The identified gap in social media use between age cohorts may have negative implications for communication in oncology. Despite advancements in social media and efforts to integrate social media into medical education, most oncologists and trainees use social media rarely, which, along with the age-related gap in use, may have consequences for collaboration and education in oncology. Investigations to further understand barriers to social media use should be undertaken to enhance physician collaboration and knowledge sharing through social media.
BackgroundUse of the neoadjuvant approach to treat breast cancer patients has increased since the early 2000s, but the overall pathway of care for such patients can be highly variable. The aim of our project was to establish a multidisciplinary consensus among clinicians with expertise in neoadjuvant therapy (nat) for breast cancer and to determine if that consensus reflects published methods used in randomized controlled trials (rcts) in this area.MethodsA modified Delphi protocol, which used iterative surveys administered to 85 experts across Canada, was established to obtain expert consensus concerning all aspects of the care pathway for patients undergoing nat for breast cancer. All rcts published between January 1, 1967, and December 1, 2012, were systematically reviewed. Data extracted from the rcts were analyzed to determine if the methods used matched the expert consensus for specific areas of nat management. A scoring system determined the strength of the agreement between the literature and the expert consensus.ResultsConsensus was achieved for all areas of the pathway of care for patients undergoing nat for breast cancer, with the exception of the role of magnetic resonance imaging in the pre-treatment or preoperative setting. The levels of agreement between the consensus statements and the published rcts varied, primarily because specific aspects of the pathway of care were not well described in the reviewed literature.ConclusionsA true consensus of expert opinion concerning the pathway of care appropriate for patients receiving nat for breast cancer has been achieved. A review of the literature illuminated gaps in the evidence about some elements of nat management. Where evidence is available, agreement with expert opinion is strong overall. Our study is unique in its approach to establishing consensus among medical experts in this field and has established a pathway of care that can be applied in practice for patients receiving nat.
Results: Family members felt that Palliative Care Primary Team managed Pain (44.8% vs 21.9%) (p ¼ 0.09) and Delirium better (64.7% vs 14.3%) (p ¼ 0.08). Families also felt that the Palliative Care Primary Team attended to patient's emotional needs (53.3% vs 30.0%) (p ¼ 0.01) and caregivers emotional needs (75.0% vs 41.7%) (p LT 0.001). 90.0% would recommend the Palliative Care Primary team to others facing a similar situation compared to non-palliative care teams (73.3%) (p ¼ 0.02). Discussion and Conclusion: Patients experienced better control of pain, delirium and dyspnea when under palliative care primary teams. Family members also felt that patient and their own emotional needs were better supported and would recommend the Palliative Care team to others going through a similar situation. The presence of a Palliative Care Primary Care team in an acute hospital improves patient and family outcomes for patients near the end-of-life.
196 Background: Introducing palliative care early in the cancer journey results in a better quality of life, less aggressive care and longer survival compared to patients receiving standard care. The INTEGRATE project goal is to identify and manage patients who may benefit from palliative care earlier in their care. Multidisciplinary cancer conferences (MCCs) are scheduled meetings for oncology teams to prospectively discuss patient diagnostic tests and treatment options. In this study, we tested whether MCCs could be used as a forum to identify patients using the UK Gold Standards Framework Surprise Question (Would you be surprised if this person died within the next year?). Methods: Cancer centres volunteered to participate in a pilot project to test the efficacy of the Surprise Question at MCCs and implement a palliative model of care. Prior to initiation, a survey was completed to identify provider comfort in providing palliative care. All sites received primary level palliative care education by completing Pallium Canada’s LEAP Oncology module. Identified patients received Advance Care Planning, symptom management, referrals and standardized reporting to primary care. Results: A baseline survey showed over 50% of providers had no palliative care training. 157 providers participated in LEAP Oncology. Three MCC disease sites (Lung, GI and CNS) are participating in 3 academic and 1 non-academic cancer centres. Implementation of the Surprise Question began in February 2015 and by August 2016, 300 patients were identified out of 1086 total reviewed patients. At the CNS MCC, 100% of all glioblastoma patients were identified. The Lung and GI sites had lower identification rates (19% and 19%, respectively). Identified patients will have their healthcare utilization (community referrals, billing patterns, etc.) analyzed and final results will be synthesized by project completion in January 2017. Conclusions: MCCs appear to be an excellent forum for identifying patients who may benefit from a palliative approach to care within CNS, Lung and GI site groups. Further analysis will inform broader palliative care recommendations in Ontario.
A systematic review was conducted to assess the use of social media to enhance breast cancer care. In addition, a Web-based search using common search engines and publicly available social media was conducted to determine the prevalence of information and networking pages aimed at patients and clinicians. Over 400 articles were retrieved; 81% focused on delivery of information or online support to patients, 17% focused on delivery of information to physicians, and 1% focused on the use of social media to improve collaboration among clinicians. Web searches retrieved millions of hits, with very few hits relating to improving collaboration among clinicians. Although there is significant potential to utilize current technologies to improve care for patients and improve connectedness among clinicians, most of the currently available technologies focus solely on the delivery of information.
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