ABSTRACT
Increased knowledge regarding the heterogeneity of Prostate Cancer (PC) and its variable outcomes has generated controversy over the best clinical approach. Nowadays, it is well-known that patient outcomes and clinical management may be improved by an efficient organization of the national health care system. The Interdisciplinary Group for Oncological Care (GICO) for PC patients was created by our healthcare management company in September 2010. Since then, a multidisciplinary internal report was applied to PC patients. This report highlights our methodology and experience of planning a GICO, and illustrates the results obtained for the management of PC patients before and after the adopted GICO criteria in a single institution, the SS Annunziata Hospital (Chieti, Italy).
ABSTRACT
AIM: To report our experience on implementation and preliminary results of a decision-making model based on the recommendations of an Interdisciplinary Oncological Care Group developed for the management of colorectal cancer. PATIENTS AND METHODS: The multidisciplinary team identified a reference guideline using appraisal of guidelines for research and evaluation (AGREE) tool based on a sequential assessment of the guideline quality. Thereafter, internal guidelines with diagnostic and therapeutic management for early, locally advanced and metastatic colonic and rectal cancer were drafted; organizational aspects, responsibility matrices, protocol actions for each area of specialty involved and indicators for performing audits were also defined. RESULTS: The National Institute for Health and Care Excellence (NICE) UK guideline was the reference for drafting the internal guideline document; from February to November 2013, 125 patients with colorectal cancer were discussed by and taken under the care of the Interdisciplinary Oncological Care Group. The first audit performed in December 2013 revealed optimal adherence to the internal guideline, mainly in terms of uniformity and accuracy of perioperative staging, coordination and timing of multi-modal therapies. To date, all patients under observation are within the diagnostic and therapeutic course, no patient came out from the multidisciplinary "path" and only in 14% of cases have the first recommendations proposed been changed. The selected indicators appear effective and reliable, while at the moment, it is not yet possible to assess the impact of the multidisciplinary team on clinical outcome. CONCLUSION: Although having a short observation period, our model seems capable of determining optimal uniformity of diagnostic and therapeutic management, to a high degree of patient satisfaction. A longer observation period is necessary in order to confirm these observations and for assessing the impact on clinical outcome.
Subject(s)
Colorectal Neoplasms/therapy , Disease Management , Medical Oncology/standards , Practice Guidelines as Topic/standards , HumansABSTRACT
The elective didactic activities, (the student choice) in the regulation nursing degree corse represent an inviting formative moment for the students, since they can choose on the didactic fan proposed, the offer that most like and capture one own learning process. The proposal of the Role Playing session, active didactic methodology for excellence, since it favours the learning taking advantage of ludic analogy power, has consented, in the elective activities a ambit, with a lot of favour by nurse students that have lived in the simulation some emblematic situations of the clinical daily. The students group has focused theme attention on some ordinary situations in the hospital context performed by actorsstudents and they are analysed psychological mechanism, particularly as far as concerned the communication and the approach nurse-patient-patient relative: the behaviour mistakes perceived by oneself and somebody else, are become elements for discussions and new information for to acquire relationship competences.
