Obtaining Patient-Reported Outcomes Electronically With “OncoFunction” in Head and Neck Cancer Patients During Aftercare

The disease and treatment of patients with head and neck cancer can lead to multiple late and long-term sequelae. Especially pain, psychosocial problems, and voice issues can have a high impact on patients’ health-related quality of life. The aim was to show the feasibility of implementing an electronic Patient-Reported Outcome Measure (PROM) in patients with head and neck cancer (HNC). Driven by our department’s intention to assess Patient-Reported Outcomes (PRO) based on the International Classification of Functioning during tumor aftercare, the program “OncoFunction” has been implemented and continuously refined in everyday practice. The new version of “OncoFunction” was evaluated by 20 head and neck surgeons and radiation oncologists in an interview. From 7/2013 until 7/2017, 846 patients completed the PROM during 2,833 of 3,610 total visits (78.5%). The latest software version implemented newly developed add-ins and increased the already high approval ratings in the evaluation as the number of errors and the time required decreased (6 vs. 0 errors, 1.35 vs. 0.95 min; p<0.01). Notably, patients had different requests using PRO in homecare use. An additional examination shows that only 59% of HNC patients use the world wide web. Using OncoFunction for online-recording and interpretation of PROM improved data acquisition in daily HNC patients’ follow-up. An accessory timeline grants access to former consultations and their visualization supported and simplified structured examinations. This provides an easy-to-use representation of the patient’s functional outcome supporting comprehensive aftercare, considering all aspects of the patient’s life

Improving the transition from pediatric to adult care for survivors of pediatric cancer in Newfoundland, Canada

Advances in the treatment of childhood cancer have led to improved survival rates. Yet, childhood cancer survivors (CCS) have greater health risks and other health burdens that require appropriate follow-up and surveillance throughout their lives. Higher survival rates mean that significantly more pediatric oncology patients will reach adulthood and will be transitioned into adult care for their continued follow-up or aftercare. The transition from pediatric to adult-centered care is, however, increasingly being recognized as a period during which patients risk become disconnected with the healthcare system and having poorer health outcomes. This situation can be potentially very troubling for patients who require continued, regular surveillance. The focus of this doctoral research is to explore the transition from pediatric care to adult care and aftercare practices for CCS in Newfoundland (NL), Canada. Guided by the World Health Organization’s Quality of Care: A Process for Making Strategic Choices in Health Systems framework, we first reviewed models of care (MOC) and interventions aimed at improving aftercare that had been evaluated in the academic literature, including those specific to transition. We then conducted a qualitative study to detail the processes and barriers of transition for CCS in NL. Based on this information and discussions with local stakeholders, we identified the need for locally relevant educational resources. We then developed an educational workbook, titled After the Janeway, to be used by CCS in NL during their transition into adult-focused aftercare. Finally, we evaluated the workbook using a validated scale for assessing patient educational materials. The assessments clearly show that the adoption of this workbook into clinical practice should improve the experiences of CCS transitioning into adult care in NL. Collectively, our studies establish a thesis that is novel and potentially serves as the groundwork for future research related to improving the quality of the transitions and aftercare for CCS

The effects of booster sessions on self-management interventions for chronic musculoskeletal pain: a systematic review and meta-analysis of randomised controlled trials

Our objective was to investigate the effectiveness of booster sessions after self-management interventions as a means of maintaining self-management behaviours in the treatment of chronic musculoskeletal pain. We searched MEDLINE, EMBASE, Science Citation Index, Cochrane Central Register of Controlled Trials and PsycINFO. Two authors independently identified eligible trials and collected data. We calculated the odds ratio (OR) for the analyses of dichotomous data, and standardised mean differences (SMD) with 95% confidence interval (CI) for continuous variables. Our search identified 14 studies with a total of 1695 patients. All studies were at high risk of bias and provided very low quality evidence. For the primary outcomes, booster sessions had no evidence of an effect on improving patient-reported outcomes on physical function (SMD-0.13, 95%CI -0.32 to -0.06; P=0.18), pain-related disability (SMD-0.16, 95%CI -0.36 to 0.03; P=0.11) and pain self-efficacy (SMD 0.15, 95%CI -0.07 to 0.36; P=0.18). For the secondary outcomes, booster sessions caused a significant reduction in patient-reported pain catastrophising (SMD-0.42, 95%CI -0.64 to -0.19; P=0.0004), and no evidence of an effect on patient-reported pain intensity, depression, coping or treatment adherence. There is currently little evidence that booster sessions are an effective way to prolong positive treatment effects or improve symptoms of long-term musculoskeletal conditions following self-management interventions. However, the studies were few with high heterogeneity, high risk of bias and overall low quality of evidence. Our review argues against including booster sessions routinely to self-management interventions for the purpose of behaviour maintenance

Systematic review and meta-analysis of patient reported outcomes for nurse-led models of survivorship care for adult cancer patients

Purpose: This systematic review aimed to determine the effectiveness of nurse-led cancer survivorship care, compared with existing models of care, on patient reported outcomes for cancer survivors. Methods: Randomised and non-randomised controlled trials and controlled before-after studies published in English between 1 January 2007 and 28 July 2017 were identified in bibliographic databases including Medline, Pubmed and PsychINFO. Included studies described nurse-led cancer care after treatment to adults (age ≥18 years) \u3c2 years post treatment completion. Risk of bias was assessed using Joanna Briggs Institute’s tools and meta-analysis was undertaken. Results: Twenty one publications were included describing 15 tumour-specific trials involving 3278 survivors of breast (n = 5), gynecological (n = 3), head and neck (n = 2), colorectal (n = 2), upper gastrointestinal (n = 2) and prostate (n = 1) cancers. Seven trials reported quality of life (QoL) using the EORTC QLQ-C30; participants receiving nurse-led care (4–6 months) had better cognitive (4 trials, 463 participants; mean difference [MD] = 4.04 [95% CI, 0.59–7.50]; p = 0.02) and social functioning (4 trials, 463 participants; MD = 3.06 [0.14–5.97]; p = 0.04) but worse appetite loss (3 trials, 354 participants; MD = 4.43 [0.08–8.78]; p = 0.05). After intervention completion, intervention participants had reduced fatigue (4 trials, 647 participants; MD = −4.45 [−7.93 to −0.97]; p = 0.01). Conclusion: This systematic review synthesised outcomes of models of nurse-led survivorship care and contributes a meta-analysis of patient QoL to survivorship evidence. This review was limited by the risk of bias in many included studies for blinding of treatment personnel and outcome assessors. Nurse-led care appears beneficial for cancer survivors for some QoL domains

Characteristics and components of self-management interventions for improving quality of life in cancer survivors: a systematic review

Self-management can improve clinical and psychosocial outcomes in cancer survivors. Which intervention characteristics and components are beneficial is unclear, hindering implementation into practice. We systematically searched six databases from inception to 17 November 2021 for studies evaluating self-management interventions for adult cancer survivors post-treatment. Independent reviewers screened for eligibility. Data extraction included population and study characteristics, intervention characteristics (TIDieR) and components (PRISMS), (associations with) quality of life (QoL), self-efficacy, and economic outcomes. Study quality was appraised, and narrative synthesis was conducted. We identified 53 papers reporting 32 interventions. Studies had varying quality. They were most often randomised controlled trials (n = 20), targeted at survivors of breast (n = 10), prostate (n = 7), or mixed cancers (n = 11). Intervention characteristics (e.g., provider, location) varied considerably. On average, five (range 1–10) self-management components were delivered, mostly “Information about condition and its management” (n = 26). Twenty-two studies reported significant QoL improvements (6 also reported significant self-efficacy improvements); these were associated most consistently with combined individual and group delivery. Economic evaluations were limited and inconclusive. Self-management interventions showed promise for improving QoL, but study quality was variable, with substantial heterogeneity in intervention characteristics and components. By identifying what to adapt from existing interventions, these findings can inform development and implementation of self-management interventions in cancer

Perceptions of a multi-disciplinary team on the effectiveness of their treatment approach at an in-patient adolescent drug treatment facility

The problem of adolescent substance use disorder as well as the high relapse rates associated with addiction treatment has been recognised both locally and internationally. The ability to effectively implement and monitor existing treatment programs therefore becomes critical to improving treatment outcomes at addiction treatment facilities that serve adolescent clients. The Multi-disciplinary team (MDT) have a key role to play with regard to the delivery and implementation of effective adolescent addiction treatment. The main aim of this qualitative research study was to explore the functioning of the MDT at an in-patient adolescent drug treatment facility and their perceptions regarding the extent to which the nine essential key elements of effective adolescent addiction treatment aligns with their approach to program implementation. This qualitative exploratory-descriptive study employed a non-probability purposive sampling technique to recruit research participants from an adolescent drug treatment centre in Nelson Mandela Bay. Two separate focus group interviews were conducted with participants who met the study’s inclusion criteria. The first group included eight participants, with the second consisting of ten participants. Tesch’s framework for qualitative data analysis was used to analyse raw interview data; validated by an analysis conducted by an independent coder. Guba’s model was used to ensure trustworthiness throughout the research process and of the findings. Emphasis was therefore placed on the concepts of truth value, applicability, consistency, and neutrality. The findings of the study were presented in ten main themes and associated sub-themes. Ethical conduct was ensured by meeting the requirements for 1) ethical review, 2) informed consent, 3) confidentiality and anonymity, 4) the right to confidentiality and privacy of data, 5) beneficence and non-maleficence, and finally 6) exiting ethics

Hospital Capacity Management & Optimization in Covid-19

A hospital is an institute in the healthcare system that provides us with services like patient treatment focusing on specialized medical staff, including doctors, nurses and other healthcare workers, medical equipment, and procedures. The hospital is the first line of defence against any type of illness or a pandemic; it is the sector that has been the most devastated and is the most vulnerable. There are now more than 513 million reported cases of covid worldwide since the epidemic began in December 2019, with even more than 6.2 million casualties. The tremendous rise in cases, which quickly outpaced the restricted infrastructure of many of these hospitals, is among the most serious issues encountered throughout the epidemic. This led to a hospital capacity crisis due to the huge difference in the number of patients and the limited hospital resources. The purpose of this dissertation is to examine all elements and propose advice for dealing with healthcare capacities issues, with a particular emphasis on the covid-19 epidemic. That the very first section of the study is a comprehensive review of literature on healthcare strategic planning. The literature survey includes the challenges faced during the pandemic and the optimization models and techniques related to hospital capacity management. It is followed by analytical research with a data-driven simulation package. It includes picking a resource planning tool most suitable for hospital capacity management. The resource management tool's difficulties and prospects are also highlighted. This would point the way toward incorporating the capacity project management tool into healthcare facilities