Testicular cancer management: Population-wide, rapid case ascertainment to drive early expert engagement and reduced practice variation.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 39-39
Author(s):  
Andrea Harzstark ◽  
Lisa J. Herrinton ◽  
Lauren C. Walker ◽  
Liyan Liu ◽  
Tatjana Kolevska ◽  
...  
Keyword(s):  
Decision Making ◽  
Testicular Cancer ◽  
Care Delivery ◽  
Research Priorities ◽  
Practice Variation ◽  
Practice Change ◽  
Cancer Management ◽  
Case Ascertainment ◽  
Early Results ◽  
Expert Team

39 Background: Research priorities in germ cell tumor (GCT) management have moved sharply from therapeutic improvements to cancer care delivery research and biomarker-based decision making. Early intervention with centralized decision support and oversight by expert teams result in best therapeutic outcomes and survivorship with decreased resource utilization. We describe Kaiser Permanente Northern California’s (KPNC) re-organization of care delivery through rapid case ascertainment and early expert input, as well as early results of reduction in practice variation and system-wide practice change. Methods: In 2016, KPNC reorganized oncology from a distributed generalist model to a model led by a centralized multidisciplinary expert team to share in initial and ongoing care delivery for all GCT patients in the system. Central to the re-organization was rapid ascertainment of the entire population of patients with GCT within the system and early expert engagement in treatment decision-making. Results: Between May 2016 and June 2018, 274 GCT patients were recorded in the tumor registry, of whom 69% were < 40 years of age, 16% were non-white, 56% had seminoma and 63% had stage 1 disease. Rapid case ascertainment identified 89% (95% CI, 86-93%) of the cases, increasing from 79% in 2016 to 97% in 2018 as false negatives were identified and used to improve the case finding algorithm. The overall positive predictive value was 57% (52-62%) and number needed to detect was 1.75 (1.62-1.91). Of the 274 cases, 92% (89-95%) were engaged by the expert team. In addition, the team reviewed 61 testicular cancer patients who had recurrences or metastatic cancers. Among 177 patients with stage I seminoma, the preferred use of active surveillance over adjuvant chemotherapy or radiation therapy rose from 48% (95% CI, 35-62%) in 2015 to 87% (75-99%) in 2018 (p = 0.0005). For patients with nonseminoma, the rate of the preferred option of retroperitoneal lymphadenectomies being performed by a high volume urologic surgeon increased markedly from 62% in 2015 to 95% in 2018. Conclusions: To our knowledge, the KPNC re-organization of GCT care delivery with comprehensive rapid case ascertainment is unique for integrated health care delivery systems in the USA. While early, KPNC has a working platform for early, expert multidisciplinary review and bidirectional communication with local care teams for population-based care. Early evidence points to system-wide reductions in practice variation and improvements in practice.

scholarly journals Engaging Multidisciplinary Stakeholders to Drive Shared Decision-Making in Oncology

2018 ◽  
Vol 34 (1) ◽  
pp. 29-31 ◽  
Author(s):  
Gabrielle Rocque ◽  
Ellen Miller-Sonnet ◽  
Alan Balch ◽  
Carrie Stricker ◽  
Josh Seidman ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Best Practices ◽  
Shared Decision Making ◽  
Best Practice ◽  
Care Delivery ◽  
Evidence Based ◽  
Shared Decision ◽  
Oncology Practice ◽  
Development And Validation

Although recognized as best practice, regular integration of shared decision-making (SDM) approaches between patients and oncologists remains an elusive goal. It is clear that usable, feasible, and practical tools are needed to drive increased SDM in oncology. To address this goal, we convened a multidisciplinary collaborative inclusive of experts across the health-care delivery ecosystem to identify key principles in designing and testing processes to promote SDM in routine oncology practice. In this commentary, we describe 3 best practices for addressing challenges associated with implementing SDM that emerged from a multidisciplinary collaborative: (1) engagement of diverse stakeholders who have interest in SDM, (2) development and validation of an evidence-based SDM tool grounded within an established conceptual framework, and (3) development of the necessary roadmap and consideration of the infrastructure needed for engendering patient engagement in decision-making. We believe these 3 principles are critical to the success of creating SDM tools to be utilized both within and outside of clinical practice. We are optimistic that shared use across settings will support adoption of this tool and overcome barriers to implementing SDM within busy clinical workflows. Ultimately, we hope that this work will offer new perspectives on what is important to patients and provide an important impetus for leveraging patient preferences and values in decision-making.

scholarly journals PRIORITIZATION OF QUALITY CARE CRITERIA TO DELIVER QUALITY SERVICE USING DEMATEL

2015 ◽  
Vol 11 (2) ◽  
Author(s):  
Raja Rub Nawaz ◽  
Keyword(s):  
Decision Making ◽  
Graphical Representation ◽  
Care Delivery ◽  
Quality Care ◽  
Healthcare Services ◽  
Theory Approach ◽  
Quality Service ◽  
Course Of Action ◽  
Importance Ratings ◽  
Multiple Variables

Purpose:-Hospitals are very vital as an element in Quality Care delivery and their evaluation in these terms on perpetual basis are much needed as these organizations contribute in improving health outcomes for general people. Hospitals, especially privately owned, are also run like businesses these days to remain competitive in the respective arena. The environment and situation faced by many hospitals are often complicated and which definitely requires insightful solutions to steer the direction of these businesses. This study was focused on the application of group decision-making tool, DEMATEL as one of the valid methods in Multi-Criteria Decision Making (MCDM). Methodology:- The study was exploratory in nature and efforts were made to justify by highlighting the criteria prioritization procedure to be undertaken by any healthcare organization. A slight deviation from the standard four-steps of DEMATEL, a course of action was created in the shape of an eight-step procedure to exhibit a practical approach rather than mathematical theory approach. In order to make it more empirical in nature, a five-stage research framework was also devised and acted upon with the help of three separate questionnaires. Avedis Donabedian’s (1988) Quality Care framework was followed and multiple variables were devised, importance ratings were collected from patients on these devised variables and after reduction of variables in to manageable latent factors, called criteria in the study, DEMATEL method was applied to depict the prioritization of Quality Care criteria for the delivery of quality service via digraph. Findings:-The graphical representation through digraph showed that criteria were vertically divided in two halves as C1, C5, and C4 are shown as criteria influencing the lower half criteria C3, C6, and C2. The horizontal span of digraph reflected the importance of criteria prioritized and showed C1 criterion as the most important and C2 criterion with the least importance. Implications:-The prioritization of the criteria along with their cause and effect distribution gave an insight into the constitution framework of localized healthcare services of Karachi, Pakistan

scholarly journals Patient Engagement Approaches in Total Joint Arthroplasty: A Review of Two Decades

2021 ◽  
Vol 8 ◽  
pp. 237437352110365
Author(s):  
Aaron Alokozai ◽  
David N. Bernstein ◽  
Linsen T. Samuel ◽  
Atul F. Kamath
Keyword(s):  
Decision Making ◽  
Patient Engagement ◽  
Total Joint Arthroplasty ◽  
Remote Monitoring ◽  
Patient Involvement ◽  
Care Delivery ◽  
Joint Arthroplasty ◽  
Virtual Rehabilitation ◽  
The Past ◽  
Future Work

Patient engagement is a comprehensive approach to health care where the physician inspires confidence in the patient to be involved in their own care. Most research studies of patient engagement in total joint arthroplasty (TJA) have come in the past 5 years (2015-2020), with no reviews investigating the different patient engagement methods in TJA. The primary purpose of this review is to examine patient engagement methods in TJA. The search identified 31 studies aimed at patient engagement methods in TJA. Based on our review, the conclusions therein strongly suggest that patient engagement methods in TJA demonstrate benefits throughout care delivery through tools focused on promoting involvement in decision making and accessible care delivery (eg, virtual rehabilitation, remote monitoring). Future work should understand the influence of social determinants on patient involvement in care, and overall cost (or savings) of engagement methods to patients and society.

Part I: Testicular cancer—management of early disease

2003 ◽  
Vol 4 (12) ◽  
pp. 730-737 ◽  
Author(s):  
Robert H Jones ◽  
Paul A Vasey
Keyword(s):  
Testicular Cancer ◽  
Early Disease ◽  
Cancer Management

Identifying research priorities around psycho-cognitive and social factors for recovery from hip fractures: An international decision-making process

Injury ◽  
2018 ◽  
Vol 49 (8) ◽  
pp. 1466-1472 ◽  
Author(s):  
Mohammad Auais ◽  
Simon D. French ◽  
Lauren Beaupre ◽  
Lora Giangregorio ◽  
Jay Magaziner
Keyword(s):  
Decision Making ◽  
Hip Fractures ◽  
Social Factors ◽  
Research Priorities ◽  
Decision Making Process

Getting It Wrong Most of The Time: Comparing Trialists’ Choice of Primary Outcome With What Patients And Health Professionals Want

2021 ◽  
Author(s):  
Shaun Treweek ◽  
Viviane Miyakoda ◽  
Dylan Burke ◽  
Frances Shiely
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Health Care Professionals ◽  
Primary Outcome ◽  
Healthcare Professionals ◽  
Breast Cancer Patients ◽  
Additional Information ◽  
Cancer Management ◽  
Breast Cancer Management ◽  
Secondary Outcomes

Abstract Background: Randomised trials support improved decision-making through the data they collect. One important piece of data is the primary outcome – so called because it is what the investigators decide is the most important. Secondary outcomes provide additional information to support decision-making. We were interested in knowing how important patients and healthcare professionals consider the outcomes (especially the primary outcome) measured in a selection of published trials. Methods: The work had three stages: 1. We identified a body of late-stage trials in two clinical areas, breast cancer management and nephrology. 2. We identified the primary and secondary outcomes for these trials. 3. We randomly ordered these outcomes and presented them to patients and healthcare professionals (with experience of the clinical area), and we asked them to rank the importance of the outcomes. They were not told which outcomes trial authors considered primary and secondary. Results: In our sample of 44 trials with 46 primary outcomes, 29 patients, one patient representative and 12 healthcare professionals together ranked the primary outcome as the most important outcome 13/46 times, or 30%. Breast cancer patients and health care professionals considered the primary outcome to be the most important outcome for 8/21 primary outcomes chosen by trialists. For nephrology, the equivalent figure was 5/25. The primary outcome appeared in a respondent’s top 5 ranked outcomes 151/178 (85%) times for breast cancer and 225/259 (87%) times for nephrology even if the primary wasn’t considered the most important outcome. Conclusions: The primary outcome in a trial is the most important piece of data collected. It is used to determine how many participants are required, and it is the main piece of information used to judge whether the intervention is effective or not. Our study found that in the view of patients and healthcare professionals, teams doing trials in breast cancer management and nephrology got their choice of primary outcome wrong 70% of the time.

Intelligent Portals for Supporting Medical Information Needs

Web Portals ◽  
2011 ◽  
pp. 270-296 ◽  
Author(s):  
Jane Moon ◽  
Frada Burstein
Keyword(s):  
Decision Making ◽  
Web Sites ◽  
Information Seeking ◽  
Information Needs ◽  
Medical Information ◽  
Care Delivery ◽  
Internet Usage ◽  
Medical Decisions ◽  
Community Information ◽  
Decision Making Processes

The aim of this chapter is to review the way portal technology can assist users seeking medical information. There has been an increase in health Internet usage, and better health-care delivery outcomes are predicted as users are better informed when making medical decisions. At the same time, there is much concern about the need for medical portals to meet community information needs. This chapter discusses what constitutes an intelligent portal, discusses desirable portal components and attributes of intelligent portal features, and how these can be implemented to meet the needs of diverse users. Seven Australian medical Web sites have been analysed according to intelligence features. The results and analysis are presented and discussed, in particular, with respect to their functionality as defined for intelligent portals. The discussion is focused on the extent to which these attributes help users with their information seeking and therefore support their decision-making processes.

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