All.Can Roundup # 2
A regular roundup of cancer policy, research and opinion from around the world #AllCanRoundup
Policy and initiatives roundup
UK care improvement programme shows positive results
The UK’s Getting It Right First Time (GIRFT) programme was designed to document and tackle variations in clinical practice, initially in orthopaedic surgery.
Its advocates argue that it differs from the numerous other clinical audits in the NHS because it pulls various kinds of data together to draw a comprehensive picture of the clinical practice under scrutiny, from resource allocation to processes and outcomes.
Two new publications draw a positive picture of the results achieved so far. An informal assessment of the programme commissioned by the King’s Fund discusses GIRFT’s achievements and challenges, and concludes that it is producing gains in procurement, productivity and quality, and is outstandingly well received by clinicians.
The first of more than 30 reports to be published under the GIRFT programme presents the results for general surgery. It highlights great variations in what hospitals spend on medical equipment, and uncovers the potential for savings through better procurement in general surgery.
Read the report: General Surgery GIRFT Programme National Specialty Report
Variations in patient choice reveal inequalities in prostate cancer care
A study by the European Association of Urology found that 33.5% (n = 6,465) of men in the UK bypassed their nearest prostate cancer surgical centre in favour of one further away.
Men who were younger, fitter and more affluent were more likely to travel far to a surgical centre.
Patients were attracted by centres that offered robotic surgery, or by the reputation of individual clinicians. Validated measures of the quality of care were not found to play a role in patients’ choices.
The study concluded that ‘national policy based on patient choice and provider competition may have had a negative impact on equality of access, service capacity, and health system efficiency.’
Guidance for GPs’ conversations with cancer patients about existential concerns
Although aware that it is important, GPs may find it difficult to discuss cancer patients’ existential concerns with them.
GPs, doctors and expert groups in Norway and Denmark developed the EMAP (existential communication in general practices) tool, aiming to facilitate communication about existential problems and resources.
The tool contains 10 questions and 13 sub-questions that can serve as an orientation for the GP in the assessment of their patient’s distress. It may help to increase patient satisfaction and improve the patient–doctor relationship.
Choosing Wisely campaign needs more reinforcement in oncology practices in the US
The Choosing Wisely campaign has been positively received in the US as a step towards reducing unnecessary practices in cancer care. Its idea has been embraced in countries all over the world.
An evaluation compared concordance rates and practice variability over time in 314 oncology practices in the US. Concordance with Choosing Wisely recommendations varied significantly between practices and over time, from 67.7% for use of biomarkers or advanced imaging tests for surveillance in early breast cancer to 83% for other recommendations.
Read the article: Choosing Wisely in Oncology: Are We Ready For Value-Based Care?
Strengthening the role of specialist nurses in cancer care teams
In England, cancer patients may have an assigned specialist nurse as a ‘key worker’ (main point of contact) to help them navigate through the cancer journey and communicate with everyone involved in their care.
This survey explored patient and staff perspectives on the implementation of the key worker role. While it is highly valued by patients, who preferred to keep the same key worker over the entire care pathway, staff felt that more training and clarification of the role was needed. Staff also called for improved communication within the multidisciplinary care team.
A systematic review looked at seven qualitative studies about the experience of gynaecological cancer patients receiving specialist nurse care.
The synthesis of the studies found that specialist nurses play an important part in identifying the individual needs of women with gynaecological cancer. The nurses are seen as an accessible and trusted source of guidance, knowledge and support.
The authors suggest that specialist nurses should be available at key points along the continuum of care. They call for assurance that nurses can spend sufficient time with patients to identify their needs and deliver personalised care.
With the intention to add to the evidence base for the employment of specialist cancer nurses, a systematic review is planned to look at the impact of cancer nursing on patient outcomes and delivery of care.
The review will primarily focus on how cancer nurses can have an impact on care quality, and tackle contested questions like cost of services.
Read the protocol for the systematic review: Recognising European Cancer Nursing: Protocol for a systematic review and meta-analysis of the evidence of effectiveness and value of cancer nursing
New studies focus on caregivers’ impact on cancer patients’ wellbeing
Two articles focus on often-overlooked caregivers, suggesting that interventions around cancer care should take them into account more explicitly as they heavily impact on the wellbeing of cancer patients.
A systematic review looked at the effect of giving care on the post-bereavement mental health of adult caregivers of cancer patients. Results varied, but indicated that caregiver burden (especially emotional burden) has an adverse effect on post-bereavement mental health.
A second study looked at the carer–patient relationship and how each person’s sense of coherence and illness acceptance interacted.
Compared with cancer patients, their caregivers presented with significantly lower levels of perceived social support and a weaker sense of coherence. This had an impact on the patients’ acceptance of illness.
The authors conclude that the functioning of cancer patients is modulated by the psychosocial characteristics of their caregivers.
Identifying unmet needs in cancer survivorship care
As the number of cancer survivors grows, follow-up care responding to the needs of cancer survivors becomes increasingly important. There are significant knowledge gaps with regard to the care needs of cancer survivors and the effectiveness of interventions.
To shed light on cancer survivors’ preferences regarding psychological elements of care in comparison with the care they received, a recent US study surveyed 345 cancer survivors.
Participants stated professional counselling as their preferred form of psychological support, followed by professionally led cancer support groups. They least preferred pharmacological forms of support – the intervention they were most likely to have received. Their need for individual counselling, however, was often unmet.
Mindfulness-based cancer recovery as effective psychological support programme
A Hungarian RCT at the Firebird Foundation tested the effectiveness of mindfulness-based cancer recovery (MBCR) programme among Hungarian cancer patients.
The programme resulted in an improvement in quality of life and psychological variables such as increased optimism and vitality, levels of observed stress and depression decreased of observed stress and depression, and an escalation in optimism and vitality.
More importantly, these improvements were maintained over the whole course of the study which suggests that a mindfulness based cancer recovery programme may have lasting impact on mood and quality of life.
The challenge of balancing usability and usefulness of electronic medical records
A comment in the Journal of Oncology Practice focuses on the use of electronic medical records (EMR) in oncology in the US. However, many of the issues raised may be encountered in European health systems.
Putting emphasis on complete and comprehensive EMR comes with a trade-off in time for patient consultations: most physicians now spend more time in front of the computer than with patients.
This highlights the need to developing usable, adaptable EMR. This is a challenging task, particularily in cancer care. Oncologists have to coordinate and display complex therapies and outcomes involving a range of different healthcare professionals. Hence, the EMR system must support different users working in various contexts, which can result in lack of simplicity, naturalness, consistency and forgiveness.
The author suggests that improved usability of EMR will make healthcare safer, more efficient and more patient-centred.
Read the article: Usability Considerations in Oncology Electronic Medical Records