BackgroundThe Wellness Beyond Cancer Program (wbcp) was launched in 2012, first accepting patients with

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pathways in breast, colorectal, and prostate cancer disease sites; rectal cancer surgery centralization; increased use of sentinel lymph node biopsies in breast cancer surgery; and decreased positive surgical margin rates in prostate cancer. ConclusionsImproved quality is likely a result of diverse confounding factors. The deliberately cultivated multihospital multidisciplinary cops have contributed to positive structural and functional change in cancer surgery in the region. This regional cop model has the potential to play an important role in the development of successful collaborations in care quality improvement. KEY WORDSCommunity of practice, regional collaboration, quality improvement, cancer care

Background To date, little research has examined the quality of life and cancer-associated needs of bladder cancer patients. The objective of the current study was to assess the quality of life (QoL), informational needs, and supportive care needs (SCN) in a large sample of muscle invasive (MIBC) and non-muscle invasive (NMIBC) bladder cancer survivors across the treatment trajectory (newly diagnosed and undergoing treatment, post-treatment follow-up, and treatment for advanced/recurrent disease). Methods Questionnaires were distributed to a convenience sample of patients registered with Bladder Cancer Canada, the Princess Margaret Cancer Centre, or The Ottawa Hospital. Eligibility criteria included being > 18 years of age, English-speaking, and diagnosed with bladder cancer. The questionnaire included an adapted tool to measure informational needs, and validated measures for QoL (Bladder Utility Symptom Scale, BUSS) and SCN (Cancer Survivors’ Unmet Needs Measure, CaSUN). QoL scores and unmet needs were calculated and compared between disease groups and cancer trajectory groups. Results and limitations Of the 1126 surveys distributed, 586 were completed (response = 52%). Mean age was 67.3 ± 10.2 years, and 401 participants (68.7%) were male. The mean QoL score (BUSS) for the sample was 78.1 ± 17.9 (median 81.7). Respondents with MIBC had significantly lower QoL scores compared to NMIBC. Further, scores differed across the cancer phase groups with the follow-up surveillance group having significantly higher QoL scores compared to the newly diagnosed and advance/recurrent disease groups. The ten most highly ranked informational needs were from the medical, physical, and practical domains. Eighty-eight percent (95% CI 85–91%) of respondents reported at least one SCN, with a median of 12. Over half of the participants (54%, 95% CI 49–59%) had at least one unmet need and 15% had ≥ 10 unmet needs. Newly diagnosed participants had the highest number of unmet needs. Conclusion We found that the number of unmet supportive care needs and quality of life differed across cancer trajectory and disease groups. Future efforts should focus on the development and evaluation of tailored resources and programs to address the needs of people diagnosed and treated for BC. Electronic supplementary material The online version of this article (10.1007/s00520-019-4649-z) contains supplementary material, which is available to authorized users.

ConclusionBladder cancer survivors are not meeting guidelines for important lifestyle behaviours that may improve their overall HRQoL. Future research should investigate the impact of behavioural and educational interventions for health behaviours on HRQoL in this population. Keywordshealth behaviours, health-related quality of life, patient education, supportive care, #BladderCancer, #blcsm

not on the role of cops in large-scale collaborations across multiple disciplines 6,7 .The idea that a cop can be deliberately started and supported by an organization to facilitate multiprofessional collaboration is a new and emerging area of enquiry. It has also been increasingly used as a theoretical approach to analyze and compare large-scale health care collaborations 1,5,8 . Additionally, a number of recent research findings have suggested that features of cop might be beneficial in addressing the challenges of multi-professional, multi-organizational collaborations [9][10][11] .The present paper attempts to close the gap between cop conceptualization and its application in health care settings by describing a working model that was used in the implementation of regional cops in cancer surgery. In addition, we explore the nature of peer networks within health care organizations and the opportunity for integrating existing networks from independent hospitals within a region into a manageable community. RESEARCH DESIGN Phase One: Literature ReviewIn our 2007 study of collaborative initiatives development in health care, we explored the possibility of applying a cop model to facilitate quality improvements in cancer surgery 8 . Using that model as an analytic approach in our 2009 systematic literature review of surgical collaborations, we looked for common elements in enabling operating infrastructures and tools 2 . The review further enhanced development of our model. The optimal structure for the collaboration was described as regional in scope, evidence-based, data-driven, and supported institutionally through strategic partnerships providing comprehensive support as part of the continuous quality improvement cycle 2,12 .Here, we examine recent findings on the role of cops in large-scale health care collaborations, with a ABSTRACTPressing challenges have forced health care providers to rethink traditional silos and professional boundaries. Communities of practice (cops) have been identified as a means to share knowledge across silos and boundaries. However, clarity sufficient to enable their easy and uniform reproducibility is lacking, leading to a gap between cop conceptualization and implementation. This paper explores a cop structure and outlines a framework that is adaptable, measurable, and implementable across health disciplines in a regional cancer surgery program. KEY WORDSCommunity of practice, regional collaborations, quality improvement, health care services research, knowledge translation

Objectives Shared medical appointments are group appointments, with an optional individual consultation, for patients diagnosed with chronic illnesses. Shared medical appointments improve diabetes management, but little is known about their use for other illnesses. The objective was to determine the effect that shared medical appointments have on patients with a physical chronic illness, healthcare providers, and the healthcare system. Methods A systematic review was conducted searching databases from January 1970 to September 2016. Eligible trials evaluated shared medical appointments for patients with a homogeneous chronic illness, excluding diabetes and mental illness. Screening, data extraction, and risk of bias were conducted independently by two authors. Analysis was descriptive. Results Of 2364 citations, nine randomized trials were included. Shared medical appointments were evaluated for cardiovascular illnesses (four studies), breast cancer, chronic kidney disease, Parkinson's disease, stress urinary incontinence, and carpal tunnel syndrome. Compared to usual care, no negative effects on patient quality of life, knowledge and satisfaction were reported. One study reported no difference in healthcare provider satisfaction. Another study showed fewer hospital admissions for patients who attended shared medical appointments. Discussion Few rigorous studies evaluated the use of shared medical appointments for chronic illnesses. Overall, there appears to be no patient harms. Further studies should include more objective outcomes and larger sample sizes.

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