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JCO Global Oncology Mar 2021To examine the trends and quality metrics of publications by radiation oncologists in Saudi Arabia.
PURPOSE
To examine the trends and quality metrics of publications by radiation oncologists in Saudi Arabia.
METHODS
PubMed was searched using names of all Saudi radiation oncologists to retrieve published articles between January 2010 and December 2019. International collaboration, journal impact factor and country of origin, and number of citations were collected. Each article was assessed for epidemiologic type and independently assigned a level of evidence (LOE) by two authors. The trend in publications was examined and compared in the first and second 5-year periods (2010-2014 and 2015-2019) using relevant parameters.
RESULTS
A total of 186 publications were found and included. The most common type of research was cohort studies followed by case reports and case series in 24%, 14%, and 13% of all publications, respectively. Dosimetry, clinical, and preclinical studies formed 7%, 8.6%, and 7.5% of the total publications, respectively. The LOE was I, II, III, IV, and not applicable in 8.6%, 22%, 25.8%, 29%, and 14.5% of the included publications, respectively. Comparing the first and second 5-year periods, there was an increase in international collaboration ( < .001) in the second period. The number of citations ( < .001) and journal impact factor ( = .028) were lower in the second period. LOE and publications in international journals were not statistically different between the two periods.
CONCLUSION
Although radiation oncology research activity in Saudi Arabia has gained momentum in terms of volume and international collaboration over time, the LOE has not improved. This calls for a national effort to make the contribution to the literature a priority, allocate adequate resources, and apply appropriate measures to enhance research productivity and quality.
Topics: Biomedical Research; Developing Countries; Humans; Publications; Radiation Oncologists; Saudi Arabia
PubMed: 33720748
DOI: 10.1200/GO.20.00449 -
Patient Education and Counseling Oct 2021Providing a second opinion (SO) in oncology is complex, and communication during SOs remains poorly understood. This study aimed to systematically observe how patients...
OBJECTIVE
Providing a second opinion (SO) in oncology is complex, and communication during SOs remains poorly understood. This study aimed to systematically observe how patients and oncologists communicate about SO-specific topics (i.e., patient motivation, the referring oncologist, treatment transfer/back-referral), and how such communication affects patient satisfaction.
METHODS
A prospective mixed-methods study of cancer patients seeking a SO (N = 69) and consulting oncologists was conducted. Before the SO, patients reported their expected place of future treatment. Following the SO, patients' and oncologists' satisfaction was assessed. All SOs were audio-recorded. Absolute and relative duration of SO-specific talk were calculated and specific events (e.g., questions/utterances) were coded (incl. valence, explicitness).
RESULTS
SOs lasted 19-73 min, of which 3.7% was spent discussing motivations. Oncologists rarely explored patients' motivations. Talk about referring oncologists (12.5% of consultation) was mostly critical by patients (M = 43.0%), but positive/confirming by consulting oncologists (M = 73.5%). Although 22.2% of patients expected a treatment transfer, this topic (3.3% of consultation time) was rarely explicitly discussed. Patients who were referred back were significantly less satisfied (d = 0.85).
CONCLUSION
Patient-provider communication in oncological SOs appears insufficiently aligned.
PRACTICE IMPLICATIONS
Patients and oncologists need support to explicitly and productively communicate about SO-specific topics and to better manage expectations. Recommendations are provided.
Topics: Communication; Humans; Neoplasms; Oncologists; Physician-Patient Relations; Prospective Studies; Referral and Consultation
PubMed: 33744055
DOI: 10.1016/j.pec.2021.03.011 -
Annals of Palliative Medicine Aug 2021In this review we will focus on doctor-patient communication as one of the most important modifiable factors which may have a significant impact especially on the... (Review)
Review
OBJECTIVE
In this review we will focus on doctor-patient communication as one of the most important modifiable factors which may have a significant impact especially on the important transition between the ambulatory and terminal phases of cancer.
BACKGROUND
High quality communication about prognosis for cancer patients is a critical component of advance care planning, and it plays a critical role among all the complex factors that affect end of life care decisions. In this review we focus on doctor-patient communication as the most important modifiable factor impacting the transitional period between the ambulatory phase and the terminal phase of cancer. We also discuss how prognostic understanding among advanced cancer patients influences decisions in regard to their cancer care.
METHODS
We investigated studies that examined advanced cancer patients and prognosis-related communication.
CONCLUSIONS
We believe that oncologists' skills, experience, and comfort level in managing patients' reactions to negative information is a principal barrier that contributes substantially to the deficit of high-quality prognosis-related communication described in the literature. We also believe that it is useful to categorize oncologists with regard to their ability to engage in high quality communication, and we suggest category-specific strategies to improve oncologists' skills to conduct more effective prognosis related communication with their patients.
Topics: Communication; Humans; Neoplasms; Oncologists; Physician-Patient Relations; Prognosis
PubMed: 34328017
DOI: 10.21037/apm-21-142 -
Current Oncology (Toronto, Ont.) Dec 2019Shared decision-making at end of life (eol) requires discussions about goals of care and prioritization of length of life compared with quality of life. The purpose of...
BACKGROUND
Shared decision-making at end of life (eol) requires discussions about goals of care and prioritization of length of life compared with quality of life. The purpose of the present study was to describe patient and oncologist discordance with respect to goals of care and to explore possible predictors of discordance.
METHODS
Patients with metastatic cancer and their oncologists completed an interview at study enrolment and every 3 months thereafter until the death of the patient or the end of the study period (15 months). All interviewees used a 100-point visual analog scale to represent their current goals of care, with quality of life (scored as 0) and survival (scored as 100) serving as anchors. Discordance was defined as an absolute difference between patient and oncologist goals of care of 40 points or more.
RESULTS
The study enrolled 378 patients and 11 oncologists. At baseline, 24% discordance was observed, and for patients who survived, discordance was 24% at their last interview. For patients who died, discordance was 28% at the last interview before death, with discordance having been 70% at enrolment. Dissatisfaction with eol care was reported by 23% of the caregivers for patients with discordance at baseline and by 8% of the caregivers for patients who had no discordance ( = 0.049; ϕ = 0.20).
CONCLUSIONS
The data indicate the presence of significant ongoing oncologist-patient discordance with respect to goals of care. Early use of a simple visual analog scale to assess goals of care can inform the oncologist about the patient's goals and lead to delivery of care that is aligned with patient goals.
Topics: Adult; Aged; Decision Making; Female; Humans; Male; Middle Aged; Neoplasms; Oncologists; Patient Care Planning; Physician-Patient Relations; Quality of Life; Terminal Care
PubMed: 31896935
DOI: 10.3747/co.26.5431 -
BMJ Open May 2021Shared care models in the field of cancer aim to improve care coordination, role clarification and patient satisfaction. Cross-sectoral communication is pivotal.... (Randomized Controlled Trial)
Randomized Controlled Trial
Cross-sectoral communication by bringing together patient with cancer, general practitioner and oncologist in a video-based consultation: a qualitative study of oncologists' and nurse specialists' perspectives.
UNLABELLED
Shared care models in the field of cancer aim to improve care coordination, role clarification and patient satisfaction. Cross-sectoral communication is pivotal. Involvement of patients may add to intended mechanisms.A randomised controlled trial 'The Partnership Study' tested the effect of bringing together patient, general practitioner (GP) and oncologist for a consultation conducted by video.
PURPOSE
As part of the process evaluation, this study aimed to explore experiences, attitudes and perspectives of the oncological department on sharing patient consultations with GPs using video.
METHODS
Four semistructured interviews with five oncologists and four nurse specialists were conducted in February 2020. We focused on the informants' experiences and reflections on the potential of future implementation of the concept 'inviting the GP for a shared consultation by video'. The analyses were based on an inductive, open-minded, hermeneutic phenomenological approach.
RESULTS
A total of six overall themes were identified: structuring consultation and communication, perceptions of GP involvement in cancer care, stressors, making a difference, alternative ways of cross-sector communication and needs for redesigning the model. The concept made sense and was deemed useful, but solving the many technical and organisational problems is pivotal. Case-specific tasks and relational issues were targeted by pragmatically rethinking protocol expectations and the usual way of communication and structuring patient encounters. Case selection was discussed as one way of maturing the concept.
CONCLUSION
This Danish study adds new insight into understanding different aspects of the process, causal mechanisms as well as the potential of future implementation of video-based tripartite encounters. Beyond solving the technical problems, case selection and organisational issues are important. Acknowledging the disruption of the usual workflow, the introduction of new phases of the usual encounter and the variety of patient-GP relationships to be embraced may help to better understand and comply with barriers and facilitators of communication and sharing.
TRIAL REGISTRATION NUMBER
NCT02716168.
Topics: Communication; General Practitioners; Humans; Neoplasms; Nurse Specialists; Oncologists; Physician-Patient Relations; Qualitative Research; Referral and Consultation
PubMed: 33952540
DOI: 10.1136/bmjopen-2020-043038 -
Inquiry : a Journal of Medical Care... 2021Within the past decade, the U.S. health care market has undergone massive vertical integration, prompting economists to study the underlying causes and consequences of...
Within the past decade, the U.S. health care market has undergone massive vertical integration, prompting economists to study the underlying causes and consequences of hospital-physician integration. This paper examines whether or not hospitals strategically choose to vertically integrate with clinical oncologists in order to capture facility fees, a commonly cited reason for increased consolidation in the health care market. To address this question, I match data on hospitals' ownership of clinical oncologists with Medicare payment data disaggregated to the physician and specific service level. I leverage a 2014 policy change that drastically altered the payment structure of Medicare's facility fees paid to hospitals for evaluation and management services-and yet, it did not alter the direct payments made to physicians. Contrary to popular belief, I find no evidence that the financial incentives of facility fees have an effect on the probability that a hospital and a clinical oncologist vertically integrate.
Topics: Aged; Hospitals; Humans; Medicare; Motivation; Oncologists; Ownership; United States
PubMed: 34269086
DOI: 10.1177/00469580211022968 -
Cancer Control : Journal of the Moffitt... 2023Patients with advanced cancers and their oncologists are often faced with difficult treatment decisions, especially when there are borderline situations of expected... (Review)
Review
Patients with advanced cancers and their oncologists are often faced with difficult treatment decisions, especially when there are borderline situations of expected benefit or increased risk of complications. In this narrative review, we will explore the decision-making process for patients with advanced cancers and provide insights on how to approach this complex task, while didactically dividing the oncologist's assessments according to a mnemonic rule of the ABCDE of therapeutic decision-making. Part A (advanced cancer) recalls that the rule is to be used specifically for advanced cancers. Parts B (potential benefits) and C (clinical conditions and risks) represents the traditional risk vs benefit scale. In Part D, we discuss ways to identify and understand patients' desires, values, preferences, and beliefs. The prognostic estimation, from Part E, may function as an "adjust" for the antineoplastic treatment decision-making. Treatment decisions need to be conducted by skilled oncologists, in a patient-centered care, aiming to promote valuable oncology with lower rates of aggressive care.
Topics: Humans; Neoplasms; Antineoplastic Agents; Medical Oncology; Palliative Care; Oncologists; Decision Making
PubMed: 37178323
DOI: 10.1177/10732748231176639 -
Current Oncology (Toronto, Ont.) Feb 2020
Topics: Delivery of Health Care; General Practitioners; Humans; Oncologists
PubMed: 32218653
DOI: 10.3747/co.27.5961 -
Families, Systems & Health : the... Dec 2019This article describes a conversation between a father diagnosed with cancer and his son, who is an oncologist. The father has turned to his son for medical advice and...
This article describes a conversation between a father diagnosed with cancer and his son, who is an oncologist. The father has turned to his son for medical advice and the son subsequently becomes his father's "personal oncologist." (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Topics: Back Pain; Bone Neoplasms; Family Relations; Fathers; Humans; Intergenerational Relations; Male; Oncologists
PubMed: 31815516
DOI: 10.1037/fsh0000445 -
PloS One 2022A diagnosis of cancer is associated with significant physical, psychological and financial burden. Including costs of cancer is an important component of shared decision...
BACKGROUND
A diagnosis of cancer is associated with significant physical, psychological and financial burden. Including costs of cancer is an important component of shared decision making. Doctors bear a responsibility towards educating patients about the financial aspects of care. Multiple organisations have advocated for price transparency and implementing Informed Financial Consent in the clinic. However, few studies have evaluated the perspectives of oncologists on the current state of this discussion.
AIMS
The aim of this study is to determine the views and perspectives of medical oncologists regarding communication of costs and financial burden in patients with cancer.
METHODS
We conducted a prospective cross-sectional online survey via REDCap. The survey was distributed to medical oncologists and advanced trainees currently registered with Medical Oncology Group of Australia (MOGA). Data was collected using the online survey comprising socio-demographic characteristics, discussion of costs and financial burden, and facilitators and barriers to these discussions.
RESULTS
547 members of MOGA were invited to participate in the study, and 106 of 547 MOGA members (19%) completed the survey. Most oncologists (66%) felt that it was their responsibility to discuss costs of care, however a majority of oncologists (59.3%) reported discussing costs with less than half of their patients. Only 25% of oncologists discussed financial concerns with more than half of their patients, and most oncologists were unfamiliar with cancer-related financial burden. Most Oncologists with greater clinical experience and those working in private practice were more likely to discuss costs with a majority of their patients.
CONCLUSIONS
Certain characteristics of medical oncologists and their practices were associated with reported prevalence of discussing costs of care and financial burden with their patients. In the context of rising costs of cancer care, interventions targeting modifiable factors such as raising oncologist awareness of costs of care and financial burden, screening for financial toxicity and availability of costs information in an easily accessible manner, may help increase the frequency of patient-doctor discussions about costs of care, contributing to informed decision-making and higher-quality cancer care.
Topics: Humans; Financial Stress; Cross-Sectional Studies; Prospective Studies; Oncologists; Medical Oncology; Neoplasms
PubMed: 36269711
DOI: 10.1371/journal.pone.0273620