10 research outputs found
Physicians' awareness and assessment of shared decision making in oncology practice
Fundamentos: La implementación de la Toma de
Decisiones Compartidas (TDC) en oncología es escasa.
El objetivo del estudio fue determinar el conocimiento de
la TDC que tienen los médicos que tratan a pacientes con
cáncer, la utilidad que le conceden, el rol que desempeñan,
la evaluación que hacen, y las barreras y facilitadores que
encuentran para su uso.
Métodos: Se realizó una encuesta a oncólogos
médicos, oncólogos radioterápicos y cirujanos generales
que ejercían en Andalucía (España). Se recogieron
variables sociodemográficas, clínico-asistenciales y
de aspectos de la TDC. La TDC se evaluó mediante el
cuestionario SDM-Q-Doc. Se emplearon contrastes no
paramétricos para determinar las posibles diferencias
entre especialidades médicas.
Resultados: El cuestionario se envió a 351 médicos
y la tasa de respuesta fue del 37,04%. Respondieron 63
mujeres y 67 hombres, con un promedio de 45,6 años
de edad y 18,04 años de experiencia. El 33,08% eran
oncólogos médicos, el 34,61% oncólogos radioterápicos
y el 29,23% cirujanos generales. El 82,3% no tenía
formación en TDC y el 33,8% reconocía saber bastante
y utilizarla en su práctica habitual. El 80% consideró que
era muy útil. El 60% respondió que la decisión sobre el
tratamiento la tomaban mayormente ellos. Al evaluar la
TDC con la escala SDM-Q-Doc, todas las especialidades
obtuvieron más de 80 puntos sobre 100. Las principales
barreras para aplicar la TDC fueron la dificultad del
paciente para entender lo que necesitaba saber, la falta de
instrumentos de apoyo, así como la falta de tiempo.
Conclusiones: Un 82% de los médicos no tiene
formación en TDC y un 66% no la utiliza en su práctica
habitual, tomando la decisión sobre el tratamiento
mayoritariamente ellos. Es importante adoptar estrategias
para aumentar la formación en TDC e implementarla en la
práctica clínica diaria.Background: Implementation of Shared Decision
Making (SDM) in oncology is limited. The objective
of the study was to determine the extent of physicians’
awareness of Shared Decision Making (SDM) in their
treatment of cancer patients, the usefulness that they
assign to SDM, the role they play, their assessment of
SDM, and perceptions of the main barriers and facilitators
to its use.
Methods: A questionnaire was completed by medical
oncologists, radiation oncologists and general surgeons
working in Andalusia (Spain). Sociodemographic,
clinical-care and aspects of SDM variables were collected.
SDM was evaluated using the SDM-Q-Doc questionnaire.
Non-parametric contrasts were used to determine the
possible differences between medical specialties.
Results: The questionnaire was sent to 351
physicians. The response rate was 37.04%, 63 women and
67 men, with an average age of 45.6 years and 18.04 years’
experience. Of these, 33.08% were medical oncologists,
34.61% radiation oncologists and 29.23% general
surgeons. A total of 82.3% stated they had received no
training in SDM, whereas 33.8% said they knew a lot
about SDM and applied it in practice; 80% considered it
to be very useful. In addition, 60% of respondents said
they were mainly the ones who made the decisions on
treatment. An evaluation of SDM on the SDM-Q-Doc
scale showed that all the specialities scored more than
80/100. The main barriers to applying SDM were the
difficulty patients experienced in understanding what they
needed to know, the lack of decision aids and time.
Conclusions: Some 82% of physicians have no
training in SDM and 66% don´t use it in practice, with
decisions on treatment taken mainly by the physicians
themselves. Strategies to increase training in SDM and to
implement it into clinical practice are important
Actualización del cribado de cáncer colorrectal en Andalucía
Folleto y AnexosYesPrograma que pone de manifiesto la relación entre la detección precoz del cáncer colorrectal y la supervivencia
Adherence to Clinical Practice Guidelines and Colorectal Cancer Survival: A Retrospective High-Resolution Population-Based Study in Spain
Colorectal cancer (CRC) is the third most common cancer worldwide. Population-based,
high-resolution studies are essential for the continuous evaluation and updating of diagnosis
and treatment standards. This study aimed to assess adherence to clinical practice guidelines
and investigate its relationship with survival. We conducted a retrospective high-resolution
population-based study of 1050 incident CRC cases from the cancer registries of Granada and
Girona, with a 5-year follow-up. We recorded clinical, diagnostic, and treatment-related information
and assessed adherence to nine quality indicators of the relevant CRC guidelines. Overall adherence
(on at least 75% of the indicators) significantly reduced the excess risk of death (RER) = 0.35 [95%
confidence interval (CI) 0.28–0.45]. Analysis of the separate indicators showed that patients for whom
complementary imaging tests were requested had better survival, RER = 0.58 [95% CI 0.46–0.73], as
did patients with stage III colon cancer who underwent adjuvant chemotherapy, RER = 0.33, [95%
CI 0.16–0.70]. Adherence to clinical practice guidelines can reduce the excess risk of dying from
CRC by 65% [95% CI 55–72%]. Ordering complementary imagining tests that improve staging and
treatment choice for all CRC patients and adjuvant chemotherapy for stage III colon cancer patients
could be especially important. In contrast, controlled delays in starting some treatments appear not
to decrease survival.ERANET within the framework of the call on "Translational research on tertiary prevention in cancer patients" (TRANSCAN)Instituto de Salud Carlos III
AC14/00036Andalusian Department of Health, Research, Development, and Innovation
PI-0152/201
Cost–utility analysis of germline BRCA1/2 testing in women with high‑grade epithelial ovarian cancer in Spain
Purpose: Germline mutations in BRCA1 and/or BRCA2 genes (gBRCA1/2m) are associated with an increased risk of breast cancer (BC) and ovarian cancer (OC). The aim of this study was to estimate the efficiency of providing germline BRCA1/2 testing to high-grade epithelial ovarian cancer (HGEOC) patients without family history of OC or BC and the subsequent testing and management of their relatives with gBRCA1/2m in Spain.
Methods/patients: Incident HGEOC patients without family history of OC or BC who were gBRCA1/2m carriers and their relatives were simulated in a 50-year time horizon. The study compared two scenarios: BRCA1/2 testing vs no testing, using the perspective of the Spanish National Health Service. Cancer risk among gBRCA1/2m carriers was estimated based on their age and whether they had undergone risk-reducing surgeries. Direct healthcare costs and utilities of patients who developed EOC and BC were also included. A probabilistic sensitivity analysis (PSA) with 5 thousand simulations was developed considering ± 25% of the base-case value.
Results: The BRCA1/2-testing scenario amounted to €13,437,897.43 while the no-testing scenario amounted to €12,053,291.17. It was estimated that the screening test improved the quality of life among the patients' relatives by 43.8 quality-adjusted life years (QALYs). The incremental cost-utility ratio (ICUR) was €31,621.33/QALY in the base case. The PSA showed that 89.12% of the simulations were below the €50,000/QALY threshold.
Conclusion: Providing this screening test to HGEOC patients and their relatives is cost-effective and it allows one to identify a target population with high risk of cancer to provide effective prevention strategies
Cost-utility analysis of germline BRCA1/2 testing in women with high-grade epithelial ovarian cancer in Spain.
Germline mutations in BRCA1 and/or BRCA2 genes (gBRCA1/2m) are associated with an increased risk of breast cancer (BC) and ovarian cancer (OC). The aim of this study was to estimate the efficiency of providing germline BRCA1/2 testing to high-grade epithelial ovarian cancer (HGEOC) patients without family history of OC or BC and the subsequent testing and management of their relatives with gBRCA1/2m in Spain. Incident HGEOC patients without family history of OC or BC who were gBRCA1/2m carriers and their relatives were simulated in a 50-year time horizon. The study compared two scenarios: BRCA1/2 testing vs no testing, using the perspective of the Spanish National Health Service. Cancer risk among gBRCA1/2m carriers was estimated based on their age and whether they had undergone risk-reducing surgeries. Direct healthcare costs and utilities of patients who developed EOC and BC were also included. A probabilistic sensitivity analysis (PSA) with 5 thousand simulations was developed considering ± 25% of the base-case value. The BRCA1/2-testing scenario amounted to €13,437,897.43 while the no-testing scenario amounted to €12,053,291.17. It was estimated that the screening test improved the quality of life among the patients' relatives by 43.8 quality-adjusted life years (QALYs). The incremental cost-utility ratio (ICUR) was €31,621.33/QALY in the base case. The PSA showed that 89.12% of the simulations were below the €50,000/QALY threshold. Providing this screening test to HGEOC patients and their relatives is cost-effective and it allows one to identify a target population with high risk of cancer to provide effective prevention strategies
Cost–utility analysis of germline BRCA1/2 testing in women with high‑grade epithelial ovarian cancer in Spain
Purpose: Germline mutations in BRCA1 and/or BRCA2 genes (gBRCA1/2m) are associated with an increased risk of breast cancer (BC) and ovarian cancer (OC). The aim of this study was to estimate the efficiency of providing germline BRCA1/2 testing to high-grade epithelial ovarian cancer (HGEOC) patients without family history of OC or BC and the subsequent testing and management of their relatives with gBRCA1/2m in Spain.
Methods/patients: Incident HGEOC patients without family history of OC or BC who were gBRCA1/2m carriers and their relatives were simulated in a 50-year time horizon. The study compared two scenarios: BRCA1/2 testing vs no testing, using the perspective of the Spanish National Health Service. Cancer risk among gBRCA1/2m carriers was estimated based on their age and whether they had undergone risk-reducing surgeries. Direct healthcare costs and utilities of patients who developed EOC and BC were also included. A probabilistic sensitivity analysis (PSA) with 5 thousand simulations was developed considering ± 25% of the base-case value.
Results: The BRCA1/2-testing scenario amounted to €13,437,897.43 while the no-testing scenario amounted to €12,053,291.17. It was estimated that the screening test improved the quality of life among the patients' relatives by 43.8 quality-adjusted life years (QALYs). The incremental cost-utility ratio (ICUR) was €31,621.33/QALY in the base case. The PSA showed that 89.12% of the simulations were below the €50,000/QALY threshold.
Conclusion: Providing this screening test to HGEOC patients and their relatives is cost-effective and it allows one to identify a target population with high risk of cancer to provide effective prevention strategies
Colonoscopia de seguimiento: documento de apoyo al PAI cáncer colorrectal
YesDocumento de consenso que permite ayudar a la toma de decisiones clínicas, tanto en la indicación de cribado de cáncer colorrectal en personas con antecedentes familiares como en las indicaciones de colonoscopias de seguimiento de pacientes con pólipos de colon resecados o intervenidos por un cáncer colorrectal
II Plan Integral de Oncología de Andalucía : 2007-2012
Publicado en la página web de la Consejería de Salud: www.juntadeandalucia.es/salud (Consejería de Salud / Ciudadanía / Quiénes somos / Planes y Estrategias). Tiene dos documentos relacionados: Prevención del cáncer y Código de buenas prácticas en comunicación.YesEl Plan Integral de Oncología de Andalucía 2007-2012 tiene como principal finalidad ordenar las prioridades en el campo de la atención al problema del cáncer, desde una perspectiva social y sanitaria. Para ello se organiza en torno a 9 líneas de trabajo que contienen un total de 46 objetivos específicos y 77 acciones, que se orientan hacia la consecución de 6 objetivos generales.
Con su desarrollo se pretende conseguir una atención sanitaria centrada en las personas afectadas, a quienes se quiere ofrecer un trato integral que incluya los aspectos físicos, emocionales y sociales
Cáncer de Pulmón: Proceso Asistencial Integrado. 2ª ed
YesUno de los procesos asistenciales integrados considerado prioritario entre los elaborados en la primera edición, fue el de Cáncer Pulmón. Las razones que así lo determinaron siguen siendo vigentes pero algunos aspectos han experimentado cambios significativos siendo ésta la razón fundamental que ha motivado una actualización