Conducting Goals-of-Care Discussions Takes Less Time Than Imagined

2020 ◽  
Vol 16 (12) ◽  
pp. e1499-e1506
Author(s):  
Sofya Pintova ◽  
Ryan Leibrandt ◽  
Cardinale B. Smith ◽  
Kerin B. Adelson ◽  
Jason Gonsky ◽  
...  
Keyword(s):  
Cancer Progression ◽  
High Quality ◽  
Goals Of Care ◽  
Coaching Model ◽  
Face To Face ◽  
Significant Difference ◽  
Encounter Time ◽  
Face Time ◽  
To Receive

PURPOSE: To describe the length of encounter during visits where goals-of-care (GoC) discussions were expected to take place. METHODS: Oncologists from community, academic, municipal, and rural hospitals were randomly assigned to receive a coaching model of communication skills to facilitate GoC discussions with patients with newly diagnosed advanced solid-tumor cancer with a prognosis of < 2 years. Patients were surveyed after the first restaging visit regarding the quality of the GoC discussion on a scale of 0-10 (0 = worst; 10 = best), with ≥ 8 indicating a high-quality GoC discussion. Visits were audiotaped, and total encounter time was measured. RESULTS: The median face-to-face time oncologists spent during a GoC discussion was 15 minutes (range, 10-20 minutes). Among the different hospital types, there was no significant difference in encounter time. There was no difference in the length of the encounter whether a high-quality GoC discussion took place or not (15 v 14 minutes; P = .9). If there was imaging evidence of cancer progression, the median encounter time was 18 minutes compared with 13 minutes for no progression ( P = .03). In a multivariate model, oncologist productivity, patient age, and Medicare coverage affected duration of the encounter. CONCLUSION: Oncologists can complete high-quality GoC discussions in 15 minutes. These data refute the common misperception that discussing such matters with patients with advanced cancer requires significant time.

scholarly journals Impact of High-Quality Goals-of-Care Discussions on Oncologist Productivity

2020 ◽  
Vol 16 (3) ◽  
pp. e290-e297
Author(s):  
Sofya Pintova ◽  
Ryan Leibrandt ◽  
Cardinale B. Smith ◽  
Kerin B. Adelson ◽  
Jason P. Gonsky ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Community Hospital ◽  
Rural Setting ◽  
Study Patient ◽  
High Quality ◽  
Goals Of Care ◽  
Coaching Model ◽  
Significant Difference ◽  
To Receive

PURPOSE: To study factors that have an impact on the conduct of high-quality goals of care (GoC) discussions and productivity of oncologists among four different practice settings in patients with advanced cancer. METHODS: Solid-tumor oncologists from community, academic, municipal, and rural hospitals were randomly assigned to receive a coaching model of communication skills to help them facilitate a GoC discussion with newly diagnosed patients with advanced cancer who had a less-than-2-year prognosis. Patients were surveyed after the first restaging visit regarding the quality of the GoC discussion on a scale of 0 to 10 (0, worst; 10, best) with a score of 8 or better indicating a high-quality GoC discussion. Productivity was measured by work revenue value units (wRVUs) per hour for the day each oncologist saw the study patient after imaging. RESULTS: The four sites differed significantly in the socioeconomic patient populations they served and in the characteristics of the oncologists who cared for the patients. Overall median productivity across the four sites was 3.6 wRVU/hour, with the highest observed in the community hospital (4.3 wRVU/hour) and the lowest in the rural setting (2.9 wRVU/hour; P < .001). There was no significant difference in productivity observed when high-quality GOC discussion occurred versus when it did not (3.6 v 3.7 wRVU/hour; P = .86). CONCLUSION: Despite differences in patient populations and oncologists’ characteristics between the four practice settings, the conduct of high-quality GoC discussions did not affect productivity.

Medical visit time and predictors in health facilities: a mega systematic review and meta-analysis

2019 ◽  
Vol 12 (5) ◽  
pp. 373-402 ◽  
Author(s):  
Sakineh Hajebrahimi ◽  
Ali Janati ◽  
Morteza Arab-Zozani ◽  
Mobin Sokhanvar ◽  
Elaheh Haghgoshayie ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Visit Time ◽  
Medical Visit ◽  
High Quality ◽  
Content Type ◽  
Face To Face ◽  
Significant Difference ◽  
Meta Analyses

Purpose Visit time is a crucial aspect of patient–physician interaction; its inadequacy can negatively impact the efficiency of treatment and diagnosis. In addition, visit time is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to determine factors influencing the consultation length of physicians and to compare consultation length in different countries. Design/methodology/approach MEDLINE (PubMed), Web of Science, Cochrane, ProQuest, Scopus, and Google Scholar were searched. In addition, references of references were checked, and publication lists of individual scholars in the field were examined. We used data sources up to June 2018, without language restriction. We used a random-effects model for the meta-analyses. Meta-analyses were conducted using Comprehensive Meta-Analysis Version (CMA) 3.0. Findings Of 16,911 identified studies, 189 studies were assessed of which 125 cases (67 percent) have been conducted in the USA. A total of 189 studies, 164 (86.77 percent) involved face-to face-consultations. The effects of three variables, physician gender, patient gender, and type of consultation were analyzed. According to moderate and strong evidence studies, no significant difference was found in the consultation lengths of female and male doctors (Q=42.72, df=8, I2=81.27, p=0.891) and patients’ gender (Q=55.98, df=11, I2=80.35, p=0.314). In addition, no significant difference was found in the telemedicine or face-to-face visits (Q=41.25, df=5, I2=87.88, p=0.170). Originality/value In this systematic review and meta-analysis, all of physicians’ visits in 34 countries were surveyed. The evidence suggests that specified variables do not influence the length of consultations. Good relationship is essential to a safe and high-quality consultation and referral process. A high-quality consultation can improve decisions and quality of visits, treatment effectiveness, efficiency of service, quality of care, patient safety and physician and patient satisfaction.

Disparities in length of goals of care conversations between oncologists and patients with advanced cancer.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 19-19
Author(s):  
Cardinale B. Smith ◽  
Sofya Pintova ◽  
Kerin B. Adelson ◽  
Jason Parker Gonsky ◽  
Natalia Egorova ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Skills Training ◽  
Advanced Cancer Patients ◽  
Goals Of Care ◽  
Coaching Model ◽  
Quality Cancer Care ◽  
Progression Of Disease ◽  
Encounter Time

19 Background: Studies show minority patients have inadequate discussions about treatment, prognosis, and goals of care (GoC) which translate into substandard treatment, worse quality of life, and poorer survival than whites. However, there is a paucity of data on the quality of communication among minority patients with advanced cancer. We studied factors impacting the oncologists’ time spent during GoC discussion visits with their minority and non-minority patients. Methods: At community, academic, municipal, and rural hospitals, we recruited and randomized solid tumor oncologists and their newly diagnosed advanced cancer patients with <2-year prognosis to participate in a RCT, testing a coaching model of communication skills training. Patients were surveyed after post-imaging visits. These visits were audiotaped and median encounter time recorded. We define GoC discussions as patients report that their doctor talked about preferences for cancer treatment and clarified things most important to them given their illness. Comparisons were made using non-parametric tests. We used mix-effect models for risk adjustment. Results: For 22 randomized oncologists in the study,142 post-imaging encounters were audiotaped. Of these, 38% were non-Hispanic White, 32% non-Hispanic Black and 19% Hispanic. The median face to face time oncologists spent during a GoC encounter with an advanced cancer minority patient was 12 minutes compared to 17 minutes for non-minorities (p=0.002). Median encounter times varied between the four sites, ranging from 10 minutes to 18 minutes, p=0.009. For visits that took place after progression of disease, duration of visit was 18 minutes versus 13 minutes if there were no progression, p=0.007. After controlling for clustering of the patients within the hospitals and progression of disease, time spent with minority patients remained less than with non-minority patients (15 min vs. 18 min, p=0.02). Conclusions: Oncologists' time spent conducting GoC conversations with minority cancer patients is significantly less than with non-minority patients. Evaluating factors that contribute to this disparity is critically important to ensure minority patients receive high-quality cancer care. Clinical trial information: NCT02374255.

scholarly journals PARE0023 ORAL HEALTH IN RHEUMATOID ARTHRITIS: LISTENING TO PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1297.2-1297
Author(s):  
J. Protudjer ◽  
C. Billedeau ◽  
C. Stavropoulou ◽  
A. Cholakis ◽  
R. Schroth ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Oral Health ◽  
Periodontal Disease ◽  
Oral Care ◽  
Structured Interviews ◽  
Face To Face ◽  
Oral Health Education ◽  
To Receive ◽  
Latent Content

Background:Rates of periodontal disease and tooth loss are increased in rheumatoid arthritis (RA). Periodontal disease may exacerbate RA inflammation and complicate RA care. Understanding factors that contribute to the increased burden of periodontal disease in RA is critical to improving oral health and possibly arthritis outcomes. People with RA may have unique needs and/or barriers to maintain oral health.Objectives:To determine from people with RA what are their experiences and perceptions about their oral health, their most important questions relating to oral health, and how they wish to receive oral health information.Methods:Semi-structured interviews were conducted with RA patients. Recorded interview transcripts underwent iterative content analysis. Transcripts were initially reviewed to develop a coding guide. Latent content, or larger themes, were then applied to the transcripts. Constructs were considered saturated when no new themes were identified with subsequent interviews. We report identified themes with representative quotes.Results:Interviews with 11 RA (10[91%] female; all on RA medication) averaged 19 minutes (range 8-31 minutes) and were mostly conducted face-to-face. Many believed RA medication contributed to dry mouth. Most participants had not previously considered other links between oral health and RA. Themes identified included the need for complicated oral health routines, barriers of cost and access to dental care, and shame relating to oral health (Table 1). Participants preferred to receive oral health education from their rheumatologists or dentists over printed or online resources.Conclusion:RA patients have unique needs relating to oral health and report poor oral quality of life. Strategies to optimize oral health in RA may include educational tools for optimizing oral self-care appropriate for RA, and improved access to oral care professionals who are aware of the needs of arthritis patients.Disclosure of Interests:Jennifer Protudjer: None declared, Corrie Billedeau: None declared, Chrysi Stavropoulou: None declared, Anastasia Cholakis: None declared, Robert Schroth: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada

PP30 ‘I can’t remember’ – patients views of receiving pain management from paramedics for suspected hip fracture

2019 ◽  
Vol 36 (1) ◽  
pp. e12.1-e12
Author(s):  
Bridie Evans ◽  
Alan Brown ◽  
Jenna Bulger ◽  
Greg Fegan ◽  
Simon Ford ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Hip Fracture ◽  
Pain Management ◽  
Prehospital Care ◽  
Face To Face ◽  
Experience Of Care ◽  
Ambulance Transport ◽  
Fascia Iliaca Compartment Block ◽  
To Receive

BackgroundUp to 40% of patients with suspected hip fracture report inadequate or no pre-hospital pain management. Morphine may raise risk of complications and may be avoided by paramedics. Fascia Iliaca Compartment Block (FICB) is used in Emergency Department and orthopaedic wards. The RAPID trial tested feasibility of paramedics administering FICB to patients with suspected hip fracture.ObjectiveTo explore patients’ views and experience of care received for suspected hip fracture and in particular FICB before ambulance transport to hospital.MethodWe interviewed six patients and the daughter of a patient who received FICB to manage their suspected hip fracture. Interviews, by telephone or face-to-face, were audio-recorded with consent. We conducted thematic analysis of transcripts. Two researchers, one paramedic and one lay member were in the analysis teamResultsRespondents’ memory of prehospital care was dominated by their experience of extreme pain. While they recalled events before falling, they only had partial memory of care prior to hip surgery. Although they recalled paramedics’ arrival, which they reported was up to six hours after their injury, respondents said they remembered little else. Just one recalled consenting to receiving FICB and could describe the process. Other respondents said they were in too much pain to comprehend what occurred or respond coherently. They explained their priority was to receive pain management and they expected the paramedics to treat them safely and effectively. Respondents appeared to be a stoical and trusting group who accepted the treatment they were offered. They did recall high quality of care and praised paramedics for their reassuring and calm manner.ConclusionsHip fracture patients’ overwhelming memory of injury and treatment was of pain and their priority was to receive pain relief. The quality of care, reassurance and administration of pain management was more important to patients than the mechanism of delivering the intervention.

scholarly journals Influence of lucerne and meadow hay quality on the digestibility of nutrients in the roe deer

2011 ◽  
Vol 50 (No. 2) ◽  
pp. 74-80 ◽  
Author(s):  
A. Sommer ◽  
M. Vodňanský ◽  
P. Petrikovič ◽  
R. Požgaj
Keyword(s):  
Organic Matter ◽  
Crude Protein ◽  
Roe Deer ◽  
Live Weight ◽  
Nutrient Digestibility ◽  
Crude Fibre ◽  
High Quality ◽  
Nitrogen Free Extract ◽  
Significant Difference

It was confirmed in metabolic experiments with 4 individuals of roe deer (2 males and 2 females with the live weight of 20.8 and 17.9 kg, respectively) that due to the animals&rsquo; selective choice of a part of feeds there was no significant difference in the intake of lucerne hay of different quality and high-quality meadow hay (515.86 &plusmn; 66.97 and 597.82 &plusmn; 94.87 g, respectively). However, different quality of lucerne hay influenced the animals&rsquo; intake of crude protein and crude fibre. When the animals were fed meadow hay, they took in significantly less crude protein and fibre and significantly more nitrogen-free extract, fat and ash. Digestibility of crude protein was observed to be significantly decreased in hay of lower quality (by 10.1%). Digestibility coefficients for crude protein, crude fibre, organic matter and fat were significantly lower in grass hay compared to lucerne hay. Based on the coefficients of nutrient digestibility it can be stated that meadow hay, even if of excellent quality, is not a suitable supplement for the roe deer. &nbsp;

Prospective evaluation of epoetin-alfa (EA) vs epoetin-beta (EB) vs darbepoetin (DE) in anemic cancer patients (pts) receiving chemotherapy (CT): Early results of an independent observational survey by the Italian ReVERTO network

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18548-18548
Author(s):  
C. F. Pollera ◽  
F. Nelli ◽  
T. Gamucci ◽  
I. Sperduti ◽  
A. M. Giampaolo ◽  
...  
Keyword(s):  
Treatment Schedule ◽  
Weekly Schedule ◽  
Severe Anemia ◽  
Treatment Groups ◽  
Therapy Efficacy ◽  
Early Results ◽  
Significant Difference ◽  
To Receive ◽  
Major Data

18548 Background: Direct comparison of EA vs EB vs DE has never been performed. In order to define the efficacy, impact on quality of life (QL) and pt’s preference, a prospective observational comparison of erythropoietic agents has been carried out. Methods: Anemic pts (hgb <11 gr/dL) scheduled to receive at least 3 cycles of CT were stratified according to 5 factors (platinum-based CT vs non-platinum; hgb ≤9,5 vs >9,5; PS ≤0–1 vs >1; previous CT vs upfront CT; and previous antianemic therapy vs not) and were autonomously assigned by 15 investigators to EA (3 times a week) or EB (3 times a week and only in pts receiving platinum-based CT) or DE (once a week) therapy. Efficacy by hgb level changes and transfusion needing was evaluated after each cycle of CT, QL by Fact-An questionnaire after 1 and 3 cycles of CT, and pt’s preference for standard vs weekly schedule at least once thereafter. Results: From 09/04 to 12/05 177 pts were recruited: 41%, 39% and 20% were assigned to DE, EA and EB, respectively. Severe anemia at baseline (≤9,5) was reported in 29% of pts, whereas 47% received platinum-based CT. Stratifying categories were well balanced among the treatment groups. Baseline mean hgb values were 9.7, 9.9, and 10 for DE, EA and EB, respectively. As of the general population, DE produced higher subsequent mean hgb increase in respect to EA and EB (Mean increase [gr/dL] for DE: 0.84, 1.58, 2.03; EA: 0.34, 0.84, 1.68; EB: 0.76, 1.54, 1.17). No difference was observed neither among pts receiving platinum-based CT, (mean increase: DE: 0.34, 1.76, 2.8; EA: 0.7, 1.27, 2.14; EB: 0.76, 1.54, 1.71) nor among pts with severe anemia at baseline (DE: 0.98, 2, 2.6; EA: 1.24, 1.94, 3.13; EB: 1.25, 2.25, 2.75). Transfusion needing ranged from 7% for DE to 3% for EB without any significant difference. To date 67% of pts completed at least one subsequent QL valuation, whereas 62% gave their preference for treatment schedule. Conclusions: Early results of our prospective analysis show that antianemic therapy with D is at least as effective as standard schedule of EA or EB. Efficacy of DE seems confirmed in pts with bad prognostic categories for anemia. Major data on QL and pt’s preference will be presented. No significant financial relationships to disclose.

Melphalan and prednisone plus thalidomide or placebo in elderly patients with multiple myeloma

Blood ◽  
2010 ◽  
Vol 116 (9) ◽  
pp. 1405-1412 ◽  
Author(s):  
Anders Waage ◽  
Peter Gimsing ◽  
Peter Fayers ◽  
Niels Abildgaard ◽  
Lucia Ahlberg ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Partial Response ◽  
Controlled Study ◽  
Plateau Phase ◽  
Life Outcomes ◽  
Double Blind ◽  
Skin Reactions ◽  
Significant Difference ◽  
To Receive

Abstract In this double-blind, placebo-controlled study, 363 patients with untreated multiple myeloma were randomized to receive either melphalan-prednisone and thalidomide (MPT) or melphalan-prednisone and placebo (MP). The dose of melphalan was 0.25 mg/kg and prednisone was 100 mg given daily for 4 days every 6 weeks until plateau phase. The dose of thalidomide/placebo was escalated to 400 mg daily until plateau phase and thereafter reduced to 200 mg daily until progression. A total of 357 patients were analyzed. Partial response was 34% and 33%, and very good partial response or better was 23% and 7% in the MPT and MP arms, respectively (P < .001). There was no significant difference in progression-free or overall survival, with median survival being 29 months in the MPT arm and 32 months in the MP arm. Most quality of life outcomes improved equally in both arms, apart from constipation, which was markedly increased in the MPT arm. Constipation, neuropathy, nonneuropathy neurologic toxicity, and skin reactions were significantly more frequent in the MPT arm. The number of thromboembolic events was equal in the 2 treatment arms. In conclusion, MPT had a significant antimyeloma effect, but this did not translate into improved survival. This trial was registered at www.clinicaltrials.gov as #NCT00218855.

scholarly journals Augmented Reality (AR) Technology-Based Learning: The Effect on Physics Learning during the COVID-19 Pandemic

2022 ◽  
Vol 12 (2) ◽  
pp. 132-140
Author(s):  
Doni Ropawandi ◽  
◽  
Lilia Halim ◽  
Hazrati Husnin
Keyword(s):  
Augmented Reality ◽  
Physics Education ◽  
Teaching And Learning ◽  
Control Group ◽  
Technology In Education ◽  
Learning And Teaching ◽  
Face To Face ◽  
Significant Difference ◽  
Experimental Group

The COVID-19 pandemic has significantly disrupted education and has instantaneously shifted education from being conducted predominately ‘face to face’ to being totally ‘online’. For most teachers, this unexpected teaching approach has impelled them into finding ways to provide the same quality of education to their students. One way of doing this is by adopting educational technologies in learning and teaching, including the use of augmented reality (AR) technology. AR technology has been integrated into the field of physics education. In this study, the effects of AR technology on understanding of the concepts of electricity in an online learning environment for 11th-grade students was investigated. Pretest and posttest were carried out in the control group and the experimental group. The results showed that AR technology improved understanding of electrical concepts for the students in the experimental group compared to the control group, with a very significant difference between both groups. This research contributes to the development of AR technology in education, especially in relation to the teaching and learning of abstract physics concepts.

scholarly journals The spinal adjuvent - intrathecal nalbuphine as effective as intrathecal fentanyl

2020 ◽  
Vol 11 (3) ◽  
pp. 4492-4498
Author(s):  
Pratibha Deshmukh ◽  
Medha Sangawar ◽  
Nikita Dhumne ◽  
Vivek Chakole
Keyword(s):  
Dural Puncture ◽  
Local Anaesthetics ◽  
Hyperbaric Bupivacaine ◽  
Time Duration ◽  
Post Dural Puncture Headache ◽  
Intraoperative Hypotension ◽  
Number Of Patients ◽  
Significant Difference ◽  
To Receive

Opioids are favoured as adjuvants to local anaesthetics for spinal anaesthesia. The present study was aimed to compare the clinical efficiency of intrathecal nalbuphine with fentanyl as an adjuvant to 0.5% hyperbaric bupivacaine. 100 adult patients of either sex, ASA grade I and II, aged 18–60 years were randomized into two groups of 50 each to receive either fentanyl 25 μg (Group BF) or nalbuphine 500µg (Group BN) with 3 ml 0.5% hyperbaric bupivacaine, making drug volume to 3.5 ml in each group. Sensory and motor block characteristics, duration of analgesia, VAS score, haemodynamic and side effects were recorded. The sensorimotor characteristics were comparable and found no significant difference between the two groups, (P>0.05). The time duration for adequate analgesia in group BN was 366.40 ± 37.32min, and in the group, BF was 361.39 ± 43.96min, (P= 0.567). In both, the groups, quality of analgesia during the procedure was excellent in a maximum number of patients (96% each group). Sedation score, hemodynamic and respiratory rate changes were comparable between the two groups. In group BF, 4 (8%) patients complained nausea/ vomiting, pruritus was observed in 2 (4%), intraoperative hypotension in 3 (6%) and bradycardia in 2 (4%) and post-dural puncture headache in 2 patient (4%). In group BN, only bradycardia was observed in 3 (6%) patients. Nalbuphine and fentanyl were found to be equally efficient, but nalbuphine had a lower side effect profile, readily available as it does not come under the Narcotic act. However, we suggest Nalbuphine-bupivacaine combination as a better alternative than fentanyl-bupivacaine combination.

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