Development and pilot evaluation of a complex intervention to improve experienced continuity of care in patients with cancer

PurposeThis review aimed to examine (a) trends in the number of publications on unmet needs over time and (b) the effectiveness of interventions designed to reduce unmet needs among cancer patients.MethodsAn electronic literature search of Medline to explore trends in the number of publications on patients’ unmet needs and an additional literature search of Medline, CINAHL, PsychINFO, and Web of Science databases to identify methodologically rigorous research trials that evaluated interventions to reduce unmet needs were conducted.ResultsPublications per year on unmet needs have increased over time, with most being on descriptive research. Nine relevant trials were identified. Six trials reported no intervention effect. Three trials reported that intervention participants had a lower number of unmet needs or lower unmet needs score, compared to control participants. Of these, one study found that the intervention group had fewer supportive care needs and lower mean depression scores; one study found that intervention participants with high problem-solving skills had fewer unmet needs at follow-up; and one study found an effect in favor of the intervention group on psychological need subscale scores.ConclusionsReasons for varying results across trials and the limited effectiveness of unmet needs interventions are more broadly discussed. These include inadequacies in psychometric rigor, problems with scoring methods, the use of ineffective interventions, and lack of adherence to intervention protocols.

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“…Four of the seven RCTs reported that allocation was concealed when eligibility was being assessed [29–32]. …”

Section: Resultsmentioning

confidence: 99%

The unfulfilled promise: a systematic review of interventions to reduce the unmet supportive care needs of cancer patients

Carey

Lambert

Smits

et al. 2011

Support Care Cancer

138

110

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“…These additional team members may be physically present at the MDC meeting or available for consult. This ensures that the patient is informed and guided during and after treatment, from inpatient status to outpatient status, moving patient care prospectively (12,16). Table 1 summarizes the ways in which the MDC team has differed historically from tumor boards, although in practice these distinctions can sometimes be blurred and models can blend various dimensions (17).…”

Section: Treatment Processes and Teammentioning

confidence: 99%

The Organization of Multidisciplinary Care Teams: Modeling Internal and External Influences on Cancer Care Quality

et al. 2010

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Quality cancer care is complex and depends upon careful coordination between multiple treatments and providers and upon technical information exchange and regular communication flow between all those involved in treatment (including patients, specialist physicians, other specialty disciplines, primary care physicians [PCPs], and support services) (1). Earlier in this supplement, Taplin and others have pointed out the challenges of transferring information and responsibility among providers and institutions; a problem at the interfaces of care. Advances in surgical procedures, chemotherapy, computer technology, and targeted molecular and radiation therapies have all led to an increase in multimodality therapy, which increases the number of interfaces among cancer specialists and other clinicians in the treatment of any single patient. Contemporary cancer care thus presents a paradox: The potential for unparalleled quality and sophisticated treatment is high, yet the number of potential "failure" events in the continuum of cancer treatment (2) has multiplied significantly. Each failure in communication between various physicians and care providers and every transition and interface miscue can result in delayed treatment planning and implementation, unnecessary duplication of tests, incomplete follow-up, increased patient anxiety, decreased patient satisfaction, and declines in quality of life.This article will examine a particular type of organizational structure focused on the interfaces between multiple specialists involved in cancer treatment: the multidisciplinary treatment care (MDC) team. This structure has been identified as one method of ensuring the exchange of patient-related and technical information between all physicians and support services involved in a patient's care. The setting and format of the MDC encourage active involvement of all actors (including the patient and his/her family) in the development of a care plan. Once formed, MDC team meetings can be convened at multiple times throughout the process of cancer care (Figure 1 in Taplin) (3) and can thus serve as an ongoing communication structure aimed at smoothing the transitions between multiple stages of care.MDC teams are the successors to the tumor conference, and they have been an arrangement for coordinating cancer care for at least 30 years (4,5). The health-care management literature advocates for more frequent use of MDC teams (6,7), and the National Cancer Institute has historically supported their development and diffusion, dating back to the cancer network demonstrations of the late 1970s and early 1980s (5,8), and through the National Cancer Institute Community Cancer Center Programs of recent times (9). However, little, if any empirical evidence exists on the prevalence, efficacy, and diffusion of MDC teams in cancer treatment or on their effectiveness in smoothing transitions across stages of cancer care.This article presents a targeted review of the literature (primarily since 2000) on what is known about various types of MDC ...

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“…We noted knowledge gaps about issues such as coordination of care, follow up and survivorship (King et al, 2009;Schmidt-Hansen, Baldwin & Hasler, 2012;Surapaneni, Singh, Rajagopalan, & Hageboutros, 2012). Conducting an in-depth review of the prevention and screening literature was beyond the scope of our research.…”

Section: Variations In Treatments Offeredmentioning

confidence: 99%

Evidence-practice gaps in lung cancer: A scoping review

et al. 2016

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Lung cancer is a significant international health problem. Aligning clinical practice with evidence-based guideline recommendations has the potential to improve patient outcomes. This scoping review describes evidence-practice gaps across the diagnostic and management care pathway for lung cancer. We conducted searches of online databases Medline, PsychInfo, Cinahl and the Cochrane Library to identify studies published between 2008 and 2012. Of 614 articles screened, 65 met inclusion criteria. We identified seven evidence-practice gaps: (1) delays in timely diagnosis and referral; (2) curative and (3) palliative treatments are under-utilised; (4) older age and co-morbidities influence the use of treatments; (5) the benefits of multidisciplinary team review are not available to all lung cancer patients; (6) psychosocial needs are unmet; and (7) early referral to palliative care services is under-utilised. The scoping review highlighted three key messages: (1) there are significant challenges in the timely diagnosis and referral of lung cancer; (2) curative and palliative treatments, psychosocial support and palliative care are under-utilised in lung cancer management; and (3) variations in treatment utilisation appear to be associated with non-disease factors such as patient characteristics, provider practices and the organisation of health care services. Future research should focus on designing interventions to overcome variations in care.

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Development and pilot evaluation of a complex intervention to improve experienced continuity of care in patients with cancer

Cited by 32 publications

References 10 publications

The unfulfilled promise: a systematic review of interventions to reduce the unmet supportive care needs of cancer patients

The unfulfilled promise: a systematic review of interventions to reduce the unmet supportive care needs of cancer patients

The Organization of Multidisciplinary Care Teams: Modeling Internal and External Influences on Cancer Care Quality

Evidence-practice gaps in lung cancer: A scoping review

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