scholarly journals Identifying Cancer Care Team Competencies to Improve Care Coordination in Multiteam Systems: A Modified Delphi Study

2020 ◽  
Vol 16 (11) ◽  
pp. e1324-e1331
Author(s):  
Veronica Chollette ◽  
Sallie J. Weaver ◽  
Grace Huang ◽  
Sophia Tsakraklides ◽  
Shin-Ping Tu
Keyword(s):  
Care Coordination ◽  
Delphi Study ◽  
Cancer Care ◽  
Web Based ◽  
Modified Delphi ◽  
Quality Cancer Care ◽  
Multiteam Systems ◽  
Multidisciplinary Group ◽  
The Impact ◽  
Initial List

PURPOSE: Identifying nontechnical, teamwork competencies (knowledge, skills, and attitudes) underlying coordination within and across the network of teams—or multiteam system (MTS) involved in cancer care is foundational to optimizing high-quality cancer care. METHODS: A multidisciplinary group of cancer care stakeholders refined an initial list of competency statements during three rounds of a web-based modified Delphi survey. RESULTS: Panelists reached consensus on a final list of four domains and 20 associated team-based competencies important for effective coordination in cancer care MTS. CONCLUSION: This study provides an initial foundation for testing, modifying, measuring and evaluating the impact of identified competencies on care coordination, outcomes, and costs, for people being screened, treated, or surviving cancer.

Do rural cancer patients receive lower quality cancer care? Assessing the impact of rurality on oncology practice performance measures.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 166-166
Author(s):  
Catherine R. Fedorenko ◽  
Laura Elizabeth Panattoni ◽  
Qin Sun ◽  
Li Li ◽  
Karma L. Kreizenbeck ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Cancer Patients ◽  
Cancer Care ◽  
Performance Measure ◽  
Area Deprivation ◽  
Cancer Type ◽  
Quality Cancer Care ◽  
Practice Performance ◽  
The Impact

166 Background: Rural residents are diagnosed at later stages of cancer compared to urban residents, have poorer survival, and face distinct barriers to receiving quality cancer care. ASCO has developed policy initiatives to address rural cancer care; however, little is known about quality of cancer care among patients residing in rural areas. This study examined the impact of rurality on performance metrics, controlling for socioeconomic status and insurance type. Methods: We linked Washington state cancer registry records from 2015-2017 with claims records for two large commercial insurers, Medicare, and Medicaid. Using claims from this database, we generated eight nationally recognized quality measures. Rurality was measured by the Rural-Urban Commuting Area Codes (RUCAs) categorized into 4 levels (Metro, Metro with commute, Micropolitan, Small Town/Rural). Process and outcome measures were adjusted for age, sex, race, comorbidity score, stage, cancer type, marital status, the Area Deprivation Index, and treatment factors where appropriate. Results were stratified by payer type. Results: The table below lists the effect of a patient’s rurality on the quality metric where significant (p<0.05). Where rurality did not impact the performance measure, results are left blank. Conclusions: After controlling for socioeconomic status and payer type, quality of cancer care for rural cancer patients was not consistently poorer compared to urban patients. These results suggest that lower survival among rural patients may be due to factors beyond quality of care.[Table: see text]

Examining patient burden and drivers of delayed care in patients undergoing surgical treatment of primary lung cancer.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 153-153
Author(s):  
Caleb Barnhill ◽  
Charles Hillenbrand ◽  
Stephen Kaplan ◽  
Madhan Kuppusamy ◽  
Michal Hubka
Keyword(s):  
Lung Cancer ◽  
Surgical Treatment ◽  
Care Coordination ◽  
Cancer Care ◽  
Medical Center ◽  
Primary Lung Cancer ◽  
Cancer Center ◽  
Healthcare Team ◽  
The Impact ◽  
Travel Burden

153 Background: Patients’ geographic location can impact access to specialty care and affect the appropriateness and timeliness of evaluation leading to primary surgical treatment of lung cancer. Cancer care coordination has long been speculated to lead to greater efficiency in oncologic care, yet objective measures demonstrating the utility of such healthcare team members is lacking. We aimed to study the impact of patients’ residence on healthcare encounters, travel burden and the distribution of physiologic and oncologic workup leading to delays in care at a specialty cancer center. Methods: We conducted a single center retrospective cohort study of 103 patients undergoing workup of primary lung cancer between January 2015 and August 2017. The shortest route between patient residence and treating medical center was measured in miles and classified as: urban ( < 40 miles); rural (40.1 – 100 miles); and regional (100.1 – 1,000 miles). Average total miles traveled (i.e. travel burden), total number of healthcare encounters, and the distribution of physiologic and oncologic evaluations as drivers of delay in care were examined. Results: Patients were categorized as urban n = 80 (77.7%); rural n = 12 (11.7%); and regional n = 11 (10.7%). Median travel burden (urban = 100 miles [interquartile range, IQR 56-216.8]; rural = 385.7 [127.1 – 769]; regional = 780 [560 – 1936]; p < 0.001) and median total healthcare encounters (urban = 7 [6-9]; rural = 9 [7-9.5]; regional = 10 [7-12]; p = 0.3) increased with greater distance of patient residence from treating medical center. Additional necessary physiologic workup was associated with delayed care and greater burden in the rural and regional patients compared to those residing in urban locations (urban = 21% increase; rural = 152%; regional = 162%). Additional oncologic workup was associated with delayed care in the regional group only (49% increase). These trends remained even when controlling for clinical stage. Conclusions: These findings demonstrate the need for better cancer care coordination for rural and regional lung cancer patients to improve efficiency, appropriateness and timeliness of care while decreasing patient-related burdens.

scholarly journals Development of An Implementation Process Model: A Delphi Study

2021 ◽  
Author(s):  
Gillian Parker ◽  
Monika Kastner ◽  
Karen Born ◽  
Whitney Berta
Keyword(s):  
Knowledge Translation ◽  
Clinical Outcomes ◽  
Delphi Study ◽  
Process Model ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Implementation Support ◽  
Support Tool ◽  
Modified Delphi ◽  
The Impact

Abstract Background: There is general scarcity of research on key elements of implementation processes and the factors which impact implementation success. Implementation of healthcare interventions is a complex process. Tools to support implementation can facilitate this process and improve effectiveness of the interventions and clinical outcomes. Understanding the impact of implementation support tools is a critical aspect of this process. The objective of this study was to solicit knowledge and consensus from relevant implementation science and knowledge translation healthcare experts in order to refine and validate a process model of key elements in the implementation process.Methods: A two round consensus-based modified Delphi study involving international experts in knowledge translation and implementation (researchers, scientists, professors, decision-makers) was conducted. Participants rated and commented on all aspects of the process model, including the organization, content, scope, and structure. Delphi questions rated at 75% agreement or lower were reviewed and revised. Qualitative comments supported the restructuring and refinement. A second-round survey followed the same process as Round 1. Results: Fifty-four experts participated in Round 1, and 32 experts participated in Round 2. Twelve percent (n=6) of the Round 1 questions did not reach consensus. Key themes for revision and refinement were: stakeholder engagement throughout the process, iterative nature of the implementation process; importance of context; and importance of using guiding theories or frameworks. The process model was revised and refined based on the quantitative and qualitative data and reassessed by the experts in Round 2. Consensus was achieved on all items in Round 2 and the Delphi concluded. Additional feedback was obtained regarding terminology, target users and definition of the implementation process.Conclusions: High levels of agreement were attained for all sub-domains, elements, and sub-elements of the Implementation Process Model. This validated model will be used to develop an Implementation Support Tool to be used by healthcare providers to facilitate effective implementation and improved clinical outcomes.

Identifying indicators of colorectal cancer care coordination: a Delphi study

2013 ◽  
Vol 16 (1) ◽  
pp. 17-25 ◽  
Author(s):  
J. M. Young ◽  
L. M. Masya ◽  
M. J. Solomon ◽  
H. L. Shepherd
Keyword(s):  
Colorectal Cancer ◽  
Care Coordination ◽  
Delphi Study ◽  
Cancer Care

scholarly journals Development of entrustable professional activities for residents rotating nephrology department in a Japanese university hospital: a Delphi study

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047923
Author(s):  
Akihito Tanaka ◽  
Takeshi Kondo ◽  
Yuka Urushibara-Miyachi ◽  
Shoichi Maruyama ◽  
Hiroshi Nishigori
Keyword(s):  
Delphi Method ◽  
Delphi Study ◽  
Evaluation Criteria ◽  
University Hospital ◽  
Entrustable Professional Activities ◽  
Affiliate Hospital ◽  
Japanese University ◽  
Professional Activities ◽  
Modified Delphi ◽  
Initial List

ObjectivesTraining strategies regarding entrustable professional activities (EPAs) vary from country to country; one such strategy is for residents. However, there are no reports of EPAs developed for residents who rotate to the nephrology departments. We aimed to construct such EPAs, which could be generalised to other institutions.DesignPurposive design and a modified Delphi method to build consensus.SettingThe department of nephrology in a university hospital in Aichi Prefecture, Japan.ParticipantsBased on the attainment goals used in our department, an initial list was developed within the research group. The expert panel included 25 nephrologists from our affiliate hospital. Responses were based on a 5-point method and agreement was reached if both (A) and (B) were met: (A) mean≥4 with a SD <1; (B) more than 75% of respondents rated the item 4 or more. With agreement, the item was left for the next round. This round was repeated.ResultsAn initial list of 11 items was developed; after three Delphi rounds and revisions, eight items remained that were then established as the final EPAs. These items can serve as a list of goals to be reached by residents who rotate to the department of nephrology. The results indicated that most of the experts believed residents should be able to perform tasks deemed necessary or urgent for all physicians, such as those that deal with hyperkalaemia and heart failure.ConclusionsThe concept of EPAs enabled us to develop goals and evaluation criteria for residents’ training in nephrology. This study can serve as a springboard for future discussions and contribute to the development of resident education in nephrology.

scholarly journals An Evidence-Based, Nursing Handover Standard for a Multisite Public Hospital in Switzerland: Web-Based, Modified Delphi Study

JMIR Nursing ◽  
10.2196/17876 ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. e17876
Author(s):  
Nadine Tacchini-Jacquier ◽  
Hélène Hertzog ◽  
Kilian Ambord ◽  
Peter Urben ◽  
Pierre Turini ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Delphi Study ◽  
Public Hospital ◽  
Group Discussion ◽  
Survey Method ◽  
Evidence Based ◽  
Web Based ◽  
Modified Delphi ◽  
Evidence Based Nursing

Background Ineffective communication procedures create openings for errors when health care professionals fail to transfer complete, consistent information. Deficient or absent clinical handovers, or failures to transfer information, responsibility, and accountability, can have severe consequences for hospitalized patients. Clinical handovers are practiced every day, in many ways, in all institutional health care settings. Objective This study aimed to design an evidence-based, nursing handover standard for inpatients for use at shift changes or internal transfers between hospital wards. Methods We carried out a modified, multiround, web-based, Delphi data collection survey of an anonymized panel sample of 264 nurse experts working at a multisite public hospital in Switzerland. Each survey round was built on responses from the previous one. The surveys ended with a focus group discussion consisting of a randomly selected panel of participants to explain why items for the evidence-based clinical nursing handover standard were selected or not selected. Items had to achieve a consensus of ≥70% for selection and inclusion. Results The study presents the items selected by consensus for an evidence-based nursing handover standard for inpatients for use at shift changes or internal transfers. It also presents the reasons why survey items were or were not included. Conclusions This modified Delphi survey method enabled us to develop a consensus- and evidence-based nursing handover standard now being trialed at shift changes and the internal transfers of inpatients at our multisite public hospital in Switzerland.

scholarly journals Development of an Implementation Process Model: A Delphi Study

2020 ◽  
Author(s):  
Gillian Parker ◽  
Monika Kastner ◽  
Karen Born ◽  
Whitney Berta
Keyword(s):  
Knowledge Translation ◽  
Clinical Outcomes ◽  
Delphi Study ◽  
Process Model ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Implementation Support ◽  
Support Tool ◽  
Modified Delphi ◽  
The Impact

Abstract Background: There is general scarcity of research on key elements of implementation processes and the factors which impact implementation success. Implementation of healthcare interventions is a complex process. Tools to support implementation can facilitate this process and improve effectiveness of the interventions and clinical outcomes. Understanding the impact of implementation support tools is a critical aspect of this process. The objective of this study was to solicit knowledge and consensus from relevant implementation science and knowledge translation healthcare experts in order to refine and validate a process model of key elements in the implementation process.Methods: A two round consensus-based modified Delphi study involving international experts in knowledge translation and implementation (researchers, scientists, professors, decision-makers) was conducted. Participants rated and commented on all aspects of the process model, including the organization, content, scope, and structure. Delphi questions rated at 75% agreement or lower were reviewed and revised. Qualitative comments supported the restructuring and refinement. A second-round survey followed the same process as Round 1. Results: Fifty-four experts participated in Round 1, and 32 experts participated in Round 2. Twelve percent (n=6) of the Round 1 questions did not reach consensus. Key themes for revision and refinement were: stakeholder engagement throughout the process, iterative nature of the implementation process; importance of context; and importance of using guiding theories or frameworks. The process model was revised and refined based on the quantitative and qualitative data and reassessed by the experts in Round 2. Consensus was achieved on all items in Round 2 and the Delphi concluded. Additional feedback was obtained regarding terminology, target users and definition of the implementation process.Conclusions: High levels of agreement were attained for all sub-domains, elements, and sub-elements of the Implementation Process Model. This validated model will be used to develop an Implementation Support Tool to be used by healthcare providers to facilitate effective implementation and improved clinical outcomes.

Access to quality cancer care: consensus statement. American Federation of Clinical Oncologic Societies.

1998 ◽  
Vol 16 (4) ◽  
pp. 1628-1630 ◽  
Keyword(s):  
Health Care ◽  
Clinical Oncology ◽  
Health Care Providers ◽  
Cancer Care ◽  
Consensus Statement ◽  
Presidential Address ◽  
Care Providers ◽  
American Federation ◽  
Quality Cancer Care ◽  
The Impact

In his Presidential address on May 17, 1996, Dr John Glick proposed the formation of the American Federation of Clinical Oncologic Societies (AFCOS), a coalition of all professional clinical oncology societies. AFCOS was intended to address heightened concerns about changes in the health care delivery system and the impact that they may have on quality patient care. AFCOS places primary emphasis on educating patients, their families, health care providers, payors, legislators, regulators, and the general public about what constitutes quality care, advocating access to and coverage for such care, including clinical trials, and supporting and promoting patient-oriented research. Several meetings of the coalition have resulted in the development of a consensus statement on quality cancer care, which the Journal of Clinical Oncology is pleased to publish in this edition. The consensus statement was the product of collaboration among the Federation's nine member societies as well as national patient advocacy groups represented by the Cancer Leadership Council.

Choosing Wisely Africa: 10 low-value or harmful practices that should be avoided in cancer care.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19213-e19213
Author(s):  
Fidel Rubagumya ◽  
Gunita Mitera ◽  
Sidy Ka ◽  
Achille Van Christ Manirakiza ◽  
Phillipa Kibugu-Decuir ◽  
...  
Keyword(s):  
Cancer Care ◽  
Task Force ◽  
Sub Saharan Africa ◽  
Choosing Wisely ◽  
Modified Delphi ◽  
Quality Cancer Care ◽  
The Usa ◽  
Private And Public ◽  
Patient Advocacy Group ◽  
Sub Saharan

e19213 Background: Choosing Wisely Africa, builds on Choosing Wisely (CW) in the USA, Canada and India, and aims to identify low-value, unnecessary, or harmful cancer practices that are frequently used on the African continent. Methods: The CWA Task Force was convened by African Organization for Research and Training in Cancer (AORTIC) and included representatives in surgical, medical and radiation oncology, the private and public sectors and patient advocacy group. Consensus was built through a modified Delphi process shortening a long list of practices to a short list then to a final list. Results: Of the 10 practices on the final list, one is a new suggestion, 9 are revisions or adaptations of practices from previous CW campaign lists. One item relates to palliative care, 8 concern treatment, and 1 relates to surveillance. Conclusions: The success of this campaign will be measured by how the list is implemented across sub-Saharan Africa and whether it improves the delivery of high-quality cancer care. [Table: see text]

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