Promoting assessment and management of function through navigation: opportunities to bridge oncology and rehabilitation systems of care

Stout, Nicole L.; Sleight, Alix G.; Pfeiffer, Denise; Galantino, Mary Lou; DeSouza, Bianca

doi:10.1007/s00520-019-04741-0

Cited by 30 publications

(33 citation statements)

References 44 publications

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“…The survivorship care team is ideally positioned to use the screening algorithm throughout cancer care and to improve access to supportive care services, including exercise. Implementation strategies to integrate the screening tool into oncology practice include leveraging patient navigation frameworks for screening and exercise referrals, 70 using patient‐reported outcomes measures to identify symptom changes that warrant referrals, 71 and using prospective supportive care services from the point of diagnosis 23,72 . Colocated services with same‐day appointments for onsite supportive care interventions promote earlier engagement and improve patient outcomes and satisfaction 73 …”

Section: Methodsmentioning

confidence: 99%

“…The algorithm herein identifies screening questions and provides prompts toward an exercise clinical pathway. Ideally, oncology professionals will discuss exercise with their patients, but this may not always be feasible; therefore, the referral pathway to rehabilitation or exercise professionals may be optimal from a time management perspective 70 …”

Section: Methodsmentioning

confidence: 99%

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An exercise oncology clinical pathway: Screening and referral for personalized interventions

Stout

Brown

Schwartz

et al. 2020

Cancer

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INTRODUCTIONThere are approximately 17 million cancer survivors living in the United States, and by 2040, this estimate is predicted to increase to 26.1 million. 1 Exercise provides a myriad of health benefits to individuals during and after cancer treatment by reducing treatment-related symptoms, improving functional status and quality of life, and lowering the risk of disease recurrence. 2,3 Despite the established benefits, an individual's level of physical activity often decreases during treatment and does not return to prediagnosis levels after treatment completion. 4,5 Although exercise is regarded as safe and beneficial for individuals with cancer, promoting exercise for this population is complex. A patient-centered pathway is needed that can guide oncology and primary care professionals in the efficient assessment of an individual's condition and enable personalized referrals for exercise interventions that promote physical activity. The purpose of this article is to provide a framework for clinical decision making that enables personalized condition assessment, risk stratification, and referral to optimal settings for exercise promotion for cancer survivors. Implementation strategies are also offered to support the integration of this model into an oncology clinical workflow.With guidance from their medical provider, individuals are more likely to engage in exercise and maintain levels of physical activity during cancer treatments. 6 However, the number of individuals with cancer who report receiving exercise-specific guidance from their health care providers is low. 7 Of particular concern is the lack of knowledge and training among health care professionals about exercise prescription for this complex population. 8

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

An exercise oncology clinical pathway: Screening and referral for personalized interventions

Stout

Brown

Schwartz

et al. 2020

Cancer

Self Cite

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“…Collaborative clinical models that integrate rehabilitation providers in oncology care can enhance guideline concordant symptom and condition management by promoting more timely assessment of functional morbidity and efficient referral to rehabilitation care. 44,166,168 Recent calls for escalating the use of Patient Reported Outcomes 171 (PROs) and use of detailed functional assessment batteries, such as the Geriatric Assessment (GA) will only improve outcomes if they are used to go beyond characterizing the suitability of an individual for antineoplastic therapies or determining the superiority of an agent in drug comparison trials. A better understanding of the definition of function and improved accuracy of functional assessment can be enhanced by rehabilitation professionals, but more so, can establish the much needed linkage so that providers optimize the use of PROs and functional assessment to enable referrals for services that actually enhance function.…”

Section: Future Directionmentioning

confidence: 99%

“…Time points in the care continuum, symptom severity, and type of treatment interventions are identified across many guidelines as events that should trigger rehabilitation referrals. Exploring better use of electronic health records 163 and multidimensional team‐based care 164,165 , co‐location of rehabilitation services 166,167 , and extending navigation work processes to include rehabilitation 168 could improve guideline concordant care. Such research questions provide insight on opportunities to substantially improve quality of life and function among survivors.…”

Section: Future Directionmentioning

confidence: 99%

A systematic review of rehabilitation and exercise recommendations in oncology guidelines

Stout

Mina

Lyons

et al. 2020

CA A Cancer J Clinicians

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155

140

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Guidelines promote high quality cancer care. Rehabilitation recommendations in oncology guidelines have not been characterized and may provide insight to improve integration of rehabilitation into oncology care. This report was developed as a part of the World Health Organization (WHO) Rehabilitation 2030 initiative to identify rehabilitation-specific recommendations in guidelines for oncology care. A systematic review of guidelines was conducted. Only guidelines published in English, for adults with cancer, providing recommendations for rehabilitation referral and assessment or interventions between 2009 and 2019 were included. 13840 articles were identified. After duplicates and applied filters, 4897 articles were screened. 69 guidelines were identified with rehabilitation-specific recommendations. Thirtyseven of the 69 guidelines endorsed referral to rehabilitation services but provided no specific recommendations regarding assessment or interventions. Thirty-two of the 69 guidelines met the full inclusion criteria and were assessed using the AGREE II tool. Twenty-one of these guidelines achieved an AGREE II quality score of ≥ 45 and were fully extracted. Guidelines exclusive to pharmacologic interventions and complementary and alternative interventions were excluded. Findings identify guidelines that recommend rehabilitation services across many cancer types and for various consequences of cancer treatment signifying that rehabilitation is a recognized component of oncology care. However, these findings are at odds with clinical reports of low rehabilitation utilization rates suggesting that guideline recommendations may be overlooked. Considering that functional morbidity negatively affects a majority of cancer survivors, improving guideline concordant rehabilitative care could have substantial impact on function and quality of life among cancer survivors. CA Cancer

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“…Traditionally, the CP is mainly implemented by medical personnel to prepare the most suitable and timely care plan for diagnosis. The dawn of the knowledge era raises new requirements on the CP: provide the patients with the best care by minimizing recovery delay and resource waste and maximizing the efficiency of clinical work and quality of medical services [8]. Hence, synchronous knowledge management is necessary before implementing the CP module in regional information network [9].…”

Section: Introductionmentioning

confidence: 99%

An Information System of Clinical Pathway Management Based on the Integration Between Knowledge Management and Learning Organization

Liu¹,

Kai²

2019

ISI

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Inspired by the integration between knowledge management and learning organization (K-L integration), this paper sets up a clinical pathway (CP) management model based on K-L integration, and puts forward several hypotheses on the chain of positive impacts between CP management process, CP organizational optimization and CP performance. To verify the effectiveness of the model, a questionnaire survey was carried out at a provincial first-class hospital, and the survey data were subjected to reliability and validity tests. The proposed hypotheses were verified based on the reliable and valid samples. The data analysis shows that the proposed model has good fitting effect. Based on the model, the authors established an information system of CP management that enhances the CP knowledge among medical personnel, promotes medical quality and reduces the medical cost. The research results shed new light on the CP management in hospitals.

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Promoting assessment and management of function through navigation: opportunities to bridge oncology and rehabilitation systems of care

Cited by 30 publications

References 44 publications

An exercise oncology clinical pathway: Screening and referral for personalized interventions

An exercise oncology clinical pathway: Screening and referral for personalized interventions

A systematic review of rehabilitation and exercise recommendations in oncology guidelines

An Information System of Clinical Pathway Management Based on the Integration Between Knowledge Management and Learning Organization

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