Introduction of a Patient as Teacher Program into family medicine residency: an exploratory pilot study

Background: Family medicine residents should be prepared to address the psychosocial issues that breast cancer survivors may experience. Objectives: Our study aimed to implement a patient-centred approach model into the family medicine residency program and evaluate the impact of such a program on residents. Methods: An interactive virtual session (75 minutes), was integrated into the academic half-day of the family medicine residency program at St. Michael’s Hospital. The session was led by a cancer survivor and her partner. They discussed how illness has impacted their lives and reflect on their experiences with the health care system.  The session was facilitated by a trained facilitator in health care. A qualitative approach was used to evaluate the impact of this program. Two focus groups for residents was conducted to evaluate the delivery mode, recommendations and impact of the proposed program. The focus group discussions were recorded, transcribed and thematically analyzed. Results: This program has had positive influences on residents by improving therapeutic relationships and enhancing the residents' understanding of the experience of illness. This program allowed residents to appreciate the importance of understating patients’ perspectives and values. Additionally, adding the partner perspective to the program was appreciated and valued by residents. Conclusions: Based on the school’s specific curriculum, this program can be integrated into the residents’ academic activities. This can improve important competencies for family medicine residents including confidence in communication and increased empathy. Family medicine residency programs wishing to enhance such humanism skills by family physicians might consider this model

Application of artificial intelligence in symptom monitoring in adult cancer survivorship: a systematic review

PURPOSE The adoption of artificial intelligence (AI) in health care may afford new avenues for personalized and patient-centered care. This systematic review explored the role of AI in symptom monitoring for adult cancer survivors. METHODS A comprehensive search was performed from inception to November 2023 in seven bibliographic databases and three clinical trial registries. This PROSPERO registered review (ID: CRD42023476027) assessed reports of empirical research studies of AI use in symptom monitoring (physical and psychological symptoms) across all cancer types in adults. RESULTS A total of 18,530 reports were identified, of which 41 met review criteria and were analyzed. Included studieswere predominantly published between 2021 and 2023, originated in the United States (39.0%) and Japan (14.6%), and primarily used cohort designs (80.5%), followed by cross-sectional designs (12.2%). The mean sample size was 617.14 (standard deviation 5 1,401.37), with most studies primarily including multiple tumor types (31.7%) or breast cancer survivors (26.8%). Machine learning algorithms (43.9%) was the most used AI method, followed by natural language processing (29.3%), AI-driven chatbots (17.1%), and decision support tools (9.8%). The most common inputs to the AI algorithms were textual data, patient-reported symptoms, and physiologic measurements. The most examined symptom was pain (34.2% of studies), followed by fatigue and nausea (17.1% of studies each). Overall, the review showed increasing AI technology use in the prediction and monitoring of cancer symptoms. CONCLUSION AI is being used to enhance symptom monitoring in various cancer settings. When considering integration into clinical practice, standardization of data capture, the use of analytics, investing in infrastructure, and the end-user experience should be considered for successful implementation and monitoring the improvement of patient outcomes

Multinational Association of Supportive Care in Cancer (MASCC) clinical practice guidance for the prevention of breast cancer-related arm lymphoedema (BCRAL): international Delphi consensus-based recommendationsResearch in context

Summary: Background: Developing strategies to prevent breast cancer-related arm lymphoedema (BCRAL) is a critical unmet need because there are no effective interventions to eradicate it once it reaches a chronic state. Certain strategies such as prospective surveillance programs and prophylactic lymphatic reconstruction have been reported to be effective in clinical trials. However, a large variation exists in practice based on clinician preference, organizational standards, and local resources. Methods: A two-round international Delphi consensus process was performed from February 27, 2023 to May 25, 2023 to compile opinions of 55 experts involved in the care and research of breast cancer and lymphoedema on such interventions. Findings: Axillary lymph node dissection, use of post-operative radiotherapy, relative within-arm volume increase one month after surgery, greater number of lymph nodes dissected, and high body mass index were recommended as the most important risk factors to guide selection of patients for interventions to prevent BCRAL. The panel recommended that prospective surveillance programs should be implemented to screen for and reduce risks of BCRAL where feasible and resources allow. Prophylactic compression sleeves, axillary reverse mapping and prophylactic lymphatic reconstruction should be offered for patients who are at risk for developing BCRAL as options where expertise is available and resources allow. Recommendations on axillary management in clinical T1–2, node negative breast cancer patients with 1–2 positive sentinel lymph nodes were also provided by the expert panel. Routine axillary lymph node dissection should not be offered in these patients who receive breast conservation therapy. Axillary radiation instead of axillary lymph node dissection should be considered in the same group of patients undergoing mastectomy. Interpretation: An individualised approach based on patients' preferences, risk factors for BCRAL, availability of treatment options and expertise of the healthcare team is paramount to ensure patients at risk receive preventive interventions for BCRAL, regardless of where they are receiving care. Funding: This study was not supported by any funding. RJC received investigator grant support from the Australian National Health and Medical Research Council (APP1194051)