Effect of PARACT (PARAmedical Interventions on Patient ACTivation) on the Cancer Care Pathway: Protocol for Implementation of the Patient Activation Measure-13 Item (PAM-13) Version (Preprint)

Mapping Intimacies ◽

10.2196/preprints.17485 ◽

2019 ◽

Author(s):

Elise Verot ◽

Wafa Bouleftour ◽

Corinne Macron ◽

Romain Rivoirard ◽

Franck Chauvin

Keyword(s):

Nursing Care ◽

Cancer Care ◽

Care Pathway ◽

Patient Activation ◽

Oncology Nurses ◽

Multicentric Study ◽

Cancer Centers ◽

Comprehensive Cancer Centers ◽

Semistructured Interviews ◽

Patient Activation Measure

BACKGROUND The increase in the number of cancer cases and the evolution of cancer care management have become a significant problem for the French health care system, thereby making patient empowerment as a long sought-after goal in chronic pathologies. The implementation of an activation measure via the Patient Activation Measure-13 item (PAM-13) in the course of cancer care can potentially highlight the patient’s needs, with nursing care adapting accordingly. OBJECTIVE The objectives of this PARACT (PARAmedical Interventions on Patient ACTivation) multicentric study were as follows: (1) evaluate the implementation of PAM-13 in oncology nursing practices in 5 comprehensive cancer centers, (2) identify the obstacles and facilitators to the implementation of PAM-13, and (3) produce recommendations for the dissemination of such interventions in other comprehensive cancer centers. METHODS This study will follow the “Reach, Effectiveness, Adoption, Implementation, and Maintenance” framework and will consist of 3 stages. First, a robust preimplementation analysis will be conducted using the Theoretical Domains Framework (TDF) linked to the “Capability, Opportunity, Motivation, and Behavior” model to identify the obstacles and facilitators to implementing new nursing practices in each context. Then, using the Behavior Change Wheel, we will personalize a strategy for implementing the PAM-13, depending on the specificities of each context, to encourage acceptability by the nursing staff involved in the project. This analysis will be performed via a qualitative study through semistructured interviews. Second, the patient will be included in the study for 12 months, during which the patient care pathway will be studied, particularly to collect all relevant contacts of oncology nurses and other health professionals involved in the pathway. The axes of nursing care will also be collected. The primary goal is to implement PAM-13. Secondary factors to be measured are the patient’s anxiety level, quality of life, and health literacy level. The oncology nurses will be responsible for completing the questionnaires when the patient is at the hospital for his/her intravenous chemotherapy/immunotherapy treatment. The questionnaires will be completed thrice in a year: (1) at the time of the patient’s enrollment, (2) at 6 months, and (3) at 12 months. Third, a postimplementation analysis will be performed through semistructured interviews using the TDF to investigate the implementation problems at each site. RESULTS This study was supported by a grant from the French Ministry of Health (PHRIP PARACT 2016-0405) and the Lucien Neuwirth Institute of Cancerology of Saint-Etienne, France. Data collection for this study is ongoing. CONCLUSIONS This study would improve the implemented targeted nursing interventions in cancer centers so that a patient is offered a personalized cancer care pathway. Furthermore, measuring the level of activation and the implementation of measures intended to increase such activation could constitute a significant advantage in reducing social health inequalities. CLINICALTRIAL ClinicalTrials.gov NCT03240341; https://clinicaltrials.gov/ct2/show/NCT03240341 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17485

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Effect of PARACT (PARAmedical Interventions on Patient ACTivation) on the Cancer Care Pathway: Protocol for Implementation of the Patient Activation Measure-13 Item (PAM-13) Version

JMIR Research Protocols ◽

10.2196/17485 ◽

2020 ◽

Vol 9 (12) ◽

pp. e17485

Author(s):

Elise Verot ◽

Wafa Bouleftour ◽

Corinne Macron ◽

Romain Rivoirard ◽

Franck Chauvin

Keyword(s):

Nursing Care ◽

Cancer Care ◽

Care Pathway ◽

Patient Activation ◽

Oncology Nurses ◽

Multicentric Study ◽

Cancer Centers ◽

Comprehensive Cancer Centers ◽

Semistructured Interviews ◽

Patient Activation Measure

Background The increase in the number of cancer cases and the evolution of cancer care management have become a significant problem for the French health care system, thereby making patient empowerment as a long sought-after goal in chronic pathologies. The implementation of an activation measure via the Patient Activation Measure-13 item (PAM-13) in the course of cancer care can potentially highlight the patient’s needs, with nursing care adapting accordingly. Objective The objectives of this PARACT (PARAmedical Interventions on Patient ACTivation) multicentric study were as follows: (1) evaluate the implementation of PAM-13 in oncology nursing practices in 5 comprehensive cancer centers, (2) identify the obstacles and facilitators to the implementation of PAM-13, and (3) produce recommendations for the dissemination of such interventions in other comprehensive cancer centers. Methods This study will follow the “Reach, Effectiveness, Adoption, Implementation, and Maintenance” framework and will consist of 3 stages. First, a robust preimplementation analysis will be conducted using the Theoretical Domains Framework (TDF) linked to the “Capability, Opportunity, Motivation, and Behavior” model to identify the obstacles and facilitators to implementing new nursing practices in each context. Then, using the Behavior Change Wheel, we will personalize a strategy for implementing the PAM-13, depending on the specificities of each context, to encourage acceptability by the nursing staff involved in the project. This analysis will be performed via a qualitative study through semistructured interviews. Second, the patient will be included in the study for 12 months, during which the patient care pathway will be studied, particularly to collect all relevant contacts of oncology nurses and other health professionals involved in the pathway. The axes of nursing care will also be collected. The primary goal is to implement PAM-13. Secondary factors to be measured are the patient’s anxiety level, quality of life, and health literacy level. The oncology nurses will be responsible for completing the questionnaires when the patient is at the hospital for his/her intravenous chemotherapy/immunotherapy treatment. The questionnaires will be completed thrice in a year: (1) at the time of the patient’s enrollment, (2) at 6 months, and (3) at 12 months. Third, a postimplementation analysis will be performed through semistructured interviews using the TDF to investigate the implementation problems at each site. Results This study was supported by a grant from the French Ministry of Health (PHRIP PARACT 2016-0405) and the Lucien Neuwirth Institute of Cancerology of Saint-Etienne, France. Data collection for this study is ongoing. Conclusions This study would improve the implemented targeted nursing interventions in cancer centers so that a patient is offered a personalized cancer care pathway. Furthermore, measuring the level of activation and the implementation of measures intended to increase such activation could constitute a significant advantage in reducing social health inequalities. Trial Registration ClinicalTrials.gov NCT03240341; https://clinicaltrials.gov/ct2/show/NCT03240341 International Registered Report Identifier (IRRID) DERR1-10.2196/17485

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PALLIA ‐10, a screening tool to identify patients needing palliative care referral in comprehensive cancer centers: A prospective multicentric study ( PREPA ‐10)

Cancer Medicine ◽

10.1002/cam4.2118 ◽

2019 ◽

Vol 8 (6) ◽

pp. 2950-2961 ◽

Cited By ~ 6

Author(s):

Yann Molin ◽

Caroline Gallay ◽

Julien Gautier ◽

Audrey Lardy‐Cleaud ◽

Romaine Mayet ◽

...

Keyword(s):

Palliative Care ◽

Screening Tool ◽

Multicentric Study ◽

Cancer Centers ◽

Comprehensive Cancer Centers

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Availability of Outpatient Clinical Nutrition Services for Patients With Cancer Undergoing Treatment at Comprehensive Cancer Centers

Journal of Oncology Practice ◽

10.1200/jop.2013.001134 ◽

2015 ◽

Vol 11 (1) ◽

pp. 1-5 ◽

Cited By ~ 10

Author(s):

Mary E. Platek ◽

Jordan Johnson ◽

Kathleen Woolf ◽

Nour Makarem ◽

Danielle C. Ompad

Keyword(s):

Cancer Care ◽

Multidisciplinary Care ◽

Clinical Nutrition ◽

Cancer Centers ◽

Patients With Cancer ◽

Nutrition Services ◽

Comprehensive Cancer Centers

Comprehensive cancer centers rely on referral-based clinical nutrition services, which are not always a part of multidisciplinary care. An in-depth comparison of clinical nutrition services among other approaches to cancer care is needed.

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Psychosocial and Patient Support Services in Comprehensive Cancer Centers

10.1007/978-3-030-82052-7_11 ◽

2021 ◽

pp. 93-106

Author(s):

Rajshekhar Chakraborty ◽

Navneet S. Majhail ◽

Jame Abraham

Keyword(s):

Support Services ◽

Cancer Care ◽

Holistic Care ◽

Survivorship Care ◽

Patient Support ◽

Cancer Centers ◽

Psychosocial Services ◽

Care Services ◽

Comprehensive Cancer Centers ◽

Patients Experience

AbstractPatient support and psychosocial services are an important aspect of cancer care. Comprehensive cancer centers need to provide a spectrum of these services to provide high-quality and holistic care to cancer patients. Provision of these services begins from the time of diagnosis, continues through cancer treatment, and then subsequently transitions to survivorship or end-of-life phase. Examples of these services include psychological assessment and management, patient navigation, care coordination, genetic counseling, and complementary medicine. Survivorship care is an important aspect of patients’ experience during their cancer journey and beyond. This chapter discusses key psychosocial and supportive care services that are recommended for cancer centers that strive to provide comprehensive cancer care to their patients.

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Effect of time between diagnosis and surgery in colorectal cancer patients on mortality.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.708 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 708-708

Author(s):

Benjamin D Fangman ◽

Muhammad Shaalan Beg ◽

Aravind Sanjeevaiah ◽

Farshid Araghizadeh ◽

Shannon Scielzo ◽

...

Keyword(s):

Colorectal Cancer ◽

Adjuvant Chemotherapy ◽

Negative Correlation ◽

Cancer Care ◽

Surgical Intervention ◽

Significant Negative Correlation ◽

The United States ◽

Cancer Centers ◽

Comprehensive Cancer Centers ◽

Early Surgical Intervention

708 Background: Colorectal cancer is the fourth most common cancer diagnosed in the United States and accounts for > 50,000 deaths nationwide annually. With data showing that oncologic treatment at National Cancer Institute (NCI) designated comprehensive cancer centers improves outcomes in a variety of malignancies, understanding the drivers behind this is vital to help bring the world-class care being administered at comprehensive cancer centers to underserved populations across the U.S. One component of colorectal cancer care that has a paucity of data afforded to it is the effect of increased time from diagnosis to surgery on survival. Methods: Patients diagnosed with AJCC stage II or stage III colorectal cancer between 4/2011 and 11/2015 and either underwent surgery or adjuvant chemotherapy within the University of Texas Southwestern system were selected. Several pertinent data points were abstracted via the EMR including date of diagnosis, surgery, adjuvant chemotherapy, progression, and death. A retrospective analysis was performed on the abstracted data to determine if the number of days between diagnosis and surgery was correlated with increased survival. Spearman coefficients were calculated to determine correlations between the data. All tests were two-sided. Results: Out of 203 patients identified, 113 patients had complete data available and were included in the study. The average age at diagnosis was 62.6 and average follow-up time was 41.4 months. Median time to surgery was 21 days (25th percentile-75th percentile: 4 – 53 days). There was a significant negative correlation between days from diagnosis to surgery and mortality (Spearman’s r = -.392, p < .001). Survivors had a mean of 42.7 days from diagnosis to surgery (SD = 56.4) and nonsurvivors had a mean of 61.7 days (SD = 46.9). Conclusions: There was a significant negative correlation seen in days between diagnosis and surgery and survival during the study period, which indicates that early surgical intervention may be an underappreciated indicator of quality colorectal cancer care. Further research should be conducted to better understand the relationship between early surgical intervention and prognosis in limited-stage colorectal cancer.

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French Health professionals’ attitudes about patient empowerment in the cancer care pathway

Clinical Nursing Studies ◽

10.5430/cns.v7n4p41 ◽

2019 ◽

Vol 7 (4) ◽

pp. 41

Author(s):

Elise Verot ◽

Véronique Régnier-Denois ◽

Dominique Feld ◽

Romain Rivoirard ◽

Franck Chauvin

Keyword(s):

Nursing Care ◽

Health Professionals ◽

Cancer Care ◽

Care Pathway ◽

Patient Empowerment ◽

Patient Centered Care ◽

Care Providers ◽

Patient Centered ◽

Centered Care ◽

New Form

Objective: France is experiencing a shift in health policy. The purpose of this article is to describe how cancer care health professionals define patient empowerment, describe modalities of care of the cancer patient treated by intravenous means and identify avenues for reflection on the specific challenges facing patient-centered care, from the perspective of changes in practices in the cancer care pathway.Methods: 19 individual, semi-structured interviews with health professionals working in cancer care facilities were analyzed in a qualitative study, using the Theoretical Domain Framework linked to the COM-B model.Results: The organization of care is governed by three factors. First of all, the cancer care system focuses on the strictly curative aspect of this disease. All devices lead to management centered on the pathology, and not on the patient as a whole. Secondly, the fact that the patient suffers from cancer modifies the attitudes and representations of caregivers towards the patient. Cancer introduces a relational bias in each of the stakeholders. Thirdly, the current organization of nursing care maintains paternalistic and prescriptive care in the cancer care pathway. Only new nursing jobs (coordinating nurses or pivot nurses) suggest the possibility of switching to patient-centered care. The analysis from TDF linked to the COM-B model shows that the strategy of implementing a new tool to measure the level of patient engagement, in routine nursing care, must focus on the reflective opportunity and motivation of the stakeholders.Conclusions: Caregivers should be acculturated to patient empowerment. TDF linked to the COM-B model can make it possible to think about how to prepare and adapt this change in practice at several sites of cancer treatment. Training adapted to the context to familiarize current caregivers with this new form of care is currently being implemented. To succeed, acculturating current health care providers to this new form of care, while offering them a tool to objectively assess the level of patient empowerment would undoubtedly foster their involvement in supporting patient empowerment, while allowing them to evaluate the time required to integrate this type of care.

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Cancerpedia: A Framework for Implementing Comprehensive Cancer Centres

Journal of Global Oncology ◽

10.1200/jgo.18.97800 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 244s-244s

Author(s):

N. Abdelmutti ◽

A. Chudak ◽

M. Merali ◽

T. Sullivan ◽

M. Escaf ◽

...

Keyword(s):

Palliative Care ◽

Best Practices ◽

Cancer Care ◽

Care Delivery ◽

Cancer Control ◽

System Level ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Cancer Centers ◽

Comprehensive Cancer Centers

Background and context: Comprehensive cancer centers or programs form a nucleus of cancer care delivery. Although there are frameworks for population cancer control, no similar published framework exists for cancer centers. Aim: We sought to develop a framework for designing and implementing a comprehensive cancer center or program within the context of a population-based model of cancer control that spans diagnosis, treatment, supportive care, and palliative care as well as integration with primary care and the community. Strategy/Tactics: The framework was constructed with the patient at the center and provides a system-level perspective as well as a granular view of the fundamental resources and structures needed to build and maintain individual cancer centers and programs. Due to its breadth, we focused the framework on essential information while linking to a wide range of vetted publications that detail additional standards, guidelines and best practices. Program/Policy process: “Cancerpedia” emerged as a cohesive framework for the delivery of high-quality cancer care within and beyond the cancer center. It provides an overview of the cancer control and care delivery framework, describes cancer care services (e.g., radiotherapy, chemotherapy, palliative care) and details infrastructure and core services (e.g., physical facilities, human resources). In addition to these services, the framework presents guidelines for governance that ensure oversight and quality, describes the critical need for integrating education and research and presents the best practices for engaging in philanthropy. Cancerpedia also outlines the role of the comprehensive cancer center in integration with the community and influencing policy and regulation. Over 30 chapters provide a detailed description of each element and include a description of the service or function, resources requirements such as people, equipment and facilities, management structures, quality performance guidelines and future trends in innovation. Outcomes: To our knowledge, no comparable published framework exists as a reference for developing comprehensive cancer centers. Cancerpedia was designed to serve as a global public good and is adaptable and applicable to diverse contexts and healthcare environments. It is relevant to high-, middle- and low-income countries alike and provides a reference point from which to structure a plan for growth. What was learned: While it is important to describe the various elements required for cancer care delivery, it is critical to consider and address the integration and interdependencies of these various elements. Future opportunities for learning include seeking input from a global audience to gauge the utility and applicability of Cancerperdia to local contexts.

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The moderating role of informal caregiver’s involvement on the relationship between patient activation and adherence to treatment: Implications for self-management intervention in cancer care.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12083 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12083-12083

Author(s):

Chiara Acquati ◽

Judith Hibbard ◽

Ellen Miller-Sonet ◽

Anao Zhang ◽

Elena Ionescu

Keyword(s):

Cancer Survivors ◽

Treatment Planning ◽

Cancer Care ◽

Informal Caregivers ◽

Patient Activation ◽

Self Management ◽

Adherence To Treatment ◽

Patient Activation Measure ◽

Caregiver Involvement ◽

The Relationship

12083 Background: With increasing demands for a more active role on the part of individuals with cancer and their families in cancer care, patient activation (PA) is emerging as a key factor to promote self-management, adherence to treatment, and satisfaction with treatment planning. The present work investigated the relationship between patient activation and treatment decision making. Given the role informal caregivers play on patient-reported outcomes, it was additionally assessed whether caregiver involvement acted as a moderator of this relationship. Methods: Survey data collected from 504 cancer survivors recruited through online consumer panels were utilized. The survey contained questions concerning treatment options, quality of life, adherence to treatment, next to presence and involvement of informal caregivers. Additionally, the Patient Activation Measure (PAM), sociodemographic and clinical questions were included. A path analysis Structural Equation Modeling (SEM) controlling for covariates was used to examine the relationship between Patient Activation Measure (PAM), caregiver involvement, and the identified outcomes. Moderator analysis was conducted using multiple group SEM. Results: Respondents were mostly women (57.1%), non-Hispanic white (72.9%), middle aged or older adults (68% ≥ 55 y.o.) The four largest cancer type groups were prostate (16.3%), early stage breast (9.7%), gynecological (8.9%), and colorectal cancer (8.3%). Most of the respondents were diagnosed more than 4 years earlier (52.0%). Participants were evenly split between those who received care at an academic cancer center (29.4%) and those treated at community hospital (31.7%). Patient activation was significantly associated with treatment planning being reflective of survivors ’goals and values ( p < 0.001); adherence to treatment ( p = 0.011); and satisfaction ( p < 0.001). Caregiver’s involvement significantly moderated the association between activation and adherence to treatment. Conclusions: Patient activation was positively associated with all three selected outcomes. However, for cancer survivors reporting low rates of caregiver involvement, patient activation was not associated with treatment adherence. Research is needed to deliver and test patient activation interventions inclusive of informal caregivers to improve self-management.

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Wie bewährt sich das Konzept in der Praxis?

Onkologische Welt ◽

10.1055/s-0038-1631630 ◽

2010 ◽

Vol 01 (01) ◽

pp. 44-44

Author(s):

Rainer Bubenzer

Keyword(s):

Cancer Centers ◽

Comprehensive Cancer Centers

Comprehensive Cancer Centers als interdisziplinäre, die Grundlagenwissenschaften einbeziehende Kompetenzzentren für Krebserkrankungen erweitern das Aufgabenspektrum der klassischen Tumorzentren. Aktuelle Probleme betreffen ihre nachhaltige Finanzierung (vor allem im Bereich der Patientenversorgung), die noch unzureichende wissenschaftliche Evaluation, die potenziell größer werdende Kluft der Patientenversorgung in Zentren und in der Fläche sowie die unklare Positionierung der Forschung zwischen öffentlichen und kommerziellen Interessen. Ein Fach-Symposium in Berlin gab aktuelle Einblicke in die Arbeit einiger Spitzenzentren.

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