Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 65
Filtrar
Mais filtros

Base de dados
País/Região como assunto
Tipo de documento
Intervalo de ano de publicação
1.
Support Care Cancer ; 31(2): 108, 2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36625923

RESUMO

PURPOSE: Non-profit community-based organizations (CO) remain insufficiently integrated into cancer networks. Drawing on dimensions of proximity, this study explores how and why coordination between cancer teams and COs is established and solidified. METHODS: A descriptive interpretive study is undertaken in Québec (Canada), where a cancer program has long promoted the integration of COs in the cancer trajectory. Semi-directed interviews with providers, managers and people living with and beyond cancer (total n = 46) explore the challenges of coordination between cancer and CO providers, along with facilitating or impeding factors. Three main themes related to coordination in cancer networks emerge, which are analyzed by operationalizing the multi-dimensional framework of proximity. RESULTS: Findings reveal a lack of cognitive proximity, which calls for efforts to both identify patient needs and increase cancer team knowledge and appreciation of CO resources. Organizational proximity refers to systems and rules that facilitate interactions, and we find that referral mechanisms and communication channels are inadequate, with patients often playing a linking role despite barriers. Coordination improves when relational proximity is established between cancer and CO teams, and this can be enhanced by geographic proximity; in one region, COs have a physical presence within the cancer center. CONCLUSION: Integrating COs into the cancer network can help meet the spectrum of needs faced by people living with and beyond cancer. This study offers managers and decision-makers insight into how coordination between cancer teams and COs can be supported. Proximity allows the distinct contributions of actors to be considered in context and contributes to understanding the "how" of integrated practice.


Assuntos
Neoplasias , Humanos , Neoplasias/terapia , Quebeque , Canadá
2.
Can Oncol Nurs J ; 33(3): 336-341, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38919892

RESUMO

Background: Cancer care for Canadian cancer survivors remains fragmented. Little is known about the experience of Canadian oncology nurses providing cancer care for cancer survivors, as they transition from acute treatment to primary care. Objectives: This study aimed to (1) explore the experience of oncology nurses dealing with fragmented cancer care for cancer survivors in transition to survivorship; (2) identify oncology nurses' perspectives about what promotes or inhibits their delivery of quality cancer care; and (3) obtain their suggestions to improve cancer care. Design: This study used a phenomenological design to explore the experience of oncology nurses in caring for cancer survivors during transition to survivorship and examine how the nurse participants describe their experience. Semi-structured interviews were used to collect data and an interpretative phenomenological analysis approach was used to develop themes from the data. Results: Three oncology nurses participated in this study. The following five themes emerged: (1) Under personal transition: nursing assessment, symptoms management, patient education, resources offered, refusing label of cancer survivors, promoting adjustment to a new normal life, promoting return to work, and recognizing meaning of survivorship; (2) Under cancer survivor's care transition: promoting self-care management, communication, and maximal recovery of body functions; (3) Under nurse's positive experience promoting delivery of quality cancer care: caring for cancer survivors, experience and knowledge, and advocate for cancer survivors; (4) Under barriers that negatively affected delivery of cancer care: low socioeconomic status (especially low income), cultures and languages barriers, and limited time providing nursing care; and (5) Suggestions to improve cancer care: establishing a new position - primary nurse, increasing the number of healthcare professionals, and improving knowledge, skills, and experience. Conclusion: Oncology nurses' knowledge and experience provide a good foundation for quality cancer care and contribute to the health and wellbeing of cancer survivors.

3.
J Occup Rehabil ; 32(4): 773-789, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35616770

RESUMO

Purpose This article provides a state-of-the-art review of issues and factors associated with the sustainable return to work (S-RTW) of ethnocultural minority workers experiencing disability situations attributable to one of four major causes: musculoskeletal disorders, common mental disorders, other chronic diseases or cancer. Methods Using an interpretive description method, an integrative review was conducted of the literature on ethnocultural factors influencing S-RTW issues and factors associated with these four major work-disability causes. An initial review of the 2006-2016 literature was subsequently updated for November 2016-May 2021. To explore and contextualize the results, four focus groups were held with RTW stakeholders representing workplaces, insurers, the healthcare system and workers. Qualitative thematic analysis was performed. Results A total of 56 articles were analyzed and 35 stakeholders participated in four focus groups. Two main findings emerged. First, belonging to an ethnocultural minority group appears associated with cumulative risk factors that may contribute to vulnerability situations and compound the complexity of S-RTW. Second, cultural differences with respect to the prevailing host-country culture may generate communication and trust issues, and conflicts in values and representations, in turn possibly hindering the establishment of positive relationships among all stakeholders and the ability to meet workers' needs. Being a woman in these groups and/or having a lower level of integration into the host country's culture also appear associated with greater S-RTW challenges. Conclusions Based on our findings, we recommend several possible strategies, such as the cultural humility model, for preventing differences from exacerbating the already significant vulnerability situation of some ethnocultural minority workers.


Assuntos
Doenças Musculoesqueléticas , Retorno ao Trabalho , Feminino , Humanos , Grupos Minoritários , Local de Trabalho , Pesquisa Qualitativa , Doenças Musculoesqueléticas/prevenção & controle , Licença Médica
4.
J Occup Rehabil ; 32(3): 529-537, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35076855

RESUMO

PURPOSE: Work disability stakeholders may not share the same understanding and solutions among themselves or with researchers, causing misunderstandings and hindering collaboration regarding solutions for preventing work disability. To reduce such differences, this study sought to build a common vocabulary among stakeholders and researchers, using a transdisciplinary research framework. METHODS: A consensus method based on a constructivist approach was used. A theoretical sampling method was applied to identify researchers or stakeholders representing one of the four systems in the work disability paradigm. A preliminary set of definitions for key terms was assessed using a Web-based questionnaire. It documented participants' level of agreement with each term's inclusion and relevance in the field, and the clarity of the definition, while soliciting suggestions for other terms or clearer definitions. Disagreements were discussed at group meetings, yielding consensus on the final terms and definitions. RESULTS: Eleven stakeholders representing patients, employers, unions, healthcare professionals, and legislative and insurance systems, along with 10 multidisciplinary researchers, participated. The questionnaire yielded initial consensus on the inclusion and definitions of 49 terms, and 109 suggestions mostly for modified definitions (average = 6 suggestions/term). Two preliminary terms were excluded and three terms were added. Ultimately, 80 terms and their definitions yielded consensus. CONCLUSIONS: The process we used to build a common vocabulary was carried out within a transdisciplinary framework. It required a constructivist approach, promoting idea exchanges among participants and co-construction of generally agreed results. The results were rooted in local contexts, thus ensuring the same reference points, regardless of participants' different understandings.


Assuntos
Idioma , Consenso , Humanos , Inquéritos e Questionários
5.
J Nurs Manag ; 30(1): 33-43, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34448520

RESUMO

AIM: This study aims to examine, through the lens of the Job Demands-Resources model, the influence of caring for COVID-19 patients on nurse's perception of chronic fatigue, quality of care, satisfaction at work and intention to leave their organisation and the profession. BACKGROUND: Studies have examined how fear of COVID-19 contributes to the mental, physical and work adjustment among nurses. To date, few studies have been conducted examining how caring for patients with COVID-19 contributes to work outcomes among nurses. METHODS: This is a cross-sectional survey involving 1705 frontline nurses and licensed practical nurses in Quebec, Canada. From these, 782 reported caring for COVID-19 patients. RESULTS: High chronic fatigue, poor quality of care, lower work satisfaction and higher intention to leave their organisation were found for nurses caring for COVID-19 patients. Poorly prepared and overwhelmed nurses showed higher turnover intention than those well prepared and in control. CONCLUSIONS: There is an urgent need to provide support to nurses during the pandemic, with a long-term strategy to increase their retention. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse administrators play an important role in supporting their nurses during a pandemic in the form of education, training and policy development to positively impact quality of care and retention.


Assuntos
COVID-19 , Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem Hospitalar , Estudos Transversais , Humanos , Intenção , Satisfação no Emprego , Satisfação do Paciente , Reorganização de Recursos Humanos , SARS-CoV-2 , Inquéritos e Questionários
6.
J Math Econ ; 101: 102705, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35611047

RESUMO

[This corrects the article DOI: 10.1016/j.jmateco.2021.102483.].

7.
BMC Health Serv Res ; 21(1): 929, 2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493271

RESUMO

BACKGROUND: Patient participation in decision-making has become a hallmark of responsive healthcare systems. Cancer networks in many countries have committed to involving people living with and beyond cancer (PLC) at multiple levels. However, PLC participation in network governance remains highly variable for reasons that are poorly understood. This study aims to share lessons learned regarding mechanisms that enable PLC participation in cancer network governance. METHODS: This multiple case study, using a qualitative approach in a natural setting, was conducted over six years in three local cancer networks within the larger national cancer network in Quebec (Canada), where PLC participation is prescribed by the Cancer Directorate. Data were collected from multiple sources, including individual and focus group interviews (n = 89) with policymakers, managers, clinicians and PLC involved in national and local cancer governance committees. These data were triangulated and iteratively analysed according to a framework based on functions of collaborative governance in the network context. RESULTS: We identify three main mechanisms that enable PLC participation in cancer network governance: (1) consistent emphasis on patient-centred care as a network objective; (2) flexibility, time and support to translate mandated PLC representation into meaningful participation; and (3) recognition of the distinct knowledge of PLC in decision-making. The shared vision of person-centred care facilitates PLC participation. The quality of participation improves through changes in how committee meetings are conducted, and through the establishment of a national committee where PLC can pool their experience, develop skills and establish a common voice on priority issues. PLC knowledge is especially valued around particular challenges such as designing integrated care trajectories and overcoming barriers to accessing care. These three mechanisms interact to enable PLC participation in governance and are activated to varying extents in each local network. CONCLUSIONS: This study reveals that mandating PLC representation on governance structures is a powerful context element enabling participation, but that it also delineates which governance functions are open to influence from PLC participation. While the activation of mechanisms is context dependent, the insights from this study in Quebec are transferable to cancer networks in other jurisdictions seeking to embed PLC participation in decision-making.


Assuntos
Neoplasias , Participação do Paciente , Grupos Focais , Humanos , Neoplasias/terapia , Assistência Centrada no Paciente , Rede Social
8.
J Occup Rehabil ; 31(3): 552-569, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33394267

RESUMO

PURPOSE: A sustainable return to work (S-RTW) following prolonged work disability poses different challenges, depending on gender. This article provides a synthesis of gender differences in the issues and factors influencing the S-RTW of workers following such a disability. METHODS: Using an interpretive description method, an integrative review was conducted of the literature on gender differences in S-RTW issues and factors associated with four major causes of work disability. The initial review concerned the 2000-2016 literature; it was subsequently updated for November 2016-March 2020. To explore and contextualise the results, four focus groups were held with stakeholders representing the workplace, insurance, and healthcare systems and workers. Qualitative thematic analysis was performed. RESULTS: A total of 47 articles were reviewed, and 35 stakeholders participated in the focus groups. The prevailing traditional gender roles were found to have a major gender-specific influence on the attitudes, behaviours, processes and outcomes associated with S-RTW. These differences related to the (1) cumulative workload, (2) work engagement, and (3) expressed and addressed needs. CONCLUSIONS: The results highlight the importance of taking into account both professional and personal aspects when integrating gender issues into the assessment of workers' needs and subsequently into interventions.


Assuntos
Pessoas com Deficiência , Retorno ao Trabalho , Atitude , Feminino , Humanos , Masculino , Licença Médica , Local de Trabalho
9.
J Occup Rehabil ; 31(1): 92-106, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32347441

RESUMO

Purpose A sustainable return to work (S-RTW) following prolonged work disability poses particular challenges as workers age. This article provides a synthesis of the factors and issues involved in a S-RTW process for aging workers following such a disability. Methods Using interpretive description methods, a critical review was conducted of the literature specifying return-to-work factors and issues for aging workers with regard to four major causes of work disability (musculoskeletal disorders, common mental disorders, cancer or other chronic diseases). The initial review concerned the 2000-2016 literature, and was subsequently updated for November 2016-December 2018. To further explore and contextualise the results of this literature review, four focus groups were held with stakeholders, representing the workplace, insurance, and healthcare systems and workers. Qualitative thematic analysis was performed. Results Fifty-five articles were reviewed and 35 stakeholders participated in the focus groups. Returning to work and staying at work appear to be particularly challenging for aging workers, who face notable issues and stigma concerning their ability to meet work demands, as well as their mobilisation and engagement in these processes. Such findings echo in many ways the main assertions of the literature on aging at work, except those regarding the transformation of capacities with aging, which is not mentioned in relation to workers with a work disability. The influence of healthcare and compensation systems on the S-RTW of aging work-disabled workers has also received little attention to date. Conclusions The results underscore that aging workers with a disability are frequently vulnerable in terms of their health or their jobs. Intersectoral efforts are needed to remedy this situation to keep them at work.


Assuntos
Doenças Musculoesqueléticas , Retorno ao Trabalho , Envelhecimento , Humanos , Licença Médica , Local de Trabalho
10.
J Math Econ ; 93: 102483, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33583995

RESUMO

We analyze the spread of an infectious disease in a population when individuals strategically choose how much time to interact with others. Individuals are either of the severe type or of the asymptomatic type. Only severe types have symptoms when they are infected, and the asymptomatic types can be contagious without knowing it. In the absence of any symptoms, individuals do not know their type and continuously tradeoff the costs and benefits of self-isolation on the basis of their belief of being the severe type. We show that all equilibria of the game involve social interaction, and we characterize the unique equilibrium in which individuals partially self-isolate at each date. We calibrate our model to the COVID-19 pandemic and simulate the dynamics of the epidemic to illustrate the impact of some public policies.

11.
Support Care Cancer ; 27(8): 2771-2781, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30519734

RESUMO

PURPOSE: Although family caregivers (FCs) of older adults with cancer (OACs) provide invaluable assistance by fulfilling multiple tasks along the cancer trajectory, evidence suggests that their needs are poorly assessed, and there is a scarcity of supportive interventions that influence their well-being. Viewing these issues as opportunities for improvement, we conducted this qualitative study to understand FCs' needs and identify promising needs-focused interventions. METHODS: This descriptive interpretive qualitative study was conducted in Quebec, Canada, in a French Canadian Oncology Clinic. Participants were FCs who were spouses or adult children (n = 25) of OACs aged 70 years or older. Data were collected via focus groups and were analyzed using an ongoing analytic process following each interview. RESULTS: Three types of needs were of particular importance: information, relationships between FC and others, and care for oneself. The need for information was described in terms of the content, timeliness, and modalities in which information should be verbalized and delivered. The need for relationships specifically targeted health care providers (HCPs), family members, and OACs. The need to care for oneself was recognized as important throughout the cancer trajectory but also represented a challenge. Participants proposed innovative ideas for interventions, resources, and strategies for each type of need. CONCLUSIONS: According to our results, HCPs should systematically include FCs into OACs' care plan through the use of concrete actions such as the "family systems approach" suggested by Duhamel, and integrate a systematic FC's needs assessment.


Assuntos
Filhos Adultos , Cuidadores , Filho de Pais com Deficiência , Família , Grupos Focais , Necessidades e Demandas de Serviços de Saúde , Neoplasias , Adulto , Filhos Adultos/psicologia , Filhos Adultos/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Filho de Pais com Deficiência/psicologia , Filho de Pais com Deficiência/estatística & dados numéricos , Atenção à Saúde , Família/psicologia , Feminino , Pessoal de Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Quebeque/epidemiologia
12.
Health Expect ; 22(2): 235-244, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30411450

RESUMO

BACKGROUND: In the context of interprofessional practice, a patient-centred approach is recommended, which generally means power-sharing, shared decision making and involving patients as part of the health-care team. These aspects, which are essential to "patient-centred" practice, do not appear to be sufficient to illustrate the full richness of this practice. OBJECTIVE: This article aimed to understand how interprofessional patient-centred (IPPC) practice in oncology teams contributes to creating a more positive experience for patients. Objectives were to (a) describe the IPPC practice of oncology teams using the IPPC Practice Framework; (b) determine the usefulness of this framework; and (c) offer alternative proposals for expanding our understanding of IPPC practice. DESIGN: A secondary analysis was performed with data from a multicase study designed to explore the effects of interdisciplinary work among oncology teams. Data were provided from six focus groups with professionals (n = 22) and patients diagnosed with cancer (n = 16). An iterative content analysis was performed. RESULTS: Applying the theoretical framework to data analysis enabled us to distinguish between the IPPC practice of the different teams and structure the data collected in order to show the processes and place them in context. However, it proved to be difficult to describe the central component of the theoretical framework, patient-centred processes. This situation raises new hypotheses for representing practice in a real-life context. An alternative perspective for illustrating IPPC practice is therefore proposed. CONCLUSION: This study emphasizes the importance of exploring the utility of theoretical frameworks and refining them in order to broaden our understanding of IPPC practice.


Assuntos
Oncologia/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Assistência Centrada no Paciente/organização & administração , Adulto , Feminino , Grupos Focais , Humanos , Masculino
13.
BMC Health Serv Res ; 19(1): 752, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653231

RESUMO

BACKGROUND: People living with and beyond cancer (PLC) receive various forms of specialty care at different locations and many interventions concurrently or over time. They are affected by the operation of professional and organizational silos. This results in undue delays in access, unmet needs, sub-optimal care experiences and clinical outcomes, and human and financial costs for PLCs and healthcare systems. National cancer control programs advocate organizing in a network to coordinate actions, solve fragmentation problems, and thus improve clinical outcomes and care experiences for every dollar invested. The variable outcomes of such networks and factors explaining them have been documented. Governance is the "missing link" for understanding outcomes. Governance refers to the coordination of collective action by a body in a position of authority in pursuit of a common goal. The Quebec Cancer Network (QCN) offers the opportunity to study in a natural environment how, why, by whom, for whom, and under what conditions collaborative governance contributes to practices that produce value-added outcomes for PLCs, healthcare providers, and the healthcare system. METHODS/DESIGN: The study design consists of a longitudinal case study, with multiple nested cases (4 local networks nested in the QCN), mobilizing qualitative and quantitative data and mixed data from various sources and collected using different methods, using the realist evaluation approach. Qualitative data will be used for a thematic analysis of collaborative governance. Quantitative data from validated questionnaires will be analyzed to measure relational coordination and teamwork, care experience, clinical outcomes, and health-related health-related quality of life, as well as a cost analysis of service utilization. Associations between context, governance mechanisms, and outcomes will be sought. Robust data will be produced to support decision-makers to guide network governance towards optimized clinical outcomes and the reduction of the economic toxicity of cancer for PLCs and health systems.


Assuntos
Redes Comunitárias/organização & administração , Tomada de Decisão Compartilhada , Neoplasias/terapia , Redes Comunitárias/economia , Custos de Cuidados de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Institucionalização , Estudos Longitudinais , Estudos de Casos Organizacionais , Quebeque , Projetos de Pesquisa
14.
J Occup Rehabil ; 28(1): 89-96, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28271399

RESUMO

Purpose Supervisors are known to be key actors in ensuring the success of absent employees in their return-to-work process. However, to date, little is known about the perceptions of breast cancer survivors on the practices put in place by their supervisors to support them during this process. The objective of this study was to describe the perceptions of breast cancer survivors on the practices put in place by their supervisors to support them during their return-to-work process. Method A qualitative descriptive study was conducted. Semi-structured interviews were carried out with breast cancer survivors (n = 10) who had returned to work after treatment and were still at work more than 18 months later. Each interview was audio recorded and then transcribed verbatim for qualitative thematic content analysis using a semi-open codification framework. Results Participants identified three main practices put in place by their supervisors to support them and which they perceived as particularly helpful during the return-to-work process: (1) maintaining communication during their period of absence; (2) working with them to structure their return-to-work process before their actual return; and (3) allowing them flexibility in their schedule for a certain period, particularly at the beginning of the return-to-work process. Breast cancer survivors also identified an omission in the practice of employers: lack of follow-up over time. Conclusion Knowledge about the practices perceived as helpful by breast cancer survivors during their return-to-work process lays the groundwork for the eventual development of services to help breast cancer survivors in their return to work.


Assuntos
Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Retorno ao Trabalho/psicologia , Local de Trabalho/organização & administração , Adulto , Feminino , Humanos , Relações Interpessoais , Pessoa de Meia-Idade , Percepção , Pesquisa Qualitativa , Licença Médica , Apoio Social
16.
Support Care Cancer ; 25(6): 1993-2007, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28054145

RESUMO

PURPOSE: Many women who have been diagnosed with breast cancer (BC) would like to return to work after undergoing cancer treatment. This review explores the nature of interventions addressing return to work (RTW) for this population. METHOD: A scoping review was conducted using the Arksey and O'Malley framework. A search was conducted in five bibliographic databases from 2005 to 2015 to identify intervention studies. Article selection and characterization were performed by two reviewers using systematic grids. Themes were identified to construct a narrative summary of the existing literature. RESULTS: The literature search identified 17 articles published between 2005 and 2015. The interventions (n = 16) vary in terms of objectives, methodology, description of intervention activities, and period of deployment. Only one intervention referred to a theory linked to RTW. The results further show that nearly 44% of the interventions found provided only information on RTW (information booklet, individual meeting, group session). Only 38% of the interventions were work-directed and offered other activities, such as coordination of services and information, as well as instructions for drawing up an RTW plan. More than 80% of the interventions were provided by health care professionals. Interventions took place during the survivorship period (75%), at the hospital (44%), or an external rehabilitation center (38%). CONCLUSION: The variability of interventions found indicates the need to clarify the concept of RTW after a BC diagnosis. Recommendations are made for the development of multicomponent interventions that include both the clinic and the workplace to meet the particular needs of this population.


Assuntos
Neoplasias da Mama/psicologia , Retorno ao Trabalho/psicologia , Feminino , Humanos
17.
BMC Health Serv Res ; 17(1): 218, 2017 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-28320372

RESUMO

BACKGROUND: Interdisciplinary teamwork (ITW) is deemed necessary for quality cancer care practices. Nevertheless, variation in ITW intensity among cancer teams is understudied, and quantitative evidence of the effect of different ITW intensities among cancer teams on patients' perceived experience of care is limited. This study aims to compare patient-reported experience measures (PREMs) of cancer outpatients followed by teams characterized by high vs. low ITW intensity. METHODS: The study is designed as an ex post facto quasi-experimental study. Participants (n = 1379) were recruited in nine outpatient oncology clinics characterized by different ITW intensities. ITW intensities were evaluated using the characteristics of structure (team composition and size) and process (interactions among team members), as per West's seminal work on team effectiveness. ITW intensity was dichotomized (high vs. low ITW intensity). PREMs were classified and measured using validated scales corresponding to six dimensions: Prompt access to care, Person-centred response, Quality of patient-professional communication, Quality of the care environment, Continuity of care, and Results of care. Dichotomous variables were created for each dimension (positive vs. less positive experience). Multiple logistic regression analyses were performed to assess the association between ITW intensities and the six PREMs dimensions, while controlling for patient and organizational characteristics. PROC GENMOD was used to fit logistic models for categorical variables. RESULTS: Outpatients treated by teams characterized by high ITW intensity reported almost four times more positive perceptions of Prompt access to care compared to patients treated by low ITW intensity teams (OR = 3.99; CI = 1.89-8.41). High ITW intensity also positively affected patients' perceptions of Quality of patient-professional communication (OR = 2.37; CI = 1.25-4.51), Person-centred response (OR = 2.11; CI = 1.05-4.24], and Continuity of care (OR = 2.18; CI = 1.07-4.45). No significant association was found between ITW intensity and perceived Results of care (OR = 1.31; CI = 0.68-2.52) or Quality of the care environment (OR = 0.66; CI = 0.31-1.39). CONCLUSIONS: This study provides empirical evidence, from the patient's perspective, that ITW intensity affects some critical aspects of patient-reported quality of care. Future research will allow explaining how and why ITW structure and processes may contribute to positive cancer care experiences.


Assuntos
Neoplasias/terapia , Equipe de Assistência ao Paciente/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/normas , Assistência Ambulatorial/estatística & dados numéricos , Feminino , Humanos , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/normas , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente/estatística & dados numéricos , Percepção , Qualidade da Assistência à Saúde , Saúde da População Rural/estatística & dados numéricos , Inquéritos e Questionários , Saúde da População Urbana/estatística & dados numéricos , Adulto Jovem
18.
BMC Health Serv Res ; 17(1): 448, 2017 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-28659143

RESUMO

BACKGROUND: Cancer is the leading cause of death in Canada. Early cancer diagnosis could improve patients' prognosis and quality of life. This study aimed to analyze the factors influencing elapsed time between the first help-seeking trigger and cancer diagnosis with respect to the three most common and deadliest cancer types: lung, breast, and colorectal. METHODS: This paper presents the qualitative component of a larger project based on a sequential explanatory design. Twenty-two patients diagnosed were interviewed, between 2011 to 2013, in oncology clinics of four hospitals in the two most populous regions in Quebec (Canada). Transcripts were analyzed using the Model of Pathways to Treatment. RESULTS: Pre-diagnosis elapsed time and phases are difficult to appraise precisely and vary according to cancer sites and symptoms specificity. This observation makes the Model of Pathways to Treatment challenging to use to analyze patients' experiences. Analyses identified factors contributing to elapsed time that are linked to type of cancer, to patients, and to health system organization. CONCLUSIONS: This research allowed us to identify avenues for reducing the intervals between first symptoms and cancer diagnosis. The existence of inequities in access to diagnostic services, even in a universal healthcare system, was highlighted.


Assuntos
Diagnóstico Tardio , Detecção Precoce de Câncer , Neoplasias/diagnóstico , Neoplasias da Mama/diagnóstico , Neoplasias Colorretais/diagnóstico , Atenção à Saúde , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Modelos Teóricos , Programas Nacionais de Saúde , Qualidade de Vida , Quebeque , Fatores de Tempo
19.
BMC Health Serv Res ; 17(1): 834, 2017 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-29246224

RESUMO

BACKGROUND: Cancer is now viewed as a chronic disease, presenting challenges to follow-up and survivorship care. Models to shift from haphazard, suboptimal and fragmented episodes of care to an integrated cancer care continuum must be developed, tested and implemented. Numerous studies demonstrate improved care when follow-up is assured by both oncology and primary care providers rather than either group alone. However, there is little data on the roles assumed by specialized oncology teams and primary care providers and the extent to which they work together. This study aims to develop, pilot test and measure outcomes of an innovative risk-based coordinated cancer care model for patients transitioning from specialized oncology teams to primary care providers. METHODS/DESIGN: This multiple case study using a sequential mixed-methods design rests on a theory-driven realist evaluation approach to understand how transitions might be improved. The cases are two health regions in Quebec, Canada, defined by their geographic territory. Each case includes a Cancer Centre and three Family Medicine Groups selected based on differences in their determining characteristics. Qualitative data will be collected from document review (scientific journal, grey literature, local documentation), semi-directed interviews with key informants, and observation of care coordination practices. Qualitative data will be supplemented with a survey to measure the outcome of the coordinated model among providers (scope of practice, collaboration, relational coordination, leadership) and patients diagnosed with breast, colorectal or prostate cancer (access to care, patient-centredness, communication, self-care, survivorship profile, quality of life). Results from descriptive and regression analyses will be triangulated with thematic analysis of qualitative data. Qualitative, quantitative, and mixed methods data will be interpreted within and across cases in order to identify context-mechanism associations that explain outcomes. DISCUSSION: The study will provide empirical data on a risk-based coordinated model of cancer care to guide actions at different levels in the health system. This in-depth multiple case study using a realist approach considers both the need for context-specific intervention research and the imperative to address research gaps regarding coordinated models of cancer care.


Assuntos
Sobreviventes de Câncer , Continuidade da Assistência ao Paciente/organização & administração , Oncologia , Equipe de Assistência ao Paciente , Transferência de Pacientes , Atenção Primária à Saúde , Pesquisas sobre Atenção à Saúde , Humanos , Entrevistas como Assunto , Estudos de Casos Organizacionais , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida , Quebeque
20.
Sante Publique ; 29(5): 655-664, 2017 Dec 05.
Artigo em Francês | MEDLINE | ID: mdl-29384299

RESUMO

Returning to work after cancer can be challenging for cancer survivors and little is known about interventions designed to support survivors returning to work. PURPOSE: The objective of this review was to identify interventions designed to support the return-to-work process after a cancer diagnosis. METHODS: A literature review was performed mainly done by consulting bibliographical databases. Systematic analysis and interpretation of the results were then performed. RESULTS: Twenty-two articles were identified. The first finding is that very few interventions are specifically devoted to return to work after cancer and are usually administered in the clinical setting by healthcare practitioners. The activities proposed to support return to work in these interventions are individual counselling, provision of information and support groups. These activities are provided by various multidisciplinary teams composed of one or more professionals: occupational physicians, social workers and nurses. A second finding is that even with the use of experimental and quasi-experimental approaches, no effect was observed on return to work. CONCLUSION: This integrative review highlights two recommendations for the development of future interventions. First, to improve the efficacy of future interventions on return to work of cancer survivors, these interventions must be developed and supported by an intervention theory. Second, future interventions must include and mobilize workplaces.


Assuntos
Neoplasias , Retorno ao Trabalho , Sobreviventes , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA