scholarly journals Redesigning Cancer Care Delivery: Views From Patients and Caregivers

2017 ◽  
Vol 13 (4) ◽  
pp. e291-e302 ◽  
Author(s):  
Manali I. Patel ◽  
Vyjeyanthi S. Periyakoil ◽  
Douglas W. Blayney ◽  
David Moore ◽  
Andrea Nevedal ◽  
...  
Keyword(s):  
United States ◽  
Health Care Providers ◽  
Cancer Care ◽  
Care Delivery ◽  
Comparative Method ◽  
The United States ◽  
Care Providers ◽  
Patient Centered ◽  
Delivery Of Care ◽  
Targeted Interventions

Introduction: Cancer is a leading cause of death in the United States. Although treatments have improved, patients and caregivers continue to report significant gaps in their care. The objective of this study was to examine the views of patients and caregivers on their experiences with current cancer care delivery and identify key strategies to improve the delivery of care. Methods and Materials: Semistructured interviews were conducted with 75 patients and 45 caregivers across the United States. The interviews were recorded, transcribed, and analyzed using constant comparative method of qualitative analysis. Results: Participants reported multiple gaps in care delivery, including barriers in health communication with health care providers, lack of elucidation of care goals, lack of care coordination, and challenges in accessing care. Participants identified that greater use of nonphysician providers and alternative formats, such as telephone-based care and home and community-based care, would narrow these gaps. Conclusion: Understanding patients’ and caregivers’ experiences with gaps in cancer care delivery can inform cancer care delivery redesign efforts and lead to targeted interventions that result in patient-centered and family-oriented care.

Delivering End-of-Life Cancer Care: Perspectives of Providers

2017 ◽  
Vol 35 (3) ◽  
pp. 497-504 ◽  
Author(s):  
Manali I. Patel ◽  
Vyjeyanthi S. Periyakoil ◽  
David Moore ◽  
Andrea Nevedal ◽  
Tumaini R. Coker
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
Cancer Care ◽  
Care Delivery ◽  
Comparative Method ◽  
The United States ◽  
Home Delivery ◽  
Care Providers ◽  
Face To Face ◽  
Care Services

Objectives: Persistent gaps in end-of-life cancer care delivery and growing associated expenditures remain imminent US public health issues. The objective of this study was to understand clinical providers’ experiences delivering cancer care for patients at the end of life and their perspectives on potential solutions to improve quality of care. Methods: Semistructured interviews were conducted with 75 cancer care providers across the United States. The interviews were recorded, transcribed, and analyzed using constant comparative method of qualitative analysis. Results: Providers identified 3 major cancer care delivery challenges including lack of time to educate patients and caregivers due to clinical volume and administrative burdens, ambiguity in determining both prognosis and timing of palliative care at the end-of-life, and lack of adequate systems to support non-face-to-face communication with patients. To address these challenges, providers endorsed several options for clinical practice redesign in their settings. These include use of a lay health worker to assist in addressing early advance care planning, proactive non-face-to-face communication with patients specifically regarding symptom management, and community and in-home delivery of cancer care services. Discussion: Specific strategies for cancer care redesign endorsed by health-care providers may be used to create interventions that can more efficiently and effectively address gaps in end-of-life cancer care.

First data from OUT: The National Cancer Survey of LGBTQ+ survivors.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18544-e18544
Author(s):  
Nfn Scout ◽  
Michelle ED Veras ◽  
Bethany Andrews Rhoten ◽  
Reece ED Lyerly ◽  
Aurea ED Kasberg ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Health Care Providers ◽  
Coming Out ◽  
Cancer Care ◽  
The United States ◽  
Cultural Barriers ◽  
Care Providers ◽  
Patient Centered ◽  
Cross Sectional ◽  
Health Crisis

e18544 Background: Cultural barriers that inhibit LGBTQ cancer care are a public health crisis. Although LGBTQ cultural competency trainings are rapidly becoming the norm, patient-centered information is lacking for healthcare professionals in cancer care. The purpose of OUT: The National Cancer Survey is to understand the experiences of LGBTQ cancer survivors in order to make cancer care a safer and more welcoming place for survivors and their support teams. Methods: Individuals age 18 or older currently living in the United States who have been previously diagnosed with cancer and who identify as LGBTQ+ were recruited via community partnerships and targeted paid social media advertisements with an oversample of media outreach to Black Indigenous and People of Color (BIPOC). Participants completed a cross-sectional web-based survey of their cancer care experiences. This resulted in a final sample of [1,600+] survivors, the largest known sample of LGBTQ+ cancer survivors in the world. The sample was weighted to adjust for U.S. sex assigned at birth and racial/ethnic demographics. Descriptive statistics were used to summarize participant responses, crosstabs were used to compare responses across demographic categories, and excerpted responses are used to highlight qualitative themes. Results: Participants ranged in age from X to X years (median X). X% of the sample identified as either gay or lesbian, X% as bi, and X% as trans or gender nonconforming. X% of the sample identified as White only, followed by X% as Latine, X% as Black and X% as other or mixed race. Most common cancer types included XYZ. When asked about welcoming care, X% of the sample reported they specifically sought an LGBTQ+ welcoming provider after diagnosis. Most common methods for finding such a provider included: X, X, and X. Most common cues that helped patients identify welcoming providers included X, X, and X. Overall X% reported receiving care in an LGBTQ+ welcoming environment but X% did not. Of those who did not receive care in a welcoming environment, they were more likely to be X, X, and X. Overall, X% of patients were out to their providers, but this varied by X, X, and X. The most common ways of coming out included X, X, and X. When asked what they wanted to tell health care providers to ensure better care, participants highlighted several themes, including: X, X, and X. These findings provide patient driven insights into how cancer care varies within the LGBTQ+ population by different demographic factors and specific strategies providers can take to enhance care for LGBTQ+ people.

Successful Strategies to Address Disparities: Insurer and Employer Perspectives

2020 ◽  
pp. 292-300
Author(s):  
Manali I. Patel ◽  
Richard Snyder ◽  
Otis Brawley
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Low Income ◽  
Cancer Care ◽  
Care Delivery ◽  
The United States ◽  
Cancer Disparities ◽  
Care Providers ◽  
High Quality ◽  
Quality Cancer Care

Disparities in cancer have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Disparate cancer outcomes continue to affect many populations in the United States and globally, including racial and ethnic minorities, populations with low income and education, and residents of rural areas or low socioeconomic neighborhoods, among others. Addressing cancer disparities requires approaches that are multilevel. Addressing social determinants of health, such as removing obstacles to health (e.g., poverty, discrimination, access to housing and education, jobs with fair pay, and health care) can reduce cancer disparities. However, to achieve cancer health equity, multilevel approaches are required to ensure that access to high-quality cancer care and equitable receipt of evidence-based services can reduce cancer disparities. Policy, health system interventions, and innovative delivery and health care coverage approaches by private and public payers, employer-based payers, and labor union organizations can assist in ensuring access to and receipt of high-quality cancer care while addressing the high costs of care delivery. Partnerships among patients, caregivers, employers, health care providers, and health care payers can make impactful changes in the way in which cancer care is delivered and, in turn, can assist in reducing cancer disparities.

Implications of Negligent Selection and Retention of Physicians in the Age of ERISA

1995 ◽  
Vol 21 (4) ◽  
pp. 383-418
Author(s):  
Torin A. Dorros ◽  
T. Howard Stone
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Providers ◽  
Health Care Delivery ◽  
Quality Of Health Care ◽  
Care Delivery ◽  
The United States ◽  
Care Providers ◽  
Insurance Reform

Enormous and fundamental changes are currently taking place in health care delivery. These changes include the consolidation of health care providers—from hospitals, physicians, and insurance companies, to medical supply businesses, managed care networks, and other health care providers—and numerous health care and insurance reform efforts by government at all levels. These changes pose significant implications for the delivery of health care in the United States, and will impact the manner, cost, and accessibility of health care delivery. These changes will almost certainly affect the quality of health care services as well. The quality of health care in the United States has for many years been a central concern of government, industry, health care providers, payors, and consumers. Quality in health care is essential to overall national health, the guarantor of a productive and healthy populace, and an important indicator of United States social and technological preeminence.

Practice gaps and challenges integrating new immuno-oncology agents in the treatment of cancer patients in the United States: A mixed-method study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 11028-11028
Author(s):  
Neal E. Ready ◽  
Aparna Raj Parikh ◽  
Patrice Lazure ◽  
Morgan Peniuta ◽  
Marianne Davies ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Cancer Patients ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Predictive Biomarkers ◽  
The United States ◽  
Care Providers ◽  
Immune Biomarkers

11028 Background: Previous research has indicated challenges integrating new immuno-oncology agents (IOAs) and predictive immune biomarkers into practice. Barriers, clinical gaps and underlying causalities explaining these challenges, however, are poorly understood. Methods: A mixed-methods educational needs assessment was conducted with physicians from 6 specialties (oncology, interventional radiology, pathology, pulmonology, emergency medicine and rheumatology), clinical pharmacists, physician assistants and advanced nurse practitioners involved in the care of cancer patients in the United States. Semi-structured interviews and discussion groups were thematically analyzed to identify challenges, barriers and underlying causalities. Qualitative findings subsequently informed the development of online surveys, which served to quantify findings. The following findings pertain to oncologists. Results: A total of 660 health care providers participated in the study, in which 17 interviews and 88 surveys were completed with oncologists. Seventy-two percent reported sub-optimal knowledge of the interactions between IOAs and the tumor’s micro-environment, while 62% reported sub-optimal skills determining which IOA to select based on this information. Oncologists reported sub-optimal knowledge of best practices for using IOAs to treat cancer in presence of an autoimmune disease (74%-80% depending on condition), and sub-optimal skills weighing the risks and benefits of prescribing IOAs for these profiles (66%-77%). In addition, 50% of oncologists reported feeling overwhelmed by the volume of new IOAs being made available. Many oncologists expressed doubts regarding the clinical benefit (59%) and innovative nature (43%) of emerging IOAs. Finally, 46% reported limited skills identifying viable treatment options based on pharmacodiagnostic test reports. Barriers to having predictive biomarkers inform treatment decisions included sub-optimal communication between specialists regarding specimen requirements and desired biomarker information. Conclusions: This study demonstrates the need to further support healthcare professionals as they face challenges integrating new IOAs and predictive immune biomarkers into practice. Given the wide array of IOAs becoming available each year, addressing the knowledge, skills, confidence and attitude gaps identified in this study could help improve health care delivery and potentially optimize outcomes for cancer patients.

The Special Perils of Being Old and Sick in Prison

2020 ◽  
Vol 32 (5) ◽  
pp. 276-284
Author(s):  
William J. Jefferson
Keyword(s):  
United States ◽  
Health Care ◽  
Medical Care ◽  
Health Care Providers ◽  
The United States ◽  
United States Constitution ◽  
Care Providers ◽  
Medical Practitioners ◽  
Medical Needs ◽  
Access To Medical Care

The United States Supreme Court declared in 1976 that deliberate indifference to the serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain…proscribed by the Eighth Amendment. It matters not whether the indifference is manifested by prison doctors in their response to the prisoner’s needs or by prison guards intentionally denying or delaying access to medical care or intentionally interfering with treatment once prescribed—adequate prisoner medical care is required by the United States Constitution. My incarceration for four years at the Oakdale Satellite Prison Camp, a chronic health care level camp, gives me the perspective to challenge the generally promoted claim of the Bureau of Federal Prisons that it provides decent medical care by competent and caring medical practitioners to chronically unhealthy elderly prisoners. The same observation, to a slightly lesser extent, could be made with respect to deficiencies in the delivery of health care to prisoners of all ages, as it is all significantly deficient in access, competencies, courtesies and treatments extended by prison health care providers at every level of care, without regard to age. However, the frailer the prisoner, the more dangerous these health care deficiencies are to his health and, therefore, I believe, warrant separate attention. This paper uses first-hand experiences of elderly prisoners to dismantle the tale that prisoner healthcare meets constitutional standards.

A survey of Instagram users with asthma to evaluate the acceptability of a planned clinical trial intervention (Preprint)

2020 ◽  
Author(s):  
Kerry Spitzer ◽  
Brent Heineman ◽  
Marcella Jewell ◽  
Michael Moran ◽  
Peter Lindenauer
Keyword(s):  
United States ◽  
Social Media ◽  
Health Care Providers ◽  
College Education ◽  
The United States ◽  
Survey Study ◽  
Care Providers ◽  
Healthy Behaviors ◽  
Social Media Platforms ◽  
Hispanic White

BACKGROUND Asthma is a chronic lung disease that affects nearly 25 million individuals in the United States. There is a need for more research into the potential for health care providers to leverage existing social media platforms to improve healthy behaviors and support individuals living with chronic health conditions. OBJECTIVE In this study, we assess the willingness of Instagram users with poorly controlled asthma to participate in a pilot study that uses Instagram as a means of providing social and informational support. In addition, we explore the potential for adapting photovoice and digital storytelling to social media. METHODS A survey study of Instagram users living with asthma in the United States, between the ages of 18 to 40. RESULTS Over 3 weeks of recruitment, 457 individuals completed the pre-survey screener; 347 were excluded. Of the 110 people who were eligible and agreed to participate in the study, 82 completed the study survey. Respondents mean age was 21(SD = 5.3). Respondents were 56% female (n=46), 65% (n=53) non-Hispanic white, and 72% (n=59) had at least some college education. The majority of respondents (n = 66, 81%) indicated that they would be willing to participate in the study. CONCLUSIONS Among young-adult Instagram users with asthma there is substantial interest in participating in a study that uses Instagram to connect participants with peers and a health coach in order to share information about self-management of asthma and build social connection.

scholarly journals Complementary and Integrative Health Knowledge and Practice in Primary Care Settings: A Survey of Primary Care Providers in the Northwestern United States

2021 ◽  
Vol 10 ◽  
pp. 216495612110233
Author(s):  
Malaika R Schwartz ◽  
Allison M Cole ◽  
Gina A Keppel ◽  
Ryan Gilles ◽  
John Holmes ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Knowledge ◽  
Care Delivery ◽  
Primary Care Providers ◽  
The United States ◽  
Research Network ◽  
Care Providers ◽  
Integrative Health ◽  
And Training

Background The demand for complementary and integrative health (CIH) is increasing by patients who want to receive more CIH referrals, in-clinic services, and overall care delivery. To promote CIH within the context of primary care, it is critical that providers have sufficient knowledge of CIH, access to CIH-trained providers for referral purposes, and are comfortable either providing services or co-managing patients who favor a CIH approach to their healthcare. Objective The main objective was to gather primary care providers’ perspectives across the northwestern region of the United States on their CIH familiarity and knowledge, clinic barriers and opportunities, and education and training needs. Methods We conducted an online, quantitative survey through an email invitation to all primary care providers (n = 483) at 11 primary care organizations from the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region Practice and Research Network (WPRN). The survey questions covered talking about CIH with patients, co-managing care with CIH providers, familiarity with and training in CIH modalities, clinic barriers to CIH integration, and interest in learning more about CIH modalities. Results 218 primary care providers completed the survey (45% response rate). Familiarity with individual CIH methods ranged from 73% (chiropracty) to 8% (curanderismo). Most respondents discussed CIH with their patients (88%), and many thought that their patients could benefit from CIH (41%). The majority (89%) were willing to co-manage a patient with a CIH provider. Approximately one-third of respondents had some expertise in at least one CIH modality. Over 78% were interested in learning more about the safety and efficacy of at least one CIH modality. Conclusion Primary care providers in the Northwestern United States are generally familiar with CIH modalities, are interested in referring and co-managing care with CIH providers, and would like to have more learning opportunities to increase knowledge of CIH.

Nurse Practitioner Challenges to the Orthodox Structure of Health Care Delivery: Regulation and Restraints on Trade

1985 ◽  
Vol 11 (2) ◽  
pp. 195-225
Author(s):  
Karla Kelly
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Delivery ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Allied Health ◽  
Care Delivery ◽  
The United States ◽  
Care Providers ◽  
Allied Health Care

AbstractUntil recently, physicians have been the primary health care providers in the United States. In response to the rising health care costs and public demand of the past decade, allied health care providers have challenged this orthodox structure of health care delivery. Among these allied health care providers are nurse practitioners, who have attempted to expand traditional roles of the registered nurse.This article focuses on the legal issues raised by several major obstacles to the expansion of nurse practitioner services: licensing restrictions, third party reimbursement policies, and denial of access to medical facilities and physician back-up services. The successful judicial challenges to discriminatory practices against other allied health care providers will be explored as a solution to the nurse practitioners’ dilemma.

Patients' Perceptions of Different Information Exchange Mechanisms: An Exploratory Study in the United States

2020 ◽  
Vol 59 (04/05) ◽  
pp. 162-178
Author(s):  
Pouyan Esmaeilzadeh
Keyword(s):  
United States ◽  
Health Care ◽  
Health Information ◽  
Health Care Providers ◽  
Information Exchange ◽  
The United States ◽  
Exchange Mechanism ◽  
Care Providers ◽  
Security Risks ◽  
Direct Exchange

Abstract Background Patients may seek health care services from various providers during treatment. These providers could serve in a network (affiliated) or practice separately (unaffiliated). Thus, using secure and reliable health information exchange (HIE) mechanisms would be critical to transfer sensitive personal health information (PHI) across distances. Studying patients' perceptions and opinions about exchange mechanisms could help health care providers build more complete HIEs' databases and develop robust privacy policies, consent processes, and patient education programs. Objectives Due to the exploratory nature of this study, we aim to shed more light on public perspectives (benefits, concerns, and risks) associated with the four data exchange practices in the health care sector. Methods In this study, we compared public perceptions and expectations regarding four common types of exchange mechanisms used in the United States (i.e., traditional, direct, query-based, patient-mediated exchange mechanisms). Traditional is an exchange through fax, paper mailing, or phone calls, direct is a provider-to-provider exchange, query-based is sharing patient data with a central repository, and patient-mediated is an exchange mechanism in which patients can access data and monitor sharing. Data were collected from 1,624 subjects using an online survey to examine the benefits, risks, and concerns associated with the four exchange mechanisms from patients' perspectives. Results Findings indicate that several concerns and risks such as privacy concerns, security risks, trust issues, and psychological risks are raised. Besides, multiple benefits such as access to complete information, communication improvement, timely and convenient information sharing, cost-saving, and medical error reduction are highlighted by respondents. Through consideration of all risks and benefits associated with the four exchange mechanisms, the direct HIE mechanism was selected by respondents as the most preferred mechanism of information exchange among providers. More than half of the respondents (56.18%) stated that overall they favored direct exchange over the other mechanisms. 42.70% of respondents expected to be more likely to share their PHI with health care providers who implemented and utilized a direct exchange mechanism. 43.26% of respondents believed that they would support health care providers to leverage a direct HIE mechanism for sharing their PHI with other providers. The results exhibit that individuals expect greater benefits and fewer adverse effects from direct HIE among health care providers. Overall, the general public sentiment is more in favor of direct data transfer. Our results highlight that greater public trust in exchange mechanisms is required, and information privacy and security risks must be addressed before the widespread implementation of such mechanisms. Conclusion This exploratory study's findings could be interesting for health care providers and HIE policymakers to analyze how consumers perceive the current exchange mechanisms, what concerns should be addressed, and how the exchange mechanisms could be modified to meet consumers' needs.

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