Background:A cancer diagnosis is a monumental event in a patient’s life and with the number of cancer survivors increasing; most of these patients will be taken care of by a primary care provider at some point after their cancer therapy. The purpose of this study is to identify primary care physician’s needs to care for a patient who has had cancer.Methods:A cross-sectional survey of the physician members of the Iowa Research Network was conducted. The survey was designed to measure physician confidence in cancer survivor’s care, office strategies regarding cancer survivorship care, and resources available for patients with cancer. Two hundred seventy-four Iowa Research Network members were invited to participate in this survey.Results:Eighty-two physicians (30%) completed the questionnaire with 96% reporting that they are aware of their patient’s cancer survivorship status. Seventy-one physicians reported they were aware of cancer survivorship status by an oncologist sending a note to the office, 68 being diagnosed in their office, 61 by the patient keeping the office apprised, and 15 receiving a survivorship care plan. Physicians reported the top changes in a cancer survivor’s physical health as fatigue (81%) and pain (59%). Sixty-two physicians reported not feeling confident for managing chemobrain, cardiotoxicity (71%), and skin changes (35%). Male physicians were significantly more confident managing patients’ skin changes (P = .049) and musculoskeletal disturbances than female physicians (P = .027), while female physicians were significantly more confident managing early-onset menopause than male physicians (P = .027).Conclusion:Most respondents are aware of their patients who are cancer survivors and are mostly confident in the care they provide for them related to long-term effects and side effects of cancer therapies with limited receipt of cancer survivorship care plans.
Introduction: Faculty and residents strive for appropriate autonomy and entrustment. Initial direct supervision of clinical care gradually shifts to increasing levels of resident independence over time. Faculty members are inconsistent in resident supervision leading to missed opportunities for resident independence. Methods: Family medicine faculty workshop participants completed teaching style self-evaluations prior to discussion of clinical examples with excessive or insufficient autonomy. Participants reviewed real resident feedback examples to increase insight into teaching styles. Participants were presented with cases to discuss varying degrees of resident autonomy and entrustment. Learners committed to one specific behavior to calibrate the degree of autonomy they provide. Results: Of the faculty, 113 members participated in the workshop with the majority (98%) finding the workshop relevant in helping them to identify strategies for reflecting on their degree of autonomy allowed and to look for appropriate situations for enhancing their resident entrustment. Discussion: This interactive workshop provided clear ways for addressing the issue of independence versus control in supervision of patient care. It provided a feedback mechanism for educators who provide too much or too little autonomy for the best resident learning. Additionally, this conversation encouraged participants to engage in self-reflection on the autonomy given to their resident.
Introduction: Electronic health records (EHRs) are often leveraged in medical research to recruit study participants efficiently. The purpose of this study was to validate and refine the logic of an EHR algorithm for identifying potentially eligible participants for a comparative effectiveness study of fecal immunochemical tests (FITs), using colonoscopy as the standard.Methods: An Epic report was built to identify patients who met the eligibility criteria to recruit patients having a screening or surveillance colonoscopy. With the goal of maximizing the number of potentially eligible patients that could be recruited, researchers, with the assistance of information technology and scheduling staff, developed the algorithm for identifying potential subjects in the EHR. Two validation methods, descriptive statistics and manual verification, were used.Results: The algorithm was refined over 3 iterations leading to the following criteria being used for generating the report: Age, Appointment Made On/Cancel Date, Appointment Procedure, Contact Type, Date Range, Encounter Departments, ICD-10 codes, and Patient Type. Appointment Serial Number/ Contact Serial Number were output fields that allowed the tracking of cancellations and reschedules.Conclusion: Development of an EHR algorithm saved time in that most individuals ineligible for the study were excluded before patient medical record review. Running daily reports that included cancellations and rescheduled appointments allowed for maximum recruitment in a time frame appropriate for the use of the FITs. This algorithm demonstrates that refining the algorithm iteratively and adding cancellations and reschedules of colonoscopies increased the accuracy of reaching all potential patients for recruitment. (
Context: Colorectal cancer (CRC) is the second most common cause of cancer death worldwide. Fecal immunochemical tests (FITs) are currently the most used strategy for population-based CRC screening in Europe and some Asian countries. Positive FIT results should be followed by colonoscopy. Objective: To identify the factors associated with false positive FIT results. Study Design and Analysis: Each participant completed five different FITs from a single stool sample prior to their colonoscopy. Colonoscopy and associated pathology reports were reviewed. Based on the pathology results, we dichotomized patients as having advanced colorectal neoplasia (ACN) or not. ACN was defined as adenomatous ≥ 10mm or sessile serrated polyps ≥ 10mm; any polyps with villous or tubulovillous pathology, or traditional serrated adenomas; any lesion with high grade dysplasia, or any stage of adenocarcinoma. FITs were false positive if no ACN was found on pathology reports. We used PROC GLIMMIX models in SAS to assess variables associated with false positive FIT results. Setting: Three academic medical centers in Iowa, North Carolina, and Texas. Population Studied: Participants ages 50-85 years undergoing a screening or surveillance colonoscopy. Participants who did not meet the definition for ACN were included in the current analysis. Instruments: Participant self-reported health questionnaire and colonoscopy/pathology review form. Results: Of the 3,759 participants, 3,440 did not have ACN and were included in this analysis. The mean age was 62.1 (±7.8) years; 64% were women, 86% White, and 29% Hispanic. The multivariable model showed the odds ratio of having a false positive FIT result vs. a true negative FIT result was 1.02 (95% CI, 1.01-1.03) for every year increase in age, 1.04 (95% CI, 1.03-1.06) for every one unit increase in BMI, 1.82 (95% CI, 1.29-2.56) for current smoker vs. never smoker, 1.33 (95% CI, 1.10-1.60) for regular aspirin use, and 2.12 (95% CI, 1.45-3.10) for blood thinner use, after controlling for the five FITs and other variables in the model. Conclusion: Several risk factors were associated with an increased odds for false positive FIT results. These findings were similar to other studies. Clinicians should be aware of these factors which may lead to false positive FITs in FIT-based colorectal cancer screening programs.
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