scholarly journals Code status communication training in postgraduate oncology programs: a needs assessment

2020 ◽  
Vol 27 (6) ◽  
Author(s):  
O.H. Levine ◽  
S.K. Dhesy-Thind ◽  
M.M. McConnell ◽  
M.C. Brouwers ◽  
S.D. Mukherjee
Keyword(s):  
Radiation Oncology ◽  
Communication Skill ◽  
Communication Training ◽  
Educational Resources ◽  
Code Status ◽  
Patients With Cancer ◽  
Formal Evaluation ◽  
Barriers To Teaching ◽  
To Receive ◽  
Skill Building

Background Discussions with patients with cancer about cardiopulmonary resuscitation directives (code status) are often led by residents. This study was carried out in Canada to identify current educational practices and gaps in training for this communication skill. Methods Canadian medical and radiation oncology residents and program directors (pds) were surveyed about teaching practices, satisfaction with current education, and barriers to teaching code status discussion skills. Relative frequencies of categorical and ordinal responses were calculated. Results Between November 2016 and February 2017, 95 (58.6%) of 162 residents and 17 (63%) of 27 pds completed surveys. Only 54.1% and 48.3% of medical and radiation oncology residents, respectively, had received any code status communication training before entering an oncology program. While 41% of residents expected to receive formal teaching on this topic during residency, 47.1% of pds endorsed inclusion of this topic in curricula. Only 20% of residents reported receiving formal evaluation of this skill while 41.2% of pds indicated that evaluations are provided. The importance of this communication skill in oncology was strongly supported. Among residents, 88% desired more training, and 82.3% of pds identified the need for new educational resources. Lack of time, resources, and evaluation tools were among the most commonly identified barriers to teaching. Conclusions Oncology residency pds and trainees feel that code status communication is important, but teaching and evaluation of this skill are limited. Barriers to teaching and skill-building have been identified. Further work is underway to develop novel educational resources for code status communication training.

Code status communication training in Canadian postgraduate oncology programs: A needs assessment survey.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 13-13
Author(s):  
Oren Hannun Levine ◽  
Sukhbinder K. Dhesy-Thind ◽  
Meghan McConnell ◽  
Melissa C. Brouwers ◽  
Som Mukherjee
Keyword(s):  
Radiation Oncology ◽  
Program Directors ◽  
Communication Training ◽  
Educational Resources ◽  
Code Status ◽  
Assessment Survey ◽  
Barriers To Teaching ◽  
Needs Assessment Survey ◽  
To Receive ◽  
Skill Building

13 Background: Discussions with cancer patients on cardiopulmonary resuscitation directives, or ‘code status,’ are often led by trainees in oncology. This study was carried out across Canada to identify current educational practices and gaps in training for this communication skill. Methods: Medical and radiation oncology residents and program directors (PDs) from across Canada were invited to complete a survey. Questions addressed current teaching practices, perceived importance of this competency, satisfaction with current education and barriers to teaching code status discussion skills. Relative frequencies of categorical and ordinal responses were calculated. Results: Between November 2016 and February 2017, 95 residents (58.6% response rate [RR]) and 17 PDs (63% RR) completed surveys. Both oncology disciplines and trainees at all levels were represented. Only 54.1% and 48.3% of medical and radiation oncology residents, respectively, had experienced any form of code status communication training before entering an oncology program. During oncology training, 41.1% of residents expect to receive formal teaching on this topic and 47.1% of PDs endorsed inclusion of this topic in curricula. Only 20% of residents reported receiving any formal evaluation for this competency while 41.2% of program directors indicated that formal evaluations are provided. All PDs and 98% of residents positively endorsed the importance of this competency in residency and clinical practice. Among residents, 88% felt that more training would be beneficial, and 82.3% of PDs identified a need for new educational resources in this area. Lack of time, educational resources and evaluation tools were among the most commonly identified barriers to teaching (by PDs and trainees). Conclusions: Canadian medical and radiation oncology residency PDs and trainees feel that code status communication is an important competency, yet teaching and evaluation are limited in this area. Barriers to teaching and skill-building have been identified. Further work is underway to develop novel educational resources for code status communication training to include in postgraduate curricula.

Rationale for heparin treatment of colon cancer

2000 ◽  
Vol 20 (03) ◽  
pp. 136-142 ◽  
Author(s):  
D. L. Ornstein ◽  
L. R. Zacharski
Keyword(s):  
Clinical Trials ◽  
Substantial Improvement ◽  
Patients With Cancer ◽  
Coagulation Mechanism ◽  
Anticoagulant Drug ◽  
Cancer Outcome ◽  
Meta Analyses ◽  
Improvement In Survival ◽  
Spectrum Of Patients ◽  
To Receive

SummaryIt is widely known that the systemic blood coagulation mechanism is often activated in malignancy, leading to an increased incidence of vascular thromboses in patients with cancer. It is not widely appreciated, however, that products of the coagulation mechanism may also support tumor growth and dissemination. Interest in this approach to cancer therapy has surged recently because of mounting evidence that the familiar anticoagulant drug, heparin, may impede tumor progression. Heparin has the capacity to modify angiogenesis, growth factor and protease activity, immune function, cell proliferation and gene expression in ways that may block malignant dissemination. Clinical trials in which heparin has been administered to a broad spectrum of patients to prevent or treat thrombosis have unexpectedly shown improvement in survival in the subset of patients with malignancy entered to these studies. Meta-analyses of clinical trials comparing unfractionated (UF) versus low molecular weight (LMW) heparin treating venous thromboembolism suggest that there may be substantial improvement in cancer outcome in patients with malignancy randomized to receive LMW heparin. These findings provide a rationale for definitive clinical trials of LMW heparin in cancer, and the results of several such studies that are currently underway are awaited with interest.

scholarly journals Extension Horses, Inc. experts act fast to create online resources to assist the horse industry during COVID-191

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Elizabeth A Greene ◽  
Wendy Hein ◽  
Carissa L Wickens ◽  
Danielle N Smarsh
Keyword(s):  
Emergency Preparedness ◽  
Business Owners ◽  
Virtual Education ◽  
Educational Resources ◽  
Web Conferencing ◽  
High Satisfaction ◽  
Horse Industry ◽  
To Receive ◽  
Web Platform ◽  
Horse Owners

Abstract The COVID-19 pandemic and resulting stay-at-home directives, adopted out of necessity to protect human health, introduced significant challenges for horse owners and small equine businesses. Restricted access, and in many cases closure of barns, resulted in a multitude of questions and concerns within the equine community which needed to be addressed rapidly. Extension Horses, Inc. (EH) coordinated the development and delivery of a variety of educational resources utilizing a combination of online formats and dissemination through social media and EH member contact lists. A series of infographics, webinars, and podcasts (three in each category) were created to provide guidance on essential care of horses, emergency preparedness, financial assistance, legal concerns, and biosecurity during the crucial, initial weeks of the pandemic (March to April 2020). Web conferencing technology (Zoom) was used to facilitate discussion and task delegation among EH members and to conduct and record webinars and podcasts. Podcasts were hosted on Buzzsprout and infographics were created using Adobe InDesign. Live webinar participants were invited to participate in several polls during the webinar and were sent a brief survey to complete at the end of the webinar series. Analytics for all educational resources combined demonstrated a 32-d total direct reach of 135,563. Most live webinar participants identified themselves as horse owners and small equine business owners (55%). The majority of live webinar participants indicated the information was useful (99%), and they would utilize the resources they had learned about (80%). Survey respondents reported that Facebook, email, and word of mouth were key ways in which they learned about the webinars. The same survey found that the web-platform was an effective method to receive information (85% high satisfaction) and respondents were highly likely to recommend future EH webinars to others (88%). The three infographics had a total Facebook reach of 131,765, the webinars had 3,522 total views, and the three podcasts had 276 total downloads. The rapid response of EH and quick turnaround of products allowed a large online audience to receive vital information for coping with COVID-19. Having the established EH network, already familiar with virtual education, was a big asset in this effort. This can serve as a model for cooperative extension to utilize in future collaborative responses to industry issues.

Use of a natural multicomponent mouthwash plus oral hygiene vs oral hygiene alone to prevent everolimus-induced stomatitis: the STOP multicenter, randomized trial

2020 ◽  
Vol 106 (3) ◽  
pp. 257-266
Author(s):  
Camillo Porta ◽  
Elena Verzoni ◽  
Silvia Zai ◽  
Caterina Messina ◽  
Vittorio Ferrari ◽  
...  
Keyword(s):  
Oral Hygiene ◽  
Mammalian Target Of Rapamycin ◽  
Dose Intensity ◽  
Treated Group ◽  
Patients With Cancer ◽  
Treatment Dose ◽  
Registration Number ◽  
Study Population ◽  
To Receive

Background: Stomatitis is highly prevalent in patients with cancer treated with the mammalian target of rapamycin inhibitor everolimus; it usually has an early onset and may compromise treatment dose intensity and patients’ quality of life. Within the randomized controlled Stomatitis Prevention trial (STOP, ISRCTN14568888), we investigated the possibility of using a commercial natural multicomponent mouthwash (Orasol Plus®) to prevent the development of stomatitis of any grade in patients with advanced renal cell carcinoma (RCC) treated with everolimus. Methods: Overall, 62 patients were randomized to receive either Orasol Plus in addition to oral hygiene or oral hygiene alone (31 patients per treatment arm). Results: In the whole study population, 28 episodes of stomatitis were observed (41.9%); in only 2 patients, stomatitis occurred more than once (2 episodes). As expected, the episodes of stomatitis occurred early in the course of treatment with everolimus. Treatment with Orasol Plus prevented the onset of everolimus-induced stomatitis: only 8 episodes of stomatitis were observed in the treated group with Orasol Plus in addition to oral hygiene vs 20 episodes in the group treated with oral hygiene only ( p = 0021). Also, a reduction in the average duration of mucositis in patients treated with Orasol Plus compared to patients treated with oral hygiene only was observed (8 days vs 11.2 days, p = 0.0416). Conclusion: This study showed that the use of a natural multicomponent mouthwash coupled with regular oral hygiene was able to reduce the severity and duration of everolimus-induced stomatitis in patients with RCC. Trial registration number: ISRCTN14568888

scholarly journals COVID-19–Related Ethics Consultations at a Cancer Center in New York City: A Content Review of Ethics Consultations During the Early Stages of the Pandemic

2020 ◽  
pp. OP.20.00440
Author(s):  
Danielle Novetsky Friedman ◽  
Liz Blackler ◽  
Yesne Alici ◽  
Amy E. Scharf ◽  
Martin Chin ◽  
...  
Keyword(s):  
New York ◽  
Health Care Providers ◽  
Ethical Issues ◽  
Cancer Center ◽  
Care Providers ◽  
Delivery Of Care ◽  
Code Status ◽  
Patients With Cancer ◽  
Early Stages ◽  
Content Review

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has raised a variety of ethical dilemmas for health care providers. Limited data are available on how a patient’s concomitant cancer diagnosis affected ethical concerns raised during the early stages of the pandemic. METHODS: We performed a retrospective review of all COVID-related ethics consultations registered in a prospectively collected ethics database at a tertiary cancer center between March 14, 2020, and April 28, 2020. Primary and secondary ethical issues, as well as important contextual factors, were identified. RESULTS: Twenty-six clinical ethics consultations were performed on 24 patients with cancer (58.3% male; median age, 65.5 years). The most common primary ethical issues were code status (n = 11), obligation to provide nonbeneficial treatment (n = 3), patient autonomy (n = 3), resource allocation (n = 3), and delivery of care wherein the risk to staff might outweigh the potential benefit to the patient (n = 3). An additional nine consultations raised concerns about staff safety in the context of likely nonbeneficial treatment as a secondary issue. Unique contextual issues identified included concerns about public safety for patients requesting discharge against medical advice (n = 3) and difficulties around decision making, especially with regard to code status because of an inability to reach surrogates (n = 3). CONCLUSION: During the early pandemic, the care of patients with cancer and COVID-19 spurred a number of ethics consultations, which were largely focused on code status. Most cases also raised concerns about staff safety in the context of limited benefit to patients, a highly unusual scenario at our institution that may have been triggered by critical supply shortages.

scholarly journals Understanding American Indian Perceptions Toward Radiation Therapy

2020 ◽  
Vol 27 (3) ◽  
pp. 107327482094599
Author(s):  
Samir H. Patel ◽  
Sasha Ebrahimi ◽  
Donald W. Northfelt ◽  
Timothy E. Mathews ◽  
Farhia M. Omar ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Adverse Effects ◽  
American Indian ◽  
Alaska Native ◽  
Medical Center ◽  
Transportation Cost ◽  
Survey Study ◽  
Cost Of Treatment ◽  
Patients With Cancer ◽  
To Receive

Many American Indian (AI) and Alaska native (AN) patients do not complete guideline-concordant cancer care for the 4 most common cancers. Our aim was to better understand AI/AN attitudes toward radiation therapy (RT). Patients eligible for this survey study were AI/AN patients with cancer at the Phoenix Indian Medical Center who either received previous RT or were recommended to receive RT. An 18-item questionnaire was administered to each of the 50 participants from October 1, 2018, through February 15, 2019. Willingness to travel for RT was compared to respondent characteristics, concerns regarding RT, and obstacles to obtain RT. Duration of RT was important to 78% of patients: 24% would consider traveling 25 miles or more for a standard course, and 48% would travel that distance for a shorter course ( P < .001). The top-ranked barriers to RT were transportation, cost of treatment, and insurance compatibility. The top-ranked concerns about RT were adverse effects, cost of treatment, and fear of RT. Concerns about adverse effects were associated with the radiation team’s inability to explain the treatment ( P = .05). Transportation concerns were significantly associated with accessibility ( P = .02), communication with the RT team ( P = .02), and fear of RT ( P = .04). AI/AN patients are concerned about the adverse effects of RT and the logistics of treatment, particularly costs, transportation, and insurance compatibility. Use of culturally specific education and hypofractionation regimens may increase acceptance of RT for AI/AN patients with cancer, and this hypothesis will be tested in a future educational intervention-based study.

Retrospective Analysis of Clinical Outcomes Associated With the Use of Pegfilgrastim On-body Injector in Patients Receiving Chemotherapy Requiring Granulocyte Colony-Stimulating Factor Support

2019 ◽  
pp. 001857871986765 ◽  
Author(s):  
Jolly Patel ◽  
Rebecca Ann Rainess ◽  
Miranda J. Benfield ◽  
Kate M. L. Rogers ◽  
Donald C. Moore ◽  
...  
Keyword(s):  
Failure Rate ◽  
Primary Prophylaxis ◽  
Primary Objective ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Device Failure ◽  
Patients With Cancer ◽  
Electronic Chart ◽  
To Receive ◽  
Stimulating Factor

Objectives: Pegfilgrastim is a granulocyte colony-stimulating factor (G-CSF) used as primary prophylaxis in patients receiving myelosuppressive chemotherapy regimens that have greater than 20% risk of developing febrile neutropenia (FN). Historically, pegfilgrastim has been administered 24 to 72 hours after chemotherapy, necessitating a return to clinic to receive the provider-administered injection. An alternative option is the pegfilgrastim on-body injector (OBI). With the OBI device, patients have their pegfilgrastim administered 27 hours after receiving chemotherapy while remaining at home, avoiding an additional clinic appointment. Concerns with pegfilgrastim OBI include lack of experience with the device in both the patient and provider, device-related failures, and the success of delivery. This study evaluates pegfilgrastim OBI failure rates through associated patient outcomes among cancer patients receiving chemotherapy requiring G-CSF. Methods: A retrospective electronic chart review was conducted of adult patients with cancer who received chemotherapy and pegfilgrastim OBI from July 1, 2016, to July 31, 2018. The primary objective of this study was the incidence of FN in patients receiving pegfilgrastim OBI. Results: There were no reported cases of hospitalization due to FN in patients who received pegfilgrastim OBI. Dose delays and dosage modifications were not observed in our review. The OBI device failure rate was found to be low (1.92%). Conclusion: The low device failure rate from this study suggests that the OBI is a viable option for administration of pegfilgrastim in patients receiving chemotherapy requiring G-CSF.

scholarly journals Impact of the Cost of Cancer Treatment: An Internet-Based Survey

2010 ◽  
Vol 6 (2) ◽  
pp. 69-73 ◽  
Author(s):  
Maurie Markman ◽  
Ryan Luce
Keyword(s):  
Cancer Treatment ◽  
Cost Of Care ◽  
Patients With Cancer ◽  
Recommended Treatment ◽  
Cancer Experience ◽  
The Cost ◽  
To Receive

Survey suggests many patients with cancer experience distress associated with cost of care. A serious issue for those with modest annual incomes, these costs affect whether patients decide to receive recommended treatment.

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