An evidence base for patient-centered cancer care: A meta-analysis of studies of observed communication between cancer specialists and their patients

2009 ◽  
Vol 77 (3) ◽  
pp. 379-383 ◽  
Author(s):  
Maria K. Venetis ◽  
Jeffrey D. Robinson ◽  
Katie LaPlant Turkiewicz ◽  
Mike Allen
Keyword(s):  
Cancer Care ◽  
Meta Analysis ◽  
Evidence Base ◽  
Patient Centered ◽  
Cancer Specialists

scholarly journals Effects of oncological care pathways in primary and secondary care on patient, professional and health systems outcomes: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Jolanda C. van Hoeve ◽  
Robin W.M. Vernooij ◽  
Michelle Fiander ◽  
Peter Nieboer ◽  
Sabine Siesling ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cancer Care ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Tertiary Care ◽  
Evidence Base ◽  
System Level ◽  
Care Pathways ◽  
Positive Effects ◽  
Oncological Care

Abstract Background: Pathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify, and synthesise existing literature on the effects of pathways in oncological care. Methods: All patients diagnosed with cancer in primary and secondary/tertiary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding patients, professionals and system level were extracted from each study. Results: Out of 13,847 search results, we selected 158 articles eligible for full text assessment. 150 studies were excluded and the remaining eight studies represented 4,786 patients. Most studies were conducted in secondary/tertiary care. Length of Stay (LOS) was the most common used indicator, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter LOS regarding gastric cancer (Weighted Mean Difference (WMD)): -2.75, CI: -4.67–-0.83) and gynaecological cancer (WMD: -1.58, CI: -2.10–-1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups. Conclusions: Despite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary/tertiary care regarding the positive effects of LOS in favour of cancer care pathways. Systematic review registration: PROSPERO CRD42017057592

Identifying challenges to breast cancer care coordination at urban community-based primary care clinics.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 83-83
Author(s):  
Tamara Hamlish ◽  
Zakiya N Moton ◽  
Zuoli Zhang ◽  
Dana Sohmer ◽  
Olufunmilayo I. Olopade ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Care Coordination ◽  
Cancer Care ◽  
Medical Records ◽  
Primary Care Providers ◽  
Primary Care Visit ◽  
Patient Centered ◽  
Care Continuum ◽  
Cancer Specialists

83 Background: Primary care providers (PCPs) are well positioned to play a significant role in improving cancer care in the U.S. and achieving the Institute of Medicine (IOM) recommendation for patient-centered, coordinated, comprehensive cancer care across the care continuum. This is particularly important in underserved communities where fragmented care contributes to widening disparities in cancer mortality. However, PCPs can face considerable challenges delivering cancer care. This research examines challenges to breast cancer survivorship (BCS) care coordination at federally qualified health centers (FQHCs). Methods: We conducted a chart review at five Chicago FQHCs to assess BCS-related follow-up care provided by PCPs. We reviewed patient electronic medical records for documentation of breast cancer-related health information by the PCP and for documentation from cancer specialists, including consultant notes, pathology reports, and treatment histories. Based on BC ICD -9 codes we identified 109 patients who had a BC diagnosis within five years and a primary care visit at one of the five FQHCS within 2 years. Results: The patient population was primarily comprised of African Americans (81%), with 16% Hispanic, and 4% Asian or non-Hispanic White. Mean age at diagnosis was 55 years with 30% diagnosed < 50 years. Medicaid (59%) was the most common health insurance. More than half of the patients had ≥1 chronic disease. Critical clinical BC information was missing from patient medical records, including BC pathology (65%), mammogram (60%), last clinical breast examination (49%), and cancer specialist notes (45%). Documentation of family history and genetic counseling were missing from 76% and 98% of the records, respectively. Conclusions: Our data indicate that PCPs at FQHCs currently have a limited role in delivering IOM recommended patient-centered, coordinated, comprehensive cancer care across the care continuum. The research results underscore a need for improvement in two key areas: 1) support for PCPs to build capacity in BCS care and 2) enhanced communication and care coordination between cancer specialists and PCPS in order to make PCPs an active part of the BCS care team.

scholarly journals Effects of oncological care pathways in primary and secondary care on patient, professional and health systems outcomes: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Jolanda C. van Hoeve ◽  
Robin W.M. Vernooij ◽  
Michelle Fiander ◽  
Peter Nieboer ◽  
Sabine Siesling ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cancer Care ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Tertiary Care ◽  
Evidence Base ◽  
System Level ◽  
Care Pathways ◽  
Positive Effects ◽  
Oncological Care

Abstract Background: Pathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify, and synthesise existing literature on the effects of pathways in oncological care. Methods: All patients diagnosed with cancer in primary and secondary/tertiary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding patients, professionals and system level were extracted from each study. Results: Out of 13,847 search results, we selected 158 articles eligible for full text assessment. 150 studies were excluded and the remaining eight studies represented 4,786 patients. Most studies were conducted in secondary/tertiary care. LOS was the most common used indicator, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter Length of Stay (LOS) regarding gastric cancer (Weighted Mean Difference (WMD)): -2.75, CI: -4.67–-0.83) and gynaecological cancer (WMD: -1.58, CI: -2.10–-1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups. Conclusions: Despite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary/tertiary care regarding the positive effects of LOS in favour of cancer care pathways. Systematic review registration: PROSPERO CRD42017057592

scholarly journals Effects of oncological care pathways in primary and secondary care on patient, professional and health systems outcomes: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Jolanda C. van Hoeve ◽  
Robin W.M. Vernooij ◽  
Michelle Fiander ◽  
Peter Nieboer ◽  
Sabine Siesling ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Cancer Care ◽  
Secondary Care ◽  
Meta Analysis ◽  
Evidence Base ◽  
Care Pathways ◽  
Positive Effects ◽  
Oncological Care ◽  
Study Results

Abstract Background Pathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify, and synthesise existing literature on the effects of pathways in oncological care. Methods All patients diagnosed with cancer in primary and secondary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding “patient outcomes” and “costs” were extracted from each study. Results Out of 12,689 search results, we selected 158 articles eligible for full text assessment. The remaining 10 studies represented 4,786 patients. Most studies were conducted in secondary care. LOS was the most common used indicator for patients outcomes, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter LOS regarding gastric cancer (WMD: -2.75, CI: -4.67–-0.83) and gynaecological cancer (WMD: -1.58, CI: -2.10–-1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups. Conclusions Despite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary care regarding the positive effects of LOS in favour of cancer care pathways.

scholarly journals Comparing the use of aggregate data and various methods of integrating individual patient data to network meta-analysis and its application to first-line ART

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Steve Kanters ◽  
Mohammad Ehsanul Karim ◽  
Kristian Thorlund ◽  
Aslam H. Anis ◽  
Michael Zoratti ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Evidence Base ◽  
Aggregate Data ◽  
World Health ◽  
Coefficient Estimates ◽  
Two Stage ◽  
Individual Patient Level ◽  
One Stage ◽  
Meta Regression ◽  
Empirical Priors

Abstract Background The 2018 World Health Organization HIV guidelines were based on the results of a network meta-analysis (NMA) of published trials. This study employed individual patient-level data (IPD) and aggregate data (AgD) and meta-regression methods to assess the evidence supporting the WHO recommendations and whether they needed any refinements. Methods Access to IPD from three trials was granted through ClinicalStudyDataRequest.com (CSDR). Seven modelling approaches were applied and compared: 1) Unadjusted AgD network meta-analysis (NMA) – the original analysis; 2) AgD-NMA with meta-regression; 3) Two-stage IPD-AgD NMA; 4) Unadjusted one-stage IPD-AgD NMA; 5) One-stage IPD-AgD NMA with meta-regression (one-stage approach); 6) Two-stage IPD-AgD NMA with empirical-priors (empirical-priors approach); 7) Hierarchical meta-regression IPD-AgD NMA (HMR approach). The first two were the models used previously. Models were compared with respect to effect estimates, changes in the effect estimates, coefficient estimates, DIC and model fit, rankings and between-study heterogeneity. Results IPD were available for 2160 patients, representing 6.5% of the evidence base and 3 of 24 edges. The aspect of the model affected by the choice of modeling appeared to differ across outcomes. HMR consistently generated larger intervals, often with credible intervals (CrI) containing the null value. Discontinuations due to adverse events and viral suppression at 96 weeks were the only two outcomes for which the unadjusted AgD NMA would not be selected. For the first, the selected model shifted the principal comparison of interest from an odds ratio of 0.28 (95% CrI: 10.17, 0.44) to 0.37 (95% CrI: 0.23, 0.58). Throughout all outcomes, the regression estimates differed substantially between AgD and IPD methods, with the latter being more often larger in magnitude and statistically significant. Conclusions Overall, the use of IPD often impacted the coefficient estimates, but not sufficiently as to necessitate altering the final recommendations of the 2018 WHO Guidelines. Future work should examine the features of a network where adjustments will have an impact, such as how much IPD is required in a given size of network.

scholarly journals A Collaborative Model to Implement Flexible, Accessible and Efficient Oncogenetic Services for Hereditary Breast and Ovarian Cancer: The C-MOnGene Study

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2729
Author(s):  
Julie Lapointe ◽  
Michel Dorval ◽  
Jocelyne Chiquette ◽  
Yann Joly ◽  
Jason Robert Guertin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Genetic Counseling ◽  
Evidence Base ◽  
Annual Number ◽  
Breast And Ovarian Cancer ◽  
Patient Centered ◽  
Collaborative Model ◽  
Counseling And Testing ◽  
Number Of Patients

Medical genetic services are facing an unprecedented demand for counseling and testing for hereditary breast and ovarian cancer (HBOC) in a context of limited resources. To help resolve this issue, a collaborative oncogenetic model was recently developed and implemented at the CHU de Québec-Université Laval; Quebec; Canada. Here, we present the protocol of the C-MOnGene (Collaborative Model in OncoGenetics) study, funded to examine the context in which the model was implemented and document the lessons that can be learned to optimize the delivery of oncogenetic services. Within three years of implementation, the model allowed researchers to double the annual number of patients seen in genetic counseling. The average number of days between genetic counseling and disclosure of test results significantly decreased. Group counseling sessions improved participants’ understanding of breast cancer risk and increased knowledge of breast cancer and genetics and a large majority of them reported to be overwhelmingly satisfied with the process. These quality and performance indicators suggest this oncogenetic model offers a flexible, patient-centered and efficient genetic counseling and testing for HBOC. By identifying the critical facilitating factors and barriers, our study will provide an evidence base for organizations interested in transitioning to an oncogenetic model integrated into oncology care; including teams that are not specialized but are trained in genetics.

scholarly journals PS2-26: Measuring Patient-Centered Communication in Cancer Care: A Systematic Approach

2011 ◽  
Vol 9 (3-4) ◽  
pp. 143-143
Author(s):  
L. McCormack ◽  
K. Treiman ◽  
M. Olmsted ◽  
D. Rupert ◽  
N. Arora
Keyword(s):  
Cancer Care ◽  
Systematic Approach ◽  
Patient Centered

Evaluating the effectiveness of interventions to reducing screen time in children: meta-analysis of randomized controlled trials

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Duygu Akçay ◽  
Nuray Barış
Keyword(s):  
Effect Size ◽  
Subgroup Analysis ◽  
Screen Time ◽  
Meta Analysis ◽  
Intervention Group ◽  
Evidence Base ◽  
Control Group ◽  
Content Type ◽  
Mean Differences ◽  
The Impact

Purpose The purpose of this paper is to evaluate the impact of interventions focused on reducing screen time in children. Design/methodology/approach Studies that aim to investigate the effects of interventions aimed at reducing the time spent in front of the screen (i.e. screen time). A Random-effects model was used to calculate the pooled standard mean differences. The outcome was to evaluate the screen time in children in the 0–18 age range. A subgroup analysis was performed to reveal the extent to which the overall effect size varied by subgroups (participant age, duration of intervention and follow). Findings For the outcome, the meta-analysis included 21 studies, and the standard difference in mean change in screen time in the intervention group compared with the control group was −0.16 (95% confidence interval [CI], −0.21 to −0.12) (p < 0.001). The effect size was found to be higher in long-term (=7 months) interventions and follow-ups (p < 0.05). Originality/value Subgroup analysis showed that a significant effect of screen time reduction was observed in studies in which the duration of intervention and follow-up was =7 months. As the evidence base grows, future researchers can contribute to these findings by conducting a more comprehensive analysis of effect modifiers and optimizing interventions to reduce screen time.

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