scholarly journals Establishing Cancer Treatment Programs in Resource-Limited Settings: Lessons Learned From Guatemala, Rwanda, and Vietnam

2018 ◽  
pp. 1-14
Author(s):  
Claire M. Wagner ◽  
Federico Antillón ◽  
François Uwinkindi ◽  
Tran Van Thuan ◽  
Sandra Luna-Fineman ◽  
...  
Keyword(s):  
Clinical Education ◽  
Cancer Care ◽  
Care Delivery ◽  
Case Reports ◽  
Lessons Learned ◽  
Treatment Programs ◽  
Program Leaders ◽  
Policy Goals ◽  
Resource Limited ◽  
Health Care Delivery Systems

Purpose The global burden of cancer is slated to reach 21.4 million new cases in 2030 alone, and the majority of those cases occur in under-resourced settings. Formidable changes to health care delivery systems must occur to meet this demand. Although significant policy advances have been made and documented at the international level, less is known about the efforts to create national systems to combat cancer in such settings. Methods With case reports and data from authors who are clinicians and policymakers in three financially constrained countries in different regions of the world—Guatemala, Rwanda, and Vietnam, we examined cancer care programs to identify principles that lead to robust care delivery platforms as well as challenges faced in each setting. Results The findings demonstrate that successful programs derive from equitably constructed and durable interventions focused on advancement of local clinical capacity and the prioritization of geographic and financial accessibility. In addition, a committed local response to the increasing cancer burden facilitates engagement of partners who become vital catalysts for launching treatment cascades. Also, clinical education in each setting was buttressed by international expertise, which aided both professional development and retention of staff. Conclusion All three countries demonstrate that excellent cancer care can and should be provided to all, including those who are impoverished or marginalized, without acceptance of a double standard. In this article, we call on governments and program leaders to report on successes and challenges in their own settings to allow for informed progression toward the 2025 global policy goals.

The oncology pharmacy in cancer care delivery in a resource-constrained setting in western Kenya

2012 ◽  
Vol 18 (4) ◽  
pp. 406-416 ◽  
Author(s):  
R Matthew Strother ◽  
Kamakshi V Rao ◽  
Kelly M Gregory ◽  
Beatrice Jakait ◽  
Naftali Busakhala ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
Multidisciplinary Care ◽  
Cost Effective ◽  
Lessons Learned ◽  
Care Providers ◽  
Resource Constrained ◽  
Western Kenya ◽  
Care Services ◽  
Resource Limited

The movement to deliver cancer care in resource-limited settings is gaining momentum, with particular emphasis on the creation of cost-effective, rational algorithms utilizing affordable chemotherapeutics to treat curable disease. The delivery of cancer care in resource-replete settings is a concerted effort by a team of multidisciplinary care providers. The oncology pharmacy, which is now considered integral to cancer care in resourced medical practice, developed over the last several decades in an effort to limit healthcare provider exposure to workplace hazards and to limit risk to patients. In developing cancer care services in resource-constrained settings, creation of oncology pharmacies can help to both mitigate the risks to practitioners and patients, and also limit the costs of cancer care and the environmental impact of chemotherapeutics. This article describes the experience and lessons learned in establishing a chemotherapy pharmacy in western Kenya.

Patient Navigation and Cancer Care Delivery

2018 ◽  
Author(s):  
Harold P. Freeman ◽  
Melissa A. Simon
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Patient Navigation ◽  
Care Delivery ◽  
Clinical Care ◽  
Quality Care ◽  
Successful Implementation ◽  
Care Continuum ◽  
Patient Navigators ◽  
Health Care Delivery Systems

Although the US health care system offers the very best care to many, the poor and uninsured typically face challenges in accessing timely health care, even when faced with a life-threatening disease such as cancer. Spurred by unmet patient needs and the growing complexity of health care delivery systems, patient navigation seeks to diminish social, economic, cultural, and medical system barriers to timely quality care. This case study discusses the emergence of patient navigation as a strategy for improving cancer outcomes, especially among vulnerable populations. It explores challenges and opportunities related to advancing successful implementation of patient navigation across the cancer care continuum. It seeks to harness and apply the power and energy of patient navigators with the goal of guiding individuals across the health care continuum—from the communities where they live all the way through screening, diagnosis, and treatment at clinical care sites.

Designing comprehensive patient and family centered oncology care to achieve value based quality outcomes: Lessons learned from the field in creating sustainable change.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18225-e18225
Author(s):  
Tamira Harris ◽  
Lalan S. Wilfong
Keyword(s):  
Cancer Care ◽  
Gap Analysis ◽  
Care Delivery ◽  
Strong Relationship ◽  
Lessons Learned ◽  
Care Team ◽  
Need To Evaluate ◽  
Oncology Care ◽  
Value Based Care ◽  
Family Centered

e18225 Background: Of all clinical specialties cancer care is often thought of as one of the most patient and family centered due to the nature of the disease and course of treatment. Traditionally a strong relationship is held among the physicians, office practice staff and patients and family. Cancer care requires multidisciplinary collaboration and alignment for the optimized patient experience. Comparatively speaking this has been the case. The office based oncology care team has worked side by side to move the patient through the system during various treatments and settings. Most often the relationships and bonds that are formed are long lasting as cancer is a life changing experience. Opportunities for change however do exist and are needed in today’s increasingly complex healthcare environment. As demographics shift, and treatment methodologies continue to be discovered costs have escalated giving rise to the need to evaluate different care delivery models such as value based care. The Centers for Medicaid and Medicare Innovation Center (CMMI) Oncology Care Model (OCM) initiative has addressed this in their 5 year OCM pilot. Methods: Using qualitative and six sigma lean techniques practices redesigned patient throughput and experience based on data from gap analysis assessments, observation and collaboration. Results: The session will highlight lessons learned from the practice setting in initiating the changes required to meet CMS objectives and change the face of oncology care. Learn how practices designed patient navigation, created care team huddles, designed technology that facilities decision making, identified new models and partnerships for care, and standardized approaches across practice sites among other successes. Conclusions: This interactive session will explore what worked well, what physicians would change, and next steps planned.

Nurse Project Consultant: Critical Care Nurses Move Beyond the Bedside to Affect Quality and Safety

2018 ◽  
Vol 38 (3) ◽  
pp. 54-66 ◽  
Author(s):  
Lynn G. Mackinson ◽  
Juliann Corey ◽  
Veronica Kelly ◽  
Kristin P. O’Reilly ◽  
Jennifer P. Stevens ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Delivery ◽  
Critical Care Nurses ◽  
Lessons Learned ◽  
Scope Of Practice ◽  
Clinical Expertise ◽  
Health Care Delivery Systems

A nurse project consultant role empowered 3 critical care nurses to expand their scope of practice beyond the bedside and engage within complex health care delivery systems to reduce harms in the intensive care unit. As members of an interdisciplinary team, the nurse project consultants contributed their clinical expertise and systems knowledge to develop innovations that optimize care provided in the intensive care unit. This article discusses the formal development of and institutional support for the nurse project consultant role. The nurse project consultants’ responsibilities within a group of quality improvement initiatives are described and their challenges and lessons learned discussed. The nurse project consultant role is a new model of engaging critical care nurses as leaders in health care redesign.

scholarly journals American Society of Clinical Oncology Road to Recovery Report: Learning From the COVID-19 Experience to Improve Clinical Research and Cancer Care

2021 ◽  
Vol 39 (2) ◽  
pp. 155-169
Author(s):  
Nathan A. Pennell ◽  
Melissa Dillmon ◽  
Laura A. Levit ◽  
E. Allyn Moushey ◽  
Ajjai S. Alva ◽  
...  
Keyword(s):  
Clinical Research ◽  
Cancer Care ◽  
Care Delivery ◽  
Well Being ◽  
Lessons Learned ◽  
Scientific Integrity ◽  
High Quality ◽  
Quality Cancer Care ◽  
American Society ◽  
Made In

This report presents the American Society of Clinical Oncology’s (ASCO’s) evaluation of the adaptations in care delivery, research operations, and regulatory oversight made in response to the coronavirus pandemic and presents recommendations for moving forward as the pandemic recedes. ASCO organized its recommendations for clinical research around five goals to ensure lessons learned from the COVID-19 experience are used to craft a more equitable, accessible, and efficient clinical research system that protects patient safety, ensures scientific integrity, and maintains data quality. The specific goals are: (1) ensure that clinical research is accessible, affordable, and equitable; (2) design more pragmatic and efficient clinical trials; (3) minimize administrative and regulatory burdens on research sites; (4) recruit, retain, and support a well-trained clinical research workforce; and (5) promote appropriate oversight and review of clinical trial conduct and results. Similarly, ASCO also organized its recommendations regarding cancer care delivery around five goals: (1) promote and protect equitable access to high-quality cancer care; (2) support safe delivery of high-quality cancer care; (3) advance policies to ensure oncology providers have sufficient resources to provide high-quality patient care; (4) recognize and address threats to clinician, provider, and patient well-being; and (5) improve patient access to high-quality cancer care via telemedicine. ASCO will work at all levels to advance the recommendations made in this report.

Implementation Science for Global Oncology: The Imperative to Evaluate the Safety and Efficacy of Cancer Care Delivery

2016 ◽  
Vol 34 (1) ◽  
pp. 43-52 ◽  
Author(s):  
Neo M. Tapela ◽  
Tharcisse Mpunga ◽  
Nadine Karema ◽  
Ignace Nzayisenga ◽  
Temidayo Fadelu ◽  
...  
Keyword(s):  
Implementation Science ◽  
Treatment Program ◽  
Cancer Care ◽  
Care Delivery ◽  
Scale Up ◽  
Cancer Center ◽  
Resource Constrained ◽  
Resource Limited ◽  
Set Up ◽  
Treatment Safety

Purpose The development of cancer care treatment facilities in resource-constrained settings represents a challenge for many reasons. Implementation science—the assessment of how services are set up and delivered; contextual factors that affect delivery, treatment safety, toxicity, and efficacy; and where adaptations are needed—is essential if we are to understand the performance of a treatment program, know where the gaps in care exist, and design interventions in care delivery models to improve outcomes for patients. Methods The field of implementation science in relation to cancer care delivery is reviewed, and the experiences of the integrated implementation science program at the Butaro Cancer Center of Excellence in Rwanda are described as a practical application. Implementation science of HIV and tuberculosis care delivery in similar challenging settings offers some relevant lessons. Results Integrating effective implementation science into cancer care in resource-constrained settings presents many challenges, which are discussed. However, with carefully designed programs, it is possible to perform this type of research, on regular and ongoing bases, and to use the results to develop interventions to improve quality of care and patient outcomes and provide evidence for effective replication and scale-up. Conclusion Implementation science is both critical and feasible in evaluating, improving, and supporting effective expansion of cancer care in resource-limited settings. In ideal circumstances, it should be a prospective program, established early in the lifecycle of a new cancer treatment program and should be an integrated and continual process.

scholarly journals Overcoming Current and Preventing Future Nosocomial Outbreaks during the COVID-19 Pandemic: Lessons Learned at Three Hospitals in Japan

2021 ◽  
Vol 18 (19) ◽  
pp. 10226
Author(s):  
Makiko Komasawa ◽  
Myo Nyein Aung ◽  
Kiyoko Saito ◽  
Mitsuo Isono ◽  
Go Tanaka ◽  
...  
Keyword(s):  
Infection Control ◽  
Large Scale ◽  
Practical Knowledge ◽  
Care Delivery ◽  
Lessons Learned ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Infection Control Measures ◽  
Health Care Delivery Systems ◽  
And Control

Hospitals are increasingly challenged by nosocomial infection (NI) outbreaks during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Although standardized guidelines and manuals regarding infection prevention and control (IPC) measures are available worldwide, case-studies conducted at specified hospitals that are required to cope with real settings are limited. In this study, we analyzed three hospitals in Japan where large-scale NI outbreaks occurred for hints on how to prevent NI outbreaks. We reviewed openly available information from each hospital and analyzed it applying a three domain framework: operation management; identification of infection status; and infection control measures. We learned that despite having authorized infection control teams and using existing standardized IPC measures, SARS-CoV-2 may still enter hospitals. Early detection of suspected cases and confirmation by PCR test, carefully dealing with staff-to-staff transmission were the most essential factors to prevent NI outbreaks. It was also suggested that ordinary training on IPC for staff does not always provide enough practical knowledge and skills; in such cases external technical and operational supports are crucial. It is expected that our results will provide insights into preventing NI outbreaks of COVID-19, and contribute to mitigate the damage to health care delivery systems in various countries.

scholarly journals The Practice of Urban Experimentation in Dutch City Labs

2021 ◽  
Vol 6 (1) ◽  
pp. 161-170
Author(s):  
Christian Scholl ◽  
Joop De Kraker
Keyword(s):  
Urban Planning ◽  
Lessons Learned ◽  
Small Subset ◽  
Urban Living ◽  
Policy Goals ◽  
Resource Limited ◽  
Comprehensive Picture ◽  
Living Labs ◽  
Group Interviews ◽  
Dutch City

‘Urban planning by experiment’ can be seen as an approach that uses experimentation to innovate and improve urban planning instruments, approaches, and outcomes. Nowadays, urban experiments—interventions in the city with the aim to innovate, learn, or gain experience—are increasingly taking place in the context of Urban Living Labs. In the Netherlands, a certain type of Urban Living Lab, called city labs, is flourishing, and it has been suggested that these labs could make an important contribution to ‘urban planning by experiment.’ However, previous studies have indicated that this will depend on how experimentation is conducted in these labs. To obtain a more comprehensive picture of the practice of experimentation, we conducted a survey among Dutch city labs, supplemented by individual and group interviews with practitioners from a small subset of the 17 responding labs. We conclude that there is a poor match between the practice of experimentation in Dutch city labs and the characteristics that are considered to support effective ‘urban planning by experiment’ (i.e., a structured approach to experimentation, co-creation of experiments, active and targeted dissemination of lessons learned, and experiments as linking pins between municipal policy goals and the needs of urban society). This suggests that the current contribution of Dutch city labs to ‘urban planning by experiment’ is probably quite limited. Further research is needed to determine whether the typical practice of experimentation encountered in the Dutch city labs, i.e., action-oriented, resource-limited, and largely driven by opportunities, is also found in Urban Living Labs elsewhere.

Lessons learned from implementing the first Alliance NCORP Research Base Cancer Care Delivery Research (CCDR) trial A191402CD.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 175-175
Author(s):  
Joel E Pacyna ◽  
Jeff A. Sloan ◽  
Simon P. Kim ◽  
Hillary Sedlacek ◽  
Jon Charles Tilburt
Keyword(s):  
Clinical Trials ◽  
Cancer Care ◽  
Early Stage ◽  
Care Delivery ◽  
Decision Aids ◽  
Symptom Control ◽  
Cluster Randomized Trial ◽  
Lessons Learned ◽  
Oncology Research ◽  
Minority Men

175 Background: Biomedical research focused on the experiences of cancer patients in care delivery has progressed remarkably in recent years, including the emergence of Cancer Care Delivery Research (CCDR) within the NCI Community Oncology Research Program (NCORP). CCDR is a relatively new mechanism with the NCORP to support protocols that test questions beyond standard clinical trials for treatment or symptom control interventions. CCDR leverages the NCORP infrastructure to develop and test care delivery interventions in community hospital settings and in settings serving underserved and minority populations. CCDR enables researchers to conduct care delivery studies in critical places and in niche populations. Methods: We will describe our experience coordinating the first Alliance NCORP Research Base Cancer CCDR trial. Our trial – a four arm, cluster-randomized trial of decision aids among sites capable of oversampling minority men with a diagnosis of early stage prostate cancer – was the first CCDR trial in the Alliance NCORP Research Base. We will describe the opportunities and challenges we encountered. Results: We implemented a CCDR protocol even as the oversight for CCDR was being worked out in parallel. Curating partnerships outside of established channels of clinical trials, engaging minority serving institutions, and engaging surgical practices like urology illustrate some of the challenges of implementing a care-delivery trial in a diverse multi-site network. Research staff must learn the art of mitigating the disruption of care delivery research procedures within clinics. Additionally, the researcher’s skills are drawn upon at multiple points— establishing relationships, advocating for flexibility in implementing rules, cheerleading, connecting dots, and directing traffic. Conclusions: Our “lessons learned” presentation will provide an experiential account that will inform aspiring care delivery researchers in their work and describe some of the emerging aspects of the institutional implementation of new initiatives in modern cooperative group research. Our presentation will also inform key stakeholders about how to best facilitate this type of research.

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