scholarly journals Doctor, what are my options? A prospective cohort study of an individualized care plan for patients with gastrointestinal cancer

2015 ◽  
Vol 22 (3) ◽  
pp. 171 ◽  
Author(s):  
A.E. Hird ◽  
M. Lemke ◽  
M. Turovsky ◽  
V. Malecki ◽  
K. Kumar ◽  
...  
Keyword(s):  
Health Care ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Health Care Professionals ◽  
Prospective Cohort ◽  
Care Plan ◽  
Care Plans ◽  
Individualized Care ◽  
Gi Cancer

BackgroundFor cancer patients, information about their disease and its treatment is often delivered within a short time period, potentially leading to patient misunderstanding, which can impede optimal patient care. In this 3-part clinical study, we investigated the utility of an individualized care plan for patients with gastrointestinal (gi) cancer starting a new treatment.Methods In part 1, a comprehensive literature search identified items for potential inclusion in the care plan. Those items were formatted into a questionnaire. The questionnaire was then administered to patients as a structured interview. In part 2, health care professionals involved in the care of patients with gi cancer evaluated the resulting care plan for content and relevancy. In part 3, a 20-week prospective cohort study (10 weeks using standard of care, 10 weeks using individualized care plans) was conducted. Outcomes were assessed at baseline and at 2–4 weeks after administration of the care plan.Results In part 1, a 73-item questionnaire was developed and completed by 20 patients in semi-structured interviews. In part 2, long and short versions of the care plan were created. Most health care professionals preferred the long version. Based on their comments, a final version of the care plan was created. The part 3 study enrolled 104 patients. Overall satisfaction scores were significantly higher in the intervention group at baseline (p = 0.010) and follow-up (p = 0.005). Compared with control patients, the intervention cohort also reported significantly higher overall quality of life (p = 0.044) and fewer symptoms of anxiety (p = 0.048) at follow-up.Conclusions Provision of an individualized care plan resulted in improvements in outcome measures at both baseline and follow-up. Future studies are needed to confirm these findings.

Doctor, what are my options? A prospective cohort study of an individualized care plan for patients with gastrointestinal cancer.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 12-12
Author(s):  
Amanda E. Hird ◽  
Madeline Lemke ◽  
Miriam Turovsky ◽  
Carlo DeAngelis ◽  
Edward Chow ◽  
...  
Keyword(s):  
Cohort Study ◽  
Depressive Symptoms ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Intervention Group ◽  
Treatment Compliance ◽  
Care Plan ◽  
Treatment Schedule ◽  
Individualized Care ◽  
Gi Cancer

12 Background: For new cancer patients, information about the complexity of the disease, treatment schedule and potential side effects is often delivered during an emotional, stressful visit which can lead to misunderstanding. Appropriate informational support can improve informed decision making, adherence to treatment, and reduce anxiety and cancer morbidity. This is a 3-part clinical study investigating the utility of a patient-centered individualized care plan for patients with gastrointestinal (GI) cancer starting a new treatment. Methods: Part 1: Items identified in a comprehensive literature search were formatted into a questionnaire. For each item, participants ranked its importance. Part 2: MDs and RNs involved in the care of patients with GI cancer provided comments about the content of the care plan. Part 3: A prospective cohort study was conducted. During the first 10-weeks, patients received the standard of care. During the subsequent 10-weeks, patients received the intervention, a written individualized care plan. Outcomes were assessed at baseline and 2-4 weeks: QOL (FACT-G), anxiety and depression (HADS), treatment compliance and patient satisfaction (FACT-TS-PS). Results: Part 1: 73 items were included in the questionnaire. 20 patients completed the interview. Part 2: A long and short version of the care plan were created. The majority of MDs and RNs preferred the long version. Based on the comments, the final version was created. Part 3: 54 and 41 patients have been enrolled in the control and intervention cohorts, respectively. Analysis of the baseline data revealed fewer self-reported anxious (p=0.008) and depressive symptoms (p=0.002) in the intervention group. The nursing satisfaction score was significantly higher in the intervention group (7.09 vs. 4.80, p=0.018). Overall QOL and satisfaction scores were higher in the intervention group, but not statistically significant (81.30 vs. 76.25, 79.70 vs. 76.27). Conclusions: The care plan resulted in fewer anxious and depressive symptoms. There was a trend towards improved QOL and satisfaction in the intervention group, although not significant. We are continuing to enroll patients and analyze follow-up data.

scholarly journals Community palliative care services on addressing physical and psychosocial needs in people with advanced illness: a prospective cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Helen Yue-lai Chan ◽  
Carmen Ka-man Chung ◽  
Shawn Sze-chai Tam ◽  
Rita Suk-kuen Chow
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Care Program ◽  
Physical Symptoms ◽  
Palliative Care Program ◽  
Symptom Experience

Abstract Background The integration of palliative care into primary health care has been advocated to improve its accessibility and the continuity of care. Recent studies on such an approach have mainly focused on health care cost and utilization. This study aims to evaluate the effects of a community interdisciplinary palliative care program on the symptom experience of patients with advanced disease. Methods A prospective cohort study was conducted. The Integrated Palliative Care Outcome Scale was used for monthly assessment to monitor their condition. Wilcoxon signed-rank test was used to examine changes in symptom experience across time. Results Forty-eight patients with a predominance of cancer diagnoses, enrolled in the program. They reported anxiety, hardly feeling at peace, and neither receiving information as wanted nor being able to share their feeling with family/friends as more overwhelming than physical symptoms. Improvements in emotional symptoms was statistically significant at 1-month follow up (p < 0.001). Improvements in communication/practical issues were also significant at the 1-month (p < 0.001) and 2-month (p = 0.005) follow-up. However, changes in symptom experiences in the subsequent months were not apparent. Conclusions This study reveals the overwhelming emotional, communication and information needs among patients with advanced diseases and provides empirical evidence of the community palliative care program in short term. Further work is needed to strengthen the medical-social partnership to support care in place albeit health deterioration.

scholarly journals Are physical activity levels of health care professionals consistent with activity guidelines? A prospective cohort study in New Zealand

2018 ◽  
Vol 7 ◽  
pp. 204800401774901 ◽  
Author(s):  
Lydia Chan ◽  
Harry McNaughton ◽  
Mark Weatherall
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Cohort Study ◽  
New Zealand ◽  
Prospective Cohort Study ◽  
Health Care Professionals ◽  
Prospective Cohort ◽  
Daily Step ◽  
Daily Step Count ◽  
Steps Per Day

Objective We aimed to estimate the level of physical activity undertaken by health care professionals and the proportion that achieved a daily target of 10,000 steps. Design This was a prospective cohort study. Setting Participants were recruited in Wellington Regional Hospital, a tertiary hospital in New Zealand. Participants Neurology, Cardiology, and Endocrinology staff were invited to participate. Main outcome measures Pedometer-measured step counts were recorded over seven days and the proportion that achieved a daily target of 10,000 steps was calculated. Results We included 50 staff in the study. The mean daily step count was 10,620 (standard deviation = 3141) with a median daily step count of 10,606 (interquartile range = 7791–12,469). Sixty-five per cent of the staff achieved 10,000 steps per day. Conclusion This cohort was more active compared to other pedometer-based studies in health care professionals. The daily target of 10,000 steps per day was achieved at a higher proportion than reported in international studies and the general New Zealand.

scholarly journals GD06: Derivation and internal validation of a clinical prognostic tool for recurrent emergency visits for hyperglycemia in patients with diabetes mellitus: a multicentre prospective cohort study

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S64-S65
Author(s):  
J. Yan ◽  
K. Gushulak ◽  
T. Spaic ◽  
S. Liu ◽  
L. Siddiqi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Cohort Study ◽  
Blood Glucose ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Internal Validation ◽  
Clinical Risk ◽  
Ed Visits

Background: Patients with poorly controlled diabetes mellitus (DM) often visit the emergency department (ED) for management of hyperglycemic episodes, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). It has been previously reported that risk factors for readmission to the intensive care unit (ICU) in DKA include older age, female sex and the presence of significant comorbidity including sepsis. However, there are no ED-based studies on this topic, particularly in a Canadian setting, and data on outcomes such as recurrent ED visits, hospital or ICU admission after discharge in these patients is lacking. Objectives: The primary objective of this study is to derive and internally validate a clinical risk tool for prognosis of patients presenting with hyperglycemic emergencies to identify those at higher risk of adverse outcomes within 30 days of initial ED presentation. Methods: This will be a multicentre prospective cohort study of eligible consecutive adult patients with an ED diagnosis of hyperglycemia, DKA or HHS. We will include all visits of adult (≥18 years) ED patients with either a known or unknown history of DM and a diagnosis of hyperglycemia (blood glucose &gt;11.0 mmol/L), DKA or HHS. We will include patients with co-morbid diagnoses in addition to hyperglycemia. We will exclude patients: a) with advanced care directives for resuscitation involving refusal of treatment, and b) who are initially assessed at a peripheral hospital and transferred to our sites for ongoing management. Research assistants will then contact the enrolled participants via telephone for follow-up regarding clinical outcomes, including repeat visits to see a health care provider, changes in diabetic medications, and time taken off of work or school. Participants will be followed to determine if they have further ED visits, admissions or ICU admissions after their ED visit for hyperglycemia. Data on missed patients or those who refused consent will be collected to assess for selection/enrolment bias. Statistical considerations: The primary outcome will be an unplanned return ED visit for hyperglycemia within 30 days of initial presentation. Secondary outcomes will include unplanned admission to hospital or ICU for hyperglycemia, or death within 30 days of the index ED visit. Additionally, we hope to characterize patient-important and health-care system outcomes such as time taken off work or school and follow-up visits to see a healthcare provider. We will conduct descriptive statistics on investigations, treatments, disposition and patient-important outcomes. We will perform an initial univariate logistic regression, followed by a multivariate analysis to identify predictor variables associated with adverse events such as recurrent ED visits, and admission to hospital or ICU for hyperglycemia within 30 days. We will include individual patients who have multiple recurrent visits to the ED during the study period and statistically weight for these using generalized estimating equations (GEE), which are used to develop regression models for correlated data that arise from repeated measures of the same individuals over time. Finally, a clinical risk tool will be derived by rounding the beta co-efficients. Internal validation will be conducted using bootstrapping techniques. Importance: ED visits for hyperglycemia significantly affect both the healthcare system overall and the individual patient. The results of this project will assist clinicians to better identify these patients and enable them to intervene either medically or educationally to prevent subsequent visits to the ED. As a result, patients will have improved care, better blood glucose control, and be identified for closer follow-up with a family physician or diabetes specialist. Furthermore, by aiming to reduce the number of recurrent visits, this project may reduce ED utilization and the associated healthcare costs with frequent visits and admissions for hyperglycemia.

Sign in / Sign up

Export Citation Format

Share Document