How can diagnostic assessment programs be implemented to enhance inter-professional collaborative care for cancer?

BackgroundInter-professional collaborative care (ICC) for cancer leads to multiple system, organizational, professional, and patient benefits, but is limited by numerous challenges. Empirical research on interventions that promote or enable ICC is sparse so guidance on how to achieve ICC is lacking. Research shows that ICC for diagnosis could be improved. Diagnostic assessment programs (DAPs) appear to be a promising model for enabling ICC. The purpose of this study was to explore how DAP structure and function enable ICC, and whether that may be associated with organizational and clinical outcomes.MethodsA case study approach will be used to explore ICC among eight DAPs that vary by type of cancer (lung, breast), academic status, and geographic region. To describe DAP function and outcomes, and gather information that will enable costing, recommendations expressed in DAP standards and clinical guidelines will be assessed through retrospective observational study. Data will be acquired from databases maintained by participating DAPs and the provincial cancer agency, and confirmed by and supplemented with review of medical records. We will conduct a pilot study to explore the feasibility of estimating the incremental cost-effectiveness ratio using person-level data from medical records and other sources. Interviews will be conducted with health professionals, staff, and referring physicians from each DAP to learn about barriers and facilitators of ICC. Qualitative methods based on a grounded approach will be used to guide sampling, data collection and analysis.DiscussionFindings may reveal opportunities for unique structures, interventions or tools that enable ICC that could be developed, implemented, and evaluated through future research. This information will serve as a formative needs assessment to identify the nature of ongoing or required improvements, which can be directly used by our decision maker collaborators, and as a framework by policy makers, cancer system managers, and DAP managers elsewhere to strategically plan for and implement diagnostic cancer services

Facilitating collaborative supervision in a university speech-language pathology clinic

Clinical education is a key element of graduate school training in the field of speech-language pathology. Graduate students are required to obtain 375 supervised clinical practice hours in order to earn their provisional license and begin their career. Supervision of clinical hours is most often provided by experienced speech-language pathologists with minimal, if any, training in effective supervision practices. Within the field of speech-language pathology, Anderson’s Continuum of Supervision (Anderson, 1988) is the most widely accepted model and provides a structure and sequence for supervisors to follow in order to facilitate the clinical development of their student clinician. Anderson’s model suggests that the collaborative supervision style should be used to transition student clinicians from directive supervision (where they are reliant on the supervisor for direction) to self-supervision, which represents independence. Despite this, and because of a lack of evidenced-based methods and a lack of training opportunities, many supervisors have difficulty implementing the collaborative supervision style. This study examines the effectiveness of an external tool, the Clinician’s Hierarchy for Advancing Treatment (CHAT) (Duthie, 2008), in helping supervisors to implement the collaborative supervision style. This is an exploratory quantitative, quasi-experimental non-equivalent groups study. Students and supervisors were surveyed about their perceptions of the supervisory process following their participation in a semester-long clinical practicum in a university speech-language pathology clinic. Prior to working with a second cohort of students, the supervisor group was trained on the CHAT. This method features a chart which objectively defines levels of client performance and corresponding levels of clinical supports needed for the client to advance in treatment. Supervisors were trained to use this tool to guide student clinicians in the clinical decision-making processes. Implementation of the CHAT occurred across the following semester in the same university clinic with a new group of student clinicians. Supervisors and students were again surveyed at the end of the semester on their experience of the supervisory process to determine if the perception of collaborative supervision had increased with the implementation of the CHAT. The Supervisory Relationship Measure (Pearce et al., 2013) and the Supervisory Relationship Questionnaire (Palomo et al., 2010) were used to survey the student clinicians and supervisors, respectively. Independent-samples, one-tailed t-tests were conducted to determine if there was a significant increase in the perception of collaborative supervision. These analyses were conducted using the Safe Base Subscale score from the surveys, of which items focus on the interactions and relationship between the supervisor and the student clinician as they relate to collaboration. Analysis resulted in insufficient evidence to suggest an increase in the perception of collaborative supervision from the first semester (without CHAT) to the second semester when CHAT was implemented. Additional analyses were also conducted on items that were considered particularly salient to collaborative supervision. Results of item-level analyses were marginally significant for two items from the supervisor surveys, both of which queried the supervisor’s perception of the student’s level of openness and honesty in supervisory conferences. These findings suggest that using an external tool such as the CHAT, may result in student clinicians being more open and honest about their experience of the clinical process in the supervisory conference. It is argued that the objectivity of the external tool prompts more objective conversation between the supervisor and student clinician. The increase in objective conversation, in turn, decreases the judgment and evaluation that students often associate with supervision, thereby creating a safer environment in which to voice their honest reflections

Facilitating collaborative supervision in a university speech-language pathology clinic

Clinical education is a key element of graduate school training in the field of speech-language pathology. Graduate students are required to obtain 375 supervised clinical practice hours in order to earn their provisional license and begin their career. Supervision of clinical hours is most often provided by experienced speech-language pathologists with minimal, if any, training in effective supervision practices. Within the field of speech-language pathology, Anderson’s Continuum of Supervision (Anderson, 1988) is the most widely accepted model and provides a structure and sequence for supervisors to follow in order to facilitate the clinical development of their student clinician. Anderson’s model suggests that the collaborative supervision style should be used to transition student clinicians from directive supervision (where they are reliant on the supervisor for direction) to self-supervision, which represents independence. Despite this, and because of a lack of evidenced-based methods and a lack of training opportunities, many supervisors have difficulty implementing the collaborative supervision style. This study examines the effectiveness of an external tool, the Clinician’s Hierarchy for Advancing Treatment (CHAT) (Duthie, 2008), in helping supervisors to implement the collaborative supervision style. This is an exploratory quantitative, quasi-experimental non-equivalent groups study. Students and supervisors were surveyed about their perceptions of the supervisory process following their participation in a semester-long clinical practicum in a university speech-language pathology clinic. Prior to working with a second cohort of students, the supervisor group was trained on the CHAT. This method features a chart which objectively defines levels of client performance and corresponding levels of clinical supports needed for the client to advance in treatment. Supervisors were trained to use this tool to guide student clinicians in the clinical decision-making processes. Implementation of the CHAT occurred across the following semester in the same university clinic with a new group of student clinicians. Supervisors and students were again surveyed at the end of the semester on their experience of the supervisory process to determine if the perception of collaborative supervision had increased with the implementation of the CHAT. The Supervisory Relationship Measure (Pearce et al., 2013) and the Supervisory Relationship Questionnaire (Palomo et al., 2010) were used to survey the student clinicians and supervisors, respectively. Independent-samples, one-tailed t-tests were conducted to determine if there was a significant increase in the perception of collaborative supervision. These analyses were conducted using the Safe Base Subscale score from the surveys, of which items focus on the interactions and relationship between the supervisor and the student clinician as they relate to collaboration. Analysis resulted in insufficient evidence to suggest an increase in the perception of collaborative supervision from the first semester (without CHAT) to the second semester when CHAT was implemented. Additional analyses were also conducted on items that were considered particularly salient to collaborative supervision. Results of item-level analyses were marginally significant for two items from the supervisor surveys, both of which queried the supervisor’s perception of the student’s level of openness and honesty in supervisory conferences. These findings suggest that using an external tool such as the CHAT, may result in student clinicians being more open and honest about their experience of the clinical process in the supervisory conference. It is argued that the objectivity of the external tool prompts more objective conversation between the supervisor and student clinician. The increase in objective conversation, in turn, decreases the judgment and evaluation that students often associate with supervision, thereby creating a safer environment in which to voice their honest reflections

Cancer Informatics for Cancer Centers (CI4CC): Building a Community Focused on Sharing Ideas and Best Practices to Improve Cancer Care and Patient Outcomes.

Cancer Informatics for Cancer Centers (CI4CC) is a grassroots, nonprofit 501c3 organization intended to provide a focused national forum for engagement of senior cancer informatics leaders, primarily aimed at academic cancer centers anywhere in the world but with a special emphasis on the 70 National Cancer Institute-funded cancer centers. Although each of the participating cancer centers is structured differently, and leaders' titles vary, we know firsthand there are similarities in both the issues we face and the solutions we achieve. As a consortium, we have initiated a dedicated listserv, an open-initiatives program, and targeted biannual face-to-face meetings. These meetings are a place to review our priorities and initiatives, providing a forum for discussion of the strategic and pragmatic issues we, as informatics leaders, individually face at our respective institutions and cancer centers. Here we provide a brief history of the CI4CC organization and meeting highlights from the latest CI4CC meeting that took place in Napa, California from October 14-16, 2019. The focus of this meeting was "intersections between informatics, data science, and population science." We conclude with a discussion on "hot topics" on the horizon for cancer informatics

Curriculum renewal for interprofessional education in health

In this preface we comment on four matters that we think bode well for the future of interprofessional education in Australia. First, there is a growing articulation, nationally and globally, as to the importance of interprofessional education and its contribution to the development of interprofessional and collaborative health practices. These practices are increasingly recognised as central to delivering effective, efficient, safe and sustainable health services. Second, there is a rapidly growing interest and institutional engagement with interprofessional education as part of pre-registration health professional education. This has changed substantially in recent years. Whilst beyond the scope of our current studies, the need for similar developments in continuing professional development (CPD) for health professionals was a consistent topic in our stakeholder consultations. Third, we observe what might be termed a threshold effect occurring in the area of interprofessional education. Projects that address matters relating to IPE are now far more numerous, visible and discussed in terms of their aggregate outcomes. The impact of this momentum is visible across the higher education sector. Finally, we believe that effective collaboration is a critical mediating process through which the rich resources of disciplinary knowledge and capability are joined to add value to existing health service provision. We trust the conceptual and practical contributions and resources presented and discussed in this report contribute to these developments.Office of Learning and Teaching Australi

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Interprofessional education: a necessity in Alzheimer’s dementia care—a pilot study

Introduction: Interprofessional collaboration is seen as an indispensable prerequisite for high-quality health services and patient care, especially for complex diseases such as dementia. Thus, the current project aimed to extend interprofessional and competency-based education in the field of dementia care to the previously understudied therapy professions of nutrition, speech-language pathology, and physiotherapy. Methods: A three-day workshop was designed to provide specific learning objectives related to patient-centered dementia care, as well as competences for interprofessional collaboration. Teaching and learning approaches included case-based learning in simulated interprofessional case-conferences and peerteaching. A total of 42 students (n  =  20 nutrition therapy and counseling, n  =  8 speech-language pathology, n  =  14 physiotherapy), ranging from first to seventh semester, finished the whole workshop and were considered in data analysis. Changes in self-perceived attitudes toward interprofessional collaboration and education were measured by the German version of the UWE-IP. An in-house questionnaire was developed to evaluate knowledge and skills in the field of dementia, dementia management and interprofessional collaboration. Results: Participation in the workshop led to significant improvements in the total scores of the UWE-IP-D and the in-house questionnaire, as well as their respective subscales. Moderate to large effect sizes were achieved. All professions improved significantly in both questionnaires with large effect sizes. Significant differences between professions were found in the UWE-IP-D total score between students of speech-language pathology and physiotherapy in the posttest. Students of nutrition therapy and counseling revealed a significant lower level of self-perceived knowledge and skills in the in-house questionnaire pre- and post-testing. Discussion: The pilot-study confirms the effectiveness of interprofessional education to promote generic and interprofessional dementia care competencies and to develop positive attitudes toward interprofessional learning and collaboration in the therapy professions, thus increasing professional diversity in interprofessional education research. Differences between professions were confounded by heterogenous semester numbers and participation conditions. To achieve a curricular implementation, interprofessional education should be expanded to include a larger group of participants belonging to different professions, start early in the study program, and be evaluated over the long term

The Blended Learning Unit, University of Hertfordshire: A Centre for Excellence in Teaching and Learning, Evaluation Report for HEFCE

The University of Hertfordshire’s Blended Learning Unit (BLU) was one of the 74 Centres for Excellence in Teaching and Learning (CETLs) funded by the Higher Education Funding Council for England (HEFCE) between 2005 and 2010. This evaluation report follows HEFCE’s template. The first section provides statistical information about the BLU’s activity. The second section is an evaluative reflection responding to 13 questions. As well as articulating some of our achievements and the challenges we have faced, it also sets out how the BLU’s activity will continue and make a significant contribution to delivery of the University of Hertfordshire’s 2010-2015 strategic plan and its aspirations for a more sustainable future. At the University of Hertfordshire, we view Blended Learning as the use of Information and Communication Technology (ICT) to enhance the learning and learning experience of campus-based students. The University has an excellent learning technology infrastructure that includes its VLE, StudyNet. StudyNet gives students access to a range of tools, resources and support 24/7 from anywhere in the world and its robustness, flexibility and ease of use have been fundamental to the success of the Blended Learning agenda at Hertfordshire. The BLU has comprised a management team, expert teachers seconded from around the University, professional support and a Student Consultant. The secondment staffing model was essential to the success of the BLU. As well as enabling the BLU to become fully staffed within the first five months of the CETL initiative, it has facilitated access to an invaluable spectrum of Blended Learning, research and Change Management expertise to inform pedagogically sound developments and enable change to be embedded across the institution. The BLU used much of its capital funding to reduce barriers to the use of technology by, for example, providing laptop computers for all academic staff in the institution, enhancing classroom technology provision and wirelessly enabling all teaching accommodation. Its recurrent funding has supported development opportunities for its own staff and staff around the institution; supported evaluation activities relating to individual projects and of the BLU’s own impact; and supported a wide range of communication and dissemination activities internally and externally. The BLU has led the embedding a cultural change in relation to Blended Learning at the University of Hertfordshire and its impact will be sustained. The BLU has produced a rich legacy of resources for our own staff and for others in the sector. The University’s increased capacity in Blended Learning benefits all our students and provides a learning experience that is expected by the new generation of learners in the 21st century. The BLU’s staffing model and partnership ways of working have directly informed the structure and modus operandi of the University’s Learning and Teaching Institute (LTI). Indeed a BLU team will continue to operate within the LTI and help drive and support the implementation of the University’s 2010-2015 Strategic plan. The plan includes ambitions in relation to Distance Learning and Flexible learning and BLU will be working to enable greater engagement with students with less or no need to travel to the university. As well as opening new markets within the UK and overseas, even greater flexibility for students will also enable the University to reduce its carbon footprint and provide a multifaceted contribution to our sustainability agenda. We conclude this executive summary with a short paragraph, written by Eeva Leinonen, our former Deputy Vice-Chancellor, which reflects our aspiration to transform Learning and Teaching at the University of Hertfordshire and more widely in the sector. ‘As Deputy Vice Chancellor at Hertfordshire I had the privilege to experience closely the excellent work of the Blended Learning Unit, and was very proud of the enormous impact the CETL had not only across the University but also nationally and internationally. However, perhaps true impact is hard to judge at such close range, but now as Vice Principal (Education) at King's College London, I can unequivocally say that Hertfordshire is indeed considered as the leading Blended Learning university in the sector. My new colleagues at King's and other Russell Group Universities frequently seek my views on the 'Hertfordshire Blended Learning' experience and are keen to emulate the successes achieved at an institutional wide scale. The Hertfordshire CETL undoubtedly achieved not only what it set out to achieve, but much more in terms of scale and impact. All those involved in this success can be justifiably proud of their achievements.’ Professor Eeva Leinonen, Vice Principal (Education), King's College, Londo

Impact evaluation of international multidisciplinary tumor boards

Over the last 20 years, cancer clinicians have begun to improve the efficacy of cancer care through tumor boards, meetings of multidisciplinary patient care teams used to educate attendees and align treatment plans. In addition to the potential for collaboration between different disciplines, these meetings allow for the incorporation of information from peer-reviewed literature. Despite their use, very little research has been done on the effect of tumor boards on treatment efficacy. Within this small body of work, the indicators used are often inherently biased, and little concern is given to their confounding effects. This document will discuss alternative metrics that provide a less biased estimate of the impact of tumor boards. Given their educational aspects, tumor boards are beginning to be used in an international context to support clinicians in developing nations. Despite the relative lack of evidence supporting use of tumor boards, they provide a low-cost method for improving clinician education in a setting where treatment protocols vary greatly. Moreover, international tumor boards provide a way for low-resource hospitals to tap into facilities of high-resource hospitals, receive resource-sensitive guidelines for future practice, and collaborate with clinicians from other hospitals. However, there are serious barriers to implementing international tumor boards, including technological, logistical, linguistic, and oversight issues. This document outlines potential issues and methods to circumvent them, as well as benefits of international tumor boards (including future collaboration)