scholarly journals Leveraging patient‐reported outcomes data to inform oncology clinical decision making: Introducing the FACE‐Q Head and Neck Cancer Module

Cancer ◽  
2018 ◽  
Vol 125 (6) ◽  
pp. 863-872 ◽  
Author(s):  
Jennifer R. Cracchiolo ◽  
Anne F. Klassen ◽  
Danny A. Young‐Afat ◽  
Claudia R. Albornoz ◽  
Stefan J. Cano ◽  
...  
Keyword(s):  
Decision Making ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Patient Reported Outcomes ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cancer Module ◽  
Patient Reported ◽  
The Face

scholarly journals Deliberações clínicas na atuação em pacientes com câncer de cabeça e pescoço: atualidades e desafios na disfagia

2020 ◽  
Vol 31 (4) ◽  
pp. 693-697
Author(s):  
Guilherme Maia Zica ◽  
Andressa Silva de Freitas
Keyword(s):  
Decision Making ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision

Starmer H, Edwards J. Clinical Decision Making with Head and Neck Cancer Patients with Dysphagia. Semin Speech Lang. 2019 Jun;40(3):213-226.

Clinical Practices in Head and Neck Cancer: A Speech-Language Pathologist Practice Pattern Survey

2021 ◽  
pp. 000348942110010
Author(s):  
Ashley M. Logan ◽  
Mario A. Landera
Keyword(s):  
Decision Making ◽  
Head And Neck Cancer ◽  
Best Practices ◽  
Head And Neck ◽  
Neck Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Years Of Experience ◽  
Group Consensus ◽  
Clinical Practices

Objective: Clinical practices of speech-language pathologists (SLP) treating head and neck cancer (HNC) patients range widely despite literature trending toward best practices. This survey study was designed to identify current patterns and assess for gaps in clinical implementation of research evidence. Method: A web-based survey was distributed to SLPs via listserv and social media outlets. Descriptive statistics and group calculations were completed to identify trends and associations in responses. Results: Of 152 received surveys, the majority of respondents were hospital-based (86%) and had greater than 5 years of experience (65%). There was group consensus for the use of prophylactic exercise programs (95%), recommendations for SLP intervention during HNC treatment (75%), and use of maintenance programs post-treatment (97%). Conversely, no group consensus was observed for use of pre-treatment swallow evaluations, frequency of service provision, and content of therapy sessions. Variation in clinical decision making was noted in use of prophylactic feeding tubes and number of patients taking nothing by mouth during treatment. No associations were found between years of experience and decision-making practices, nor were any associations found between practice setting and clinical decision making. Conclusion: Despite the growing body of literature outlining evidence-based treatment practices for HNC patients, clinical practice patterns among SLPs continue to vary widely resulting in inconsistent patient care across practice settings. As compared to prior similar data, increased alignment with best practices was observed relative to early referrals, implementation of prophylactic intervention programs, and intervention with the SLP during the period of HNC treatment.

Clinical Decision Making with Head and Neck Cancer Patients with Dysphagia

2019 ◽  
Vol 40 (03) ◽  
pp. 213-226
Author(s):  
Heather Starmer ◽  
Jeffrey Edwards
Keyword(s):  
Decision Making ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Surgical Removal ◽  
Epidemiologic Factors ◽  
Cancer Management ◽  
Nonsurgical Patient

AbstractDysphagia is a common challenge faced by patients with head and neck cancer. Management of these patients is quite distinct from many other dysphagia etiologies due to the nature of surgical removal of organs critical to swallowing, the ability to provide preventative therapies, and the variable risk for complications related to dysphagia. Thus, clinicians providing care to the head and neck cancer population need to understand these differences when employing clinical decision making. In addition, changes in the demographics of head and neck cancer, related predominantly to the epidemic of oropharyngeal cancer associated with the human papillomavirus, have further transformed both the types of patients and the types of treatments offered. These epidemiologic factors further complicate the decision-making process for clinicians. This article provides a framework for decision making in the surgical and nonsurgical patient with head and neck cancer.

scholarly journals The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers

2020 ◽  
Vol 7 (1) ◽  
pp. 41-53
Author(s):  
Jaden D. Evans ◽  
Riley H. Harper ◽  
Molly Petersen ◽  
William S. Harmsen ◽  
Aman Anand ◽  
...  
Keyword(s):  
Decision Making ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Clinical Decision Making ◽  
Cox Model ◽  
Clinical Decision ◽  
Concurrent Chemotherapy ◽  
Cumulative Probability ◽  
Kaplan Meier

Abstract Purpose To understand how verification computed tomography-quality assurance (CT-QA) scans influenced clinical decision-making to replan patients with head and neck cancer and identify predictors for replanning to guide intensity-modulated proton therapy (IMPT) clinical practice. Patients and Methods We performed a quality-improvement study by prospectively collecting data on 160 consecutive patients with head and neck cancer treated using spot-scanning IMPT who underwent weekly verification CT-QA scans. Kaplan-Meier estimates were used to determine the cumulative probability of a replan by week. Predictors for replanning were determined with univariate (UVA) and multivariate (MVA) Cox model hazard ratios (HRs). Logistic regression was used to determine odds ratios (ORs). P < .05 was considered statistically significant. Results Of the 160 patients, 79 (49.4%) had verification CT-QA scans, which prompted a replan. The cumulative probability of a replan by week 1 was 13.7% (95% confidence interval [CI], 8.82-18.9), week 2, 25.0% (95% CI, 18.0-31.4), week 3, 33.1% (95% CI, 25.4-40.0), week 4, 45.6% (95% CI, 37.3-52.8), and week 5 and 6, 49.4% (95% CI, 41.0-56.6). Predictors for replanning were sinonasal disease site (UVA: HR, 1.82, P = .04; MVA: HR, 3.64, P = .03), advanced stage disease (UVA: HR, 4.68, P < .01; MVA: HR, 3.10, P < .05), dose > 60 Gy equivalent (GyE; relative biologic effectiveness, 1.1) (UVA: HR, 1.99, P < .01; MVA: HR, 2.20, P < .01), primary disease (UVA: HR, 2.00 versus recurrent, P = .01; MVA: HR, 2.46, P = .01), concurrent chemotherapy (UVA: HR, 2.05, P < .01; MVA: not statistically significant [NS]), definitive intent treatment (UVA: HR, 1.70 versus adjuvant, P < .02; MVA: NS), bilateral neck treatment (UVA: HR, 2.07, P = .03; MVA: NS), and greater number of beams (5 beam UVA: HR, 5.55 versus 1 or 2 beams, P < .02; MVA: NS). Maximal weight change from baseline was associated with higher odds of a replan (≥3 kg: OR, 1.97, P = .04; ≥ 5 kg: OR, 2.13, P = .02). Conclusions Weekly verification CT-QA scans frequently influenced clinical decision-making to replan. Additional studies that evaluate the practice of monitoring IMPT-treated patients with weekly CT-QA scans and whether that improves clinical outcomes are warranted.

Between a logic of disruption and a logic of continuation: Negotiating the legitimacy of algorithms used in automated clinical decision-making

2021 ◽  
pp. 136345932199674
Author(s):  
Rikke Torenholt ◽  
Henriette Langstrup
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Patient Reported Outcomes ◽  
Patient Involvement ◽  
Clinical Decision Making ◽  
Diagnostic Procedures ◽  
Clinical Decision ◽  
Patient Reported ◽  
Pro Tools

In both popular and academic discussions of the use of algorithms in clinical practice, narratives often draw on the decisive potentialities of algorithms and come with the belief that algorithms will substantially transform healthcare. We suggest that this approach is associated with a logic of disruption. However, we argue that in clinical practice alongside this logic, another and less recognised logic exists, namely that of continuation: here the use of algorithms constitutes part of an established practice. Applying these logics as our analytical framing, we set out to explore how algorithms for clinical decision-making are enacted by political stakeholders, healthcare professionals, and patients, and in doing so, study how the legitimacy of delegating to an algorithm is negotiated and obtained. Empirically we draw on ethnographic fieldwork carried out in relation to attempts in Denmark to develop and implement Patient Reported Outcomes (PRO) tools – involving algorithmic sorting – in clinical practice. We follow the work within two disease areas: heart rehabilitation and breast cancer follow-up care. We show how at the political level, algorithms constitute tools for disrupting inefficient work and unsystematic patient involvement, whereas closer to the clinical practice, algorithms constitute a continuation of standardised and evidence-based diagnostic procedures and a continuation of the physicians’ expertise and authority. We argue that the co-existence of the two logics have implications as both provide a push towards the use of algorithms and how a logic of continuation may divert attention away from new issues introduced with automated digital decision-support systems.

scholarly journals Call for action: how to improve use of patient-reported outcomes to guide clinical decision making in rheumatoid arthritis

2018 ◽  
Vol 38 (6) ◽  
pp. 935-947 ◽  
Author(s):  
Bruno Fautrel ◽  
Rieke Alten ◽  
Bruce Kirkham ◽  
Inmaculada de la Torre ◽  
Frederick Durand ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Making ◽  
Patient Reported Outcomes ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Patient Reported

Swallowing in the first year after chemoradiotherapy for head and neck cancer: Clinician-and patient-reported outcomes

Head & Neck ◽  
2013 ◽  
Vol 36 (3) ◽  
pp. 352-358 ◽  
Author(s):  
Joanne M. Patterson ◽  
Elaine McColl ◽  
Paul N. Carding ◽  
Anthony J. Hildreth ◽  
Charles Kelly ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Patient Reported Outcomes ◽  
First Year ◽  
Patient Reported
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