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Nursing Administration QuarterlyA 50% estimated increase in new cancer cases over the next few decades will significantly challenge health care systems already strained by a shortage of oncology...
A 50% estimated increase in new cancer cases over the next few decades will significantly challenge health care systems already strained by a shortage of oncology providers. Radiation oncology (RO), 1 of 3 three primary pillars of oncology care, treats half of all new cancer cases. Workforce shortages, reimbursement changes, delays in patient treatment, and the lack of follow-up care all continue to increase pressure on RO centers to boost efficiency, improve patient and staff retention, and strive for service satisfaction. Nurse practitioners (NPs) can bring greater capacity, expertise, and profitability to RO, especially in light of the fact that demand is predicted to outstrip supply by as much as 10 times. It is critical, however, that NPs receive specialized training in RO's clinical, technological, and operational processes before assuming patient-facing roles.
Topics: Humans; Radiation Oncologists; Delivery of Health Care; Radiation Oncology; Workforce; Neoplasms
PubMed: 37643229
DOI: 10.1097/NAQ.0000000000000599 -
Psycho-oncology Jun 2022Informed treatment decision-making necessitates accurate prognostication, including predictions about quality of life.
BACKGROUND
Informed treatment decision-making necessitates accurate prognostication, including predictions about quality of life.
AIMS
We examined whether oncologists, patients with advanced cancer, and caregivers accurately predict patients' future quality of life and whether these predictions are prospectively associated with end-of-life care and bereavement.
MATERIALS & METHODS
We conducted secondary analyses of clinical trial data. Patients with advanced cancer (n = 156), caregivers (n = 156), and oncologists (n = 38) predicted patient quality of life 3 months into the future. Patients subsequently rated their quality of life 3 months later. Medical record data documented chemotherapy and emergency department (ED)/inpatient visits in the 30 days before death (n = 79 decedents). Caregivers self-reported on depression, anxiety, grief, purpose, and regret 7-months post-mortem. In mixed-effects models, patient, caregiver, and oncologist quality-of-life predictions at study entry were used to predict end-of-life care and caregiver outcomes, controlling for patients' quality of life at 3-month follow-up, demographic and clinical characteristics, and nesting within oncologists.
RESULTS
Caregivers (P < 0.0001) and oncologists (P = 0.001) predicted lower quality of life than what patients actually experienced. Among decedents, 24.0% received chemotherapy and 54.5% had an ED/inpatient visit. When caregivers' predictions were more negative, patients were less likely to receive chemotherapy (P = 0.028) or have an ED/inpatient visit (P = 0.033), and caregivers reported worse depression (P = 0.002), anxiety (P = 0.019), and grief (P = 0.028) and less purpose in life (P < 0.001) 7-months post-mortem.
CONCLUSION
When caregivers have more negative expectations about patients' quality of life, patients receive less intensive end-of-life care, and caregivers report worse bereavement outcomes.
Topics: Bereavement; Caregivers; Grief; Humans; Neoplasms; Oncologists; Quality of Life; Terminal Care
PubMed: 35088926
DOI: 10.1002/pon.5887 -
Der Pathologe Sep 2017
Review
Topics: Autopsy; Hematology; Humans; Oncologists
PubMed: 28656361
DOI: 10.1007/s00292-017-0318-5 -
PloS One 2022While health systems have implemented multifaceted interventions to improve physician and patient communication in serious illnesses such as cancer, clinicians vary in... (Randomized Controlled Trial)
Randomized Controlled Trial
Oncologist phenotypes and associations with response to a machine learning-based intervention to increase advance care planning: Secondary analysis of a randomized clinical trial.
BACKGROUND
While health systems have implemented multifaceted interventions to improve physician and patient communication in serious illnesses such as cancer, clinicians vary in their response to these initiatives. In this secondary analysis of a randomized trial, we identified phenotypes of oncology clinicians based on practice pattern and demographic data, then evaluated associations between such phenotypes and response to a machine learning (ML)-based intervention to prompt earlier advance care planning (ACP) for patients with cancer.
METHODS AND FINDINGS
Between June and November 2019, we conducted a pragmatic randomized controlled trial testing the impact of text message prompts to 78 oncology clinicians at 9 oncology practices to perform ACP conversations among patients with cancer at high risk of 180-day mortality, identified using a ML prognostic algorithm. All practices began in the pre-intervention group, which received weekly emails about ACP performance only; practices were sequentially randomized to receive the intervention at 4-week intervals in a stepped-wedge design. We used latent profile analysis (LPA) to identify oncologist phenotypes based on 11 baseline demographic and practice pattern variables identified using EHR and internal administrative sources. Difference-in-differences analyses assessed associations between oncologist phenotype and the outcome of change in ACP conversation rate, before and during the intervention period. Primary analyses were adjusted for patients' sex, age, race, insurance status, marital status, and Charlson comorbidity index. The sample consisted of 2695 patients with a mean age of 64.9 years, of whom 72% were White, 20% were Black, and 52% were male. 78 oncology clinicians (42 oncologists, 36 advanced practice providers) were included. Three oncologist phenotypes were identified: Class 1 (n = 9) composed primarily of high-volume generalist oncologists, Class 2 (n = 5) comprised primarily of low-volume specialist oncologists; and 3) Class 3 (n = 28), composed primarily of high-volume specialist oncologists. Compared with class 1 and class 3, class 2 had lower mean clinic days per week (1.6 vs 2.5 [class 3] vs 4.4 [class 1]) a higher percentage of new patients per week (35% vs 21% vs 18%), higher baseline ACP rates (3.9% vs 1.6% vs 0.8%), and lower baseline rates of chemotherapy within 14 days of death (1.4% vs 6.5% vs 7.1%). Overall, ACP rates were 3.6% in the pre-intervention wedges and 15.2% in intervention wedges (11.6 percentage-point difference). Compared to class 3, oncologists in class 1 (adjusted percentage-point difference-in-differences 3.6, 95% CI 1.0 to 6.1, p = 0.006) and class 2 (adjusted percentage-point difference-in-differences 12.3, 95% confidence interval [CI] 4.3 to 20.3, p = 0.003) had greater response to the intervention.
CONCLUSIONS
Patient volume and time availability may be associated with oncologists' response to interventions to increase ACP. Future interventions to prompt ACP should prioritize making time available for such conversations between oncologists and their patients.
Topics: Advance Care Planning; Female; Humans; Machine Learning; Male; Neoplasms; Oncologists; Phenotype
PubMed: 35622812
DOI: 10.1371/journal.pone.0267012 -
Current Opinion in Supportive and... Sep 2018The prevalence of cancer survivors is increasing. Those living with and beyond a cancer diagnosis have a range of physical, psychosocial and practical needs. This review... (Review)
Review
PURPOSE OF REVIEW
The prevalence of cancer survivors is increasing. Those living with and beyond a cancer diagnosis have a range of physical, psychosocial and practical needs. This review aims to discuss the role of primary care in meeting these needs.
RECENT FINDINGS
Patients have increased contact with primary care after a cancer diagnosis but the role of the primary care team in the formal delivery of cancer aftercare is not clearly defined and varies depending on setting and context. Research suggests that both patients and health professionals are receptive to greater involvement of primary care, with informational and personal continuity of care, and good co-ordination of care being particularly valued by patients. Recent evidence indicates that shared care between oncologists and primary care physicians can be as effective as and more cost effective than secondary care-led follow-up, and that primary-care nurses could play a role in optimizing survivorship care.
SUMMARY
The four pillars of primary care - contact, comprehensiveness, continuity and coordination - are recurring themes in the cancer survivorship literature and emphasize that the traditional core values of general practice lend themselves to innovative interventions to improve the efficiency and efficacy of survivorship care.
Topics: Cancer Survivors; Comprehensive Health Care; Continuity of Patient Care; Humans; Oncologists; Patient-Centered Care; Primary Health Care
PubMed: 30074923
DOI: 10.1097/SPC.0000000000000369 -
JAMA Network Open Aug 2021Therapeutic alliance is a core component of patient- and family-centered care, particularly in the setting of advancing cancer. Communication approaches used by...
IMPORTANCE
Therapeutic alliance is a core component of patient- and family-centered care, particularly in the setting of advancing cancer. Communication approaches used by pediatric oncologists to foster therapeutic alliance with children with cancer and their families are not well understood.
OBJECTIVES
To identify key oncologist-driven facilitators associated with building and sustaining therapeutic alliance in the setting of advancing pediatric cancer and to develop a framework to guide clinical practice and future investigation of therapeutic alliance.
DESIGN, SETTING, AND PARTICIPANTS
In this qualitative study, serial disease reevaluation discussions that occurred in the clinic, inpatient hospital, or off campus via telephone were recorded among pediatric oncologists, patients with high-risk cancer, and their families across 24 months or until death, whichever occurred first, from 2016 to 2020. This analysis focused on recorded discussions for pediatric patients who experienced progressive disease during the study period. Content analysis was conducted across recorded dialogue to derive inductive codes and identify themes. Participants were patient-parent dyads for whom a primary oncologist projected the patient's survival to be 50% or less, all family members and friends who attended any of their recorded disease reevaluation conversations, and their oncologists and other clinicians who attended the recorded discussions.
RESULTS
A total of 33 patient-parent dyads were enrolled and followed longitudinally. From this cohort, 17 patients experienced disease progression during the study period, most of whom were female (11 [64.7%]) and White (15 [88.2%]) individuals. For these patients, 141 disease reevaluation discussions were audio recorded, comprising 2400 minutes of medical dialogue. Most children (14 [82.4%]) died during the study period. A median of 7 disease reevaluation discussions per patient (range, 1-19) were recorded. Content analysis yielded 28 unique concepts associated with therapeutic alliance fostered by oncologist communication. Ultimately, 7 core themes emerged to support a framework for clinician approaches associated with optimizing therapeutic alliance: human connection, empathy, presence, partnering, inclusivity, humor, and honesty.
CONCLUSIONS AND RELEVANCE
In this qualitative study, pediatric oncologists used diverse communication approaches associated with building and deepening connections across advancing illness. These findings offer a framework to support clinical and research strategies for strengthening therapeutic alliance among pediatric oncologists, patients, and families.
Topics: Child; Female; Humans; Longitudinal Studies; Male; Neoplasms; Oncologists; Physician-Patient Relations; Professional-Family Relations; Qualitative Research; Therapeutic Alliance
PubMed: 34415315
DOI: 10.1001/jamanetworkopen.2021.20925 -
JAMA Network Open Dec 2022Physician headcounts provide useful information about the cancer care delivery workforce; however, efforts to track the oncology workforce would benefit from new...
IMPORTANCE
Physician headcounts provide useful information about the cancer care delivery workforce; however, efforts to track the oncology workforce would benefit from new measures that capture how essential a physician is for meeting the multidisciplinary cancer care needs of the region. Physicians are considered linchpins when fewer of their peers are connected to other physicians of the same specialty as the focal physician. Because they are locally unique for their specialty, these physicians' networks may be particularly vulnerable to their removal from the network (eg, through relocation or retirement).
OBJECTIVE
To examine a novel network-based physician linchpin score within nationwide cancer patient-sharing networks and explore variation in network vulnerability across hospital referral regions (HRRs).
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study analyzed fee-for-service Medicare claims and included Medicare beneficiaries with an incident diagnosis of breast, colorectal, or lung cancer from 2016 to 2018 and their treating physicians. Data were analyzed from March 2022 to October 2022.
EXPOSURES
Physician characteristics assessed were specialty, rurality, and Census region. HRR variables assessed include sociodemographic and socioeconomic characteristics and use of cancer services.
MAIN OUTCOMES AND MEASURES
Oncologist linchpin score, which examined the extent to which a physician's peers were connected to other physicians of the same specialty as the focal physician. Network vulnerability, which distinguished HRRs with more linchpin oncologists than expected based on oncologist density. χ2 and Fisher exact tests were used to examine relationships between oncologist characteristics and linchpin score. Spearman rank correlation coefficient (ρ) was used to measure the strength and direction of relationships between HRR network vulnerability, oncologist density, population sociodemographic and socioeconomic characteristics, and cancer service use.
RESULTS
The study cohort comprised 308 714 patients with breast, colorectal, or lung cancer. The study cohort of 308 714 patients included 161 206 (52.2%) patients with breast cancer, 76 604 (24.8%) patients with colorectal cancer, and 70 904 (23.0%) patients with lung cancer. In our sample, 272 425 patients (88%) were White, and 238 603 patients (77%) lived in metropolitan areas. The cancer patient-sharing network included 7221 medical oncologists and 3573 radiation oncologists. HRRs with more vulnerable networks for medical oncology had a higher percentage of beneficiaries eligible for Medicaid (ρ, 0.19; 95% CI, 0.08 to 0.29). HRRs with more vulnerable networks for radiation oncology had a higher percentage of beneficiaries living in poverty (ρ, 0.17; 95% CI, 0.06 to 0.27), and a higher percentage of beneficiaries eligible for Medicaid (ρ, 0.21; 95% CI, 0.09 to 0.31), and lower rates of cohort patients receiving radiation therapy (ρ, -0.18; 95% CI, -0.28 to -0.06; P = .003). The was no association between network vulnerability for medical oncology and percent of cohort patients receiving chemotherapy (ρ, -0.03; 95% CI, -0.15 to 0.08).
CONCLUSIONS AND RELEVANCE
This study found that patient-sharing network vulnerability was associated with poverty and lower rates of radiation therapy. Health policy strategies for addressing network vulnerability may improve access to interdisciplinary care and reduce treatment disparities.
Topics: Aged; Humans; Colorectal Neoplasms; Cross-Sectional Studies; Lung Neoplasms; Medicare; United States; Health Services Accessibility; Oncologists; Female; Breast Neoplasms; Health Workforce
PubMed: 36525275
DOI: 10.1001/jamanetworkopen.2022.45995 -
JCO Oncology Practice Sep 2023
Topics: Humans; Curriculum; Oncologists
PubMed: 37379500
DOI: 10.1200/OP.23.00165 -
Seminars in Hematology Oct 2017Social media utilizes specific media platforms to allow increased interactivity between participants. These platforms serve diverse groups and purposes including... (Review)
Review
Social media utilizes specific media platforms to allow increased interactivity between participants. These platforms serve diverse groups and purposes including participation from patients, family caregivers, research scientists, physicians, and pharmaceutical companies. Utilization of these information outlets has increased with integration at conferences and between conferences with the use of hashtags and "chats". In the realm of the "e-Patient" it is key to not underestimate your audience. Highly technical information is just as useful as a basic post. With growing use, social media analytics help track the volume and impact of content. Additionally, platforms are leveraging each other for uses, including Twitter, blogs, web radio, and recorded video and images. We explore information on social media resources and applications from varying perspectives. While these platforms will evolve over time, or disappear with new platforms taking their place, it is apparent they are now a part of the everyday experience of oncology communication.
Topics: Humans; Oncologists; Social Media
PubMed: 29153077
DOI: 10.1053/j.seminhematol.2017.06.006 -
Supportive Care in Cancer : Official... Nov 2022To support the care of lung cancer patients, oncologists have needed to stay current on treatment advancements and build relationships with a new group of survivors in...
INTRODUCTION
To support the care of lung cancer patients, oncologists have needed to stay current on treatment advancements and build relationships with a new group of survivors in an era where lung cancer survivorship has been re-defined. The objectives of the study were to (1) understand the perspectives of advanced lung cancer patients whose tumors have oncogenic alterations about their care experiences with their oncologist(s) and (2) describe the perceptions of advanced lung cancer patients about seeking second opinions and navigating care decisions.
METHODS
In this qualitative study, patients with advanced lung cancer (n = 25) on targeted therapies were interviewed to discuss their ongoing experience with their oncologists. We used deductive and inductive qualitative approaches in the coding of the data. We organized the data using the self-determination framework.
RESULTS
Patients described both positive and negative aspects of their care as related to autonomy, provider competency, and connectedness. Patients sought second opinions for three primary reasons: expertise, authoritative advice, and access to clinical trial opportunities. When there is disagreement in the treatment plan between the primary oncologist and the specialist, there can be confusion and tension, and patients have to make difficult choices about their path forward.
CONCLUSIONS
Patients value interactions that support their autonomy, demonstrate the competency of their providers, and foster connectedness. To ensure that patients receive quality and goal-concordant care, developing decision aids and education materials that help patients negotiate recommendations from two providers is an area that deserves further attention.
Topics: Humans; Oncologists; Qualitative Research; Neoplasms; Survivors; Cancer Survivors; Lung Neoplasms
PubMed: 35948849
DOI: 10.1007/s00520-022-07309-7