scholarly journals Telehealth in Oncology: ASCO Standards and Practice Recommendations

2021 ◽  
pp. OP.21.00438
Author(s):  
Robin T. Zon ◽  
Erin B. Kennedy ◽  
Kerin Adelson ◽  
Sibel Blau ◽  
Natalie Dickson ◽  
...  
Keyword(s):  
Expert Panel ◽  
Care Delivery ◽  
Evidence Base ◽  
Advanced Practice ◽  
Allied Health Professionals ◽  
Additional Information ◽  
Practice Recommendations ◽  
Final Manuscript ◽  
General Guidance

PURPOSE To provide standards and practice recommendations specific to telehealth in oncology. METHODS A systematic review of the literature on telehealth in oncology was performed, including the use of technologies and telecommunications systems, and other electronic methods of care delivery and sharing of information with patients. The evidence base was combined with the opinion of the ASCO Telehealth Expert Panel to develop telehealth standards and guidance. Public comments were solicited and considered in preparation of the final manuscript. RESULTS The Expert Panel determined that general guidance on implementing telehealth across general and specialty settings has been published previously and these resources are endorsed. A systematic search for studies on topics specific to oncology resulted in the inclusion of two clinical practice guidelines, 12 systematic reviews, and six primary studies. STANDARDS AND GUIDANCE Standards and guidance are provided for which patients in oncology can be seen via telehealth, establishment of the doctor-physician relationship, role of allied health professionals, role of advanced practice providers, multidisciplinary cancer conferences, and teletrials in oncology. Additional information is available at www.asco.org/standards .

Future of specialised roles in allied health practice: who is responsible?

2015 ◽  
Vol 39 (3) ◽  
pp. 255 ◽  
Author(s):  
Elizabeth H. Skinner ◽  
Kimberley J. Haines ◽  
Kate Hayes ◽  
Daniel Seller ◽  
Jessica C. Toohey ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Health Professionals ◽  
Allied Health ◽  
Service Providers ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Evidence Base ◽  
Allied Health Professionals ◽  
Clinical Placements ◽  
Effective Manner

Allied health professions have developed specialised advanced and extended scope roles over the past decade, for the benefit of patient outcomes, allied health professionals’ satisfaction and to meet labour and workforce demands. There is an essential need for formalised, widely recognised training to support these roles, and significant challenges to the delivery of such training exist. Many of these roles function in the absence of specifically defined standards of clinical practice and it is unclear where the responsibility for training provision lies. In a case example of physiotherapy practice in the intensive care unit, clinical placements and independence of practice are not core components of undergraduate physiotherapy degrees. Universities face barriers to the delivery of postgraduate specialised training and, although hospital physiotherapy departments are ideally placed, resources for training are lacking and education is not traditionally considered part of healthcare service providers’ core business. Substantial variability in training, and its evaluation, leads to variability in practice and may affect patient outcomes. Allied health professionals working in specialised roles should develop specific clinical standards of practice, restructure models of health care delivery to facilitate training, continue to develop the evidence base for their roles and target and evaluate training efficacy to achieve independent practice in a cost-effective manner. Healthcare providers must work with universities, the vocational training sector and government to optimise the ability of allied health to influence decision making and care outcomes for patients.

The Evolving Role of Advanced Practice Providers in Otolaryngology: Improving Patient Access and Patient Satisfaction

2021 ◽  
pp. 019459982110203
Author(s):  
Pratyusha Yalamanchi ◽  
Meredith Blythe ◽  
Kristi S. Gidley ◽  
William R. Blythe ◽  
Richard W. Waguespack ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Care Delivery ◽  
Physician Assistants ◽  
Neck Surgery ◽  
Physician Workforce ◽  
Advanced Practice ◽  
Patient Access ◽  
Few Data ◽  
Improve Access

The aging US population requires an increasing volume of otolaryngology–head and neck surgery services, yet the otolaryngologist physician workforce remains static. Advanced practice providers (APPs), including physician assistants and nurse practitioners, improve access across the continuum of primary and subspecialty health care. The rapid growth of APP service is evidenced by a 51% increase in APP Medicare billing for otolaryngology procedures over 5 years. APPs increasingly participate in delivering otolaryngology care; however, reaping the benefits of enhanced patient access and modernizing care delivery is predicated on successful integration of APPs into practices. Few data are available on how best to incorporate APPs into team-based models or how to restructure practices to allow graduated responsibility that supports autonomy and effective teamwork. We compare national APP and physician workforce trends in otolaryngology, consider approaches to optimizing efficiency by integrating APPs, and identify opportunities for improving data collection and practice.

scholarly journals Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline

2018 ◽  
Vol 36 (13) ◽  
pp. 1343-1373 ◽  
Author(s):  
Hedy L. Kindler ◽  
Nofisat Ismaila ◽  
Samuel G. Armato ◽  
Raphael Bueno ◽  
Mary Hesdorffer ◽  
...  
Keyword(s):  
Malignant Pleural Mesothelioma ◽  
Literature Search ◽  
Expert Panel ◽  
Evidence Base ◽  
Evidence Based ◽  
Pleural Mesothelioma ◽  
Additional Information ◽  
Thoracic Cancer ◽  
American Society ◽  
Meta Analyses

Purpose To provide evidence-based recommendations to practicing physicians and others on the management of malignant pleural mesothelioma. Methods ASCO convened an Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, pathology, imaging, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1990 through 2017. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. Results The literature search identified 222 relevant studies to inform the evidence base for this guideline. Recommendations Evidence-based recommendations were developed for diagnosis, staging, chemotherapy, surgical cytoreduction, radiation therapy, and multimodality therapy in patients with malignant pleural mesothelioma. Additional information is available at www.asco.org/thoracic-cancer-guidelines and www.asco.org/guidelineswiki .

scholarly journals Chemotherapy in Combination With Radiotherapy for Definitive-Intent Treatment of Stage II-IVA Nasopharyngeal Carcinoma: CSCO and ASCO Guideline

2021 ◽  
pp. JCO.20.03237
Author(s):  
Yu-Pei Chen ◽  
Nofisat Ismaila ◽  
Melvin L. K. Chua ◽  
A. Dimitrios Colevas ◽  
Robert Haddad ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Literature Search ◽  
Expert Panel ◽  
Healthcare Providers ◽  
Evidence Base ◽  
Stage Ii ◽  
Chinese Society ◽  
Evidence Based ◽  
Head Neck Cancer ◽  
Additional Information

PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other healthcare providers on definitive-intent chemoradiotherapy for patients with stage II-IVA nasopharyngeal carcinoma (NPC). METHODS The Chinese Society of Clinical Oncology (CSCO) and ASCO convened an expert panel of radiation oncology, medical oncology, surgery, and advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2020. Outcomes of interest included survival, distant and locoregional disease control, and quality of life. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 108 relevant studies to inform the evidence base for this guideline. Five overarching clinical questions were addressed, which included subquestions on radiotherapy (RT), chemotherapy sequence, and concurrent, induction, and adjuvant chemotherapy options. RECOMMENDATIONS Evidence-based recommendations were developed to address aspects of care related to chemotherapy in combination with RT for the definitive-intent treatment of stage II to IVA NPC. Additional information is available at www.asco.org/head-neck-cancer-guidelines .

scholarly journals Transition to a New Cancer Care Delivery System: Opportunity for Empowerment of the Role of the Advanced Practice Provider

2012 ◽  
Vol 3 (1) ◽  
Author(s):  
Ruth McCorkle, PhD, FAAN ◽  
Constance Engelking, RN, MS ◽  
M. Tish Knobf, PhD, FAAN, AOCN® ◽  
Mark Lazenby, PhD, APRN ◽  
Marianne Davies, APRN ◽  
...  
Keyword(s):  
Delivery System ◽  
Cancer Care ◽  
Care Delivery ◽  
Advanced Practice

scholarly journals Invited Commentary: Opportunities That Come With Studying the Co-Occurrence of Multiple Outcomes

2020 ◽  
Vol 189 (9) ◽  
pp. 982-984 ◽  
Author(s):  
Sebastien Haneuse ◽  
Deborah Schrag ◽  
Daniel Nevo
Keyword(s):  
Health Care Providers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Base ◽  
Clinical Settings ◽  
Care Providers ◽  
Additional Information ◽  
Potential Benefits ◽  
Almost All

Abstract In almost all clinical settings, patients are at risk for multiple potential events and, in consultation with health-care providers, must weigh the potential benefits and harms across these events when making decisions. As researchers seek to build an evidence base to inform these decisions, they must contend with a choice as to how they will handle the different events. One approach, arguably the standard approach in the literature, is to consider the events individually by conducting analyses and publishing results for each one at a time. Doing so, however, fails to acknowledge or exploit the inherent multivariate nature of the data, represents a lost opportunity, and results in an evidence base that is not aligned with how clinical decision-making is actually performed. The article by Prentice et al. (Am J Epidemiol. 2020;189(9):972–981) in this issue of the Journal moves beyond this standard by illustrating recently developed methods that directly take advantage of information on the co-occurrence of multiple events. Moreover, their article highlights the role of modern methods in deriving additional information and insight from studies of multiple clinical outcomes by making full use of multivariate data, with the goal being to complement, not replace, existing methods.

scholarly journals Management of Dyspnea in Advanced Cancer: ASCO Guideline

2021 ◽  
Vol 39 (12) ◽  
pp. 1389-1411
Author(s):  
David Hui ◽  
Kari Bohlke ◽  
Ting Bao ◽  
Toby C. Campbell ◽  
Patrick J. Coyne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Expert Panel ◽  
Meta Analysis ◽  
Supplemental Oxygen ◽  
Evidence Base ◽  
Healthcare Research ◽  
Additional Information ◽  
Dyspnea Assessment

PURPOSE To provide guidance on the clinical management of dyspnea in adult patients with advanced cancer. METHODS ASCO convened an Expert Panel to review the evidence and formulate recommendations. An Agency for Healthcare Research and Quality (AHRQ) systematic review provided the evidence base for nonpharmacologic and pharmacologic interventions to alleviate dyspnea. The review included randomized controlled trials (RCTs) and observational studies with a concurrent comparison group published through early May 2020. The ASCO Expert Panel also wished to address dyspnea assessment, management of underlying conditions, and palliative care referrals, and for these questions, an additional systematic review identified RCTs, systematic reviews, and guidelines published through July 2020. RESULTS The AHRQ systematic review included 48 RCTs and two retrospective cohort studies. Lung cancer and mesothelioma were the most commonly addressed types of cancer. Nonpharmacologic interventions such as fans provided some relief from breathlessness. Support for pharmacologic interventions was limited. A meta-analysis of specialty breathlessness services reported improvements in distress because of dyspnea. RECOMMENDATIONS A hierarchical approach to dyspnea management is recommended, beginning with dyspnea assessment, ascertainment and management of potentially reversible causes, and referral to an interdisciplinary palliative care team. Nonpharmacologic interventions that may be offered to relieve dyspnea include airflow interventions (eg, a fan directed at the cheek), standard supplemental oxygen for patients with hypoxemia, and other psychoeducational, self-management, or complementary approaches. For patients who derive inadequate relief from nonpharmacologic interventions, systemic opioids should be offered. Other pharmacologic interventions, such as corticosteroids and benzodiazepines, are also discussed. Additional information is available at www.asco.org/supportive-care-guidelines .

Posttransplant CMV infection and the role of immunosuppression (Sponsor: Novartis Pharma GmbH, Nürnberg)

2016 ◽  
Vol 04 (01) ◽  
pp. 4-10
Keyword(s):  
Lower Incidence ◽  
Paradigm Shift ◽  
Mtor Inhibitor ◽  
De Novo ◽  
Expert Panel ◽  
Risk Of Infection ◽  
Cmv Infection ◽  
Expert Meeting ◽  
Selection Of

AbstractImmunosuppression permits graft survival after transplantation and consequently a longer and better life. On the other hand, it increases the risk of infection, for instance with cytomegalovirus (CMV). However, the various available immunosuppressive therapies differ in this regard. One of the first clinical trials using de novo everolimus after kidney transplantation [1] already revealed a considerably lower incidence of CMV infection in the everolimus arms than in the mycophenolate mofetil (MMF) arm. This result was repeatedly confirmed in later studies [2–4]. Everolimus is now considered a substance with antiviral properties. This article is based on the expert meeting “Posttransplant CMV infection and the role of immunosuppression”. The expert panel called for a paradigm shift: In a CMV prevention strategy the targeted selection of the immunosuppressive therapy is also a key element. For patients with elevated risk of CMV, mTOR inhibitor-based immunosuppression is advantageous as it is associated with a significantly lower incidence of CMV events.

Embodied Spatial Practices and the Power to Care

2019 ◽  
pp. 360-377
Author(s):  
Elise Paradis ◽  
Warren Mark Liew ◽  
Myles Leslie
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Ethnographic Study ◽  
Spatial Practices ◽  
Critical Care Units ◽  
Interprofessional Care ◽  
The Social

Drawing on an ethnographic study of teamwork in critical care units (CCUs), this chapter applies Henri Lefebvre’s ([1974] 1991) theoretical insights to an analysis of clinicians’ and patients’ embodied spatial practices. Lefebvre’s triadic framework of conceived, lived, and perceived spaces draws attention to the role of bodies in the production and negotiation of power relations among nurses, physicians, and patients within the CCU. Three ethnographic vignettes—“The Fight,” “The Parade,” and “The Plan”—explore how embodied spatial practices underlie the complexities of health care delivery, making visible the hidden narratives of conformity and resistance that characterize interprofessional care hierarchies. The social orderings of bodies in space are consequential: seeing them is the first step in redressing them.

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