Appendices_online_supp – Supplemental material for Exploring the Impact of Quality of Life on Survival: A Case Study in Total Knee Replacement Surgery

Supplemental material, Appendices_online_supp for Exploring the Impact of Quality of Life on Survival: A Case Study in Total Knee Replacement Surgery by Michelle Tew, Kim Dalziel, Michelle Dowsey, Peter F. Choong and Philip Clarke in Medical Decision Making</p

DataSheet_1_Why is advance care planning underused in oncology settings? A systematic overview of reviews to identify the benefits, barriers, enablers, and interventions to improve uptake.docx

BackgroundAdvance care planning (ACP) centres on supporting people to define and discuss their individual goals and preferences for future medical care, and to record and review these as appropriate. Despite recommendations from guidelines, rates of documentation for people with cancer are considerably low.AimTo systematically clarify and consolidate the evidence base of ACP in cancer care by exploring how it is defined; identifying benefits, and known barriers and enablers across patient, clinical and healthcare services levels; as well as interventions that improve advance care planning and are their effectiveness.MethodsA systematic overview of reviews was conducted and was prospectively registered on PROSPERO. PubMed, Medline, PsycInfo, CINAHL, and EMBASE were searched for review related to ACP in cancer. Content analysis and narrative synthesis were used for data analysis. The Theoretical Domains Framework (TDF) was used to code barriers and enablers of ACP as well as the implied barriers targeted by each of the interventions.ResultsEighteen reviews met the inclusion criteria. Definitions were inconsistent across reviews that defined ACP (n=16). Proposed benefits identified in 15/18 reviews were rarely empirically supported. Interventions reported in seven reviews tended to target the patient, even though more barriers were associated with healthcare providers (n=40 versus n=60, respectively).ConclusionTo improve ACP uptake in oncology settings; the definition should include key categories that clarify the utility and benefits. Interventions need to target healthcare providers and empirically identified barriers to be most effective in improving uptake.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42021288825.</p

DataSheet_2_Why is advance care planning underused in oncology settings? A systematic overview of reviews to identify the benefits, barriers, enablers, and interventions to improve uptake.doc

BackgroundAdvance care planning (ACP) centres on supporting people to define and discuss their individual goals and preferences for future medical care, and to record and review these as appropriate. Despite recommendations from guidelines, rates of documentation for people with cancer are considerably low.AimTo systematically clarify and consolidate the evidence base of ACP in cancer care by exploring how it is defined; identifying benefits, and known barriers and enablers across patient, clinical and healthcare services levels; as well as interventions that improve advance care planning and are their effectiveness.MethodsA systematic overview of reviews was conducted and was prospectively registered on PROSPERO. PubMed, Medline, PsycInfo, CINAHL, and EMBASE were searched for review related to ACP in cancer. Content analysis and narrative synthesis were used for data analysis. The Theoretical Domains Framework (TDF) was used to code barriers and enablers of ACP as well as the implied barriers targeted by each of the interventions.ResultsEighteen reviews met the inclusion criteria. Definitions were inconsistent across reviews that defined ACP (n=16). Proposed benefits identified in 15/18 reviews were rarely empirically supported. Interventions reported in seven reviews tended to target the patient, even though more barriers were associated with healthcare providers (n=40 versus n=60, respectively).ConclusionTo improve ACP uptake in oncology settings; the definition should include key categories that clarify the utility and benefits. Interventions need to target healthcare providers and empirically identified barriers to be most effective in improving uptake.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42021288825.</p

Table_1_Why is advance care planning underused in oncology settings? A systematic overview of reviews to identify the benefits, barriers, enablers, and interventions to improve uptake.docx

BackgroundAdvance care planning (ACP) centres on supporting people to define and discuss their individual goals and preferences for future medical care, and to record and review these as appropriate. Despite recommendations from guidelines, rates of documentation for people with cancer are considerably low.AimTo systematically clarify and consolidate the evidence base of ACP in cancer care by exploring how it is defined; identifying benefits, and known barriers and enablers across patient, clinical and healthcare services levels; as well as interventions that improve advance care planning and are their effectiveness.MethodsA systematic overview of reviews was conducted and was prospectively registered on PROSPERO. PubMed, Medline, PsycInfo, CINAHL, and EMBASE were searched for review related to ACP in cancer. Content analysis and narrative synthesis were used for data analysis. The Theoretical Domains Framework (TDF) was used to code barriers and enablers of ACP as well as the implied barriers targeted by each of the interventions.ResultsEighteen reviews met the inclusion criteria. Definitions were inconsistent across reviews that defined ACP (n=16). Proposed benefits identified in 15/18 reviews were rarely empirically supported. Interventions reported in seven reviews tended to target the patient, even though more barriers were associated with healthcare providers (n=40 versus n=60, respectively).ConclusionTo improve ACP uptake in oncology settings; the definition should include key categories that clarify the utility and benefits. Interventions need to target healthcare providers and empirically identified barriers to be most effective in improving uptake.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42021288825.</p

Breakdown of excess cost of care due to sepsis.

(DOCX)</p

Variations in the 1-year cumulative excess cost by sex and age groups.

(A) Haematolgy. (B) Solid tumour. The dotted vertical line represents the excess cost presented in our main analysis (overall grouped average). Error bars represent the 95% confidence intervals.</p

Mean monthly cost of care by malignancy type.

(A) Haematolgy. (B) Solid tumour. The shaded area represents excess cost associated with sepsis, solid line represents mean monthly cost of care among sepsis (cases) and dotted line for no sepsis (controls).</p

Data source.

(DOCX)</p

Sensitivity analyses.

(DOCX)</p

Characteristics of cancer patients with sepsis by malignancy type.

Characteristics of cancer patients with sepsis by malignancy type.</p