scholarly journals Difficulties in Accessing Cancer Care in a Small Island State: A Community-Based Pilot Study of Cancer Survivors in Saint Lucia

2021 ◽  
Vol 18 (9) ◽  
pp. 4770
Author(s):  
Aviane Auguste ◽  
Glenn Jones ◽  
Dorothy Phillip ◽  
James St. Catherine ◽  
Elizabeth Dos Santos ◽  
...  
Keyword(s):  
Health Services ◽  
Cancer Survivors ◽  
Cancer Care ◽  
Care Delivery ◽  
Research Capacity ◽  
Small Island ◽  
Future Research ◽  
Snowball Sampling ◽  
Community Based ◽  
Saint Lucia

Developing robust systems for cancer care delivery is essential to reduce the high cancer mortality in small island developing states (SIDS). Indigenous data are scarce, but community-based cancer research can inform care in SIDS where formal research capacity is lacking, and we describe the experiences of cancer survivors in Saint Lucia in accessing health services. Purposive and snowball sampling was used to constitute a sample of survivors for interviews. Subjects were interviewed with a questionnaire regarding socio-demographics, clinical characteristics, health services accessed (physicians, tests, treatment), and personal appraisal of experience. We recruited 50 survivors (13 men, 37 women). Only 52% of first presentations were with general practitioners. The mean turnaround for biopsy results in Saint Lucia was three times longer than overseas (p = 0.0013). Approximately half of survivors commenced treatment more than one month following diagnosis (median of 32 days, IQR 19–86 days), and 56% of survivors traveled out-of-country for treatment. Most survivors (60%) paid for care with family/friends support, followed by savings and medical insurance (38% each). In conclusion, cancer survivors in Saint Lucia are faced with complex circumstances, including access-to-care and health consequences. This study can guide future research, and possibly guide practice improvements in the near term.

scholarly journals Enriching Future Research: The Power of Qualitative Methods in Cancer-Related Health Services Research

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 687-688
Author(s):  
Sean Halpin
Keyword(s):  
Older Adults ◽  
Health Services Research ◽  
Health Services ◽  
Qualitative Methods ◽  
Cancer Care ◽  
Care Delivery ◽  
Guideline Implementation ◽  
Population Diversity ◽  
Future Research ◽  
Services Research

Abstract The ever-changing landscape of cancer care for older adults—with novel treatments, increasing survival rates, and growing population diversity—makes effective cancer care delivery increasingly complex. Qualitative research is uniquely poised to make sense of this complexity and shape potential interventions and their implementation. While the potential power of qualitative methods in cancer-related health services research and implementation science is great, as recognized in a recent National Cancer Institute report, the range of qualitative methods can make identifying and applying the most appropriate method(s) challenging. To meet this challenge, this symposium will bring together researchers across disciplines to report on three qualitative techniques and how each was applied in cancer research with older adults. Halpin will present on the use of applied conversation analysis to study medical education delivery to patients with multiple myeloma. The method is particularly well-suited to investigate health education and communicative efficacy. Carrion will discuss in-depth qualitative interviews that were conducted to understand the cancer beliefs and attitudes of older Latinx adults. The interviews, conducted in Spanish, offer an opportunity to consider how qualitative methods are key to illuminating the experiences of underrepresented populations. Seaman will report on the multiple qualitative methods used, including questionnaires, interviews, and site observations, to document survivorship care practices among head and neck cancer programs. The triangulation of qualitative methods allowed for an unparalleled understanding of guideline implementation and program variation. Exploring a range of methods, the presentations make a powerful argument for qualitative methods in cancer-related health services research.

scholarly journals Sexual healthcare professionals’ views on the rapid provision of remote services at the beginning of COVID-19 pandemic: A mixed-methods study

2021 ◽  
pp. 095646242110230
Author(s):  
Alexandria Lunt ◽  
Carrie Llewellyn ◽  
Jake Bayley ◽  
Tom Nadarzynski
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
Health Inequalities ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Digital Tools ◽  
Future Research ◽  
Snowball Sampling ◽  
Remote Services ◽  
Sexual Healthcare

Introduction: The COVID-19 pandemic and social distancing measures forced sexual health services to engage with patients remotely. We aimed to understand perceived barriers and facilitators to the provision of digital sexual health services during the first months of the pandemic. Methods: An online survey and qualitative interviews with UK sexual healthcare professionals recruited online and via snowball sampling were conducted in May–July 2020. Results: Amongst 177 respondents (72% female, 86% White, mean age = 46, SD = 9), most utilised telephone and email as their main communication channels; however, their perceived effectiveness varied (94% and 66%, respectively). Most agreed that staff needed additional training (89%), the available technology was not adequate (66%) and health professionals were hesitant to provide online consultations (46%). They had positive attitudes towards digitalisation, improving service quality and cost-effectiveness but were concerned about exacerbating health inequalities. Discussion: The study identifies a need for clear guidelines and training around the use of digital tools as well as a demand for investment in hardware and software required for the provision of remote services. Future research needs to explore the acceptability, safety and effectiveness of various digital tools to narrow health inequalities in sexual health service users.

Abstract 2552: Adapting a novel cancer care delivery model: identifying barriers unique to care coordination for LGBTQ cancer survivors

2021 ◽  
Author(s):  
Nicolas Francone ◽  
Jonathan Alhalel ◽  
Will Dunne ◽  
Sankirtana Danner ◽  
Nihmotallahi Adebayo ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Care Coordination ◽  
Cancer Care ◽  
Care Delivery ◽  
Delivery Model ◽  
Care Delivery Model

scholarly journals Community-based psychiatry services in Sri Lanka: A new model in the making

2021 ◽  
Author(s):  
Mahesh Rajasuriya
Keyword(s):  
Sri Lanka ◽  
Care Delivery ◽  
Rapid Development ◽  
Community Services ◽  
The State ◽  
Small Island ◽  
Service Development ◽  
State Health ◽  
Community Based ◽  
Health Authorities

Sri Lanka is a lower middle-income small island nation in the Indian Ocean with a multi-ethnic population of 22 million. The healthcare system of the country is well-established and fairly advanced, the delivery of which is free to the consumer. The health indicators of the country are impressive compared to regional figures. Psychiatric care in Sri Lanka saw a rapid development over the last four decades as the care model transformed from an asylum-based one, established during the British colonial times, to a district-wise hospital-based care delivery model. Gradually, the teams that provided inpatient and outpatient services at the hospitals started to also provide community-based care. The newly added community based services include outreach clinics, residential intermediate rehabilitation centres, home based care, community resource/support centres and telephone help lines. There is no or little separate funding for community-based care services. The teams that deliver community services are funded, mostly indirectly, by the state health authorities. This is so as these community teams are essentially the same psychiatry teams that are based at the hospitals, which are funded and run by the state health authorities. This lack of separation of the community and hospital teams without separate and dedicated funding is an impediment to service development, which needs to be addressed. Paradoxically, it conforms an advantage by making care delivery from the hospital to the community continuous, as it is the same team that provides both hospital- and community-based care. In addition to the essential mental health care provision in the community with this basic infrastructure, each community service has improvised and adapted utilization of other resources available to them, formally as well as informally, to compensate their financial and human resource limitations. These other resources are the community officials and the community services of the non-health sectors of the government, mainly of the civil administration. Though sustainability maybe questionable when services involve informal resources from the non-health sectors, it has so far proven useful and effective, in a resource-poor environment, as it brings the community and various sectors together to facilitate services to support their own community.

scholarly journals Regional Multiteam Systems in Cancer Care Delivery

2016 ◽  
Vol 12 (11) ◽  
pp. 1059-1066 ◽  
Author(s):  
Katia Noyes ◽  
John R.T. Monson ◽  
Irfan Rizvi ◽  
Ann Savastano ◽  
James S.A. Green ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Treatment Options ◽  
High Volume ◽  
Future Research ◽  
Multidisciplinary Teams ◽  
Real Patient ◽  
Patient Journey

Teamwork is essential for addressing many of the challenges that arise in the coordination and delivery of cancer care, especially for the problems that are presented by patients who cross geographic boundaries and enter and exit multiple health care systems at various times during their cancer care journeys. The problem of coordinating the care of patients with cancer is further complicated by the growing number of treatment options and modalities, incompatibilities among the vast variety of technology platforms that have recently been adopted by the health care industry, and competing and misaligned incentives for providers and systems. Here we examine the issue of regional care coordination in cancer through the prism of a real patient journey. This article will synthesize and elaborate on existing knowledge about coordination approaches for complex systems, in particular, in general and cancer care multidisciplinary teams; define elements of coordination derived from organizational psychology and human factors research that are applicable to team-based cancer care delivery; and suggest approaches for improving multidisciplinary team coordination in regional cancer care delivery and avenues for future research. The phenomenon of the mobile, multisystem patient represents a growing challenge in cancer care. Paradoxically, development of high-quality, high-volume centers of excellence and the ease of virtual communication and data sharing by using electronic medical records have introduced significant barriers to effective team-based cancer care. These challenges urgently require solutions.

Incidence of asymptomatic COVID-19 positivity in cancer patients and effects on therapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13506-e13506
Author(s):  
Nicole Ross ◽  
Elizabeth A. Handorf ◽  
Caitlin R. Meeker ◽  
Giana Chen ◽  
Donald Baldwin ◽  
...  
Keyword(s):  
General Population ◽  
Cancer Care ◽  
Care Delivery ◽  
Conditional Logistic Regression ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Future Research ◽  
Co Morbidity ◽  
Procedure Type

e13506 Background: As the coronavirus disease 2019 (COVID-19) pandemic threatens the delivery of cancer care, challenges to providing safe and quality care persist. Screening measures including SARS-CoV-2 polymerase-chain reaction (CovPCR) testing prior to invasive procedures, therapy administration, were instituted to address risk of spread from asymptomatic (AS) pts. Studies have documented poor outcomes with COVID-19 in cancer pts with rate of AS COVID-19 ranging from 0.6%- 8%. (Liang et.al, 2020; Al-Shamsi, et.al, 2020, Shah et.al. 2020). In the general population, rates of AS cases was estimated to be 17% (Byambasuren, O., 2020). This study aimed to examine the incidence and characteristics of AS COVID -19 in cancer pts, and determine its effect on cancer care delivery at a tertiary care center. Methods: With IRB approval, a retrospective chart review was conducted on cancer pts undergoing CoVPCR screening. Pts were considered AS if they had no recent fever (≥100.5 °F), cough, headache, loss of taste/smell, shortness of breath, diarrhea, or high risk exposure. This analysis compared cases (positive CoVPCR) identified by screening of AS pts to control (negative CoVPCR) pts (matched by planned procedure type and month of screening). Each COVID case was matched to 2 negative controls on month and planned procedure type. Patient characteristics and outcomes were compared between cases and controls using conditional logistic regression or Mantel-Haenszel tests. Results: Between 03/2020 and 09/2020, 4143 AS pts underwent CovPCR testing and 75 were chosen for analysis (25 cases; 50 controls). The incidence of AS COVID-19 in cancer pts was 0.6% (25/4143). Median age was lower in the cases (64 vs 70y, p = 0.04). Gender, race, primary cancer diagnosis, and co-morbidity distribution was similar between cases and controls. Of the cases, 10 pts (40%) never underwent the planned oncologic intervention while 11 (44%) had a delay related to the positive CoVPCR (2 pts had no intervention planned). Only 1 pt (2%) in control arm didn’t undergo the planned procedure. The mean duration of delay was 18 days (range 0-49 days, SD 16.72) in cases versus Zero days in control. Four (16.7%) cases developed symptoms within 14 days of positive CoVPCR testing but the PCR value did not predict this conversion. Conclusions: Incidence of AS COVID in our cancer pts was significantly lower than general population. Active screening delayed oncologic care but with institution of safety measures like separate treatment rooms and scheduling procedures at the end of the day have ensured safe and prompt cancer care delivery during the pandemic. Future research needs will address incorporating vaccination status into the screening algorithm to limit widespread CoVPCR screening, thus improving care delivery and cost effectiveness.

Moving Toward Improved Teamwork in Cancer Care: The Role of Psychological Safety in Team Communication

2016 ◽  
Vol 12 (11) ◽  
pp. 1000-1011 ◽  
Author(s):  
Anshu K. Jain ◽  
Mary L. Fennell ◽  
Anees B. Chagpar ◽  
Hannah K. Connolly ◽  
Ingrid M. Nembhard
Keyword(s):  
Cancer Care ◽  
Planning Process ◽  
Early Stage ◽  
Care Delivery ◽  
Clinical Care ◽  
Community Setting ◽  
Psychological Safety ◽  
Future Research ◽  
Care Providers ◽  
High Quality

Effective communication is a requirement in the teamwork necessary for improved coordination to deliver patient-centered, value-based cancer care. Communication is particularly important when care providers are geographically distributed or work across organizations. We review organizational and teams research on communication to highlight psychological safety as a key determinant of high-quality communication within teams. We first present the concept of psychological safety, findings about its communication effects for teamwork, and factors that affect it. We focus on five factors applicable to cancer care delivery: familiarity, clinical hierarchy–related status differences, geographic dispersion, boundary spanning, and leader behavior. To illustrate how these factors facilitate or hinder psychologically safe communication and teamwork in cancer care, we review the case of a patient as she experiences the treatment-planning process for early-stage breast cancer in a community setting. Our analysis is summarized in a key principle: Teamwork in cancer care requires high-quality communication, which depends on psychological safety for all team members, clinicians and patients alike. We conclude with a discussion of the implications of psychological safety in clinical care and suggestions for future research.

Telemedicine and tele-health services for cancer-care delivery in India

2008 ◽  
Vol 2 (2) ◽  
pp. 231 ◽  
Author(s):  
S. Sudhamony ◽  
K. Nandakumar ◽  
P.J. Binu ◽  
S. Issac Niwas
Keyword(s):  
Health Services ◽  
Cancer Care ◽  
Care Delivery

scholarly journals Factors for Satisfaction Among Providers of Ancillary Health Services in a Community-Based Cancer Prevention Program: A Pilot Study in Nevada

2006 ◽  
Vol 6 ◽  
pp. 727-733 ◽  
Author(s):  
Emmanuel C. Gorospe ◽  
Christopher R. Cochran ◽  
Elena E. Cabb
Keyword(s):  
Health Services ◽  
Cancer Prevention ◽  
Low Income ◽  
Prevention Program ◽  
Care Delivery ◽  
Cervical Cancer Prevention ◽  
Community Based ◽  
Care Assessment ◽  
Cancer Prevention Program ◽  
Three Components

Providers of ancillary health services are essential members of any health care delivery system. They supply laboratory, radiology, and other diagnostic modalities necessary for quality medical care. Assessment of the providers' factors for satisfaction in participating in cancer prevention programs can contribute to better services and can serve as a model for other community-based health programs.We conducted a pilot survey of providers of ancillary services in the Nevada Women's Health Connection, a community breast and cervical cancer prevention program. Of the 93 participating providers, a total of 44 providers completed the survey. We subjected the survey data to factor analysis using iterative principal axis factoring with Varimax rotation. Three components of satisfaction were identified, comprising satisfaction with the (1) reimbursement process, (2) positive perception of the program, and (3) familiarity with program's requirements. All three components accounted for 72.08% of the total variance before the rotation. Amount of financial gain was not a significant factor for satisfaction among participating providers. Providers of ancillary health services were satisfied in their participation in this community-based cancer prevention program. There were three components of satisfaction identified. Further attention should be given on these issues as they have implications for quality improvement in health services for community-based programs dealing with low income and uninsured patients.

scholarly journals Financial toxicity in cancer care: origins, impact, and solutions

2021 ◽  
Vol 11 (11) ◽  
pp. 2043-2054 ◽  
Author(s):  
Hannah R Abrams ◽  
Sienna Durbin ◽  
Cher X Huang ◽  
Shawn F Johnson ◽  
Rahul K Nayak ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
Financial Burden ◽  
Indirect Costs ◽  
Future Research ◽  
Financial Toxicity ◽  
Patients With Cancer ◽  
The Past ◽  
Financial Burdens ◽  
The Impact

Abstract Financial toxicity describes the financial burden and distress that can arise for patients, and their family members, as a result of cancer treatment. It includes direct out-of-pocket costs for treatment and indirect costs such as travel, time, and changes to employment that can increase the burden of cancer. While high costs of cancer care have threatened the sustainability of access to care for decades, it is only in the past 10 years that the term “financial toxicity” has been popularized to recognize that the financial burdens of care can be just as important as the physical toxicities traditionally associated with cancer therapy. The past decade has seen a rapid growth in research identifying the prevalence and impact of financial toxicity. Research is now beginning to focus on innovations in screening and care delivery that can mitigate this risk. There is a need to determine the optimal strategy for clinicians and cancer centers to address costs of care in order to minimize financial toxicity, promote access to high value care, and reduce health disparities. We review the evolution of concerns over costs of cancer care, the impact of financial burdens on patients, methods to screen for financial toxicity, proposed solutions, and priorities for future research to identify and address costs that threaten the health and quality of life for many patients with cancer.

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