scholarly journals Improving Outcomes Through Principles of Best Practice Management: Australia's National Lung Cancer Framework

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 243s-243s
Author(s):  
B. Daveson ◽  
V. Milch ◽  
J. Chynoweth ◽  
L. Kable ◽  
M. Austen ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Care ◽  
Best Practice ◽  
Cancer Control ◽  
Communication Strategy ◽  
Practice Management ◽  
System Level ◽  
Local Context ◽  
Evidence Based ◽  
National Implementation

Background and context: Lung cancer is estimated to be the fifth most commonly diagnosed cancer and leading cause of cancer death in Australia, representing 9.2% of all new cancer cases (n = 138,321) diagnosed and 18.9% of all cancer deaths (n = 48,586). The 5-year survival rate for those with lung cancer is 16%, compared with 68% for all cancers combined (between 2009 and 2013). Lung cancer is also the leading cause of cancer burden in Australia and patients affected by lung cancer may experience high levels of unmet need with associated psychological distress and decreased quality of life. Cancer Australia, Australia's national cancer control agency, developed the national Lung Cancer Framework: Principles for Best Practice Lung Cancer Care (Framework) to provide evidence-based, best practice information, strategies, tools and resources to support local adoption of the 5 principles for best practice management of lung cancer (principles): patient-centered care; multidisciplinary care; timely access to evidence-based care; coordination, communication and continuity of care; and data-driven improvements. Aim: The framework aims to improve the outcomes and experiences of people affected by lung cancer in Australia by supporting national uptake of the principles. Strategy/Tactics: Cancer Australia: • established a Lung Cancer Advisory Group to advise on strategies for national implementation of the framework and its principles • conducted a national lung cancer demonstration project, with advice from an Expert Steering Group, to demonstrate the delivery of lung cancer care according to the principles across a range of service delivery settings, and identify key factors contributing to ongoing delivery of best practice cancer care • completed systematic reviews for each principle to determine the effectiveness of the principles in improving lung cancer care processes and outcomes. Program/Policy process: To support national adoption of the framework and its principles, Cancer Australia: • developed a promotion and communication strategy for widespread national dissemination • convened a National Summit to bring together policy makers, clinical stakeholders and consumers to support local application of the principles, and drive optimal care for people affected by lung cancer • identified and communicated consumer, service, and system-level approaches to aid sustainable use of the principles. Outcomes: The evidence-based approach to the development of the framework and its principles identified ways to improve the healthcare system to achieve better outcomes for those affected by lung cancer in Australia. A coordinated approach to the delivery of the National Summit supported those involved in lung cancer care to share and adopt innovative and multilevel strategies for best practice care. What was learned: Embedding strategies to support implementation of the principles, responsive to local context, was key to enabling sustainable improvements in national lung cancer control.

Using behavioural science to explore patient perceptions

2018 ◽  
Vol 12 (4) ◽  
pp. 463-485
Author(s):  
Andria Hanbury ◽  
Hannah Wood
Keyword(s):  
Health Professionals ◽  
Best Practice ◽  
Communication Strategy ◽  
Behaviour Change Techniques ◽  
Evidence Based ◽  
Behavioural Science ◽  
Summary Table ◽  
Content Type ◽  
Practice Recommendations ◽  
Swallowing Difficulties

Purpose This paper aims to develop a behavioural science informed communication strategy aimed at health professionals and patients promoting best practice recommendations regarding the use of specialist liquid medicines for elderly people with swallowing difficulties. Design/methodology/approach The medicine prescribing, formulation and administration related challenges and experiences of health professionals and elderly patients with swallowing difficulties were identified through a pragmatic literature search. Key findings across the papers were synthesised into themes, before being linked to domains from a behavioural science framework. Published recommendations for behaviour change techniques that can be used to target the domains were then mapped to the domains. Guidance on how to develop a communication strategy, drawing on the insight gained from the literature review and the behavioural science recommendations, and designed to stimulate change in health-care professionals’ and patients’ behaviours, was then developed. Findings In total, 13 themes emerged across 15 papers, including “patient and health professional roles and remits”. These themes were linked to nine domains from the framework, highlighting the range of individual, social and environmental factors influencing patients’ and health professionals’ perceptions and experiences. A summary table, mapping the domains and underpinning themes to recommended behaviour change techniques, was used to develop the subsequent communication strategy recommendations. Recommendations include using techniques such as providing social processes of encourage, pressure and support to change patients’ and health professionals’ perceptions of their roles/responsibilities in medicines prescribing and administration, delivered via, for example, an educational leaflet and/or online training. Practical implications The summary table and guidance can inform development of an evidence-based strategy for communicating best practice recommendations regarding the use of liquid medicines for elderly patients with swallowing difficulties, tailored to the perceptions and challenges identified. Originality/value The behavioural science approach is less established within the pharmaceutical industry for promotion of best practice recommendations and related products, yet it offers a framework for an evidence-based and systematic approach that goes beyond a literature review or focus group.

scholarly journals Regional process redesign of lung cancer care: a learning health system pilot project

2018 ◽  
Vol 25 (1) ◽  
pp. 59 ◽  
Author(s):  
M. Fung-Kee-Fung ◽  
D.E. Maziak ◽  
J.R. Pantarotto ◽  
J. Smylie ◽  
L. Taylor ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health System ◽  
Cancer Care ◽  
Initial Treatment ◽  
Best Practice ◽  
System Optimization ◽  
Transformation Model ◽  
Patient Journey ◽  
Ottawa Hospital ◽  
Learning Health System

 Background The Ottawa Hospital (toh) defined delay to timely lung cancer care as a system design problem. Recognizing the patient need for an integrated journey and the need for dynamic alignment of providers, toh used a learning health system (lhs) vision to redesign regional diagnostic processes. A lhs is driven by feedback utilizing operational and clinical information to drive system optimization and innovation. An essential component of a lhs is a collaborative platform that provides connectivity across silos, organizations, and professions.Methods To operationalize a lhs, we developed the Ottawa Health Transformation Model (ohtm) as a consensus approach that addresses process barriers, resistance to change, and conflicting priorities. A regional Community of Practice (cop) was established to engage stakeholders, and a dedicated transformation team supported process improvements and implementation.Results The project operationalized the lung cancer diagnostic pathway and optimized patient flow from referral to initiation of treatment. Twelve major processes in referral, review, diagnostics, assessment, triage, and consult were redesigned. The Ottawa Hospital now provides a diagnosis to 80% of referrals within the provincial target of 28 days. The median patient journey from referral to initial treatment decreased by 48% from 92 to 47 days.Conclusions The initiative optimized regional integration from referral to initial treatment. Use of a lhs lens enabled the creation of a system that is standardized to best practice and open to ongoing innovation. Continued transformation initiatives across the continuum of care are needed to incorporate best practice and optimize delivery systems for regional populations.

Pragmatic approach to quality metrics development in cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 60-60
Author(s):  
Donna Chung ◽  
Aniruddha Dwarakanath ◽  
Charlotte Williams ◽  
Kathy Pritchard-Jones ◽  
James Mountford ◽  
...  
Keyword(s):  
Patient Experience ◽  
Cancer Care ◽  
Best Practice ◽  
Local Population ◽  
Quality Measures ◽  
System Level ◽  
Patient Pathway ◽  
Small Set ◽  
Surrounding Areas ◽  
Key Pathways

60 Background: London Cancer aims to use transparency of service and quality measures to drive improvement in cancer care in North and East London and surrounding areas, serving our population of 3.5m people. Whilst the on-going implementation of the National Outcome and Service Dataset for UK is expected to take 18 months we have chosen to develop quality measures with the teams accountable to deliver the service by using available data from a variety of existent sources and illustrate this in value scorecards tracking the patient pathway. Methods: Building on an engagement exercise with patients, clinicians and charities in 2011 to identify which outcomes mattered most to patients, a small set of key pathways metrics was identified for each site specific cancer pathway board to monitor their progress in implementing integrated cancer care. Metrics were selected only if (a) clinically useful, in line with the current work plan and improvement effort; (b) accessible on a recurrent basis and requiring minimal manual effort; (c) facilitate the understanding of the patient pathway; (d) align with London Cancer objectives in improving survival, patient experience, and access to innovation and clinical trials. Pathway boards were invited to contribute with the intention to provide a pathway metrics value scorecards on a quarterly basis. Results: The first set pathway metrics scorecards, with 31 metrics, were published by June 2013. Key items include adherence to established best practice (16), data completeness (6), survival (3), pathway efficiency (3), and patient experience (3). Conclusions: Pathway metrics are reported at a system level, reflecting the care for our local population, against measures that are important to them and will allow visibility of success. Whilst current pathway metric development is limited by the availability of meaningful data we aim to build on the existing metrics in an iterative fashion. For this we are working with stakeholders to improve data quality.

scholarly journals Engaging Stakeholders in the Adaptation of the Connect for Health Pediatric Weight Management Program for National Implementation

2020 ◽  
Author(s):  
Meg Simione ◽  
Holly M. Frost ◽  
Rachel Cournoyer ◽  
Fernanda Neri Mini ◽  
Jackie Cassidy ◽  
...  
Keyword(s):  
Primary Care ◽  
Weight Management ◽  
Stakeholder Engagement ◽  
Quantitative Methods ◽  
Management Program ◽  
System Level ◽  
Evidence Based ◽  
Weight Management Program ◽  
National Implementation ◽  
Delivery Options

Abstract Background: Connect for Health is an evidence-based weight management program with clinical- and family-facing components for delivery in pediatric primary care for families of children ages 2 to 12 years. We used the Consolidated Framework for Implementation Research (CFIR) to guide formative work prior to national implementation. The purpose of this study was to describe the process and results of stakeholder engagement and program adaptation.Methods: We used mixed qualitative and quantitative methods to iteratively adapt and optimize the program by assessing needs and perspectives of clinicians and parents, as well as contextual barriers, facilitators and organizational readiness for the uptake of the proposed program tools and implementation strategies. We conducted interviews with primary care clinicians from four health care organizations in Boston, MA, Denver, CO, and Greenville, SC and used principles of immersion-crystallization for qualitative analyses. We also conducted surveys of parents of children with a body mass index ≥ 85th percentile.Results: We reached thematic saturation after 52 clinician interviews. Emergent themes representing the CFIR domains of intervention characteristics, outer and inner setting, and process included: (1) importance of evidence-based clinical decision support tools that integrate into the workflow and do not extend visit time; (2) developing resources that respond to family’s needs; (3) using multimodal delivery options for family resources; (4) addressing childhood obesity while balancing competing demands; (5) emphasizing patient care rather than documentation and establishing sustainability plans; and (6) offering multiple training methods that incorporate performance feedback. Of the parents surveyed (n=400), approximately 50% were Spanish-speaking and over 75% reported an annual income < $50,000. Parents affirmed the importance of addressing weight management during well-child visits, being provided with referrals and resources, and offering multiple methods for resource delivery. Decisions about program modifications were made at the program and healthcare-system level and based on stakeholder engagement findings. Modifications included cultural, geographic, and target audience adaptations, as well as varied resource delivery options. Conclusions: To ensure the fit between the Connect for Health program and national implementation settings, adaptations were systematically made through engagement of clinician and parent stakeholders to support adoption, sustainability, and health outcomes. Trial Registration: NCT04042493

O-189 Practitioner feedback on lung cancer practice guidelines developed through cancer care Ontario's program in evidence-based care

Lung Cancer ◽  
2003 ◽  
Vol 41 ◽  
pp. S56
Author(s):  
William K. Evans ◽  
David Cameron ◽  
Jean Mackay ◽  
Nancy Laetsch ◽  
Melissa Brouwers
Keyword(s):  
Lung Cancer ◽  
Practice Guidelines ◽  
Cancer Care ◽  
Evidence Based ◽  
Evidence Based Care

scholarly journals Effective Collaborative Project to Reduce Disparities and Inequities in Cancer Care and for Cancer Control in Low-Resource Setting Countries: South African Experience

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 65-65
Author(s):  
Daniel Osei-Fofie
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Palliative Care ◽  
Health Care Workers ◽  
Rural Areas ◽  
Cancer Care ◽  
Cancer Control ◽  
Mine Dumps ◽  
Care Workers ◽  
Northern Cape

PURPOSE The Northern Cape Province is the largest province in South Africa; however, it has the fewest resources for cancer care. There is a high incidence and prevalence of mesothelioma and lung cancer as a result of the previous indiscriminate mining of asbestos without proper legislation for the protection of miners and the environment. Mine dumps remain near villages and schools after the banning of asbestos mining, resulting in continuous exposure to asbestos fibers. Unfortunately, majority of cancers are diagnosed in late stages because of a lack of awareness and the misdiagnosis of lung cancer and mesothelioma as tuberculosis. METHODS The Northern Cape Department of Health, Bristol-Myers Squibb Foundation, and Cancer Charity Workers formed a collaboration in May 2017 to reduce disparities and inequities in cancer care and for cancer control. The Northern Cape Department of Health also collaborated with Project ECHO at the University of New Mexico to use the ECHO model for training community health care workers, training in palliative care, and mentorship and empowerment of doctors and nurses in rural areas. The aim is to recognize early symptoms and signs of cancers affecting the lung and to make referrals for early diagnosis and treatment. RESULTS An advocacy group has engaged the Provincial and National Department of Mining and Environmental Affairs for rehabilitation of asbestos mine dumps. Community health care workers have been trained and are assisting with community awareness and patient navigation. Doctors have been trained in palliative care and are training other health care workers in palliative care. A center of excellence for the diagnosis and treatment of lung cancer, palliative care, survivorship, and research has been established. Retention of doctors and nurses in rural areas for cancer care and early referral is improving. A lung cancer research laboratory is being set up. CONCLUSION Effective collaborative projects can help address disparities in cancer care and effective cancer control in areas with limited resources.

scholarly journals Evaluating the national implementation of Bright IDEAS in clinical settings: applying the RE-AIM framework to characterize the clinical perspective

2021 ◽  
Author(s):  
Demetria McNeal ◽  
O.J. Sahler ◽  
Robert B. Noll ◽  
Diane L. Fairclough ◽  
Megan E. Voll ◽  
...  
Keyword(s):  
Problem Solving ◽  
Clinical Setting ◽  
Scale Up ◽  
Cancer Control ◽  
Skills Training ◽  
Clinical Settings ◽  
Evidence Based ◽  
Training Experience ◽  
Problem Solving Skills ◽  
National Implementation

Abstract Background Bright IDEAS: Problem-Solving Skills Training (Bright IDEAS), a psychosocial intervention, has shown to improve problem-solving skills and reduce emotional distress in caregivers of children recently diagnosed with cancer. Though efforts have been made to scale up cancer control interventions, there are limited data assessing the adoption of Evidence-Based Cancer Control Programs (EBCCP) into clinical practice. This study describes the barriers and facilitators to implementation experienced by practitioners trained to use Bright IDEAS in their clinical settings.Methods A total of 209 Pediatric psychosocial oncology practitioners were trained through 10 workshops. Adaptations were made to the training agenda and curriculum based on practitioner feedback following implementation in local institutions. Practitioners were interviewed to understand their training experience and gain their perspective on the effectiveness of delivering Bright IDEAS in the clinical setting. The RE-AIM framework was used to guide the evaluation process we employed to assess the effectiveness of this national effort to disseminate Bright IDEAS.Results Interviews were conducted with 47 practitioners. Practitioners in the pre-adaptation group reported the identification of a particular profile of a client as a facilitator to intervention use. Additionally, perceived rigidity of the protocol, lack of consistency in intervention use with clients, feelings of being overwhelmed by the client as rationale for lack of interest, and lack of multiple trained practitioners at institutions were identified as barriers to intervention use. Practitioners in the post-adaptation group reported similar identification of a profile for an appropriate client for the intervention, more usage of Bright IDEAS materials, implementation across multiple clinical settings, and expressed continued commitment to intervention use as well as discussion of internal training for colleagues.Conclusions This study provides insight into how psychosocial practitioners adopt, implement, and maintain Bright IDEAS in the clinical setting and identified important considerations and needs for both practitioners and larger health care systems. It also provides some cautions to those who wish to promulgate evidence-based interventions.

scholarly journals Low Provider Knowledge Is Associated With Less Evidence-Based Lung Cancer Screening

2019 ◽  
Vol 17 (4) ◽  
pp. 339-346 ◽  
Author(s):  
Jennifer A. Lewis ◽  
Heidi Chen ◽  
Kathryn E. Weaver ◽  
Lucy B. Spalluto ◽  
Kim L. Sandler ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Lung Cancer Screening ◽  
System Level ◽  
Smoking History ◽  
Secondary Outcome ◽  
Evidence Based ◽  
The Past ◽  
High Knowledge ◽  
Provider Knowledge

Background: Despite widespread recommendation and supportive policies, screening with low-dose CT (LDCT) is incompletely implemented in the US healthcare system. Low provider knowledge of the lung cancer screening (LCS) guidelines represents a potential barrier to implementation. Therefore, we tested the hypothesis that low provider knowledge of guidelines is associated with less provider-reported screening with LDCT. Patients and Methods: A cross-sectional survey was performed in a large academic medical center and affiliated Veterans Health Administration in the Mid-South United States that comprises hospital and community-based practices. Participants included general medicine providers and specialists who treat patients aged >50 years. The primary exposure was LCS guideline knowledge (US Preventive Services Task Force/Centers for Medicare & Medicaid Services). High knowledge was defined as identifying 3 major screening eligibility criteria (55 years as initial age of screening eligibility, smoking status as current or former smoker, and smoking history of ≥30 pack-years), and low knowledge was defined as not identifying these 3 criteria. The primary outcome was self-reported LDCT order/referral within the past year, and the secondary outcome was screening chest radiograph. Multivariable logistic regression evaluated the adjusted odds ratio (aOR) of screening by knowledge. Results: Of 625 providers recruited, 407 (65%) responded, and 378 (60.5%) were analyzed. Overall, 233 providers (62%) demonstrated low LCS knowledge, and 224 (59%) reported ordering/referring for LDCT. The aOR of ordering/referring LDCT was less among providers with low knowledge (0.41; 95% CI, 0.24–0.71) than among those with high knowledge. More providers with low knowledge reported ordering screening chest radiographs (aOR, 2.7; 95% CI, 1.4–5.0) within the past year. Conclusions: Referring provider knowledge of LCS guidelines is low and directly proportional to the ordering rate for LDCT in an at-risk US population. Strategies to advance evidence-based LCS should incorporate provider education and system-level interventions to address gaps in provider knowledge.

scholarly journals Best Evidence to Best Practice: Implementing an Innovative Model of Nutrition Care for Patients with Head and Neck Cancer Improves Outcomes

Nutrients ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1465 ◽  
Author(s):  
Merran Findlay ◽  
Nicole M. Rankin ◽  
Tim Shaw ◽  
Kathryn White ◽  
Michael Boyer ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Multidisciplinary Team ◽  
Best Practice ◽  
System Level ◽  
Evidence Based ◽  
Model Of Care ◽  
New Model ◽  
Nutrition Care ◽  
Pre Treatment ◽  
Key Interventions

Malnutrition is prevalent in patients with head and neck cancer (HNC), impacting outcomes. Despite publication of nutrition care evidence-based guidelines (EBGs), evidence–practice gaps exist. This study aimed to implement and evaluate the integration of a patient-centred, best-practice dietetic model of care into an HNC multidisciplinary team (MDT) to minimise the detrimental sequelae of malnutrition. A mixed-methods, pre–post study design was used to deliver key interventions underpinned by evidence-based implementation strategies to address identified barriers and facilitators to change at individual, team and system levels. A data audit of medical records established baseline adherence to EBGs and clinical parameters prior to implementation in a prospective cohort. Key interventions included a weekly Supportive Care-Led Pre-Treatment Clinic and a Nutrition Care Dashboard highlighting nutrition outcome data integrated into MDT meetings. Focus groups provided team-level evaluation of the new model of care. Economic analysis determined system-level impact. The baseline clinical audit (n = 98) revealed barriers including reactive nutrition care, lack of familiarity with EBGs or awareness of intensive nutrition care needs as well as infrastructure and dietetic resource limitations. Post-implementation data (n = 34) demonstrated improved process and clinical outcomes: pre-treatment dietitian assessment; use of a validated nutrition assessment tool before, during and after treatment. Patients receiving the new model of care were significantly more likely to complete prescribed radiotherapy and systemic therapy. Differences in mean percentage weight change were clinically relevant. At the system level, the new model of care avoided 3.92 unplanned admissions and related costs of $AUD121K per annum. Focus groups confirmed clear support at the multidisciplinary team level for continuing the new model of care. Implementing an evidence-based nutrition model of care in patients with HNC is feasible and can improve outcomes. Benefits of this model of care may be transferrable to other patient groups within cancer settings.

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