Patientoriented Algorithm for the X-ray Therapy Cabinet of Oncology Dispensary

Results: IIntroduction: Superficial X-ray therapy is a common treatment of non-melanoma skin cancer with a high incidence worldwide. Interrupting the course of radiation therapy can negatively affect patient survival and treatment results. Low treatment adherence may be associated with a lack of a patient-centered approach and ineffective communications. The original study shows that patients undergoing X-ray therapy for cancer may have different needs. Based on the study results an algorithm for a patient-oriented approach has been developed for the X-ray cabinets. Purpose: To develop a patient-oriented algorithm of the X-ray therapy room to address the issues of increasing patient satisfaction and forming their adherence to treatment. The objectives of the study included studying and detailing the needs of the patients who passed the X-ray therapy and to develop the patient-oriented algorithm for the X-ray therapy room. Material and methods: The study of the patient's values was carried out from 2019 to 2020 by interviewing using open-ended questions to find out the deep motives and beliefs of patients. The study was based on Milton Rokich’s (2005) model of value orientations, which was adapted to the objectives of the study. Results: The study included 116 patients undergoing treatment with the X-ray therapy at the City Clinical Oncology Dispensary. As a result of the study, the following patient needs were identified: clinical outcome of the procedure 111 (96 %), safety of treatment and adverse reactions 106 (91 %), cosmetic outcome 53 (46 %), convenience of the treatment schedule 42 (36 %), painlessness of the procedure 39 (34 %), the ability to lead a normal lifestyle 27 (23 %), comfortable conditions for the procedure 16 (14 %), financial costs associated with treatment 10 (9 %), preservation of organ function 4 (3 %). On the basis of the data obtained, a patient-oriented algorithm for the X-ray therapy was developed, including a communication plan with the patient. The study results clearly demonstrate that even with the same disease and condition, patients may have different priorities hat need to be considered to improve patient experience and adherence to treatment. Conclusion: Radiation treatment decision-making based on the patients values is important for the development of the patient-centered management in oncology since this directly affects patients’ adherence to treatment. Exploring the values and needs of patients is an opportunity to influence and improve the metrics of the patient experience. Due to the mass incidence of non-melanoma skin cancer, the introduction of patient-centered approaches is an important part of patient satisfaction and increase of patients adherence to the treatment.

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Forecasting and optimization of the kilovoltage X-ray therapy office within the framework of clinical guidelines of the Association of oncologists of Russia (AOR) of the Ministry of health of the Russian Federation

Research n Practical Medicine Journal ◽

10.17709/2409-2231-2020-7-3-10 ◽

2020 ◽

Vol 7 (3) ◽

pp. 99-107

Author(s):

L. N. Izurov ◽

J. A. Zuenkova

Keyword(s):

Mathematical Model ◽

Skin Cancer ◽

Medical Care ◽

Clinical Guidelines ◽

Day Hospital ◽

Actual Performance ◽

X Ray ◽

Non Melanoma Skin Cancer ◽

Therapy Room ◽

Melanoma Skin

One of the elements of the quality of medical care is its accessibility, which depends on the material and technical base of the institution, as well as on the availability of stuff and work management. Implementation of the new clinical guidelines of the Association of Oncologists of Russia (AOR) for the treatment of non-melanoma skin cancer (NRC), revealed the problem of increasing the load on stuff and equipment. Purpose of the study. To investigate and forecast the load of the kilovoltage X-ray therapy unit taking into account the updated clinical guidelines for the treatment of patients with non-melanoma skin cancer using radiotherapy. Determine the clinical and organizational changes in the technology of x-ray therapy for non-melanoma skin cancer within the day-hospital department for the skin cancer size more than 2 cm after implementation of new clinical guidelines and fraction regimes in compare with previously used schemes; derive a mathematical model of the work of the kilovoltage x-ray therapy room. Materials and methods. Data from the kilovoltage X-ray therapy office of radiotherapy unit No. 2 of the Sverdlovsk Regional Oncology Dispensary (SROD) were used. The average duration of radiotherapy sessions per patient was estimated and calculated using timekeeping. The results were evaluated using correlation analysis. In order to forecast the use of material and human resources, an economic method of mathematical modeling was used. Results. The analysis of the kilovoltage X-ray therapy unit of radiotherapy department No. 2 of the SROD for 3 years showed an increase from 10.4 to 17.3 in the average number of therapeutic fractions per patient after the implementation of the updated clinical guidelines. An increase in the average number of radiotherapy sessions leads to a doubling of the average bed-day of the patient's stay in the day-hospital. The formula was proposed for predicting the work of the unit. There is a clear correlation between the duration of treatment, the dynamics of hospitalization and the number of treated patients. The calculated results obtained using a mathematical model fully correspond to the actual performance of the radiotherapy room. Conclusion. To ensure optimal availability of medical care, it is necessary to match treatment technologies with available resources of the organization. The introduction of new treatment programs may require both the expansion of staff (medical, nursing), and an increase in the number of units of medical equipment. The obtained mathematical model of the kilovoltage X-ray therapy room allows to predict the optimal mode of work of employees while maintaining the quality and accessability of medical care.

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