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1.
Support Care Cancer ; 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32020357

RESUMO

BACKGROUND: The use of patient-reported outcomes (PROs) for routine cancer distress screening is endorsed globally as a quality-care standard. However, there is little research on the integration of PROs in "real-world" oncology practices using implementation science methods. The Improving Patient Experience and Health Outcome Collaborative (iPEHOC) intervention was established at multisite disease clinics to facilitate the use of PRO data by clinicians for precision symptom care. The aim of this study was to examine if patients exposed to the intervention differed in their healthcare utilization compared with contemporaneous controls in the same time frame. METHODS: We used a PRE- and DURING-intervention population cohort comparison study design to estimate the effects of the iPEHOC intervention on the difference in difference (DID) for relative rates (RR) for emergency department (ED) visits, hospitalizations, psychosocial oncology (PSO), palliative care visits, and prescription rates for opioids and antidepressants compared with controls. RESULTS: A small significantly lower Difference in Difference (DID) (- 0.223) in the RR for ED visits was noted for the intervention compared with controls over time (0.947, CI 0.900-0.996); and a DID (- 0.0329) for patients meeting ESAS symptom thresholds (0.927, CI 0.869-0.990). A lower DID in palliative care visits (- 0.0097), psychosocial oncology visits (- 0.0248), antidepressant prescriptions (- 0.0260) and an increase in opioid prescriptions (0.0456) in the exposed population compared with controls was also noted. A similar pattern was shown for ESAS as a secondary exposure variable. CONCLUSION: Facilitating uptake of PROs data may impact healthcare utilization but requires examination in larger scale "real-world" trials.

2.
J Palliat Med ; 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31944866

RESUMO

Background: Early referral of cancer patients for palliative care significantly improves the quality of life. It is not clear which patients can benefit from an early referral, and when the referral should occur. A Delphi Panel study proposed 11 major criteria for an outpatient palliative care referral. Objective: To operationalize major Delphi criteria in a cohort of lung cancer patients, using a prospective approach, by linking health administrative data. Design: Population-based observational cohort study. Setting/Subjects: The study population comprised 38,851 cases of lung cancer in the Ontario Cancer Registry, diagnosed from January 1, 2012, to December 31, 2016. Measurements: We operationalized 6 of the 11 major criteria (4 diagnosis or prognosis based and 2 symptom based). Patients were considered eligible (index event) for palliative care if they qualified for any criterion. Among eligible patients, we identified those who received palliative care. Results: Twenty-eight thousand one hundred sixty-four patients were eligible for palliative care by qualifying for either the diagnosis- or prognosis-based criteria (n = 21,036, 76.5%), or for symptom-based criteria (n = 7128, 23.5%). A total of 23,199 (82.4%) patients received palliative care. The median time from palliative care eligibility to the receipt of first palliative care or death or maximum study follow-up was 56 days (range = 17-348). Conclusions: We operationalized six major criteria that identified the majority of lung cancer patients who were eligible for palliative care. Most eligible patients received the palliative care before death. Future research is warranted to test these criteria in other cancer populations.

4.
Breast Cancer Res Treat ; 175(3): 721-731, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30879223

RESUMO

PURPOSE: Studies examining symptom differences between surgeries for breast cancer patients rarely incorporate the effects of adjuvant treatment choice. We sought to understand differences in patient-reported symptoms between lumpectomy plus radiation and mastectomy in the year following surgery. METHODS: This cohort study used linked administrative datasets. The exposure was defined as lumpectomy plus radiation or mastectomy. The outcomes of moderate-to-severe (score ≥ 4) patient-reported symptoms were obtained using the Edmonton symptom assessment system (ESAS). Line plots were created to determine symptom trajectories in the 12 months following surgery, and the relationships between surgery and each of the nine symptoms were assessed using multivariable analyses. Clinical significance was determined as a difference of 10%. RESULTS: Of 13,865 Stage I-II breast cancer patients diagnosed 2007-2015, 11,497 underwent lumpectomy plus radiation and 2368 underwent mastectomy. Symptom trajectories were similar for all nine symptoms until approximately 5 months postoperatively when they diverged and mastectomy symptoms started becoming more severe. On multivariable analyses, patients undergoing mastectomy were at an increased risk of reporting moderate-to-severe depression (RR 1.19, 95% CI 1.09-1.30), lack of appetite (RR 1.11, 95% CI 1.03-1.20), and shortness of breath (RR 1.16, 95% CI 1.04-1.15) compared to those undergoing lumpectomy plus radiation. CONCLUSIONS: Even with the addition of adjuvant radiation, patients who are treated with lumpectomy fare better in three of nine patient-reported symptoms. Further examination of these differences will assist in better shared decision-making regarding surgical treatments.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Depressão/epidemiologia , Dispneia/epidemiologia , Mastectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Estudos de Coortes , Terapia Combinada , Depressão/etiologia , Dispneia/etiologia , Feminino , Humanos , Mastectomia/métodos , Mastectomia/psicologia , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Medidas de Resultados Relatados pelo Paciente , Autorrelato , Resultado do Tratamento , Adulto Jovem
5.
J Pain Symptom Manage ; 58(1): 100-107.e2, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30831238

RESUMO

PURPOSE: To evaluate factors associated with opioid use in patients with cancer surviving more than five years without recurrence. We evaluated exposures of opioid use before cancer diagnosis, opioid use between cancer diagnosis and five-year anniversary, surgeries, and chemotherapy. METHODS: We conducted a retrospective cohort study using linked provincial administrative data. Patients were aged 24-70 years and eligible for government-funded pharmacare. The index date was the five-year anniversary from diagnosis. Patients were accrued between 2010 and 2015. The main outcome was opioid prescription rate after index date. The main exposures were opioid use before diagnosis, opioid use between diagnosis and index, surgeries, and chemotherapy. A negative binomial regression model was used to estimate relative rates (RR) of opioid use after index date. RESULTS: Our cohort included 7431 individuals. The overall crude prescription rate after the index date was 2 per person-year. The factor most strongly associated with a higher rate of opioid use after index was continuous opioid use between diagnosis and index (RR 46.1, 95% confidence interval 34.8-61.2). Opioid use before diagnosis was also a factor (RR = 1.8, 95% confidence interval 1.44-2.19). A history of depression, comorbidity, and more than two years of diabetes were also associated with higher risk of post-index date opioid use. Significant interactions were identified between prior opioid use and opioid use between diagnosis and index. Most prescriptions are from family physicians. CONCLUSION: Patients who use opioids continuously between diagnosis and index date are at increased risk of continued use after five years of survival. Safe and appropriate pain management is an important survivorship issue.

6.
Support Care Cancer ; 27(6): 1965-1968, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30762143

RESUMO

Evidence supporting the benefits of exercise surrounding cancer treatment has led to internationally published guidelines, with minimal uptake by oncology care providers (OCPs). There is a need to understand how to implement research evidence into practice. Our team developed a questionnaire to assess OCPs' knowledge of exercise guidelines and barriers/facilitators to exercise counseling and program referral. We validated the questionnaire using the Theoretical Domains Framework, a knowledge translation (KT) framework used to implement evidence-based guidelines into practice. In this commentary, we describe this process and the rationale for integrating a KT framework into intervention development and implementation in oncology practice. The revised questionnaire, entitled Clinicians Perspectives on Exercise in Patients with Cancer (CliPEC), is shared to facilitate the implementation process and allow for comparison across oncology practices.


Assuntos
Assistência à Saúde/métodos , Exercício/fisiologia , Neoplasias/terapia , Humanos , Neoplasias/patologia , Ontário , Inquéritos e Questionários
7.
J Interprof Care ; 33(5): 558-569, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30557065

RESUMO

Increasing prevalence of chronic conditions and multimorbidity challenges health care systems and calls for patient-centered coordination of care. Implementation and evaluation of health policies focusing on the development of patient-centered coordination of care needs valid instruments measuring this dimension of care. The aim of this validation study was to assess the psychometric properties of the French version of the 14-item Patient-Centered Coordination by a Care Team (PCCCT) questionnaire in a primary care setting. PCCCT provides a total score from 0 (worst coordination) to 42 (best coordination). 165 adult patients consulting in primary care with one or more chronic condition(s) completed questionnaires (including PCCCT) at recruitment. After three weeks, participants completed PCCCT again, either by mail (group A) or during a telephone interview (group B). At recruitment, the mean (SD) PCCCT score was 33.3 (7.7). Exploratory factor analysis revealed a 2-dimension structure, 8 items relating to patient involvement and 6 items relating to coordination (factors loadings ranging from 0.34 to 0.88). PCCCT score correlated significantly with subscales of Haggerty's continuity questionnaire, Spearman correlation coefficients (95% confidence interval) ranging from 0.40 (0.22-0.57) to 0.52 (0.38-0.63). Internal consistency was excellent: Cronbach alpha 0.90 (0.79-0.92). Reliability was good, with an intraclass correlation coefficient of 0.68 (0.55-0.78) for test-retest reliability (group A) and of 0.65 (0.46-0.79) for reliability between the self-administered and the interviewer-administered versions of the questionnaire (group B,). The PCCCT questionnaire presents satisfactory validity and reliability; it can be used for the evaluation of health organizations involving team work in primary care.

8.
J Oncol Pract ; : JOP1800275, 2018 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-30289736

RESUMO

BACKGROUND:: Transitioning low-risk cancer survivors back to their primary care provider (PCP) has been shown to be safe but the effect on health system resources and costs has not been examined. METHODS:: A Well Follow-Up Care Initiative (WFCI) was implemented in the publicly funded health system. Low-risk breast cancer (BC) survivors in the WFCI intervention group were transitioned from oncologist-led cancer clinics to PCPs. We compared health system costs ($2,014 in Canadian dollars) and resource utilization in this intervention group with that in propensity-score-matched nontransitioned BC survivors (ie, controls) diagnosed in the same year, with similar disease profile and patient characteristics using publicly funded administrative databases. RESULTS:: A total of 2,324 BC survivors from the WFCI intervention group were 1:1 matched to controls and observed for 25 months. Compared with controls, survivors in the intervention group incurred a similar number of PCP visits (6.9 v 7.5) and fewer oncologist visits (0.3 v 1.2) per person-year. Fewer survivors in the intervention group (20.1%) were hospitalized than in the control group (24.4%). There were no differences in emergency visits. More survivors in the intervention group had mammograms (82.6% v 73.1%), but other diagnostic tests were less frequent. There was a 39.3% reduction in overall mean annual costs ($6,575 v $10,832) and a 22.1% reduction in overall median annual costs ($2,261 v $2,903). Overall survival in the intervention group was not worse than controls. CONCLUSION:: Transitioning low-risk BC survivors to PCPs was associated with lower health system resource use and a lower annual cost per patient than matched controls. The WFCI model represents a reasonable approach at the population level to delivering quality care for low-risk BC survivors that seems to be cost effective.

9.
Health Policy ; 122(12): 1364-1371, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30297301

RESUMO

Despite Canada's long history with mammography screening, little is known about citizens' perspectives about mammography and how best to support women to make informed choices about screening. To address this gap, a series of four citizen deliberation events were held in 2015-16 in Ontario, a Canadian province with an organized population-based breast screening program in place since 1990. Forty-nine individuals participated in four citizen panels, each comprising an information session highlighting the evidence about mammography, and large- and small-group deliberations about approaches to support informed decision making for screening. Following their engagement with the research evidence about mammography, participants expressed concern about their lack of full awareness of the risks and benefits and a strong desire for choice when it comes to screening. To support informed choice, mammography programs need to reflect the values of information sharing, trust and transparency, financial accountability, and allow for personal interactions and shared decision-making. Citizens are looking for balanced information about the risks and benefits of screening presented in an easy to understand, comprehensive, and transparent manner. Primary health care providers and organized screening programs are important sources of information about mammography and must be vigilant in their efforts to support informed decision-making in this area by ensuring that the information materials they are using are balanced and reflect current evidence.


Assuntos
Tomada de Decisões , Detecção Precoce de Câncer , Consentimento Livre e Esclarecido , Mamografia/métodos , Programas de Rastreamento , Neoplasias da Mama/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Medição de Risco
10.
Eur J Cancer ; 101: 1-11, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30014970

RESUMO

AIM: Breast cancer and its treatment are associated with varying symptoms. The province of Ontario (13.6 million) has implemented a provincial programme to screen for symptoms among cancer patients using the Edmonton Symptom Assessment System (ESAS). The purpose of this study was to describe symptom burden in the year after diagnosis among women with breast cancer. METHODS: This observational study linked cancer incidence, stage, treatment and demographic data with ESAS scores collected at cancer clinic visits. The cohort consisted of all adult women diagnosed with stage I-III breast cancer between 2007 and 2013 who received surgery as their primary treatment and had at least one symptom screening record. The prevalence and trajectory of moderate-to-severe and severe symptom scores in the year after diagnosis were described. Multivariable logistic regression models identified factors associated with moderate-to-severe and severe symptom scores. RESULTS: The cohort included 23,840 breast cancer patients and with 90,556 unique symptom assessments, within the first year from diagnosis. Tiredness had the highest incidence of moderate-to-severe scores; 60% reported at least one moderate-to-severe score in the 12 months after diagnosis, followed by impaired well-being (53%) and anxiety (44%). Elevated symptom scores were most commonly reported in 6 months after diagnosis. Higher comorbidity score (Aggregated Diagnosis Group ≥10), more advanced stage at diagnosis, younger age, urban residence, lower income and treatment course were associated with moderate-to-severe and severe symptom scores. CONCLUSION: These findings identify time points and patient subgroups at risk for elevated symptom scores and may benefit from personalised or targeted supportive care interventions.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Autorrelato , Avaliação de Sintomas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Neoplasias da Mama/epidemiologia , Estudos de Coortes , Comorbidade , Fadiga/diagnóstico , Fadiga/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Ontário/epidemiologia , Prevalência , Avaliação de Sintomas/métodos , Adulto Jovem
11.
Prev Med ; 112: 209-215, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29678617

RESUMO

Evolving scientific evidence about mammography has raised new questions about the net benefits of organized screening, yet gaps remain about women's current screening practices, knowledge, attitudes and values toward screening to support informed decision making in this area. We addressed this gap through an online survey of 2000 screen-eligible women from Ontario, Canada in January 2016. Likert-scaled and categorical questions were used to collect information about screening practices, knowledge of benefits and risks of screening and underlying attitudes and values toward screening. Results for all responses were summarized using descriptive statistics. Comparison of results between ever screened versus never screened respondents was performed using chi-squared tests. Most women felt informed about screening yet had doubts about how informed their decisions were. They were more confident in their knowledge of the benefits than the risks which aligned with the emphasis given to benefits in discussions with health care providers. The benefits of screening were linked with lowered anxiety about breast cancer. The never screened were less likely to overstate the benefits of screening, more likely to give weight to the risks, and less likely to report anxiety or worry about breast cancer. Findings highlight the need for improved communication strategies and decision supports that emphasize the provision of current, balanced information about the benefits and risks of screening, both at the population-level (through mass media) and within patient-provider interactions. Sensitivity to the psychosocial factors that shape women's attitudes toward mammography screening should be central to any strategy.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer , Conhecimentos, Atitudes e Prática em Saúde , Mamografia , Participação do Paciente/psicologia , Incerteza , Idoso , Tomada de Decisões , Feminino , Humanos , Internet , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Participação do Paciente/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários
12.
Support Care Cancer ; 26(5): 1533-1541, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29189967

RESUMO

BACKGROUND: Better coordination of supportive services during the early phases of cancer care has been proposed to improve the care experience of patients. We conducted a randomized trial to test a community-based nurse-led coordination of care intervention in cancer patients. METHODS: Surgical practices were cluster randomized to a control group involving usual care practices or a standardized nursing intervention consisting of an in-person supportive care assessment with ongoing support to meet identified needs, including linkage to community services. Newly diagnosed breast and colorectal cancer patients within 7 days of cancer surgery were eligible. The primary outcome was the patient-reported outcome (PRO) of continuity of care (CCCQ) measured at 3 weeks. Secondary outcomes included unmet supportive care needs (SCNS), quality of life (EORTC QLQ-C30), health resource utilization, and level of uncertainty with care trajectory (MUIS) at 3 and/or 8 weeks. RESULTS: A total of 121 breast and 72 colorectal patients were randomized through 28 surgical practices. There was a small improvement in the informational domain of continuity of care (difference 0.29 p = 0.05) and a trend to less emergency room use (15.8 vs 7.1%) (p = 0.07). There were no significant differences between groups on unmet need, quality of life, or uncertainty. CONCLUSION: We did not find substantial gaps in the PROs measured immediately following surgery for breast and colorectal cancer patients. The results of this study support a more targeted approach based on need and inform future research focused on improving navigation during the initial phases of cancer treatment. ClinicalTrials.gov Identifier: NCT00182234. SONICS-Effectiveness of Specialist Oncology Nursing.


Assuntos
Neoplasias da Mama/enfermagem , Neoplasias da Mama/cirurgia , Neoplasias Colorretais/enfermagem , Neoplasias Colorretais/cirurgia , Enfermagem Oncológica/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Qualidade de Vida
13.
Pacing Clin Electrophysiol ; 40(12): 1432-1439, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28975641

RESUMO

BACKGROUND: Silent cerebral lesions (SCLs) are a potential complication of left atrial radiofrequency ablation (RFA) procedures for paroxysmal atrial fibrillation (PAF). We aimed to compare the incidence of SCLs in patients treated with irrigated RFA multielectrode catheters (nMARQ® Catheter group) and irrigated focal RFA catheters (NAVISTAR® THERMOCOOL® Catheter; TC group) after PAF ablation from subpopulation neurological assessment (SNA) cohorts of the REVOLUTION and reMARQable studies. METHODS: Data from SNA cohorts in the prospective, nonrandomized REVOLUTION study (March 2011-September 2013) and the prospective, randomized, controlled reMARQable study (October 2013-November 2015) were included. The incidence of SCLs was assessed pre- and postablation using magnetic resonance imaging. Neurological deficits were assessed using the National Institutes of Health Stroke Scale, modified Rankin Scale, and Montreal Cognitive Assessment. RESULTS: A total of 37 patients from REVOLUTION and 76 patients from reMARQable were included in the SNA cohort of each study. In the REVOLUTION SNA cohort, the incidence of SCLs was 21.1% (4/19) in the nMARQ® Catheter group and 5.9% (1/17) in the TC group. Findings from REVOLUTION helped inform the reMARQable study protocol's stringent anticoagulation regimen. SCL incidence was subsequently reduced in both groups (nMARQ® Catheter, 7.9%; TC, 3.3%). No permanent neurological deficits were observed. CONCLUSION: Adherence to a stringent anticoagulation regimen prior to and during ablation procedures appears to be an important factor in minimizing the risk of SCL.


Assuntos
Anticoagulantes/efeitos adversos , Doenças Assintomáticas , Encefalopatias/etiologia , Encefalopatias/prevenção & controle , Ablação por Cateter/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Fibrilação Atrial/cirurgia , Coagulação Sanguínea , Encefalopatias/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Pract Neurol ; 17(5): 392-395, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28647708

RESUMO

Cerebral amyloid angiopathy-related inflammation (CAA-I) is a rare variant of cerebral amyloid angiopathy (CAA). Its precise pathophysiology remains uncertain and we currently have limited evidence on which immunosuppressive agents are the most effective in its treatment. The disease course of CAA-I disorders can vary from an isolated clinical event to recurrent episodes. We present a case of biopsy-confirmed CAA-I that gives insight into its potential relapsing nature and the challenges of its long-term management.


Assuntos
Angiopatia Amiloide Cerebral/complicações , Encefalite/etiologia , Peptídeos beta-Amiloides/metabolismo , Encéfalo/metabolismo , Encéfalo/patologia , Angiopatia Amiloide Cerebral/diagnóstico por imagem , Angiopatia Amiloide Cerebral/patologia , Progressão da Doença , Encefalite/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
15.
Syst Rev ; 6(1): 66, 2017 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-28347351

RESUMO

BACKGROUND: Cancer survivors face a range of negative physical and psychological effects that can be mitigated by participating in physical activity. Despite this, most do not meet recommended levels. Health care providers may be in a unique position to promote participation in physical activity among cancer survivors. The aim of this systematic review and meta-analysis is to synthesize the findings from randomized controlled trials and controlled clinical trials investigating the effectiveness of health care provider-administered physical activity recommendations on participation in physical activity among cancer survivors. METHODS/DESIGN: Ten electronic databases (CINAHL, CENTRAL, Education Source, EMBASE, LILACS, MEDLINE, OTSeeker, PEDro, PsycINFO, SPORTDiscus) will be searched to identify relevant studies. The electronic searches will be supplemented by scanning the reference lists of relevant articles retrieved during these searches to ensure all potentially relevant studies are identified. Two reviewers will independently screen all titles and abstracts resulting from the searches to identify potentially eligible studies. They will then screen the full-text articles passing the first screen to identify studies for inclusion using predetermined inclusion/exclusion criteria, extract data from studies meeting all criteria, and assess the risk of bias of these studies. Results will be summarized narratively and statistically. DISCUSSION: By summarizing the best available evidence for the effectiveness of health care provider physical activity recommendations for increasing participation in physical activity among cancer survivors, the results of this systematic review and meta-analysis will help determine if making physical activity recommendations effectively changes cancer survivors behaviour. It will also help to identify knowledge gaps and highlight areas in need of additional research.


Assuntos
Terapia por Exercício , Metanálise como Assunto , Neoplasias/reabilitação , Sobreviventes , Revisão Sistemática como Assunto , Terapia por Exercício/normas , Terapia por Exercício/estatística & dados numéricos , Humanos , Neoplasias/psicologia , Sobreviventes/estatística & dados numéricos
16.
Support Care Cancer ; 25(7): 2297-2304, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28258503

RESUMO

BACKGROUND: Despite the reported benefits of physical activity in alleviating the impact of cancer and its treatments, oncology care providers (OCPs) are not routinely discussing exercise with their patients, suggesting a knowledge to action gap. We sought to determine OCP's knowledge, beliefs, barriers, and facilitators to exercise discussion. METHODS: A survey was administered to OCPs at the cancer center in Hamilton, Ontario. Questions comprised of demographics, knowledge and beliefs regarding exercise guidelines, and barriers and facilitators to exercise discussion. Analysis of survey responses was descriptive. Pearson's chi-squared test was used to examine select associations. RESULTS: There were 120 respondents (61% response rate) representing a diversity of professions. Approximately, 80% of OCPs were not aware of any exercise guidelines in cancer and self-reported poor knowledge on when, how, and which patients to refer to exercise programs. OCPs who reported meeting Canada's Physical Activity guidelines were significantly more likely to identify correct guidelines (p = 0.023) and to report good knowledge on how to provide exercise counseling (p = 0.014). Across OCP groups, barriers to exercise discussion included poor knowledge, lack of time, and safety concerns. Most felt that educational sessions and having an exercise specialist on the clinical team would be beneficial. CONCLUSIONS: OCPs have low knowledge regarding exercise counseling, but believe that discussing exercise is a multidisciplinary task and expressed a desire for further training. Interventions will require a multi-pronged approach including education for OCPs and guidance on assessment for exercise safety.


Assuntos
Exercício/fisiologia , Promoção da Saúde/métodos , Oncologia/normas , Neoplasias/terapia , Oncologistas/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
17.
Healthc Policy ; 12(3): 50-65, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28277204

RESUMO

BACKGROUND AND OBJECTIVES: Better integration between cancer care systems and primary care physicians (PCPs) is a goal of most healthcare systems, but little direction exists on how this can be achieved. This study systematically examined the extent of integration between PCPs and a regional cancer program (RCP) to identify opportunities for improvement. METHOD: Cross-sectional survey of all practising PCPs in the region of interest using a study-specific instrument based on a three-tier conceptualization of integration. RESULTS: Among the 473 PCPs who responded (63% response rate), perceived role clarity and the desire for greater involvement in patient care varied across the care trajectory. Specific gaps were identified in PCPs' understanding of the referral process and patient follow-up after treatment. CONCLUSION: Our novel survey of PCPs explicated the strategies that could improve their integration in cancer care, including mechanisms to support PCPs in the initial diagnosis of their patients and standardized post-treatment transition plans outlining care roles and responsibilities.


Assuntos
Atitude do Pessoal de Saúde , Prestação Integrada de Cuidados de Saúde/organização & administração , Enfermagem Oncológica/organização & administração , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Estudos Transversais , Feminino , Humanos , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
18.
Int J Integr Care ; 17(6): 5, 2017 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-29588638

RESUMO

Introduction: There has been a growing emphasis on the use of integrated care plans to deliver cancer care. However little is known about how integrated care plans for cancer patients are developed including featured core activities, facilitators for uptake and indicators for assessing impact. Methods: Given limited consensus around what constitutes an integrated care plan for cancer patients, a scoping review was conducted to explore the components of integrated care plans and contextual factors that influence design and uptake. Results: Five types of integrated care plans based on the stage of cancer care: surgical, systemic, survivorship, palliative and comprehensive (involving a transition between stages) are described in current literature. Breast, esophageal and colorectal cancers were common disease sites. Multi-disciplinary teams, patient needs assessment and transitional planning emerged as key features. Provider buy-in and training alongside informational technology support served as important facilitators for plan uptake. Provider-level measurement was considerably less robust compared to patient and system-level indicators. Conclusions: Similarities in design features, components and facilitators across the various types of integrated care plans indicates opportunities to leverage shared features and enable a management lens that spans the trajectory of a patient's journey rather than a phase-specific silo approach to care.

19.
Can Fam Physician ; 62(10): 805-811, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27737976

RESUMO

OBJECTIVE: To offer FPs a summary of evidence-based recommendations to guide their follow-up survivorship care of women treated for breast cancer. QUALITY OF EVIDENCE: A literature search was conducted in MEDLINE from 2000 to 2016 using the search words breast cancer, survivorship, follow-up care, aftercare, guidelines, and survivorship care plans, with a focus on review of recent guidelines published by national cancer organizations. Evidence ranges from level I to level III. MAIN MESSAGE: Survivorship care involves 4 main tasks: surveillance and screening, management of long-term effects, health promotion, and care coordination. Surveillance for recurrence involves only annual mammography, and screening for other cancers should be done according to population guidelines. Management of the long-term effects of cancer and its treatment addresses common issues of pain, fatigue, lymphedema, distress, and medication side effects, as well as longer-term concerns for cardiac and bone health. Health promotion emphasizes the benefits of active lifestyle change in cancer survivors, with an emphasis on physical activity. Survivorship care is enhanced by the involvement of various health professionals and services, and FPs play an important role in care coordination. CONCLUSION: Family physicians are increasingly the main providers of follow-up care after breast cancer treatment. Breast cancer should be viewed as a chronic medical condition even in women who remain disease free, and patients benefit from the approach afforded other chronic conditions in primary care.


Assuntos
Assistência ao Convalescente/normas , Neoplasias da Mama/terapia , Promoção da Saúde/métodos , Médicos de Família/normas , Feminino , Fidelidade a Diretrizes , Humanos , Recidiva Local de Neoplasia , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Taxa de Sobrevida
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