Interdisciplinary clinician perspectives on an embedded palliative oncology model in pediatric cancer care.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 9-9
Author(s):  
Marta Salek ◽  
Cameka Woods ◽  
Jami S. Gattuso ◽  
Belinda Neal Mandrell ◽  
Justin N. Baker ◽  
...  
Keyword(s):  
Palliative Care ◽  
Focus Groups ◽  
Pediatric Cancer ◽  
Cancer Care ◽  
Care Delivery ◽  
Care Model ◽  
Structured Care ◽  
Embedded Model ◽  
Clinician Perspectives ◽  
Oncology Providers

9 Background: Integration of palliative care into cancer care is recognized as best practice by international oncology and pediatrics organizations. However, optimal strategies for integration of pediatric palliative care (PPC) within cancer care remain understudied. While the majority of PPC provision for cancer patients occurs through subspeciality consultation, growing evidence suggests that models embedding PPC within cancer care have the potential to improve quality of care. Embedded models rely on partnerships with multidisciplinary clinicians, whose perspectives regarding this model are not well known. Methods: We conducted 25 focus groups with 175 clinicians in an academic pediatric cancer center, with groups stratified by discipline (physicians, advance practice providers (APPs), nurses, psychosocial providers) and by care team (hematologic malignancy, bone marrow transplant, solid tumor, brain tumor). Focus groups were led by trained research facilitators and audio-recorded for subsequent targeted content analysis to identify clinician perspectives regarding embedded PPC models. Results: Across 4 physician, 5 APP, 12 nurse, and 4 psychosocial focus groups, 25 physicians, 30 APPs, 71 nurses, and 49 psychosocial providers participated, respectively. When asked to describe features of an “ideal” PPC model, physicians, APPs, and nurses predominantly discussed care delivery and identified early integration of PPC into cancer care as a core feature of an ideal model. Physicians, nurses, and psychosocial providers also emphasized the importance of having a formalized, structured care model. The need for collaboration was the dominant theme for psychosocial providers. Clinicians in all disciplines identified potential benefits from an embedded model, including access to PPC across care settings, normalization of PPC integration, and emphasis on collaboration, teamwork, communication, and earlier PPC involvement. Physicians, APPs, and nurses anticipated similar challenges with an embedded model, including possible reticence of oncology providers and inadequate PPC staffing. Nurses, APPs, and psychosocial providers also voiced concern about potential lack of clarity in delegation of roles and responsibilities between PPC and oncology providers. Conclusions: Pediatric oncology multidisciplinary providers recognize the potential value of an embedded model for integration of PPC in the care of children with cancer. Though providers at times identified similar themes with respect to ideal PPC provision and the benefits and challenges to an embedded model, some identified priorities varied by discipline. These findings highlight the importance of integrating varied interdisciplinary perspectives when developing an embedded care model to align with priorities of diverse pediatric cancer stakeholders.

scholarly journals What are the opportunities for cancer care and related research in primary care? A qualitative study of the views of patients, carers, and practice staff

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703505
Author(s):  
Joseph Clark ◽  
Elvis Amoakwa ◽  
John Blenkinsopp ◽  
Florence Reedy ◽  
Miriam Johnson
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Cancer Care ◽  
Information Needs ◽  
Controlled Trial ◽  
Unmet Need ◽  
Care Staff ◽  
Trial Participation

BackgroundResearch to identify the role of primary care in cancer care is important. However, trials in primary care are difficult.AimTo understand how patients, families, and primary care clinicians view their role in cancer care and identify opportunities for cancer primary care research.MethodQualitative study embedded within a feasibility cluster randomised controlled trial of a primary care based needs assessment intervention. The Supportive Cancer Needs Survey (SCNS) was the main outcome. In-depth interviews with patients/carers and focus groups with primary care staff explored views on cancer care and trial participation. Data were recorded, transcribed verbatim, and analysed thematically by three independent researchers.ResultsFifteen cancer patients and three carers were interviewed and four focus groups (n = 11) were conducted. Three themes were generated satisfaction with current care; key time-points for improved cancer care; and information and research. Satisfaction with current care among patients was high in spite of 72% reporting at least one moderate-high unmet need at baseline. Most patients undergoing cancer treatment were unsure when to access primary care. Patients and carers highly valued proactive contact from their practice following diagnosis though this was uncommon. Post-oncology discharge was a key time-point for information needs and support for patients. Patients were reluctant to consider palliative care in spite of palliative care needs. Some felt therapeutic benefit from completing study measures.ConclusionPatients are satisfied with cancer primary care despite unmet needs. Palliative care is poorly understood by many who may benefit. Research participation may benefit some patients.

Evaluation of the efficiency of an embedded palliative nurse practitioner in an oncology clinic.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 146-146
Author(s):  
Anne M. Walling ◽  
Sarah D'Ambruoso ◽  
Christopher Pietras ◽  
Jennifer Malin ◽  
Sara A. Hurvitz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nurse Practitioner ◽  
Care Delivery ◽  
Symptom Assessment ◽  
Fee For Service ◽  
Model Of Care ◽  
Time Motion ◽  
Motion Study ◽  
Embedded Model ◽  
One Year

146 Background: We embedded a palliative nurse practitioner in 2 oncologists’ clinics in March 2014 using a reproducible training program. After one year, patients with advanced cancer receiving care in the embedded model clinics, compared to other oncologists’ clinics, were more likely to have advance care planning performed and to die receiving hospice. In order to expand the intervention to other oncologists, we evaluated the efficiency in our model of care delivery. Methods: We reviewed overall caseload and a subset of patient encounters in depth to understand how much of the NP's practice could be conducted by other staff to inform alternate clinical models of palliative care delivery in an oncology clinic. Overall time spent and time spent per task (Symptom Assessment Basic (SAB), Symptom Assessment Medical (SAM), Symptom Assessment Psychosocial (SAP), Communication Basic (CB), Communication Complex (CC)) was recorded for 16 patient encounters. We also completed 3 days of time motion study in which a trained observer tracked the NP's daily activities from minute to minute. Results: After part-time clinical participation over the first year of the program, the NP had seen 68 initial consults and 141 follow-up consults, which were potentially billable. She also had 120 encounters where she met a patient with an oncologist and 158 email or phone encounters that were not billable. Mean duration of a visit was 56 minutes (range 40-70 minutes) and about half of this time was spent on symptom assessment and communication topics requiring an MD or NP (SAM and CC), whereas half of the time was spent on topics that potentially could be covered by an RN (SAB or CB) or an MSW (SAB, SAP, CB). Time motion study revealed that a significant amount of time was spent with email correspondence and talking with other providers for care coordination. Conclusions: Palliative care is time consuming and much of the work is not reimbursed by a traditional fee for service model. Approximately half of the time spent by the NP in our embedded program potentially could have been completed by an RN or other interdisciplinary staff with training in palliative care under supervision of a physician. We plan to add an RN case management component to our model of care delivery.

Areas for quality improvement in pediatric supportive oncology services.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e22022-e22022
Author(s):  
Jennifer Reichek ◽  
Christine B. Weldon ◽  
Rani Ganesan ◽  
Eugene Suh ◽  
Dipti Dighe ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pediatric Cancer ◽  
Cancer Care ◽  
Care Delivery ◽  
Institute Of Medicine ◽  
Supportive Services ◽  
Care Community ◽  
Pediatric Cancer Patients ◽  
Survey Results ◽  
Supportive Oncology

e22022 Background: In 2013, the Institute of Medicine report recommended that supportive oncology services be initiated at time of diagnosis. Providers of pediatric cancer care in the Chicagoland community, supported by The Coleman Foundation, sought to define areas for quality improvement of supportive oncology delivery to children. Methods: Focus groups and surveys with clinicians providing pediatric cancer care and supportive services at 14 sites were used to prioritize areas needing improvement. Results: 100% (14/14) of sites participated. Of the eligible sites, 6 were pediatric cancer treatment sites and 8 cancer care community organizations. Sites demonstrated consistent agreement for 8 of the 12 areas of focus for improvement. Over 50% of sites reported areas of focus (table) as important or very important. Conclusions: Sites identified the need for quality improvement in delivery of psychosocial, survivorship and palliative care for pediatric cancer patients. Survey results demonstrate a need for collaboration and efforts to guide care delivery improvement across sites. [Table: see text]

scholarly journals A qualitative exploration of interactional and organizational determinants of collaboration in cancer palliative care settings: Family members’, health care professionals’ and key informants’ perspectives

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0256965
Author(s):  
Marco Bennardi ◽  
Nicola Diviani ◽  
Georg Stüssi ◽  
Piercarlo Saletti ◽  
Claudia Gamondi ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Focus Groups ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Family Members ◽  
Personal Characteristics ◽  
Social Needs ◽  
Framework Analysis ◽  
Key Informants

As life expectancy has increased, a growing number of people experience conditions, including cancers, that carry complex health and social needs. Palliative care services have the potential to address these needs but face significant obstacles. One major obstacle is suboptimal interprofessional collaboration. This study’s goal was an in-depth exploration of interactional and organizational barriers and supports of collaboration in palliative care in Switzerland. We sought the perspectives of health care professionals, patients’ family members and leaders and experts in oncology/palliative care delivery (key informants) through interviews and focus groups with fifty HPs and key informants and ten patients’ family members. Qualitative analyses of interviews and focus groups used framework analysis. We identified three major themes of interaction: personal characteristics, communication, and connectedness with other health care professionals; and three major organizational themes: service characteristics, standardized communication and processes, and service coordination and promotion. Based on our findings, we recommend that health care professionals consider strategies to increase their collaboration and communication skills and opportunities to interact. We advocate the implementation of methods for coordinating services, standardization of consultation/referral procedures and communication between health care professionals, and the promotion of underutilized services to foster successful, sustainable collaboration.

scholarly journals Impact of COVID-19 on Cancer Care Delivery in Africa: A Cross-Sectional Survey of Oncology Providers in Africa

2021 ◽  
pp. 368-377
Author(s):  
Yehoda M. Martei ◽  
Tara J. Rick ◽  
Temidayo Fadelu ◽  
Mohammed S. Ezzi ◽  
Nazik Hammad ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
Clinical Care ◽  
Small Sample ◽  
Treatment Modalities ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Patients With Cancer ◽  
Income Groups ◽  
Oncology Providers

PURPOSE The COVID-19 pandemic has disrupted cancer care globally. There are limited data of its impact in Africa. This study aims to characterize COVID-19 response strategies and impact of COVID-19 on cancer care and explore misconceptions in Africa. METHODS We conducted a web-based cross-sectional survey of oncology providers in Africa between June and August 2020. Descriptive statistics and comparative analysis by income groups were performed. RESULTS One hundred twenty-two participants initiated the survey, of which 79 respondents from 18 African countries contributed data. Ninety-four percent (66 of 70) reported country mitigation and suppression strategies, similar across income groups. Unique strategies included courier service and drones for delivery of cancer medications (9 of 70 and 6 of 70, respectively). Most cancer centers remained open, but > 75% providers reported a decrease in patient volume. Not previously reported is the fear of infectivity leading to staff shortages and decrease in patient volumes. Approximately one third reported modifications of all cancer treatment modalities, resulting in treatment delays. A majority of participants reported ≤ 25 confirmed cases (44 of 68, 64%) and ≤ 5 deaths because of COVID-19 (26 of 45, 58%) among patients with cancer. Common misconceptions were that Africans were less susceptible to the virus (53 of 70, 75.7%) and decreased transmission of the virus in the African heat (44 of 70, 62.9%). CONCLUSION Few COVID-19 cases and deaths were reported among patients with cancer. However, disruptions and delays in cancer care because of the pandemic were noted. The pandemic has inspired tailored innovative solutions in clinical care delivery for patients with cancer, which may serve as a blueprint for expanding care and preparing for future pandemics. Ongoing public education should address COVID-19 misconceptions. The results may not be generalizable to the entire African continent because of the small sample size.

Effective Communication for Newly Diagnosed Pediatric Patients With Cancer: Considerations for the Patients, Family Members, Providers, and Multidisciplinary Team

2019 ◽  
pp. 573-581 ◽  
Author(s):  
Sarah Dobrozsi ◽  
Amy Trowbridge ◽  
Jennifer W. Mack ◽  
Abby R. Rosenberg
Keyword(s):  
Communication Skills ◽  
Pediatric Cancer ◽  
Multidisciplinary Team ◽  
Cancer Care ◽  
Care Delivery ◽  
Effective Communication ◽  
Well Being ◽  
Medical Team ◽  
High Quality ◽  
Personalized Care

Hearing that a child has been diagnosed with cancer is invariably difficult for both patients and their caregivers. Effective communication among patients, caregivers, and medical teams is necessary not only to deliver information and facilitate cancer care delivery but also to support patient and family coping and well-being. In this review, we focus on early communication in pediatric oncology care to (1) highlight the importance of communication between clinicians and patients and within the medical team and (2) describe resources and opportunities for clinicians to improve communication skills. For example, communication between patients and the medical team has several core functions, including the development of shared knowledge and decision-making and the formation of a therapeutic relationship. High-quality communication, regardless of the news being shared, supports and facilitates patient and parent adjustment to diagnosis, hope, and trust. Communication within the medical team supports the delivery of high-quality, personalized care. Despite these critical roles of communication in pediatric cancer care and evidence suggesting communication skills can be learned, formal training is limited. Resources include educational efforts, practical tools, and specific strategies to enhance systematic multidisciplinary team communication. Taken together, continued recognition of the importance of communication in pediatric cancer care has the potential to improve patient, family, and clinician experiences.

Cancer survivorship care in rural community: Provider perspective.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 50-50
Author(s):  
Katia Noyes ◽  
David Holub ◽  
Irfan Rizvi ◽  
Alex Swanger ◽  
Coty Reisdorf ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Group ◽  
Focus Groups ◽  
Multidisciplinary Team ◽  
Cancer Care ◽  
Financial Incentives ◽  
Primary Care Physicians ◽  
Performance Metrics ◽  
Care Delivery ◽  
Successful Implementation

50 Background: Advances in oncologic sciences have resulted in successful treatments for many cancers with improved survival for millions of patients. Efficient delivery of cancer care now requires not only skills and professionalism of each provider but also well-orchestrated performances of multiple oncology, primary care and social services providers acting as one multidisciplinary team. It is unknown, however, whether providers are prepared for and accept their new roles in patient cancer care teams across region. This study assessed perspectives of providers involved in care for patients with cancer about their changing roles. Methods: We conducted a focus group with a diverse group of stakeholders involved in cancer care (2 primary care physicians, 1 rural surgeon, 2 rural oncologists, 2 oncology nurses, 2 cancer patients and a caregiver). The focus group was conducted using ThinkTank software, a collaborative tool that allows participants to communicate virtually in real time, screen share, express preferences and confidentially rank each other responses. We also conducted two traditional focus groups with rural care managers, nurses, social workers and public health providers. Results: The focus groups identified significant differences in attitudes and beliefs toward regional team-based cancer care between various providers. PCPs ranked oncology issues as less important to their practices compared to other chronic conditions associated with performance metrics and financial incentives. APPs ranked care coordination issues as more important compared to PCP rankings from the same practices. Rural providers identified limited staffing, outdated health IT systems, and lack of expertise as major barriers to multidisciplinary team care. Both patients and providers highlighted importance of trust and face-to-face communication in treatment adherence and choice of care setting. Conclusions: Current health information systems, performance metrics and payment models represent significant barriers to integrated care delivery in oncology and survivorship. Successful implementation of efficient and sustainable regional oncology program will require a multi-dimensional intervention to address each of these barriers.

Patterns of healthcare utilization in patients with newly diagnosed advanced lung cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18386-e18386
Author(s):  
Emily Miller Ray ◽  
Sharon Peacock Hinton ◽  
Katherine Elizabeth Reeder-Hayes
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Intensive Care ◽  
Healthcare Utilization ◽  
Cancer Care ◽  
Care Delivery ◽  
Small Cell ◽  
Advanced Lung Cancer ◽  
Newly Diagnosed ◽  
Index Hospitalization

e18386 Background: Advanced lung cancer (ALC) is a symptomatic disease that is often diagnosed in the context of hospitalization. The index hospitalization may be a window of opportunity to improve cancer care delivery. We aimed to define the frequency of ALC diagnosis associated with hospitalization and the relationship to subsequent cancer care and readmissions. Methods: We identified patients in the SEER-Medicare database with: ALC (stage IIIB-IV non-small cell or small cell), diagnosed 2007 to 2013; with continuous enrollment in Medicare from 6 months prior to lung cancer diagnosis through death or 12/2014; and an index hospitalization within 7 days of their ALC diagnosis. Our primary outcomes of interest were 30-day re-hospitalization and emergency department (ED) use. We examined: utilization of services during index hospitalization, including intensive care and oncology or palliative care consultation; discharge destination; receipt of systemic therapy; and hospice enrollment. Results: Fifty-four percent (n = 28,976) of ALC patients had an index hospitalization, with 90% of those having their cancer diagnosed while hospitalized. During their index hospitalization, 16% had oncology consultation, and 6% had palliative care (PC) consultation. Thirty-three percent were in the intensive care unit. At discharge, 59% returned home, 8% died, and 11% went to hospice. Of those who survived to discharge, 69% later returned to the ED or were re-hospitalized, with 49% of re-hospitalizations and 35% of ED visits occurring within 30 days of the index hospitalization. Thirty-five percent of these patients eventually received systemic treatment for their cancer. By 180 days post-discharge, 77% had enrolled in hospice with a median of 10 days on hospice care. Conclusions: Newly diagnosed ALC patients are high risk for acute care utilization, and many patients experience a return to the hospital early in their cancer trajectory. These patients may benefit from additional health system support prior to hospital discharge to help prevent high-cost, low-value healthcare utilization.

Pediatric cancer care in Armenia: The results of a qualitative analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19002-e19002
Author(s):  
Saten Hovhannisyan ◽  
Ruzanna Papyan ◽  
Lilit Sargsyan ◽  
Samvel Danielyan ◽  
Lala Vagharshakyan ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
Pediatric Oncology ◽  
Pediatric Cancer ◽  
Multidisciplinary Team ◽  
Cancer Care ◽  
Care Center ◽  
High Dose ◽  
Pediatric Oncologist ◽  
The Government

e19002 Background: In Armenia the incidence of pediatric cancer accounts for around 80-100 cases per year. This qualitative study was conducted in 2018 to evaluate the needs and challenges in a provision of pediatric cancer care in Armenia. Comparative qualitative study was conducted in 2020 to evaluate the progress in the field. Methods: Qualitative research methods were incorporated to evaluate the achievements, needs and challenges in a provision of childhood cancer care in Armenia. Semi-structured in-depth interviews were conducted with selected study participants including pediatric oncologist/hematologists, pediatric surgeons, who also treat cancer patients, and radiation oncologists. Purposive sampling technique and qualitative conventional content analysis methods were used. Results: Data collected in January 2020 has shown significant improvements in the field of pediatric oncology in Armenia. In the 2018 study, some of the major issues included lack of centralized pediatric cancer care, pediatric cancer registry, palliative care center, possibility of providing high-dose methotrexate, limited nursing training, multidisciplinary team approaches and use of central catheters. Within two years, majority of these problems were solved or are in the process. In 2019 all 3 pediatric oncology and hematology units were merged and the Pediatric Cancer and Blood Disorders of Armenia was created; with the support from charitable foundations all children with cancer receive free medical and psychosocial coverage; a 25 year data has been collected from all the possible sites, the first pediatric cancer palliative care is under construction, 4 multidisciplinary cancer teams were created, pediatric oncology and hematology fellowship was created at the Yerevan State Medical University to prepare for the first time "pediatric oncologist-hematologist" as a one profession. The existing major problems include very limited provision of pediatric cancer medications by the government, as well as lack of the official registration of the number of essential drugs included in the WHO list. Conclusions: Twinning programs, multidisciplinary team discussions with international experts, improvement in availability of several resources, professional development of the staff are major tools for the progress of pediatric oncology in Armenia. Poor provision and official registration of anti-neoplastic medications by the government still remain a major obstacle.

scholarly journals Share of Oncology Versus Nononcology Spending in Episodes Defined by the Centers for Medicare & Medicaid Services Oncology Care Model

2018 ◽  
Vol 14 (11) ◽  
pp. e699-e710 ◽  
Author(s):  
James R. Baumgardner ◽  
Ahva Shahabi ◽  
Mark T. Linthicum ◽  
Christopher Zacker ◽  
Darius N. Lakdawalla
Keyword(s):  
Lung Cancer ◽  
Drug Therapy ◽  
Chronic Myeloid Leukemia ◽  
Cancer Care ◽  
Myeloid Leukemia ◽  
Small Cell ◽  
Care Model ◽  
Small Cell Lung ◽  
Oncology Care ◽  
Oncology Providers

Purpose: Performance-based payments to oncology providers participating in the Centers for Medicare & Medicaid Services (CMS) Oncology Care Model (OCM) are based, in part, on overall spending in 6-month episodes of care, including spending unrelated to oncology care. The amount of spending likely to occur outside of oncologists’ purview is unknown. Methods: Following the OCM definition of an episode, we used SEER-Medicare data from 2006 to 2013 to identify episodes of cancer care for the following diagnoses: breast cancer (BC), non–small-cell lung cancer, renal cell carcinoma, multiple myeloma (MM), and chronic myeloid leukemia. Claims were categorized by service type and, separately, whether the content fell within the purview of oncology providers (classified as oncology, with all other claims nononcology). We calculated the shares of episode spending attributable to oncology versus nononcology services. Results: The percentage of oncology spending within OCM episodes ranged from 62.4% in BC to 85.5% in MM. The largest source of oncology spending was antineoplastic drug therapy, ranging from 21.8% of total episode spending in BC to 67.6% in chronic myeloid leukemia. The largest source of nononcology spending was acute hospitalization and inpatient physician costs, ranging from 6.6% of overall spending for MM to 10.4% for non–small-cell lung cancer; inpatient oncology spending contributed roughly similar shares to overall spending. Conclusion: Most spending in OCM-defined episodes was attributable to services related to cancer care, especially antineoplastic drug therapy. Inability to control nononcology spending may present challenges for practices participating in the OCM, however.

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