have shown promise. However, evidence is still scarce and several challenges with such interventions for chronic pain exist. Exploring patients' experiences and engagement with digital interventions may be an essential step towards developing meaningful digital self-management interventions for those living with chronic pain. Objectives:This study aimed to gain insight into the experiences of people with chronic pain when engaging with EPIO, an application (app)-based cognitive-behavioral pain self-management intervention program.Methods: Participants (N=50) living with chronic pain received access to the EPIO intervention for 3 months. During this time, all participants received a follow-up phone call at 2-3 weeks, and a subsample (n=15) also participated in individual semi-structured interviews after 3 months. A qualitative design was used and thematic analysis was employed aiming to capture participants’ experiences when engaging with the EPIO intervention program. Results:Findings identifying program-related experiences and engagement were organized into three main topics, each with three sub-themes: (1) Engaging with EPIO; motivation to learn, fostering joy and enthusiasm, and helpful reminders and personalization, (2) Coping with pain in everyday life; awareness, practice and using EPIO, and (3) The value of engaging with the EPIO program; EPIO – a friend, making peace with the presence of pain, and fostering communication and social support. Conclusions: The current study explored participants’ experiences and engagement with EPIO, a digital self-management intervention program for people living with chronic pain. Findings highlighted identifying valued aspects related to motivation for engagement, incorporating content in support of daily coping, and encouraging a sense of acceptance and relatedness as vital components for facilitating program engagement.Trial Registration: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104

scholarly journals Development of an eHealth programme for self-management of persistent physical symptoms: a qualitative study on user needs in general practice

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mette Trøllund Rask ◽  
Pernille Ravn Jakobsen ◽  
Jane Clemensen ◽  
Marianne Rosendal ◽  
Lisbeth Frostholm
Keyword(s):  
General Practice ◽  
Qualitative Study ◽  
Physical Symptoms ◽  
Self Management ◽  
Structured Interviews ◽  
Patient Interviews ◽  
Mapping Strategy ◽  
Management Interventions ◽  
Self Help ◽  
Key Issues

Abstract Background Persistent physical symptoms (PPS) are estimated to be present in 17% of patients in general practice. Hence, general practitioners (GPs) play a key role in both the diagnostic assessment and the management of PPS. However, research indicates a need to improve their strategies to support self-help in patients, and eHealth tools may serve as an opportunity. This study aimed to explore patients’ and GPs’ needs related to self-management of PPS. The study was designed to inform the future development of eHealth interventions in this field. Methods This qualitative study was based on 20 semi-structured interviews (6 GPs and 14 patients with PPS). Interviews were audiotaped, transcribed verbatim and analysed through a five-step thematic analysis approach. First, we conducted an inductive analysis to identify and explore emerging subthemes. Second, using a deductive mapping strategy, we categorised the derived subthemes according to the COM-B behaviour change model and its three domains: capability, opportunity and motivation. Results We identified eleven subthemes in the patient interviews and seven subthemes in the GP interviews. Several unmet needs emerged. First, we identified a need to consider PPS early in the illness trajectory by taking a bio-psycho-social approach. Second, both patients and GPs need better skills to manage uncertainty. Third, hope is important for the patients. Fourth, patients need guidance from their GP in how to self-manage their PPS. Conclusions This study provides important insight into key issues and needs related to capability, opportunity and motivation that should be addressed in the design of future eHealth self-management interventions targeting patients with PPS in general practice in order to support and improve care.

Assessing person-centered care readiness at a cancer system level through a provincial environmental scan in Ontario.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 70-70
Author(s):  
Lesley Moody ◽  
Jorge Navarro ◽  
Esther Green ◽  
Laura Macdougall ◽  
Simron Singh
Keyword(s):  
Cultural Change ◽  
Corporate Strategy ◽  
Care Delivery ◽  
Advisory Council ◽  
System Level ◽  
Evaluation Methodology ◽  
Institute Of Medicine ◽  
Structured Interviews ◽  
Cultural Resistance ◽  
Centered Care

70 Background: Cancer Care Ontario (CCO) is an Ontario government agency which drives quality and improvement for the Ontario cancer system. Person-Centred Care (PCC) has been an identified goal both from the recent Institute of Medicine (IOM) report and as a corporate strategic priority at CCO. CCO is assessing the degree of PCC practiced in Ontario’s Cancer system to design interventions to improve this aspect of care delivery and design. Currently no established or validated indicators for PCC have been tested and evaluation methodology of PCC is unclear. A baseline of the system’s focus on PCC is required to establish a provincial plan to drive quality improvement. Methods: A series of 14 semi-structured interviews were conducted at Ontario’s regional cancer centers (RCCs) to determine the degree of development of a PCC culture in Ontario’s cancer system. Interviews were conducted with all 14 Regional Cancer Programs (RCPs) including: - 10 Patient and Family Advisors (PFAs); and - 56 RCPs and hospital leaders (Directors, Managers, Physicians, Nursing, Psychosocial Oncology providers). Sixty-six participants (direct interviews/questionnaires) were interviewed; questionnaires were received from 28 organizations (hospitals/RCCs). Results: Although 86% of interviewed organizations reported having a PCC corporate strategy, 41% of hospitals and 73% of RCCs do not have dedicated staff to support the strategy. 53% of organizations work with a Patient and Family Advisory Council (PFAC) and only 43% engage PFAs in decision-making tables with 94% of RCPs expressing a need for guidance on PFA engagement. Key facilitators to promote PCC are: strong and committed leadership and continuous staff engagement/education. Primary barriers include: equity in PFA recruitment, cultural resistance to PCC, and lack of evaluation frameworks. Conclusions: Advancing PCC requires strong provincial direction, training to foster PFA engagement, and measurement and accountability frameworks for cultural change. Clear definitions on accountabilities for PCC roles and expectations for PFAs and staff are also key to supporting PCC regionally.

scholarly journals Self-management Support in Primary Care Practice: the Development of a Conceptual Model Using a Qualitative Approach

2021 ◽  
Author(s):  
Lotte Timmermans ◽  
Dagje Boeykens ◽  
Mustafa Muhammed Sirimsi ◽  
Peter Decat ◽  
Veerle Foulon ◽  
...  
Keyword(s):  
Primary Care ◽  
Conceptual Model ◽  
Healthcare Professionals ◽  
Primary Care Practice ◽  
Self Management ◽  
Care Practice ◽  
Management Support ◽  
Structured Interviews ◽  
Chronic Patients ◽  
Management Interventions

Abstract BackgroundCoping with a chronic disease can be really challenging. Self-management represents a promising strategy to improve daily life experiences. The role of primary healthcare professionals cannot be underestimated in supporting self-management. Due to a shortage of theory, implementation of self-management support is hindered in primary care practice. The aim of this study is to create a conceptual model for self-management support by analysing patients’ care experiences towards self-management support. MethodsAn explorative-descriptive qualitative study was conducted in Flanders, Belgium. Semi-structured interviews were performed with 16 patients and their informal caregiver (dyads) using a purposive sampling strategy and processed by an inductive content analysis. ResultsInterviews revealed in-depth insights into patients’ care experiences. A conceptual model was developed for primary care practice, including five fundamental tasks for healthcare professionals - Supporting, Involving, Listening, Coordinating and Questioning (SILCQ) – contributing to the support of self-management of chronic patients.ConclusionThis qualitative paper emphasises the use of the SILCQ-model to develop optimal roadmaps and hands-on toolkits for healthcare professionals to support self-management. The model needs to be further explored by all stakeholders to support the development of self-management interventions in primary care practice.

scholarly journals Development of a cancer pain self-management resource to address patient, provider, and health system barriers to care

2019 ◽  
Vol 17 (04) ◽  
pp. 472-478
Author(s):  
Tim Luckett ◽  
Patricia M. Davidson ◽  
Anna Green ◽  
Natalie Marie ◽  
Mary-Rose Birch ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Health System ◽  
Online Survey ◽  
Care Delivery ◽  
Controlled Trial ◽  
Management Plan ◽  
Audit And Feedback ◽  
Self Management ◽  
Provider Education ◽  
Management Interventions

AbstractObjectiveThe majority of self-management interventions are designed with a narrow focus on patient skills and fail to consider their potential as “catalysts” for improving care delivery. A project was undertaken to develop a patient self-management resource to support evidence-based, person-centered care for cancer pain and overcome barriers at the levels of the patient, provider, and health system.MethodThe project used a mixed-method design with concurrent triangulation, including the following: a national online survey of current practice; two systematic reviews of cancer pain needs and education; a desktop review of online patient pain diaries and other related resources; consultation with stakeholders; and interviews with patients regarding acceptability and usefulness of a draft resource.ResultFindings suggested that an optimal self-management resource should encourage pain reporting, build patients’ sense of control, and support communication with providers and coordination between services. Each of these characteristics was identified as important in overcoming established barriers to cancer pain care. A pain self-management resource was developed to include: (1) a template for setting specific, measureable, achievable, relevant and time-bound goals of care, as well as identifying potential obstacles and ways to overcome these; and (2) a pain management plan detailing exacerbating and alleviating factors, current strategies for management, and contacts for support.Significance of resultsSelf-management resources have the potential for addressing barriers not only at the patient level, but also at provider and health system levels. A cluster randomized controlled trial is under way to test effectiveness of the resource designed in this project in combination with pain screening, audit and feedback, and provider education. More research of this kind is needed to understand how interventions at different levels can be optimally combined to overcome barriers and improve care.

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