scholarly journals Cancer care disruption and reorganisation during the COVID-19 pandemic in Australia: A patient, carer and healthcare worker perspective

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257420
Author(s):  
Rhiannon Edge ◽  
Josh Meyers ◽  
Gabriella Tiernan ◽  
Zhicheng Li ◽  
Alexandra Schiavuzzi ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cancer Care ◽  
Healthcare Workers ◽  
Psychosocial Support ◽  
Cross Sectional ◽  
Pandemic Response ◽  
Long Term Impact ◽  
Uncertain Time ◽  
Survey Responses

The COVID-19 pandemic has dramatically impacted cancer care worldwide. Disruptions have been seen across all facets of care. While the long-term impact of COVID-19 remains unclear, the immediate impacts on patients, their carers and the healthcare workforce are increasingly evident. This study describes disruptions and reorganisation of cancer services in Australia since the onset of COVID-19, from the perspectives of people affected by cancer and healthcare workers. Two separate online cross-sectional surveys were completed by: a) cancer patients, survivors, carers, family members or friends (n = 852) and b) healthcare workers (n = 150). Descriptive analyses of quantitative survey data were conducted, followed by inductive thematic content analyses of qualitative survey responses relating to cancer care disruption and perceptions of telehealth. Overall, 42% of cancer patients and survivors reported experiencing some level of care disruption. A further 43% of healthcare workers reported atypical delays in delivering cancer care, and 50% agreed that patient access to research and clinical trials had been reduced. Almost three quarters (73%) of patients and carers reported using telehealth following the onset of COVID-19, with high overall satisfaction. However, gaps were identified in provision of psychological support and 20% of participants reported that they were unlikely to use telehealth again. The reorganisation of cancer care increased the psychological and practical burden on carers, with hospital visitation restrictions and appointment changes reducing their ability to provide essential support. COVID-19 has exacerbated a stressful and uncertain time for people affected by cancer and healthcare workers. Service reconfiguration and the adoption of telehealth have been essential adaptations for the pandemic response, offering long-term value. However, our findings highlight the need to better integrate psychosocial support and the important role of carers into evolving pandemic response measures. Learnings from this study could inform service improvements that would benefit patients and carers longer-term.

Breast cancer: Does where you get treated affect survival?

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 28-28
Author(s):  
Nina A. Bickell ◽  
Jenny J Lin ◽  
Rebeca Franco ◽  
Natalia Egorova
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Care ◽  
Cox Model ◽  
Vital Statistics ◽  
Sensitivity Analyses ◽  
Breast Cancer Patients ◽  
Long Term Impact ◽  
Improve Access

28 Background: Under the ACA, more women are insured with Medicaid which should improve access to cancer care. However, Disproportionate Share Hospitals (DSH) are due to receive reduced subsidies thereby threatening resource stressed facilities and poorer hospitals are experiencing greater financial penalties due to higher readmission rates. In NYS, 83% of Medicaid breast cancer patients got their cancer surgery at DSH hospitals. As women gain more choice and access, they will require information about hospitals’ quality and outcomes of cancer care. We sought to determine whether there are survival advantages among breast cancer patients treated at hospitals with varying proportions of Medicaid patients. Methods: We used non-obstetric delivery Medicaid discharges from NYS hospitals in 2005-13 to create quintiles of hospitalized patients with Medicaid. Women treated for breast cancer were identified with a diagnostic and procedure code for breast cancer. Based on NYS hospital discharge database linked with vital statistics death records, we calculated hazard ratios using marginal Cox model with a robust sandwich variance estimator controlling for clustering of patients within the hospital, age and comorbidity. Results: Quintiles of Medicaid hospitals ranged from low (0-15%), to low medium (15-22%), medium (22-29%), medium-high (29-50%), to high ( > 50%). 26% of breast cancer patients were treated at the low; 22% at the low medium; 20% at the medium; 21% at the medium-high and 11% at high quintile hospitals. Patients treated in hospitals with > 50% Medicaid patients had a higher long-term mortality (HR = 1.51; 95%CI: 1.19-1.93) compared to those treated at the lowest quintile hospitals. Sensitivity analyses to adjust for stage are underway. Conclusions: While the ACA may improve access to breast cancer treatment, the long term impact on survival remains questionable as women with breast cancer treated at hospitals with high proportions of Medicaid patients may have worse survival. Analyses to control for stage are underway. Pending these results, hospitals with high proportions of Medicaid patients may need to target cancer quality improvement efforts to assure equitable outcomes.

scholarly journals Middle and Long-Term Impact of a Very Low-Carbohydrate Ketogenic Diet on Cardiometabolic Factors: A Multi-Center, Cross-Sectional, Clinical Study

2015 ◽  
Vol 22 (4) ◽  
pp. 389-394 ◽  
Author(s):  
Arrigo F. G. Cicero ◽  
Maddalena Benelli ◽  
Marco Brancaleoni ◽  
Giuseppe Dainelli ◽  
Desiré Merlini ◽  
...  
Keyword(s):  
Clinical Study ◽  
Ketogenic Diet ◽  
Cross Sectional ◽  
Low Carbohydrate ◽  
Long Term Impact ◽  
Cardiometabolic Factors

scholarly journals COVID-19 confessions: a qualitative exploration of healthcare workers experiences of working with COVID-19

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e043949
Author(s):  
Paul Bennett ◽  
S Noble ◽  
Stephen Johnston ◽  
David Jones ◽  
Rachael Hunter
Keyword(s):  
Healthcare Workers ◽  
Improve Patient Care ◽  
Front Line ◽  
High Profile ◽  
The Face ◽  
Discharged Patients ◽  
Front Line Workers ◽  
Long Term Impact ◽  
Qualitative Exploration

ObjectivesTo gain insight into the experiences and concerns of front-line National Health Service (NHS) workers while caring for patients with COVID-19.DesignQualitative analysis of data collected through an anonymous website (www.covidconfidential) provided a repository of uncensored COVID-19 experiences of front-line NHS workers, accessed via a link advertised on the Twitter feed of two high profile medical tweeters and their retweets.SettingCommunity of NHS workers who accessed this social media.Participants54 healthcare workers, including doctors, nurses and physiotherapists, accessed the website and left a ‘story’.ResultsStories ranged from 1 word to 10 min in length. Thematic analysis identified common themes, with a central aspect being the experience and psychological consequence of trauma. Specific themes were: (1) the shock of the virus, (2) staff sacrifice and dedication, (3) collateral damage ranging from personal health concerns to the long-term impact on, and care of, discharged patients and (4) a hierarchy of power and inequality within the healthcare system.ConclusionsCOVID-19 confidential gave an outlet for unprompted and uncensored stories of healthcare workers in the context of COVID-19. In addition to personal experiences of trauma, there were perceptions that many operational difficulties stemmed from inequalities of power between management and front-line workers. Learning from these experiences will reduce staff distress and improve patient care in the face of further waves of the pandemic.

scholarly journals Long-term impact of a ten-year intervention program on human and canine Trypanosoma cruzi infection in the Argentine Chaco

2021 ◽  
Vol 15 (5) ◽  
pp. e0009389
Author(s):  
Marta Victoria Cardinal ◽  
Gustavo Fabián Enriquez ◽  
Natalia Paula Macchiaverna ◽  
Hernán Darío Argibay ◽  
María del Pilar Fernández ◽  
...  
Keyword(s):  
Trypanosoma Cruzi ◽  
Disease Transmission ◽  
Intervention Program ◽  
Substantial Reduction ◽  
Triatoma Infestans ◽  
Incident Case ◽  
Cross Sectional ◽  
Vector Borne ◽  
Long Term Impact

Background Interruption of domestic vector-borne transmission of Trypanosoma cruzi is still an unmet goal in several American countries. In 2007 we launched a long-term intervention program aimed to suppress house infestation with the main domestic vector in southern South America (Triatoma infestans) and domestic transmission in Pampa del Indio, a resource-constrained, hyperendemic municipality with 1446 rural houses inhabited by Creole and indigenous people, in the Argentine Chaco ecoregion. Here, we assessed whether the 10-year insecticide-based program combined with community mobilization blocked vector-borne domestic transmission of T. cruzi to humans and dogs. Methods We carried out two municipality-wide, cross-sectional serosurveys of humans and dogs (considered sentinel animals) during 2016–2017 to compare with baseline data. We used a risk-stratified random sampling design to select 273 study houses; 410 people from 180 households and 492 dogs from 151 houses were examined for antibodies to T. cruzi using at least two serological methods. Results The seroprevalence of T. cruzi in children aged <16 years was 2.5% in 2017 (i.e., 4- to 11-fold lower than before interventions). The mean annual force of child infection (λ) sharply decreased from 2.18 to 0.34 per 100 person-years in 2017. One of 102 children born after interventions was seropositive for T. cruzi; he had lifetime residence in an apparently uninfested house, no outside travel history, and his mother was T. cruzi-seropositive. No incident case was detected among 114 seronegative people of all ages re-examined serologically. Dog seroprevalence was 3.05%. Among native dogs, λ in 2016 (1.21 per 100 dog-years) was 5 times lower than at program onset. Six native adult dogs born after interventions and with stable lifetime residence were T. cruzi-seropositive: three had exposure to T. infestans at their houses and one was an incident case. Conclusions These results support the interruption of vector-borne transmission of T. cruzi to humans in rural Pampa del Indio. Congenital transmission was the most likely source of the only seropositive child born after interventions. Residual transmission to dogs was likely related to transient infestations and other transmission routes. Sustained vector control supplemented with human chemotherapy can lead to a substantial reduction of Chagas disease transmission in the Argentine Chaco.

scholarly journals “We Thought We Were Prepared, but We Were Not”: Experiences from the Management of the Psychosocial Support Response during the COVID-19 Pandemic in Sweden. A Mixed-Methods Study

2021 ◽  
Vol 18 (17) ◽  
pp. 9079
Author(s):  
Karin Hugelius ◽  
Sara Johansson ◽  
Helena Sjölin
Keyword(s):  
Health Care ◽  
Large Scale ◽  
Psychosocial Support ◽  
Care Staff ◽  
Mental Wellbeing ◽  
Health Care Staff ◽  
Line Managers ◽  
Major Incidents ◽  
Pandemic Response

This study aimed to describe experiences of managing mental health and psychosocial activities during the first six months of the COVID-19 pandemic in Sweden. A national survey was answered by a non-probability sample of 340 involved in the psychosocial response. The psychosocial response operations met several challenges, mainly related to the diverse actors involved, lack of competence, and lack of preparations. Less than 80% of the participants had received specific training in the provision of psychosocial support during major incidents. The interventions used varied, and no large-scale interventions were used. The psychosocial response organizations were overwhelmed by the needs of health care staff and failed to meet the needs of patients and family members. An efficient and durable psychosocial response in a long-term crisis requires to be structured, planned and well-integrated into the overall pandemic response. All personnel involved need adequate and specific competence in evidence-based individual and large-scale interventions to provide psychosocial support in significant incidents. By increasing general awareness of mental wellbeing and psychosocial support amongst health professionals and their first-line managers, a more resilient health care system, both in everyday life and during major incidents and disasters, could be facilitated.

Long-term impact of plain packaging of cigarettes with larger graphic health warnings: findings from cross-sectional surveys of Australian adolescents between 2011 and 2017

2019 ◽  
Vol 28 (e1) ◽  
pp. e77-e84 ◽  
Author(s):  
Victoria M White ◽  
Nicola Guerin ◽  
Tahlia Williams ◽  
Melanie A Wakefield
Keyword(s):  
Smoking Prevalence ◽  
Health Warnings ◽  
Cross Sectional ◽  
Plain Packaging ◽  
School Based ◽  
Negative Perceptions ◽  
Long Term Impact ◽  
Cigarette Packs ◽  
Positive Character

ObjectiveTo assess the long-term impact of plain packaging (PP) of cigarettes with larger graphic health warnings (HW) introduced in December 2012 on adolescents’ relevant tobacco-related perceptions.MethodsCross-sectional school-based surveys of 12 to 17 year olds in 2011 (n=4413), 2013 (n=4423), 2014 (n=4576) and 2017 (n=4266). Students rated the character of four popular cigarette brands, indicated their agreement regarding brand differences in smoking ease, quitting, addictiveness, harmfulness and pack attractiveness and positive/negative perceptions of pack image. The frequency of students reading, attending to, thinking and talking about HW was assessed. Responses of students seeing cigarette packs in the previous 6 months (2011: 63%; 2013: 67%, 2014: 56%, 2017: 56%) were examined.ResultsSmoking prevalence declined from 2011 to 2017. Among students who had recently seen packs, cigarette packs were rated less positively and more negatively in 2017 than in 2011 (p<0.001) with ratings similar between 2013 and 2017. Positive character ratings for each brand reduced between 2011 and 2013 (ps<0.05) with further reductions between 2013 and 2017 (ps<0.05). Fewer students agreed, and more were uncertain, that brands differed in their smoking ease, addictiveness, harmfulness and pack attractiveness in 2017 than 2011. The frequency of students reading, attending, talking or thinking about HW did not change between 2011 and 2017.ConclusionsPP’s initial impact in reducing adolescent’s positive perceptions of cigarette packs and brand differences continued in the following years with tobacco packaging less appealing to young people in 2017 than 2011 and students more uncertain about brand differences.

A conundrum in cancer quality measurement: Performance on long-term survival reflects performance a long time ago.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18222-e18222
Author(s):  
Allison Lipitz-Snyderman ◽  
Michael A. Curry ◽  
David M. Rubin ◽  
Diane G. Li ◽  
Elaine Duck ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cancer Care ◽  
Random Effect ◽  
Care Quality ◽  
Survival Outcomes ◽  
Median Income ◽  
Long Term Outcomes ◽  
Term Survival ◽  
One Year

e18222 Background: Long term outcomes, such as five-year survival following cancer treatment, are widely accepted as important metrics of cancer care quality. But because they take years to accrue, they reflect the quality of care delivered in the past. The objective of this study was to delineate to what extent measures of long term outcomes related to cancer care could be reliably used to predict care quality in future periods. Methods: Taking advantage of FFS Medicare data from related studies, we assessed survival of cancer patients at one and four years by hospital for four separate index years 2006, 2011-2013. We assembled pairs of years across which we could compare risk adjusted outcomes separated by one year (2011 to 2012; 2012 to 2013), two years (2011 to 2013), and five through seven years comparing 2006 to 2011, 2012, or 2013 respectively. The outcome was risk adjusted mortality rates at the hospital level determined by dividing the observed number of deaths by an expected number, adjusting for age, and median income level of the zip code of residence. For each hospital and for every pair of analytic years we separately compared the correlation of one and four-year risk adjusted mortality using both Pearson and Spearman correlation statistics. A mixed effects model was fit to determine if size and year gap between measurements could explain possible differences in the correlation of hospital performance, while controlling for hospitals as a random effect. Results: There were 1,640 hospitals and more than 350,000 patients in each analysis year. Focusing on the correlation of the four year survival outcomes, the highest volume hospitals have significantly higher correlations compared to the other hospital categories (P < 0.001). The greater the elapsed time between measurement periods the lower the correlation. But in the mixed model analysis neither time elapsed between measurement periods (p = 0.51) nor the interaction between time elapsed and hospital volume (p = 0.95) were significant. Analyses of one-year outcomes produced similar findings. Conclusions: Performance on four-year survival outcomes of cancer patients was reasonably correlated for large volume hospitals, but less so for hospitals with lower volumes.

Perceptions of cancer care coordination in patient-family caregiver dyads.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14036-e14036
Author(s):  
Izumi Okado ◽  
Ian Pagano ◽  
Tracey Hewitt ◽  
Kelnia Azevedo ◽  
Cherie Guillermo ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Care Coordination ◽  
Family Caregiver ◽  
Cancer Care ◽  
Care Delivery ◽  
Bimodal Distribution ◽  
Self Report ◽  
Patient Navigator ◽  
Cross Sectional ◽  
Caregiver Involvement

e14036 Background: Family caregivers (FCGs) can play a key role in coordinating care for cancer patients. However, little is known about FCGs’ perspectives of care coordination (CC). In this cross-sectional study, we evaluated perceptions of CC in cancer patient-family caregiver dyads using the Care Coordination Instrument (CCI), a validated self-report measure with excellent psychometric properties. Methods: Patients receiving active treatment for cancer and their primary FCGs ( N = 54 dyads) completed the 29-item CCI (patient) and the CCICG (a parallel FCG version) at private oncology practices or hospital-based facilities from June to Sept. 2019. The CCI and CCICG assess overall perceptions of CC (Total) and across 3 domains: Communication, Navigation, and Operational. The CCICG includes a supplemental questionnaire that assesses the degree of caregiver CC involvement on a 4-point Likert scale. Mixed regression models were used to examine differences between patients and FCGs’ perceptions of CC and to identify predictors of dyadic differences on the CCI scores. Pearson’s correlation was used to evaluate associations between FCGs’ perceptions of CC and the degree of caregiver involvement. Results: CCICG Total scores demonstrated a bimodal distribution, representing FCGs’ perceptions of CC in distinct high and low subgroups; thus, all analyses were conducted by subgroups (highCG, lowCG). Overall, no dyadic differences were found in the highCG group on the CCI scores. However, in the lowCG group, FCGs reported poorer Total ( p < .01), Communication ( p < .01), Navigation ( p < .01), and Operational ( p < .05) scores than patients. Provider setting (private practices) and the absence of an identified patient navigator significantly predicted poorer FCG Total scores compared to patients’ perceptions ( p < .05). FCGs’ Total scores were inversely associated with the degree of caregiver involvement among FCGs in the lowCG group ( p < .05) but not among FCGs in the highCG group. Conclusions: Our findings demonstrate that a subgroup of FCGs has poorer perceptions of CC that differ significantly from patient perceptions and is most apparent for patients receiving treatment in a private practice setting and in the absence of a patient navigator. These FCGs report a high degree of caregiver involvement and may be providing additional CC support that is not recognized by cancer patients. These findings underscore the need for interventions to support FCG CC involvement as a member of the care team in order to improve the quality and value of patient-centered cancer care delivery.

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