4 research outputs found
A comparison of attitudes to laryngeal cancer treatment outcomes: a time trade-off study
Design:
Time trade-off choice experiment.
Setting:
Two large head and neck cancer centres.
Participants:
Patients who have received treatment for head and neck cancer and members of the head and neck cancer multidisciplinary team.
Main outcome measures:
Participants were asked to rank the outcome scenarios, assign utility values using time trade-off and rate the importance of survival on treatment choice.
Results:
49 head and neck cancer patients and 73 staff members were recruited. Chemoradiotherapy (CRT) optimal outcome was the most preferred health state (34/49, 69% patients and 50/73, 68% staff) and CRT with complications was least preferred (27/49 55% patients and 51/73 70% staff). Using time trade-off, mean utility values were calculated for CRT optimal outcome (0.73 for patients, 0.77 for staff), total laryngectomy (TL) optimal outcome (0.67 for patients, 0.69 for staff), TL outcome with complications (0.46 for patients, 0.51 for staff) and CRT with complications (0.36 for patients, 0.49 for staff). The average survival advantage required for a participant to change their preferred choice was 2.6 years.
Conclusions:
We have demonstrated that a significant proportion of head and neck cancer patients and staff members would not choose CRT to manage locally advanced laryngeal cancer. Staff members rated the health states associated with laryngeal cancer treatment higher than patients who have experienced them, and this is particularly evident when considering the poorer outcomes. The head and neck cancer community should develop methods of practice and decision making which incorporate elicitation and reporting of patient values as a central principle
Audit of dabigatran etexilate for the prevention of venous thromboembolism after elective hip and knee surgery
Recommended from our members
Socioeconomic and ethnic disparities associated with access to cochlear implantation for severe-to-profound hearing loss: A multicentre observational study of UK adults.
BACKGROUND: Patients with severe-to-profound hearing loss may benefit from management with cochlear implants. These patients need a referral to a cochlear implant team for further assessment and possible surgery. The referral pathway may result in varied access to hearing healthcare. This study aimed to explore referral patterns and whether there were any socioeconomic or ethnic associations with the likelihood of referral. The primary outcome was to determine factors influencing referral for implant assessment. The secondary outcome was to identify factors impacting whether healthcare professionals had discussed the option of referral. METHODS AND FINDINGS: A multicentre multidisciplinary observational study was conducted in secondary care Otolaryngology and Audiology units in Great Britain. Adults fulfilling NICE (2019) audiometric criteria for implant assessment were identified over a 6-month period between 1 July and 31 December 2021. Patient- and site-specific characteristics were extracted. Multivariable binary logistic regression was employed to compare a range of factors influencing the likelihood of implant discussion and referral including patient-specific (demographics, past medical history, and degree of hearing loss) and site-specific factors (cochlear implant champion and whether the hospital performed implants). Hospitals across all 4 devolved nations of the UK were invited to participate, with data submitted from 36 urban hospitals across England, Scotland, and Wales. Nine hospitals (25%) conducted cochlear implant assessments. The majority of patients lived in England (n = 5,587, 86.2%); the rest lived in Wales (n = 419, 6.5%) and Scotland (n = 233, 3.6%). The mean patient age was 72 卤 19 years (mean 卤 standard deviation); 54% were male, and 75路3% of participants were white, 6路3% were Asian, 1路5% were black, 0路05% were mixed, and 4路6% were self-defined as a different ethnicity. Of 6,482 submitted patients meeting pure tone audiometric thresholds for cochlear implantation, 311 already had a cochlear implant. Of the remaining 6,171, 35.7% were informed they were eligible for an implant, but only 9.7% were referred for assessment. When adjusted for site- and patient-specific factors, stand-out findings included that adults were less likely to be referred if they lived in more deprived area decile within Indices of Multiple Deprivation (4th (odds ratio (OR): 2路19; 95% confidence interval (CI): [1路31, 3路66]; p = 0路002), 5th (2路02; [1路21, 3路38]; p = 0路05), 6th (2路32; [1路41, 3路83]; p = 0.05), and 8th (2路07; [1路25, 3路42]; p = 0路004)), lived in London (0路40; [0路29, 0路57]; p < 0路001), were male (females 1路52; [1路27, 1路81]; p < 0路001), or were older (0路97; [0路96, 0路97]; p < 0路001). They were less likely to be informed of their potential eligibility if they lived in more deprived areas (4th (1路99; [1路49, 2路66]; p < 0路001), 5th (1路75; [1路31, 2路33], p < 0路001), 6th (1路85; [1路39, 2路45]; p < 0路001), 7th (1路66; [1路25, 2路21]; p < 0路001), and 8th (1路74; [1路31, 2路31]; p < 0路001) deciles), the North of England or London (North 0路74; [0路62, 0路89]; p = 0路001; London 0路44; [0路35, 0路56]; p < 0路001), were of Asian or black ethnic backgrounds compared to white patients (Asian 0路58; [0路43, 0路79]; p < 0路001; black 0路56; [0路34, 0路92]; p = 0路021), were male (females 1路46; [1路31, 1路62]; p < 0路001), or were older (0路98; [0路98, 0路98]; p < 0路001). The study methodology was limited by its observational nature, reliance on accurate documentation of the referring service, and potential underrepresentation of certain demographic groups. CONCLUSIONS: The majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are currently not appropriately referred for assessment. There is scope to target underrepresented patient groups to improve referral rates. Future research should engage stakeholders to explore the reasons behind the disparities. Implementing straightforward measures, such as educational initiatives and automated pop-up tools for immediate identification, can help streamline the referral process