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Sample records for cancer care providers

  1. Barriers to Cancer Screening by Rural Appalachian Primary Care Providers

    ERIC Educational Resources Information Center

    Shell, Renee; Tudiver, Fred

    2004-01-01

    Rural Appalachia has significantly higher overall cancer mortality compared with national rates, and lack of cancer screening is believed to be one of the contributing factors. Reducing the cancer disparity in this region must include strategies to address suboptimal cancer screening practices by rural Appalachian primary care providers (PCPs). To…

  2. Barriers to Cancer Screening by Rural Appalachian Primary Care Providers

    ERIC Educational Resources Information Center

    Shell, Renee; Tudiver, Fred

    2004-01-01

    Rural Appalachia has significantly higher overall cancer mortality compared with national rates, and lack of cancer screening is believed to be one of the contributing factors. Reducing the cancer disparity in this region must include strategies to address suboptimal cancer screening practices by rural Appalachian primary care providers (PCPs). To


  3. An opportunity for coordinated cancer care: intersection of health care reform, primary care providers, and cancer patients.

    PubMed

    Collins, Lauren G; Wender, Richard; Altshuler, Marc

    2010-01-01

    The US health care system has become increasingly unsustainable, threatened by poor quality and spiraling costs. Many Americans are not receiving recommended preventive care, including cancer screening tests. Passage of the Affordable Care Act in March 2010 has the potential to reverse this course by increasing access to primary care providers, extending coverage and affordability of health insurance, and instituting proven quality measures. In order for health care reform to succeed, it will require a stronger primary care workforce, a new emphasis on patient-centered care, and payment incentives that reward quality over quantity. Innovations such as patient-centered medical homes, accountable care organizations, and improved quality reporting methods are central features of a redesigned health care delivery system and will ultimately change the face of cancer care in the United States. PMID:21131791

  4. Providing Culturally Appropriate Care to American Muslims With Cancer.

    PubMed

    Mataoui, Fatma; Kennedy Sheldon, Lisa

    2016-02-01

    Worldwide, Islam is the second most populous religion and, in many countries in the Middle East, South and Southeast Asia, and Africa, it is the predominant religion. The population of Muslims in the United States is projected to dramatically increase in the next few decades. Understanding the role of Islam for people who believe in and follow Islam-Muslims-will provide nurses with important perspectives that affect health behaviors, cancer screening, treatment decision-making, and end-of-life care.
. PMID:26800398

  5. Are Primary Care Providers Prepared To Care For Breast Cancer Survivors In The Safety Net?

    PubMed Central

    Dawes, Aaron J.; Hemmelgarn, Marian; Nguyen, David K.; Sacks, Greg D.; Clayton, Sheilah; Cope, Jacqueline; Ganz, Patricia A.; Maggard-Gibbons, Melinda

    2015-01-01

    Introduction With the growing number of breast cancer survivors outpacing the capacity of oncology providers, there is pressure to transition patients back to primary care. Primary care providers (PCPs) working in safety-net settings may have less experience treating survivors, and little is known about their knowledge and views on survivorship care. Objective To determine the knowledge, attitudes, and confidence of PCPs in the safety net at delivering care to breast cancer survivors. Participants A modified version of the National Cancer Institute’s Survey of Physician Attitudes Regarding Care of Cancer Survivors (SPARCCS) was given to providers at 2 county hospitals and 5 associated clinics (n=59). Focus groups were held to understand barriers to survivorship care. Results While most providers believed PCPs have the skills necessary to provide cancer-related follow-up, the vast majority were not comfortable providing these services themselves. Providers were adherent to American Society of Clinical Oncology recommendations for mammography (98%) and physical exam (87%); less than 1/3 were guideline-concordant for lab testing and only 6 providers (10%) met all recommendations. PCPs universally requested additional training on clinical guidelines and the provision of written survivorship care plans prior to transfer. Concerns voiced in qualitative sessions included unfamiliarity with the management of endocrine therapy and confusion regarding who would be responsible for certain aspects of care. Conclusion Safety-net providers currently lack knowledge and confidence at providing survivorship care to breast cancer patients. Opportunities exist for additional training in evidence-based guidelines and improved coordination of care between PCPs and oncology specialists. PMID:25536301

  6. Threading the cloak: palliative care education for care providers of adolescents and young adults with cancer

    PubMed Central

    Wiener, Lori; Weaver, Meaghann Shaw; Bell, Cynthia J; Sansom-Daly, Ursula M

    2015-01-01

    Medical providers are trained to investigate, diagnose, and treat cancer. Their primary goal is to maximize the chances of curing the patient, with less training provided on palliative care concepts and the unique developmental needs inherent in this population. Early, systematic integration of palliative care into standard oncology practice represents a valuable, imperative approach to improving the overall cancer experience for adolescents and young adults (AYAs). The importance of competent, confident, and compassionate providers for AYAs warrants the development of effective educational strategies for teaching AYA palliative care. Just as palliative care should be integrated early in the disease trajectory of AYA patients, palliative care training should be integrated early in professional development of trainees. As the AYA age spectrum represents sequential transitions through developmental stages, trainees experience changes in their learning needs during their progression through sequential phases of training. This article reviews unique epidemiologic, developmental, and psychosocial factors that make the provision of palliative care especially challenging in AYAs. A conceptual framework is provided for AYA palliative care education. Critical instructional strategies including experiential learning, group didactic opportunity, shared learning among care disciplines, bereaved family members as educators, and online learning are reviewed. Educational issues for provider training are addressed from the perspective of the trainer, trainee, and AYA. Goals and objectives for an AYA palliative care cancer rotation are presented. Guidance is also provided on ways to support an AYA's quality of life as end of life nears. PMID:25750863

  7. The psychosocial oncology learning assessment: a province-wide survey of cancer care providers' learning needs.

    PubMed

    Rennie, Heather; Mackenzie, Gina

    2010-06-01

    A psychosocial oncology learning needs assessment was developed and offered online to cancer care providers in a variety of settings across all health regions in British Columbia. The purpose was to better understand the psychosocial learning needs of cancer care providers and to use this knowledge to shape continuing education priorities. Respondents' preferred learning formats, access to technology and barriers to accessing psychosocial learning opportunities were also assessed. Cancer care providers including radiation therapists, social workers, dieticians, pharmacists, physicians and nurses in both community and agency settings were surveyed. Two hundred and sixty-seven people completed the survey. Key learning needs identified included cultural aspects of care, symptom management, treating the anxious patient, self-care for the professional, care of elderly patients, basic cancer-related medical issues surrounding care and ethics. Community respondents indicated more needs than agency respondents. On-site training was the most preferred learning format, and time constraints were the biggest barrier to accessing learning opportunities. Participants had access to technology. Next steps include conducting key informant and focus group interviews to determine if interest in a learning need is the same as a relevant knowledge and practice gap. This research suggests that cancer care providers are interested in learning more about the psychosocial issues related to cancer care. PMID:20361284

  8. Lung Cancer Screening with Low-Dose Computed Tomography for Primary Care Providers

    PubMed Central

    Richards, Thomas B.; White, Mary C.; Caraballo, Ralph S.

    2015-01-01

    This review provides an update on lung cancer screening with low-dose computed tomography (LDCT) and its implications for primary care providers. One of the unique features of lung cancer screening is the potential complexity in patient management if an LDCT scan reveals a small pulmonary nodule. Additional tests, consultation with multiple specialists, and follow-up evaluations may be needed to evaluate whether lung cancer is present. Primary care providers should know the resources available in their communities for lung cancer screening with LDCT and smoking cessation, and the key points to be addressed in informed and shared decision-making discussions with patients. PMID:24830610

  9. Best practices for pediatric palliative cancer care: a primer for clinical providers.

    PubMed

    Levine, Deena; Lam, Catherine G; Cunningham, Melody J; Remke, Stacy; Chrastek, Jody; Klick, Jeffrey; Macauley, Robert; Baker, Justin N

    2013-09-01

    Cancer is the leading cause of disease-related death in children and adolescents. Pediatric patients with cancer suffer greatly at the end of life. However, palliative care interventions can reduce suffering and significantly improve the care of these patients and their families. A large percentage of pediatric deaths occur outside of the hospital setting where pediatric palliative resources may not be readily available. Patients in the home setting may be cared for by community hospice programs, which are typically staffed for adult populations. Increasingly, nonpediatric providers are asked to provide palliative care for children and adolescents at the end of life, yet they receive little formal training in this area. This review focuses on the principles of best practice in the provision of palliative care for children and adolescents with cancer. Our intent is to aid clinical providers in delivering optimal care to this patient population. Topics unique to pediatric palliative care that are addressed include: providing pain and symptom management in the broad pediatric range from neonate to adolescent; caring for and interacting with developmentally distinct groups; engaging in shared decision making with parents and adolescents; providing accommodations for prognoses that are often more uncertain than in adult patients; and delivering concurrent disease-directed therapy with palliative care. PMID:24400391

  10. Compassion fatigue: a review of the research to date and relevance to cancer-care providers.

    PubMed

    Najjar, Nadine; Davis, Louanne W; Beck-Coon, Kathleen; Carney Doebbeling, Caroline

    2009-03-01

    Fifty-seven studies were reviewed to identify the prevalence of compassion fatigue among cancer-care providers, instruments used to detect it and means of prevention and treatment. Conclusions were limited by an ambiguous definition of compassion fatigue that fails to adequately differentiate it from related constructs (e.g. burnout, secondary traumatic stress) and the modest number of cancer-related studies found. However, evidence suggests that compassion fatigue takes a toll not only on cancer-care providers but also on the workplace. These findings highlight the need to understand more clearly the link between the empathic sensitivity of healthcare professionals and their vulnerability to compassion fatigue. PMID:19237494

  11. Providers' Perspectives of Survivorship Care for Young Adult Survivors of Childhood Cancer.

    PubMed

    Berg, Carla; Stratton, Erin; Esiashvili, Natia; Mertens, Ann; Vanderpool, Robin C

    2016-03-01

    We examined healthcare providers' perceptions of the goals of survivorship care and survivor programs, systems-level barriers and individual patient-level barriers to engaging patients in survivorship care, and potential resources for increasing engagement. In 2012, we recruited 21 healthcare providers of young adult survivors of childhood cancers from a children's hospital and a cancer center in the Southeastern USA to complete telephone-based semi-structured interviews. The sample was 45.95 years old (SD = 7.57) on average, 52.4 % female, and 81.0 % MDs. The major goals of survivorship programs identified were medical care management (e.g., addressing late and long-term effects, providing survivorship care plans (SCPs), assisting in transition of care) and holistic care including addressing psychosocial issues and promoting healthy lifestyles. Systems-level barriers to engagement in survivorship care included limited resources (e.g., time), role confusion (e.g., within cancer centers, from treatment team to survivorship care, role of primary care providers), communication challenges within the medical system (e.g., limited tracking of patients, lack of understanding of the role of survivorship clinic), communication challenges with patients (e.g., setting expectations regarding transition to survivorship care), and lack of insurance coverage. Perceived patient-level factors included psychological barriers (e.g., fear, avoidance), resistance to survivorship care, and physical barriers (e.g., distance from survivorship clinics). Resources to address these barriers included increased access to information, technology-based resources, and ensuring valuable services. There are several systems-level and patient-level barriers to survivorship care, thus requiring multilevel interventions to promote engagement in care among young adult survivors of childhood cancer. PMID:25943901

  12. Effectively Communicating Colorectal Cancer Screening Information to Primary Care Providers: Application for State, Tribe or Territory Comprehensive Cancer Control Coalitions

    PubMed Central

    Redmond, Jennifer; Vanderpool, Robin; McClung, Rebecca

    2016-01-01

    Background Patients are more likely to be screened for colorectal cancer if it is recommended by a health care provider. Therefore, it is imperative that providers have access to the latest screening guidelines. Purpose This practice-based project sought to identify Kentucky primary care providers’ preferred sources and methods of receiving colorectal cancer information to improve state comprehensive cancer control provider outreach initiatives. Methods Four focus groups were conducted with primary care physicians, nurse practitioners, and physician assistants. Discussion included preferred sources and methods of receiving updated screening guidelines, legislation, and statewide public awareness campaign materials. Results Providers (N = 17) identified their preferred methods for receiving colorectal cancer information as: routine emails from trusted sources (colleagues, professional societies and research, and advocacy agencies), scientific journals, existing conferences, and the media. Discussion When delivering colorectal cancer information to primary care providers, multiple approaches are needed. An ideal partner for dissemination of information is state comprehensive cancer control coalitions, considering their prioritization of colorectal cancer screening and existing networks of partners who were identified as trusted sources. Translation to Health Education Practice Assessment of primary care providers’ preferred methods and sources of receiving colorectal cancer information informs strategies for practice among comprehensive cancer control coalitions.

  13. Effectively Communicating Colorectal Cancer Screening Information to Primary Care Providers: Application for State, Tribe or Territory Comprehensive Cancer Control Coalitions

    ERIC Educational Resources Information Center

    Redmond, Jennifer; Vanderpool, Robin; McClung, Rebecca

    2012-01-01

    Background: Patients are more likely to be screened for colorectal cancer if it is recommended by a health care provider. Therefore, it is imperative that providers have access to the latest screening guidelines. Purpose: This practice-based project sought to identify Kentucky primary care providers' preferred sources and methods of receiving…

  14. Effectively Communicating Colorectal Cancer Screening Information to Primary Care Providers: Application for State, Tribe or Territory Comprehensive Cancer Control Coalitions

    ERIC Educational Resources Information Center

    Redmond, Jennifer; Vanderpool, Robin; McClung, Rebecca

    2012-01-01

    Background: Patients are more likely to be screened for colorectal cancer if it is recommended by a health care provider. Therefore, it is imperative that providers have access to the latest screening guidelines. Purpose: This practice-based project sought to identify Kentucky primary care providers' preferred sources and methods of receiving


  15. The Gynecologist Has a Unique Role in Providing Oncofertility Care to Young Cancer Patients

    PubMed Central

    Duncan, Francesca E; Jozefik, Jennifer K; Kim, Alison M; Hirshfeld-Cytron, Jennifer; Woodruff, Teresa K

    2011-01-01

    Facing a cancer diagnosis at any age is devastating. However, young cancer patients have the added burden that life-preserving cancer treatments, including surgery, chemotherapy, and radiotherapy, may compromise their future fertility. The possibility of reproductive dysfunction as a consequence of cancer treatment has a negative impact on the quality of life of cancer survivors. The field of oncofertility, which merges the clinical specialties of oncology and reproductive endocrinology, was developed to explore and expand fertility preservation options and to better manage the reproductive status of cancer patients. Fertility preservation for females has proved to be a particular challenge because mature female gametes are rare and difficult to acquire. The purpose of this article is to provide the gynecologist with a comprehensive overview of how cancer treatments affect the female reproductive axis, delineate the diverse fertility preservation options that are currently available or being developed for young women, and describe current measures of ovarian reserve that can be used pre- and post-cancer treatment. As a primary care provider, the gynecologist will likely interact with patients throughout the cancer care continuum. Thus, the gynecologist is in a unique position to join the oncofertility team in providing young cancer patients with up-to-date fertility preservation information and referrals to specialists. PMID:21927621

  16. The Nursing Dimension of Providing Palliative Care to Children and Adolescents with Cancer

    PubMed Central

    Docherty, Sharron L.; Thaxton, Cheryl; Allison, Courtney; Barfield, Raymond C.; Tamburro, Robert F.

    2012-01-01

    Palliative care for children and adolescents with cancer includes interventions that focus on the relief of suffering, optimization of function, and improvement of quality of life at any and all stages of disease. This care is most effectively provided by a multidisciplinary team. Nurses perform an integral role on that team by identifying symptoms, providing care coordination, and assuring clear communication. Several basic tenets appear essential to the provision of optimal palliative care. First, palliative care should be administered concurrently with curative therapy beginning at diagnosis and assuming a more significant role at end of life. This treatment approach, recommended by many medical societies, has been associated with numerous benefits including longer survival. Second, realistic, objective goals of care must be developed. A clear understanding of the prognosis by the patient, family, and all members of the medical team is essential to the development of these goals. The pediatric oncology nurse is pivotal in developing these goals and assuring that they are adhered to across all specialties. Third, effective therapies to prevent and relieve the symptoms of suffering must be provided. This can only be accomplished with accurate and repeated assessments. The pediatric oncology nurse is vital in providing these assessments and must possess a working knowledge of the most common symptoms associated with suffering. With a basic understanding of these palliative care principles and competency in the core skills required for this care, the pediatric oncology nurse will optimize quality of life for children and adolescents with cancer. PMID:23641169

  17. The nursing dimension of providing palliative care to children and adolescents with cancer.

    PubMed

    Docherty, Sharron L; Thaxton, Cheryl; Allison, Courtney; Barfield, Raymond C; Tamburro, Robert F

    2012-01-01

    Palliative care for children and adolescents with cancer includes interventions that focus on the relief of suffering, optimization of function, and improvement of quality of life at any and all stages of disease. This care is most effectively provided by a multidisciplinary team. Nurses perform an integral role on that team by identifying symptoms, providing care coordination, and assuring clear communication. Several basic tenets appear essential to the provision of optimal palliative care. First, palliative care should be administered concurrently with curative therapy beginning at diagnosis and assuming a more significant role at end of life. This treatment approach, recommended by many medical societies, has been associated with numerous benefits including longer survival. Second, realistic, objective goals of care must be developed. A clear understanding of the prognosis by the patient, family, and all members of the medical team is essential to the development of these goals. The pediatric oncology nurse is pivotal in developing these goals and assuring that they are adhered to across all specialties. Third, effective therapies to prevent and relieve the symptoms of suffering must be provided. This can only be accomplished with accurate and repeated assessments. The pediatric oncology nurse is vital in providing these assessments and must possess a working knowledge of the most common symptoms associated with suffering. With a basic understanding of these palliative care principles and competency in the core skills required for this care, the pediatric oncology nurse will optimize quality of life for children and adolescents with cancer. PMID:23641169

  18. Awareness, Interest, and Preferences of Primary Care Providers in Using Point-of-Care Cancer Screening Technology.

    PubMed

    Kim, Chloe S; Vanture, Sarah; Cho, Margaret; Klapperich, Catherine M; Wang, Catharine; Huang, Franklin W

    2016-01-01

    Well-developed point-of-care (POC) cancer screening tools have the potential to provide better cancer care to patients in both developed and developing countries. However, new medical technology will not be adopted by medical providers unless it addresses a population's existing needs and end-users' preferences. The goals of our study were to assess primary care providers' level of awareness, interest, and preferences in using POC cancer screening technology in their practice and to provide guidelines to biomedical engineers for future POC technology development. A total of 350 primary care providers completed a one-time self-administered online survey, which took approximately 10 minutes to complete. A $50 Amazon gift card was given as an honorarium for the first 100 respondents to encourage participation. The description of POC cancer screening technology was provided in the beginning of the survey to ensure all participants had a basic understanding of what constitutes POC technology. More than half of the participants (57%) stated that they heard of the term "POC technology" for the first time when they took the survey. However, almost all of the participants (97%) stated they were either "very interested" (68%) or "somewhat interested" (29%) in using POC cancer screening technology in their practice. Demographic characteristics such as the length of being in the practice of medicine, the percentage of patients on Medicaid, and the average number of patients per day were not shown to be associated with the level of interest in using POC. These data show that there is a great interest in POC cancer screening technology utilization among this population of primary care providers and vast room for future investigations to further understand the interest and preferences in using POC cancer technology in practice. Ensuring that the benefits of new technology outweigh the costs will maximize the likelihood it will be used by medical providers and patients. PMID:26771309

  19. Patient satisfaction with breast cancer follow-up care provided by family physicians

    PubMed Central

    Thind, Amardeep; Liu, Yihang; Maly, Rose

    2011-01-01

    Purpose There is little evidence to document patient satisfaction with follow up care provided by family physicians/general practitioners (FP/GP) to breast cancer patients. We aimed to identify determinants of satisfaction with such care in low-income medically underserved women with breast cancer. Methods Cross sectional study of 145 women who reported receiving follow up care from a FP/GP. Women were enrolled in California’s Breast and Cervical Cancer Treatment Program and were interviewed by phone 3 years after breast cancer diagnosis. Cleary and McNeil’s model, which states that patient satisfaction is a function of patient characteristics, structure of care, and processes of care, was used to understand the determinants of satisfaction. Stepwise logistic regression was used to identify significant predictors. Results 73.4% reported that they were extremely satisfied with their treatment by the family physician/general practitioner. Women who were able to ask their family physicians questions about their breast cancer had six times greater odds of being extremely satisfied compared to women who were not able to ask any questions. Women who scored the family physician higher on the ability to explain things in a way she could understand had a higher odds of being extremely satisfied compared to women who scored their family physicians lower. Conclusions FP/GPs providing follow up care for breast cancer patients should encourage patients to ask questions, and must communicate in a way that patients understand. These recommendations are congruent with the characteristics of patient centered communication for cancer patients enunciated in a recent NCI monograph. PMID:22086814

  20. Awareness, Interest, and Preferences of Primary Care Providers in Using Point-of-Care Cancer Screening Technology

    PubMed Central

    Kim, Chloe S.; Vanture, Sarah; Cho, Margaret; Klapperich, Catherine M.; Wang, Catharine; Huang, Franklin W.

    2016-01-01

    Well-developed point-of-care (POC) cancer screening tools have the potential to provide better cancer care to patients in both developed and developing countries. However, new medical technology will not be adopted by medical providers unless it addresses a population’s existing needs and end-users’ preferences. The goals of our study were to assess primary care providers’ level of awareness, interest, and preferences in using POC cancer screening technology in their practice and to provide guidelines to biomedical engineers for future POC technology development. A total of 350 primary care providers completed a one-time self-administered online survey, which took approximately 10 minutes to complete. A $50 Amazon gift card was given as an honorarium for the first 100 respondents to encourage participation. The description of POC cancer screening technology was provided in the beginning of the survey to ensure all participants had a basic understanding of what constitutes POC technology. More than half of the participants (57%) stated that they heard of the term “POC technology” for the first time when they took the survey. However, almost all of the participants (97%) stated they were either “very interested” (68%) or “somewhat interested” (29%) in using POC cancer screening technology in their practice. Demographic characteristics such as the length of being in the practice of medicine, the percentage of patients on Medicaid, and the average number of patients per day were not shown to be associated with the level of interest in using POC. These data show that there is a great interest in POC cancer screening technology utilization among this population of primary care providers and vast room for future investigations to further understand the interest and preferences in using POC cancer technology in practice. Ensuring that the benefits of new technology outweigh the costs will maximize the likelihood it will be used by medical providers and patients. PMID:26771309

  1. Providers of Follow-Up Care in a Population-Based Sample of Breast Cancer Survivors

    PubMed Central

    Friese, Christopher R.; Martinez, Kathryn A.; Abrahamse, Paul; Hamilton, Ann S.; Graff, John J.; Jagsi, Reshma; Griggs, Jennifer J.; Hawley, Sarah T.; Katz, Steven J.

    2014-01-01

    Purpose To describe which providers provide breast cancer survivorship care. Patients and Methods We conducted a longitudinal survey of non-metastatic breast cancer patients identified by the SEER registries of Los Angeles and Detroit. Multinomial logistic regression examined the adjusted odds of surgeon compared with a medical oncologist follow up or primary care provider compared with medical oncologist follow up, adjusting for age, race/ethnicity, insurance, tumor stage, receipt of chemotherapy, endocrine therapy use, and visit to a medical oncologist at the time of diagnosis. Results were weighted to account for sample selection and non-response. Results 844 women had invasive disease and received chemotherapy or endocrine therapy. 65.2% reported medical oncologists as their main care provider at four years, followed by PCP/other physicians (24.3%) and surgeons (10.5%). Black women were more likely to receive their follow-up care from surgeons (OR 2.47, 95% CI 1.16–5.27) or PCP/other physicians (OR 2.62, 95% CI 1.47–4.65) than medical oncologists. Latinas were more likely to report PCP/other physician follow up than medical oncologists (OR 2.33, 95% CI 1.15–4.73). Compared with privately-insured women, Medicaid recipients were more likely to report PCP/other physician follow up (OR 2.52, 95% CI 1.24–5.15). Women taking endocrine therapy four years after diagnosis were less likely to report surgeons or PCP/other physicians as their primary provider of breast cancer follow up care. Conclusions Different survivorship care patterns based on race/ethnicity and insurance status. Interventions are needed to inform patients and providers on the recommended sources of breast cancer follow up. PMID:24481682

  2. An Assessment to Inform Pediatric Cancer Provider Development and Delivery of Survivor Care Plans.

    PubMed

    Warner, Echo L; Wu, Yelena P; Hacking, Claire C; Wright, Jennifer; Spraker-Perlman, Holly L; Gardner, Emmie; Kirchhoff, Anne C

    2015-12-01

    Current guidelines recommend all pediatric cancer survivors receive a survivor care plan (SCP) for optimal health management, yet clinical delivery of SCPs varies. We evaluated oncology providers' familiarity with and preferences for delivering SCPs to inform the implementation of a future SCP program at our institution. From November 2013 to April 2014, oncology providers from the Primary Children's Hospital in Salt Lake City, UT, completed a survey (n=41) and a 45-min focus group (n=18). Participants reported their familiarity with and training in SCP guidelines, opinions on SCPs, and barriers to delivering SCPs. As a secondary analysis, we examined differences in survey responses between physicians and nurses with Fisher's exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Participants reported high familiarity with late effects of cancer treatment (87.8%) and follow-up care that cancer survivors should receive (82.5%). Few providers had delivered an SCP (oncologists 35.3% and nurses 5.0%; p=0.03). Barriers to providing SCPs included lack of knowledge (66.7%), SCP delivery is not expected in their clinic (53.9%), and no champion (48.7%). In qualitative comments, providers expressed that patient age variation complicated SCP delivery. Participants supported testing an SCP intervention program (95.1%) and felt this should be a team-based approach. Strategies for optimal delivery of SCPs are needed. Participants supported testing an SCP program to improve the quality of patient care. Team-based approaches, including nurses and physicians, that incorporate provider training on and support for SCP delivery are needed to improve pediatric cancer care. PMID:25893925

  3. Predicting cancer prognosis using interactive online tools: A systematic review and implications for cancer care providers

    PubMed Central

    Rabin, Borsika A.; Gaglio, Bridget; Sanders, Tristan; Nekhlyudov, Larissa; Dearing, James W.; Bull, Sheana; Glasgow, Russell E.; Marcus, Alfred

    2013-01-01

    Cancer prognosis is of keen interest for cancer patients, their caregivers and providers. Prognostic tools have been developed to guide patient-physician communication and decision-making. Given the proliferation of prognostic tools, it is timely to review existing online cancer prognostic tools and discuss implications for their use in clinical settings. Using a systematic approach, we searched the Internet, Medline, and consulted with experts to identify existing online prognostic tools. Each was reviewed for content and format. Twenty-two prognostic tools addressing 89 different cancers were identified. Tools primarily focused on prostate (n=11), colorectal (n=10), breast (n=8), and melanoma (n=6), though at least one tool was identified for most malignancies. The input variables for the tools included cancer characteristics (n=22), patient characteristics (n=18), and comorbidities (n=9). Effect of therapy on prognosis was included in 15 tools. The most common predicted outcome was cancer specific survival/mortality (n=17). Only a few tools (n=4) suggested patients as potential target users. A comprehensive repository of online prognostic tools was created to understand the state-of-the-art in prognostic tool availability and characteristics. Use of these tools may support communication and understanding about cancer prognosis. Dissemination, testing, refinement of existing, and development of new tools under different conditions are needed. PMID:23956026

  4. Rectal cancer: An evidence-based update for primary care providers

    PubMed Central

    Gaertner, Wolfgang B; Kwaan, Mary R; Madoff, Robert D; Melton, Genevieve B

    2015-01-01

    Rectal adenocarcinoma is an important cause of cancer-related deaths worldwide, and key anatomic differences between the rectum and the colon have significant implications for management of rectal cancer. Many advances have been made in the diagnosis and management of rectal cancer. These include clinical staging with imaging studies such as endorectal ultrasound and pelvic magnetic resonance imaging, operative approaches such as transanal endoscopic microsurgery and laparoscopic and robotic assisted proctectomy, as well as refined neoadjuvant and adjuvant therapies. For stage II and III rectal cancers, combined chemoradiotherapy offers the lowest rates of local and distant relapse, and is delivered neoadjuvantly to improve tolerability and optimize surgical outcomes, particularly when sphincter-sparing surgery is an endpoint. The goal in rectal cancer treatment is to optimize disease-free and overall survival while minimizing the risk of local recurrence and toxicity from both radiation and systemic therapy. Optimal patient outcomes depend on multidisciplinary involvement for tailored therapy. The successful management of rectal cancer requires a multidisciplinary approach, with the involvement of enterostomal nurses, gastroenterologists, medical and radiation oncologists, radiologists, pathologists and surgeons. The identification of patients who are candidates for combined modality treatment is particularly useful to optimize outcomes. This article provides an overview of the diagnosis, staging and multimodal therapy of patients with rectal cancer for primary care providers. PMID:26167068

  5. The timely diagnosis of breast cancer. Principles of risk management for primary care providers and surgeons.

    PubMed

    Osuch, J R; Bonham, V L

    1994-07-01

    Alleged delay in the diagnosis of breast cancer is one of the most common reasons for medical malpractice claims in the United States, accounting for the largest indemnity payments of any single medical condition. Although the diagnosis of breast cancer can be challenging and sometimes difficult, principles of management exist to assist health providers in pursuing a resolution of any breast complaint. Studies have shown that when litigation is pursued for alleged failure to diagnose breast cancer, multiple specialists are named in the suit. In most cases, patients filing claims of alleged failure to diagnose breast cancer are premenopausal, while the majority of women diagnosed with breast cancer are postmenopausal. This reflects, in part, the challenge of diagnosing the disease in women who have difficult clinical exams to interpret, as well as dense parenchyma on mammograms, which decreases the sensitivity of the radiograph interpretation. Principles of risk management to avoid a delay in diagnosis include (1) pursuing every breast complaint to resolution, (2) following breast cancer screening guidelines, (3) establishing an office tracking system for breast cancer screening reminders, (4) tracking results of all mammograms and follow-up studies ordered, (5) referring premenopausal women for the evaluation of any breast mass that persists through a menstrual cycle, (6) considering any asymmetrical breast finding as a cause for concern, (7) referring every woman with a breast finding on physical examination for consultation, regardless of the mammogram report, and (8) carefully documenting patient history, physical exam findings, clinical impression, and follow-up plans. PMID:8004597

  6. Rural Primary Care Providers' Perceptions of Their Role in the Breast Cancer Care Continuum

    ERIC Educational Resources Information Center

    Rayman, Kathleen M.; Edwards, Joellen

    2010-01-01

    Context: Rural women in the United States experience disparity in breast cancer diagnosis and treatment when compared to their urban counterparts. Given the 11% chance of lifetime occurrence of breast cancer for women overall, the continuum of breast cancer screening, diagnosis, treatment, and recovery are of legitimate concern to rural women and


  7. Rural Primary Care Providers' Perceptions of Their Role in the Breast Cancer Care Continuum

    ERIC Educational Resources Information Center

    Rayman, Kathleen M.; Edwards, Joellen

    2010-01-01

    Context: Rural women in the United States experience disparity in breast cancer diagnosis and treatment when compared to their urban counterparts. Given the 11% chance of lifetime occurrence of breast cancer for women overall, the continuum of breast cancer screening, diagnosis, treatment, and recovery are of legitimate concern to rural women and…

  8. Provider perceptions and expectations of breast cancer post-treatment care: A University of California Athena Breast Health Network project

    PubMed Central

    Hahn, Erin E.; Ganz, Patricia A.; Melisko, Michelle; Pierce, John; von Friederichs-Fitzwater, Marlene; Lane, Karen; Hiatt, Robert

    2013-01-01

    Purpose The Athena Breast Health Network collaboration is a University of California system-wide project initiated with the intent to drive innovation in breast cancer prevention, screening and treatment. This qualitative research examines provider perceptions and expectations of post-treatment breast cancer care across five Network sites with the goal of better understanding provider behavior during the post-treatment phase of the cancer care trajectory. Methods Investigators at each site conducted semi-structured interviews with oncology specialists and primary care providers (PCPs). Interviews used case study examples and open- and closed-ended questions on the delivery of post-treatment breast cancer care. Informant responses were manually recorded by the interviewer, compiled in a database, then coded and analyzed using NVivo 9 software. Results There were 39 key informants across the sites: 14 medical oncologists, 7 radiation oncologists, 11 surgeons, 3 oncology nurses, and 4 PCPs. Care coordination was a major unprompted theme identified in the interviews. There was a perceived need for greater care coordination across institutions in order to improve delivery of post-treatment health care services and a need for greater care coordination within oncology, particularly to help avoid duplication of follow-up care and services. Participants expect frequent follow-up visits and to use biomarker tests and advanced imaging services as part of routine surveillance care. Implementing survivorship care programs was perceived as a way to improve care delivery. Conclusions These results identify a need for increased focus on care coordination during the post-treatment phase of breast cancer care within the UC system, and the potential for system and provider level interventions that could help increase coordination of post-treatment care. Implications for Cancer Survivors Breast cancer survivors do not always receive evidence-based care. This research helps to better understand what motivates provider behavior during the post-treatment phase and lays a foundation for targeted interventions to increase adherence to evidence-based recommendations. PMID:23494652

  9. Knowledge, experiences, and barriers to colorectal cancer screening: a survey of health care providers working in primary care settings.

    PubMed

    Omran, Suha; Barakat, Husam; Muliira, Joshua Kanaabi; Aljadaa, Nabeela

    2015-03-01

    Colorectal cancer (CRC) screening and early detection can effectively decrease the morbidity and mortality associated with this disease. Health care providers (HCPs) working in primary care settings as the first contact with the health care system can play a pivotal role in cancer prevention and screening for early detection. The purpose of this study was to explore the knowledge, experiences, and perceived barriers to CRC screening among HCPs working in primary care settings. A cross-sectional design and a self-administered questionnaire (SAQ) was used to collect data from 236 HCPs working in health centers in Jordan. The 236 HCPs were nurses (45.8%), physicians (45.3%), and others (7.2%). A third of the HCPs (30%) knew the recommended age to begin CRC screening for patients with average risk. Overall physicians scored higher than nurses on questions assessing CRC screening knowledge. The majority of HCPs were not knowledgeable about CRC screening recommendations but believed that CRC is preventable (75.8%). The main perceived barriers to CRC screening were patient's fear of finding out that they have cancer and lack of awareness about CRC screening tests, shortage of trained HCPs to conduct invasive screening procedures, and lack of policy/protocol on CRC screening. HCPs working in primary care settings in Jordan do not have adequate knowledge about CRC screening. There is a need for tailored continuing educational programs and other interventions to improve HCPs' knowledge, as this can increase CRC screening in primary care settings and compliance with current screening guidelines. PMID:24882440

  10. Differences in Parent-Provider Concordance Regarding Prognosis and Goals of Care Among Children With Advanced Cancer

    PubMed Central

    Rosenberg, Abby R.; Orellana, Liliana; Kang, Tammy I.; Geyer, J. Russell; Feudtner, Chris; Dussel, Veronica; Wolfe, Joanne

    2014-01-01

    Purpose Concordance between parents of children with advanced cancer and health care providers has not been described. We aimed to describe parent-provider concordance regarding prognosis and goals of care, including differences by cancer type. Patients and Methods A total of 104 pediatric patients with recurrent or refractory cancer were enrolled at three large children's hospitals. On enrollment, their parents and providers were invited to complete a survey assessing perceived prognosis and goals of care. Patients' survival status was retrospectively abstracted from medical records. Concordance was assessed via discrepancies in perceived prognosis, Îș statistics, and McNemar's test. Distribution of categorical variables and survival rates across cancer type were compared with Fisher's exact and log-rank tests, respectively. Results Data were available from 77 dyads (74% of enrolled). Parent-provider agreement regarding prognosis and goals of care was poor (Îș, 0.12 to 0.30). Parents were more likely to report cure was likely (P < .001). The frequency of perceived likelihood of cure and the goal of cure varied by cancer type for both parents and providers (P < .001 to .004). Relatively optimistic responses were more common among parents and providers of patients with hematologic malignancies, although there were no differences in survival. Conclusion Parent-provider concordance regarding prognosis and goals in advanced pediatric cancer is generally poor. Perceptions of prognosis and goals of care vary by cancer type. Understanding these differences may inform parent-provider communication and decision making. PMID:25024073

  11. [Euthanasia in patients with cancer and the continuous-care providers].

    PubMed

    Camps Herrero, Carlos; Gavilå Gregori, Joaquín; Garde Noguera, Javier; Caballero Díaz, Cristina; Iranzo Gonzålez-Cruz, Vega; Juårez Marroquí, Asunción; Safont Aguilera, Maria José; Blasco Cordellat, Ana; Berrocal Jaime, Alfonso; Sanz de Bremond, Maria Godes

    2005-08-01

    During the clinical evolution of patients with cancer there are many occasions, or phases of the disease, when there are no specific treatments and, as such, we need to provide maximum comfort following appropriate symptom control; in this stage it is fundamental to respect personal autonomy together with the option to reject futile treatment. With appropriate control of symptoms it is possible to reach the stage where the majority of the patients do not continue to suffer. Continuous-care providers for cancer patients are those who are responsible for providing help to resolve these situations. In palliative medicine there are highly-efficacious procedures to the help in these last hours. Sedation is applied when it is impossible to control symptoms by other means. With appropriate Carer cover, it is not necessary to introduce laws on assisted suicide and/or active voluntary euthanasia, neither because of the magnitude of demand, nor because of the difficulties in achieving appropriate control of symptoms. PMID:16185589

  12. How do Rural Health Care Providers and Patients View Barriers to Colorectal Cancer Screening? Insights from Appalachian Kentucky

    PubMed Central

    Hatcher, Jennifer; Dignan, Mark B.; Schoenberg, Nancy

    2011-01-01

    Synopsis This paper reports findings from a qualitative study that explored the attitudes and beliefs concerning colorectal cancer screening (CRC) among patients and health care providers in Appalachian Kentucky. We report results from five focus groups; three with primary care providers and two with patients. Providers discussed patient characteristics, financial issues and health care delivery system factors as challenges to screening. Participants reported fear, embarrassment, financial issues, lack of perceived need, qualities of the test, lack of provider recommendation, and health care delivery barriers. Although there were some areas of agreement, there are marked differences between the perceptions of Appalachian health care providers and participants regarding colorectal cancer screening. This paper compares and contrasts those perceptions and provides suggestions for culturally competent practice and culturally relevant research to improve CRC screening in this vulnerable population. PMID:21501729

  13. Guideline for referral of patients with suspected prostate cancer by family physicians and other primary care providers

    PubMed Central

    Young, Sheila-Mae; Bansal, Praveen; Vella, Emily T.; Finelli, Antonio; Levitt, Cheryl; Loblaw, Andrew

    2015-01-01

    Abstract Objective The aim of this guideline is to assist FPs and other primary care providers with recognizing features that should raise their suspicion about the presence of prostate cancer in their patients. Composition of the committee Committee members were selected from among the regional primary care leads from the Cancer Care Ontario Provincial Primary Care and Cancer Network and from among the members of the Cancer Care Ontario Genitourinary Cancer Disease Site Group. Methods This guideline was developed through systematic review of the evidence base, synthesis of the evidence, and formal external review involving Canadian stakeholders to validate the relevance of recommendations. Report Evidence-based guidelines were developed to improve the management of patients presenting with clinical features of prostate cancer within the Canadian context. Conclusion These guidelines might lead to more timely and appropriate referrals and might also be of value for informing the development of prostate cancer diagnostic programs and for helping policy makers to ensure appropriate resources are in place. PMID:25756141

  14. Views of family physicians about survivorship care plans to provide breast cancer follow-up care: exploration of results from a randomized controlled trial

    PubMed Central

    O’Brien, M.A.; Grunfeld, E.; Sussman, J.; Porter, G.; Mobilio, M. Hammond

    2015-01-01

    Background The U.S. Institute of Medicine recommends that cancer patients receive survivorship care plans, but evaluations to date have found little evidence of the effectiveness of such plans. We conducted a qualitative follow-on study to a randomized controlled trial (rct) to understand the experiences of family physicians using survivorship care plans to support the follow-up of breast cancer patients. Methods A subset of family physicians whose patients were enrolled in the parent rct in Ontario and Nova Scotia were eligible for this study. In interviews, the physicians discussed survivorship care plans (intervention) or usual discharge letters (control), and their confidence in providing follow-up cancer care. Results Of 123 eligible family physicians, 18 (10 intervention, 8 control) were interviewed. In general, physicians receiving a survivorship care plan found only the 1-page care record to be useful. Physicians who received only a discharge letter had variable views about the letter’s usefulness; several indicated that it lacked information about potential cancer- or treatment-related problems. Most physicians were comfortable providing care 3–5 years after diagnosis, but desired timely and informative communication with oncologists. Conclusions Although family physicians did not find extensive survivorship care plans useful, discharge letters might not be sufficiently comprehensive for follow-up breast cancer care. Effective strategies for two-way communication between family physicians and oncologists are still lacking. PMID:26300663

  15. Is Distance to Provider a Barrier to Care for Medicaid Patients with Breast, Colorectal, or Lung Cancer?

    ERIC Educational Resources Information Center

    Scoggins, John F.; Fedorenko, Catherine R.; Donahue, Sara M. A.; Buchwald, Dedra; Blough, David K.; Ramsey, Scott D.

    2012-01-01

    Purpose: Distance to provider might be an important barrier to timely diagnosis and treatment for cancer patients who qualify for Medicaid coverage. Whether driving time or driving distance is a better indicator of travel burden is also of interest. Methods: Driving distances and times from patient residence to primary care provider were…

  16. Is Distance to Provider a Barrier to Care for Medicaid Patients with Breast, Colorectal, or Lung Cancer?

    ERIC Educational Resources Information Center

    Scoggins, John F.; Fedorenko, Catherine R.; Donahue, Sara M. A.; Buchwald, Dedra; Blough, David K.; Ramsey, Scott D.

    2012-01-01

    Purpose: Distance to provider might be an important barrier to timely diagnosis and treatment for cancer patients who qualify for Medicaid coverage. Whether driving time or driving distance is a better indicator of travel burden is also of interest. Methods: Driving distances and times from patient residence to primary care provider were


  17. 'Palliative care': a contradiction in terms? A qualitative study of cancer patients with a Turkish or Moroccan background, their relatives and care providers

    PubMed Central

    2010-01-01

    Background Palliative cancer care aims to improve quality of life and ultimately quality of dying, while prolonging life is not an objective anymore when death nears. The question is, however, whether these perspectives on palliative care are congruent with the perspectives of immigrant families with a Turkish or Moroccan background. Methods A qualitative design was used as we were looking for the personal views of 'very ill' cancer patients with a Turkish or Moroccan background, their family members and their Dutch care providers. We interviewed 83 people, involved in 33 cases to obtain information about their views, values and norms on 'good care'. Results The main concerns about 'good care' expressed by Turkish and Moroccan families were: maximum treatment and curative care until the end of their lives, never having hope taken away, devoted care by their families, avoiding shameful situations, dying with a clear mind and being buried in their own country. Their views conflict, to some extent, with the dominant principles in palliative care, for example, the emphasis on quality of life and advanced care planning, which includes discussing diagnosis and prognosis with the patient. Conclusions Patients and their families with a Turkish or Moroccan background often have different ideas about 'good care' than their Dutch care providers. As many of them are aiming at cure until the end of life, they find 'good palliative care' a contradiction in terms. PMID:20831777

  18. Social Support, Self-Rated Health, and Lesbian, Gay, Bisexual, and Transgender Identity Disclosure to Cancer Care Providers

    PubMed Central

    Kamen, Charles S.; Smith-Stoner, Marilyn; Heckler, Charles E.; Flannery, Marie; Margolies, Liz

    2015-01-01

    Purpose/Objectives To describe factors related to diagnosis, identity disclosure, and social support among lesbian, gay, bisexual, and transgender (LGBT) patients with cancer, and to explore associations between these factors and self-rated health. Design Cross-sectional self-report survey design using descriptive and exploratory multivariate statistical approaches. Setting Online, Internet-based. Sample 291 LGBT patients (89% Caucasian; 50% gay, 36% lesbian, 7% bisexual, 3% transgender) with mixed cancers. Methods Participants completed a researcher-designed online survey assessing experiences of cancer diagnosis among LGBT patients at a single time point. Main Research Variables Demographics, which provider(s) delivered the patients’ cancer diagnoses, to whom patients had disclosed their LGBT identity, how they disclosed, who was on their social support team at the time of diagnosis, and current self-rated health. Findings 79% of participants reported disclosing their identities to more than one cancer care provider. Participants most commonly introduced the topic of LGBT identity themselves, sometimes as a way to correct heterosexual assumptions (34%). Friends were the most common members of LGBT patients’ support teams (79%). Four disclosure and support factors were consistently associated with better self-rated health. Conclusions Disclosure of LGBT identity is a common experience in the context of cancer care, and disclosure and support factors are associated with better self-reported health among LGBT patients. Implications for Nursing Creating safe environments for LGBT patients to disclose could improve cancer care delivery to this underserved population. Nurses and other providers should acknowledge and include diverse support team members in LGBT patients’ care. PMID:25542320

  19. Impact of primary care provider knowledge, attitudes, and beliefs about cancer clinical trials: implications for referral, education and advocacy.

    PubMed

    Michaels, Margo; D'Agostino, Thomas A; Blakeney, Natasha; Weiss, Elisa S; Binz-Scharf, Maria C; Golant, Mitch; Bylund, Carma L

    2015-03-01

    Primary Care Providers (PCPs) can be instrumental in helping to prepare patients for referral to cancer treatment. It has been suggested that PCPs can have an important impact on priming patients about the possibility of receiving care within a cancer treatment clinical trial (CCT). However, little is understood about how to effectively engage primary care providers in educating patients about trials. Data were collected as part of two qualitative research projects about primary care providers' role in referral to treatment and to CCTs. Participants were 27 PCPs who agreed to take part in qualitative face-to-face or telephone interviews and serve predominantly underserved, minority populations. Interviews identified a number of factors influencing referral to oncologists, including patients' insurance coverage, location and proximity to treatment facilities, and the strength of ongoing relationships with and/or previous experience with a specialist. PCPs overwhelmingly expressed disinterest in discussing any treatment options, including CCTs. Misconceptions about quality of care received through trials were also common, presenting a deterrent to discussion. PCPs need targeted, evidence-based educational interventions to appropriately address their concerns about cancer clinical trials, enhance provider communication skills, and alter patient referral behavior. Steps must also be taken to strengthen communication between oncologists and referring PCPs. PMID:24805229

  20. Choosing Your Prenatal Care Provider

    MedlinePlus

    ... Choosing your prenatal care provider Choosing your prenatal care provider E-mail to a friend Please fill ... provider. Who can you go to for prenatal care? You can choose who your prenatal care provider ...

  1. Adherence to Survivorship Care Guidelines in Health Care Providers for Non-Small Cell Lung Cancer and Colorectal Cancer Survivor Care

    ClinicalTrials.gov

    2016-03-01

    Adenocarcinoma of the Lung; Mucinous Adenocarcinoma of the Colon; Mucinous Adenocarcinoma of the Rectum; Signet Ring Adenocarcinoma of the Colon; Signet Ring Adenocarcinoma of the Rectum; Squamous Cell Lung Cancer; Stage I Colon Cancer; Stage I Rectal Cancer; Stage IA Non-small Cell Lung Cancer; Stage IB Non-small Cell Lung Cancer; Stage IIA Colon Cancer; Stage IIA Non-small Cell Lung Cancer; Stage IIA Rectal Cancer; Stage IIB Colon Cancer; Stage IIB Non-small Cell Lung Cancer; Stage IIB Rectal Cancer; Stage IIC Colon Cancer; Stage IIC Rectal Cancer; Stage IIIA Colon Cancer; Stage IIIA Non-small Cell Lung Cancer; Stage IIIA Rectal Cancer; Stage IIIB Colon Cancer; Stage IIIB Non-small Cell Lung Cancer; Stage IIIB Rectal Cancer; Stage IIIC Colon Cancer; Stage IIIC Rectal Cancer

  2. Attitudes and Beliefs of Primary Care Providers in New Mexico About Lung Cancer Screening Using Low-Dose Computed Tomography

    PubMed Central

    Hoffman, Richard M.; Sussman, Andrew L.; Getrich, Christina M.; Rhyne, Robert L.; Crowell, Richard E.; Taylor, Kathryn L.; Reifler, Ellen J.; Wescott, Pamela H.; Murrietta, Ambroshia M.; Saeed, Ali I.

    2015-01-01

    Introduction On the basis of results from the National Lung Screening Trial (NLST), national guidelines now recommend using low-dose computed tomography (LDCT) to screen high-risk smokers for lung cancer. Our study objective was to characterize the knowledge, attitudes, and beliefs of primary care providers about implementing LDCT screening. Methods We conducted semistructured interviews with primary care providers practicing in New Mexico clinics for underserved minority populations. The interviews, conducted from February through September 2014, focused on providers’ tobacco cessation efforts, lung cancer screening practices, perceptions of NLST and screening guidelines, and attitudes about informed decision making for cancer screening. Investigators iteratively reviewed transcripts to create a coding structure. Results We reached thematic saturation after interviewing 10 providers practicing in 6 urban and 4 rural settings; 8 practiced at federally qualified health centers. All 10 providers promoted smoking cessation, some screened with chest x-rays, and none screened with LDCT. Not all were aware of NLST results or current guideline recommendations. Providers viewed study results skeptically, particularly the 95% false-positive rate, the need to screen 320 patients to prevent 1 lung cancer death, and the small proportion of minority participants. Providers were uncertain whether New Mexico had the necessary infrastructure to support high-quality screening, and worried about access barriers and financial burdens for rural, underinsured populations. Providers noted the complexity of discussing benefits and harms of screening and surveillance with their patient population. Conclusion Providers have several concerns about the feasibility and appropriateness of implementing LDCT screening. Effective lung cancer screening programs will need to educate providers and patients to support informed decision making and to ensure that high-quality screening can be efficiently delivered in community practice. PMID:26160294

  3. Is Distance to Provider a Barrier to Care for Medicaid Patients With Breast, Colorectal, or Lung Cancer?

    PubMed Central

    Scoggins, John F.; Fedorenko, Catherine R.; Donahue, Sara M. A.; Buchwald, Dedra; Blough, David K.; Ramsey, Scott D.

    2011-01-01

    Purpose Distance to provider might be an important barrier to timely diagnosis and treatment for cancer patients who qualify for Medicaid coverage. Whether driving time or driving distance is a better indicator of travel burden is also of interest. Methods Driving distances and times from patient residence to primary care provider were calculated for 3,917 breast, colorectal (CRC) and lung cancer Medicaid patients in Washington State from 1997 to 2003 using MapQuest.com. We fitted regression models of stage at diagnosis and time-to-treatment (number of days between diagnosis and surgery) to test the hypothesis that travel burden is associated with timely diagnosis and treatment of cancer. Findings Later stage at diagnosis for breast cancer Medicaid patients is associated with travel burden (OR = 1.488 per 100 driving miles, P = .037 and OR = 1.270 per driving hour, P = .016). Time-to-treatment after diagnosis of CRC is also associated with travel burden (14.57 days per 100 driving miles, P = .002 and 5.86 days per driving hour, P = .018). Conclusions Although travel burden is associated with timely diagnosis and treatment for some types of cancer, we did not find evidence that driving time was, in general, better at predicting timeliness of cancer diagnosis and treatment than driving distance. More intensive efforts at early detection of breast cancer and early treatment of CRC for Medicaid patients who live in remote areas may be needed. PMID:22236315

  4. Providing hospice home care to the terminally ill elderly people with cancer in Taiwan: family experiences and needs.

    PubMed

    Lee, Hsin-Tzu Sophie; Melia, Kath M; Yao, Chien-An; Lin, Chun-Ju; Chiu, Tai-Yuan; Hu, Wen-Yu

    2014-09-01

    We explored caregivers' experiences and needs when providing hospice home care to their terminally ill elderly patients with cancer in Taiwan for 1 year. A total of 44 caregivers were interviewed using a semistructured interview once monthly during hospice home care visits until the patients' deaths. Content analysis of the interviews revealed 5 themes, hoping for a cure, experiencing fluctuating emotions, accepting the patient's dying, regarding the patient's death as a good death, and needing emotional support and information. Caregivers in hospice home care who experienced difficulties tended to seek emotional support and information throughout the entire caregiving process. With a greater understanding of caregivers' experiences and needs, nurses can alleviate caregivers' negative emotional reactions by actively attending to their needs during this process. PMID:23921288

  5. Types of health care providers

    MedlinePlus

    ... types of health care providers: Nurse practitioners Physician assistant profession ... family planning. NPs can prescribe medications. A physician assistant (PA) can provide a wide range of services ...

  6. Family Day Care Provider Handbook

    ERIC Educational Resources Information Center

    New York State Office of Children and Family Services, 2006

    2006-01-01

    Family day care providers are responsible for creating a high-quality program where children have opportunities to grow, learn and thrive. Part of providing high-quality child care includes complying with the family day care regulations from the New York State Office of Children and Family Services (OCFS). This Handbook will help day care


  7. The Relevance of Gynecologic Oncologists to Provide High-Quality of Care to Women with Gynecological Cancer

    PubMed Central

    Minig, Lucas; Padilla-Iserte, Pablo; Zorrero, Cristina

    2016-01-01

    Gynecologic oncologists have an essential role to treat women with gynecological cancer. It has been demonstrated that specialized physicians who work in multidisciplinary teams to treat women with gynecological cancers are able to obtain the best clinical and oncological outcomes. However, the access to gynecologic oncologists for women with suspected gynecological cancer is scarce. Therefore, this review analyzes the importance of specialized care of women with ovarian, cervical, and endometrial cancer. In addition, the role of gynecologic oncologists who offer fertility-sparing treatment as well as their role in assisting general gynecologists and obstetricians is also reviewed. PMID:26835417

  8. Perioperative Care of Prisoners: Providing Safe Care.

    PubMed

    Smith, Francis Duval

    2016-03-01

    Correctional nurses are trained to care for prisoners in a controlled security environment; however, when a convict is transferred to a noncorrectional health care facility, the nurses there are often unfamiliar with custody requirements or how to safely care for these patients. The care of prisoners outside of prison has not been adequately investigated, and a gap exists between research and nursing education and practice. Nurses rarely have to consider how providing care for a prisoner in custody affects their practice, the potential dissonance between routine nursing care and the requirements to maintain security, or that care of prisoners in unsecured clinical areas places the nurse and other personnel at risk for physical assault or prisoner escape. Educating perioperative nurses in the care of prisoners in a public hospital environment is important for the provision of safe care and prevention of physical and emotional repercussions to personnel. PMID:26924366

  9. Care for the Health Care Provider.

    PubMed

    Kunin, Sharon Brown; Kanze, David Mitchell

    2016-03-01

    Pretravel care for the health care provider begins with an inventory, including the destination, length of stay, logistical arrangements, type of lodging, food and water supply, team members, personal medical needs, and the needs of the community to be treated. This inventory should be created and processed well in advance of the planned medical excursion. The key thing to remember in one's planning is to be a health care provider during one's global health care travel and not to become a patient oneself. This article will help demonstrate the medical requirements and recommendations for such planning. PMID:26900113

  10. Disaster Care Provider Workforce Assessment

    PubMed Central

    Scott, Lancer A.; Crumpler, Jason; Tolley, Jessica; Jones, E. Morgan; Wahlquist, Amy E.

    2013-01-01

    Large scale disasters such as hurricanes, earthquakes and radiologic emergencies pose significant risks to both patients and patient care providers. In an era of declining federal funding for emergency preparedness training (EPT), the importance of state and local initiatives to provide EPT has increased. Unfortunately, few US regions have performed workforce assessments of their patient care providers to measure levels of preparedness, record training preferences and assess EPT needs. This project summarizes the preliminary findings the Center for Health Professional Training and Emergency Response's (CHPTER) workforce assessment of nearly 400 patient care providers in South and North Carolina. PMID:23272386

  11. Impact of the care provided by gynecologic oncologists on outcomes of cervical cancer patients treated with radical hysterectomy

    PubMed Central

    Wu, Miao-fang; Li, Jing; Lu, Huai-wu; Wang, Li-juan; Zhang, Bing-zhong; Lin, Zhong-qiu

    2016-01-01

    For many malignant diseases, specialized care has been reported to be associated with better outcomes. The purpose of this study is to investigate the influence of gynecologic oncologists on treatment outcomes for cervical cancer patients treated by radical hysterectomy. Records of patients who received radical hysterectomy between January 2005 and June 2010 were reviewed. Perioperative morbidity, recurrence-free survival, and cancer-specific survival were assessed. Cox regression model was used to evaluate gynecologic oncologists as an independent predictor of survival. A total of 839 patients were included. Of these patients, 553 were treated by gynecologic oncologists, while 286 were treated by other subspecialties. With regard to operative outcomes, significant differences in favor of operation by gynecologic oncologists were found in number of patients receiving para-aortic node sampling and dissection (P=0.038), compliance with surgical guidelines (P=0.003), operative time (P<0.0001), estimated blood loss (P<0.0001), transfusion rate (P=0.046), number of removed nodes (P=0.033), and incidences of ureteric injury (P=0.027), cystotomy (P=0.038), and fistula formation (P=0.002). Patients who were operated on by gynecologic oncologists had longer recurrence-free survival (P=0.001; hazard ratio [HR] =0.64; 95% confidence interval [CI] [0.48, 0.84]) and cancer-specific survival (P=0.005; HR=0.64; 95% CI [0.47, 0.87]), and this association remained significant in patients with locally advanced disease. Care by gynecologic oncologists was an independent predictor for improved recurrence-free survival (P<0.0001; HR=0.57; 95% CI [0.42, 0.76]) and cancer-specific survival (P=0.001; HR=0.58; 95% CI [0.42, 0.81]), which was still significant among patients with locally advanced cancer. Given the results, we believe for cervical cancer patients receiving radical hysterectomy, operation by gynecologic oncologists results in significantly improved surgical and survival outcomes. The importance of the subspecialty of a gynecologist for cervical cancer patients should be addressed in clinical practice, especially for those in developing countries. PMID:27022291

  12. Racial and Ethnic Disparities in Patient-Provider Communication, Quality-of-Care Ratings, and Patient Activation Among Long-Term Cancer Survivors

    PubMed Central

    Palmer, Nynikka R.A.; Kent, Erin E.; Forsythe, Laura P.; Arora, Neeraj K.; Rowland, Julia H.; Aziz, Noreen M.; Blanch-Hartigan, Danielle; Oakley-Girvan, Ingrid; Hamilton, Ann S.; Weaver, Kathryn E.

    2014-01-01

    Purpose We examined racial and ethnic disparities in patient-provider communication (PPC), perceived care quality, and patient activation among long-term cancer survivors. Methods In 2005 to 2006, survivors of breast, prostate, colorectal, ovarian, and endometrial cancers completed a mailed survey on cancer follow-up care. African American, Asian/Pacific Islander (Asian), Hispanic, and non-Hispanic white (white) survivors who had seen a physician for follow-up care in the past 2 years (n = 1,196) composed the analytic sample. We conducted linear and logistic regression analyses to identify racial and ethnic differences in PPC (overall communication and medical test communication), perceived care quality, and patient activation in clinical care (self-efficacy in medical decisions and perceived control). We further examined the potential contribution of PPC to racial and ethnic differences in perceived care quality and patient activation. Results Compared with white survivors (mean score, 85.16), Hispanic (mean score, 79.95) and Asian (mean score, 76.55) survivors reported poorer overall communication (P = .04 and P < .001, respectively), and Asian survivors (mean score, 79.97) reported poorer medical test communication (P = .001). Asian survivors were less likely to report high care quality (odds ratio, 0.47; 95% CI, 0.30 to 0.72) and reported lower self-efficacy in medical decisions (mean score, 74.71; P < .001) compared with white survivors (mean score, 84.22). No disparity was found in perceived control. PPC was positively associated with care quality (P < .001) and self-efficacy (P < .001). After adjusting for PPC and other covariates, when compared with whites, Asian disparities remained significant. Conclusion Asian survivors report poorer follow-up care communication and care quality. More research is needed to identify contributing factors beyond PPC, such as cultural influences and medical system factors. PMID:25403220

  13. Impact of computer-assisted data collection, evaluation and management on the cancer genetic counselor's time providing patient care.

    PubMed

    Cohen, Stephanie A; McIlvried, Dawn E

    2011-06-01

    Cancer genetic counseling sessions traditionally encompass collecting medical and family history information, evaluating that information for the likelihood of a genetic predisposition for a hereditary cancer syndrome, conveying that information to the patient, offering genetic testing when appropriate, obtaining consent and subsequently documenting the encounter with a clinic note and pedigree. Software programs exist to collect family and medical history information electronically, intending to improve efficiency and simplicity of collecting, managing and storing this data. This study compares the genetic counselor's time spent in cancer genetic counseling tasks in a traditional model and one using computer-assisted data collection, which is then used to generate a pedigree, risk assessment and consult note. Genetic counselor time spent collecting family and medical history and providing face-to-face counseling for a new patient session decreased from an average of 85-69 min when using the computer-assisted data collection. However, there was no statistically significant change in overall genetic counselor time on all aspects of the genetic counseling process, due to an increased amount of time spent generating an electronic pedigree and consult note. Improvements in the computer program's technical design would potentially minimize data manipulation. Certain aspects of this program, such as electronic collection of family history and risk assessment, appear effective in improving cancer genetic counseling efficiency while others, such as generating an electronic pedigree and consult note, do not. PMID:21240560

  14. Skin Diseases: Questions for Your Health Care Provider

    MedlinePlus

    Skip Navigation Bar Home Current Issue Past Issues Skin Diseases Questions for Your Health Care Provider Past ... dermatitis worse? What are the most common irritants? Skin cancer What type of skin cancer do I ...

  15. Cancer care in Jordan.

    PubMed

    Abdel-Razeq, Hikmat; Attiga, Fadwa; Mansour, Asem

    2015-06-01

    Cancer is the second leading cause of death in Jordan after cardiovascular diseases. Due to increase in life expectancy and prolonged exposure to risk factors, cancer mortality and morbidity are expected to increase as the young population ages. This increase will constitute a challenging burden on healthcare systems in Jordan and many other neighboring countries. Planning is key to managing the expected rise in the demand for cancer care, and this will require public health initiatives to guarantee access to quality cancer care. Over the past decade, cancer care in Jordan has witnessed remarkable improvement through access to advanced diagnostics and therapeutics. In this review, we address the history of cancer care in Jordan, including cancer statistics, infrastructure, workforce as well as cancer care outcomes. We also discuss many of the challenges that we face and offer suggestions for the improvement of cancer management in Jordan and the region. PMID:25732671

  16. CancerCare

    MedlinePlus

    ... loved ones » Cancer Care Ÿ E-News and E-Alerts Get news and updates from Cancer Care Ÿ right ... Hope Video Library Blog E-News and E-Alerts Calendar Open Portals For Patients and Survivors For ...

  17. Group Family Day Care Provider Handbook

    ERIC Educational Resources Information Center

    New York State Office of Children and Family Services, 2006

    2006-01-01

    Group family day care providers need to create high-quality programs where children have opportunities to grow, learn and thrive. Part of providing high-quality child care includes complying with the group family day care regulations from the New York State Office of Children and Family Services (OCFS). This Handbook will help day care providers:


  18. Survivorship care in breast cancer

    PubMed Central

    Smith, Sally L.; Murchison, Sonja; Singh-Carlson, Savitri; Alexander, Cheryl; Wai, Elaine S.

    2015-01-01

    Abstract Objective To compare the perceptions of breast cancer survivors and primary care physicians (PCPs) about PCPs’ ability to deliver survivorship care in breast cancer. Design Mailed survey. Setting British Columbia. Participants A total of 1065 breast cancer survivors who had completed treatment of nonmetastatic breast cancer within the previous year, and 587 PCPs who had patients with nonmetastatic breast cancer discharged to their care within the preceding 18 months. Main outcome measures Breast cancer survivors’ and PCPs’ confidence ratings of PCPs’ ability to deliver the following aspects of care: screening for recurrence; managing osteoporosis, lymphedema, endocrine therapy, menopausal symptoms, and anxiety about or fear of recurrence; and providing nutrition and exercise counseling, sex and body image counseling, and family counseling. Response options for each question included low, adequate, or good. Responses were summarized as frequencies and compared using χ2 tests. Results Response rates for breast cancer survivors and PCPs were 47% and 59%, respectively. Responses were statistically different in all categories (P < .05). Both groups were most confident in the ability of PCPs to screen for recurrence, but breast cancer survivors were 10 times as likely to indicate low confidence (10% of breast cancer survivors vs 1% of PCPs) in this aspect of care. More breast cancer survivors (23%) expressed low confidence in PCPs’ ability to provide counseling about fear of recurrence compared with PCPs (3%). Aspects of care in which both breast cancer survivors and PCPs were most likely to express low confidence included sex and body image counseling (35% of breast cancer survivors vs 26% of PCPs) and family counseling (33% of breast cancer survivors vs 24% of PCPs). Primary care physicians (24%) described low confidence in their ability to manage lymphedema. Conclusion Breast cancer survivors and PCPs are reasonably confident in a PCP-based model of survivorship care. Primary care physicians are confident in their ability to manage physical effects related to breast cancer, with the exception of lymphedema. Low confidence ratings among both groups in psychosocial aspects of care suggest an area for improvement.

  19. Choosing a primary care provider

    MedlinePlus

    ... et al. Improving patient care. The patient centered medical home. A systematic review. Ann Intern Med . 2013;158(3):169-178. PMID: 24779044 www.ncbi.nlm.nih.gov/pubmed/24779044 . Rohrer JE, Angstman KB, ... PMID: 23537159 www.ncbi.nlm.nih.gov/pubmed/23537159 .

  20. Psychotherapy Provider Attitudes toward Managed Care.

    ERIC Educational Resources Information Center

    Chambliss, Catherine; And Others

    The mental health care delivery system is undergoing a metamorphosis of unprecedented proportion as a result of managed care. Few empirical assessments of practitioner response exist. Utilizing managed care provider and telephone directories, agency lists, and the Internet, 200 managed mental health care providers were anonymously surveyed.


  1. How Do Health Care Providers Diagnose Endometriosis?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose endometriosis? Skip sharing on social media ... under a microscope, to confirm the diagnosis. 1 Health care providers may also use imaging methods to produce ...

  2. How Do Health Care Providers Diagnose Pheochromocytoma?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose pheochromocytoma? Skip sharing on social media links Share this: Page Content A health care provider uses blood and urine tests that measure ...

  3. How Do Health Care Providers Diagnose Vulvodynia?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose vulvodynia? Skip sharing on social media ... been ruled out. To diagnose vulvodynia, 1 a health care provider may recommend that a woman have blood ...

  4. How Do Health Care Providers Diagnose Hypoparathyroidism?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose hypoparathyroidism? Skip sharing on social media links Share this: Page Content A health care provider will order a blood test to determine ...

  5. Child Care Provider's Guide to Safe Sleep

    MedlinePlus

    ... Listen Español Text Size Email Print Share A Child Care Provider's Guide to Safe Sleep Page Content ... Caused By: Immunizations Vomiting or choking What can child care providers do? Follow these guidelines to help ...

  6. Health Care Provider Initiative Strategic Plan

    ERIC Educational Resources Information Center

    National Environmental Education & Training Foundation, 2012

    2012-01-01

    This document lays out the strategy for achieving the goals and objectives of NEETF's "Health Care Provider Initiative." The goal of NEETF's "Health Care Provider Initiative" is to incorporate environmental health into health professionals' education and practice in order to improve health care and public health, with a special emphasis on


  7. Family Day Care Provider Support Services Directory.

    ERIC Educational Resources Information Center

    Galblum, Trudi W.; Boyer-Shesol, Cathy

    This directory profiles numerous organizational support services for family day care providers in the Kansas City metropolitan area. The first chapter, on operating a family day care home, concerns licensing and registration, the processes of starting and marketing a day care business, zoning and municipal regulation, and substitute providers. The


  8. Liability Insurance for Family Child Care Providers.

    ERIC Educational Resources Information Center

    Gellert, Sandra, Comp.

    This pamphlet provides information to family day care providers on the need to have adequate liability insurance to cover the unique risks faced by care providers. It discusses the reasons for carrying liability insurance, including protection from lawsuits and medical claims by the parents of injured children. The pamphlet then explains what to


  9. Improving Modern Cancer Care Through Information Technology

    PubMed Central

    Clauser, Steven B.; Wagner, Edward H.; Bowles, Erin J. Aiello; Tuzzio, Leah; Greene, Sarah M.

    2011-01-01

    The cancer care system is increasingly complex, marked by multiple hand-offs between primary care and specialty providers, inadequate communication among providers, and lack of clarity about a “medical home” (the ideal accountable care provider) for cancer patients. Patients and families often cite such difficulties as information deficits, uncoordinated care, and insufficient psychosocial support. This article presents a review of the challenges of delivering well coordinated, patient-centered cancer care in a complex modern healthcare system. An examination is made of the potential role of information technology (IT) advances to help both providers and patients. Using the published literature as background, a review is provided of selected work that is underway to improve communication, coordination, and quality of care. Also discussed are additional challenges and opportunities to advancing understanding of how patient data, provider and patient involvement, and informatics innovations can support high-quality cancer care. PMID:21521595

  10. [Reembursing health-care service provider networks].

    PubMed

    Binder, A; Braun, G E

    2015-03-01

    Health-care service provider networks are regarded as an important instrument to overcome the widely criticised fragmentation and sectoral partition of the German health-care system. The first part of this paper incorporates health-care service provider networks in the field of health-care research. The system theoretical model and basic functions of health-care research are used for this purpose. Furthermore already established areas of health-care research with strong relations to health-care service provider networks are listed. The second part of this paper introduces some innovative options for reimbursing health-care service provider networks which can be regarded as some results of network-oriented health-care research. The origins are virtual budgets currently used in part to reimburse integrated care according to §§ 140a ff. SGB V. Describing and evaluating this model leads to real budgets (capitation) - a reimbursement scheme repeatedly demanded by SVR-Gesundheit (German governmental health-care advisory board), for example, however barely implemented. As a final step a direct reimbursement of networks by the German sickness fund is discussed. Advantages and challenges are shown. The development of the different reimbursement schemes is partially based on models from the USA. PMID:25625796

  11. Resources for the Family Day Care Provider.

    ERIC Educational Resources Information Center

    Brown, Jeanne, Ed.; And Others

    The 34 brief articles in this sourcebook for family day care providers are presented mainly in two large sections: (1) management of family day care business, and (2) interaction with children. Many of these articles pose and provide answers to questions that are likely to occur to child caregivers, such as "Does the IRS really expect me to keep


  12. Resources for the Family Day Care Provider.

    ERIC Educational Resources Information Center

    Brown, Jeanne, Ed.; And Others

    The 34 brief articles in this sourcebook for family day care providers are presented mainly in two large sections: (1) management of family day care business, and (2) interaction with children. Many of these articles pose and provide answers to questions that are likely to occur to child caregivers, such as "Does the IRS really expect me to keep…

  13. Provincial primary care and cancer engagement strategy

    PubMed Central

    Levitt, Cheryl A.; Lupea, Doina

    2009-01-01

    ABSTRACT PROBLEM ADDRESSED To improve integration of cancer care, Cancer Care Ontario—a provincial agency responsible for planning, advising on, implementing, and monitoring initiatives to improve cancer outcomes—proposed a primary care and cancer engagement strategy in its Ontario Cancer Plan 2008–2011. OBJECTIVE OF PROGRAM The strategy was designed to focus initially on improving screening for colorectal cancer in primary care settings and would expand to improving primary care integration, early detection, decreased mortality, and better patient experiences throughout the whole cancer journey. PROGRAM DESCRIPTION Following a symposium on integrating family practice and cancer care, leaders from Cancer Care Ontario and the Ontario College of Family Physicians developed an action plan. A Provincial Primary Care Lead and 13 Regional Primary Care Leads (RPCLs) were identified. Broad provincial, national, and international consultations and environmental scanning resulted in the development of a strategic conceptual framework guiding the integration initiatives of the primary care and cancer strategy. It includes 3 key domains of interest (vertical, clinical, and functional integration) surrounded by 2 broad and encompassing activities (knowledge transfer and exchange; measurement and monitoring). The RPCLs are the local contacts for primary care providers and regional cancer programs in Ontario. CONCLUSION It is early days, but the RPCLs are already busy participating in key organizational governance structures as decision makers; acting as key contacts for primary care providers who need information about the cancer system; and helping to organize educational events. Together they are developing a strategic plan with long- and short-term goals and are advocating for the resources required to improve integration and engagement of the primary care and cancer system. PMID:19910583

  14. Spirituality in childhood cancer care.

    PubMed

    Lima, Nådia Nara Rolim; do Nascimento, Vùnia Barbosa; de Carvalho, Sionara Melo Figueiredo; Neto, Modesto Leite Rolim; Moreira, Marcial Moreno; Brasil, Aline Quental; Junior, Francisco Telésforo Celestino; de Oliveira, Gislene Farias; Reis, Alberto Olavo Advíncula

    2013-01-01

    To deal with the suffering caused by childhood cancer, patients and their families use different coping strategies, among which, spirituality appears a way of minimizing possible damage. In this context, the purpose of the present study was to analyze the influence of spirituality in childhood cancer care, involving biopsychosocial aspects of the child, the family, and the health care team facing the disease. To accomplish this purpose, a nonsystematic review of literature of articles on national and international electronic databases (Scientific Electronic Library Online [SciELO], PubMed, and Latin American and Caribbean Health Sciences Literature [LILACS]) was conducted using the search terms "spirituality," "child psychology," "child," and "cancer," as well as on other available resources. After the search, 20 articles met the eligibility criteria and were included in the final sample. Our review showed that the relation between spirituality and health has lately become a subject of growing interest among researchers, as a positive influence of spirituality in the people's welfare was noted. Studies that were retrieved using the mentioned search strategy in electronic databases, independently assessed by the authors according to the systematic review, showed that spirituality emerges as a driving force that helps pediatric patients and their families in coping with cancer. Health care workers have been increasingly attentive to this dimension of care. However, it is necessary to improve their knowledge regarding the subject. The search highlighted that spirituality is considered a source of comfort and hope, contributing to a better acceptance of his/her chronic condition by the child with cancer, as well as by the family. Further up-to-date studies facing the subject are, thus, needed. It is also necessary to better train health care practitioners, so as to provide humanized care to the child with cancer. PMID:24133371

  15. Spirituality in childhood cancer care

    PubMed Central

    Lima, Nådia Nara Rolim; do Nascimento, Vùnia Barbosa; de Carvalho, Sionara Melo Figueiredo; Neto, Modesto Leite Rolim; Moreira, Marcial Moreno; Brasil, Aline Quental; Junior, Francisco Telésforo Celestino; de Oliveira, Gislene Farias; Reis, Alberto Olavo Advíncula

    2013-01-01

    To deal with the suffering caused by childhood cancer, patients and their families use different coping strategies, among which, spirituality appears a way of minimizing possible damage. In this context, the purpose of the present study was to analyze the influence of spirituality in childhood cancer care, involving biopsychosocial aspects of the child, the family, and the health care team facing the disease. To accomplish this purpose, a nonsystematic review of literature of articles on national and international electronic databases (Scientific Electronic Library Online [SciELO], PubMed, and Latin American and Caribbean Health Sciences Literature [LILACS]) was conducted using the search terms “spirituality,” “child psychology,” “child,” and “cancer,” as well as on other available resources. After the search, 20 articles met the eligibility criteria and were included in the final sample. Our review showed that the relation between spirituality and health has lately become a subject of growing interest among researchers, as a positive influence of spirituality in the people’s welfare was noted. Studies that were retrieved using the mentioned search strategy in electronic databases, independently assessed by the authors according to the systematic review, showed that spirituality emerges as a driving force that helps pediatric patients and their families in coping with cancer. Health care workers have been increasingly attentive to this dimension of care. However, it is necessary to improve their knowledge regarding the subject. The search highlighted that spirituality is considered a source of comfort and hope, contributing to a better acceptance of his/her chronic condition by the child with cancer, as well as by the family. Further up-to-date studies facing the subject are, thus, needed. It is also necessary to better train health care practitioners, so as to provide humanized care to the child with cancer. PMID:24133371

  16. A managed care cycle provides contract oversight.

    PubMed

    Stevenson, Paul B; Messinger, Stephen F; Welter, Terri

    2002-03-01

    In response to poor payment performance by health plans, providers are realizing that managed care contracts require systematic, ongoing management rather than a periodic focus. An effective managed care cycle that encompasses strategy development, implementation of the strategy through contracting and operations, and monitoring of contract performance can accomplish this needed oversight. Each phase requires specialized management tools, skills, and staff. Because of the importance of managed care to the provider's financial viability, a wide range of persons should be involved in the managed care cycle, including the board of directors, business office staff, senior management, and finance staff. As providers embrace a more structured approach to managed care, they will increase their chances of receiving accurate contracted payments. PMID:11899723

  17. Prediction models in cancer care

    PubMed Central

    Vickers, Andrew J.

    2011-01-01

    Prediction is ubiquitous across the spectrum of cancer care from screening to hospice. Indeed, oncology is often primarily a prediction problem: many of the early stage cancers cause no symptoms, and treatment is recommended because of a prediction that tumor progression would ultimately threaten a patient's quality of life or survival. Recent years have seen attempts to formalize risk prediction in cancer care. In place of qualitative and implicit prediction algorithms, such as cancer stage, researchers have developed statistical prediction tools that provide a quantitative estimate of the probability of a specific event for an individual patient. Prediction models generally have greater accuracy than reliance on stage or risk groupings; can incorporate novel predictors such as genomic data; can be used more rationally to make treatment decisions. Several prediction models are now widely used in clinical practice, including the Gail model for breast cancer incidence or the Adjuvant! online prediction model for breast cancer recurrence. Given the burgeoning complexity of diagnostic and prognostic information there is simply no realistic alternative to incorporating multiple variables into a single prediction model. As such, the question should not be whether but how prediction models should be used to aid decision making. Key issues will be integration of models into the electronic health record, and more careful evaluation of models, particularly with respect to their effects on clinical outcomes. PMID:21732332

  18. Concussion management by primary care providers

    PubMed Central

    Pleacher, M D; Dexter, W W

    2006-01-01

    Objective To assess current concussion management practices of primary care providers. Methods An 11 item questionnaire was mailed to primary care providers in the state of Maine, with serial mailings to non‐respondents. Results Over 50% of the questionnaires were completed, with nearly 70% of primary care providers indicating that they routinely use published guidelines as a tool in managing patients with concussion. Nearly two thirds of providers were aware that neuropsychological tests could be used, but only 16% had access to such tests within a week of injury. Conclusions Primary care providers are using published concussion management guidelines with high frequency, but many are unable to access neuropsychological testing when it is required. PMID:16371479

  19. Preconception care by the nonobstetrical provider.

    PubMed

    Frey, Keith A

    2002-05-01

    Clinicians who provide health care to women during their childbearing years have the opportunity to affect pregnancy outcomes positively through preconception care. The goal of preconception care is to identify medical and social conditions that may put the mother or fetus at risk. Key elements include screening for certain infectious diseases, obtaining genetic history, updating immunizations, providing specific nutritional advice, and optimizing health status. Some women, and their partners, may require additional care, including a prepregnancy consultation with an obstetrician or maternal-fetal medicine specialist. The clinician can also offer advice that may enhance conception and encourage either early prenatal care when a pregnancy is achieved or early evaluation for infertility. PMID:12004996

  20. Weight management practices among primary care providers.

    PubMed

    Timmerman, G M; Reifsnider, E; Allan, J D

    2000-04-01

    This pilot study examined how primary care providers manage patients with weight problems, an important component of primary care. A convenience sample of 17 nurse practitioners and 15 physicians were surveyed about assessments and interventions used in practice for weight management along with perceived barriers to providing effective weight management. Practice patterns between gender, profession and practice setting of the nurse practitioners were compared. PMID:11930414

  1. Reviewing Cancer Care Team Effectiveness

    PubMed Central

    Taplin, Stephen H.; Weaver, Sallie; Salas, Eduardo; Chollette, Veronica; Edwards, Heather M.; Bruinooge, Suanna S.; Kosty, Michael P.

    2015-01-01

    Purpose: The management of cancer varies across its type, stage, and natural history. This necessitates involvement of a variety of individuals and groups across a number of provider types. Evidence from other fields suggests that a team-based approach helps organize and optimize tasks that involve individuals and groups, but team effectiveness has not been fully evaluated in oncology-related care. Methods: We undertook a systematic review of literature published between 2009 and 2014 to identify studies of all teams with clear membership, a comparator group, and patient-level metrics of cancer care. When those teams included two or more people with specialty training relevant to the care of patients with cancer, we called them multidisciplinary care teams (MDTs). After reviews and exclusions, 16 studies were thoroughly evaluated: two addressing screening and diagnosis, 11 addressing treatment, two addressing palliative care, and one addressing end-of-life care. The studies included a variety of end points (eg, adherence to quality indicators, patient satisfaction with care, mortality). Results: Teams for screening and its follow-up improved screening use and reduced time to follow-up colonoscopy after an abnormal screen. Discussion of cases within MDTs improved the planning of therapy, adherence to recommended preoperative assessment, pain control, and adherence to medications. We did not see convincing evidence that MDTs affect patient survival or cost of care, or studies of how or which MDT processes and structures were associated with success. Conclusion: Further research should focus on the association between team processes and structures, efficiency in delivery of care, and mortality. PMID:25873056

  2. Multicultural Nursing: Providing Better Employee Care.

    PubMed

    Rittle, Chad

    2015-12-01

    Living in an increasingly multicultural society, nurses are regularly required to care for employees from a variety of cultural backgrounds. An awareness of cultural differences focuses occupational health nurses on those differences and results in better employee care. This article explores the concept of culturally competent employee care, some of the non-verbal communication cues among cultural groups, models associated with completing a cultural assessment, and how health disparities in the workplace can affect delivery of employee care. Self-evaluation of the occupational health nurse for personal preferences and biases is also discussed. Development of cultural competency is a process, and occupational health nurses must develop these skills. By developing cultural competence, occupational health nurses can conduct complete cultural assessments, facilitate better communication with employees from a variety of cultural backgrounds, and improve employee health and compliance with care regimens. Tips and guidelines for facilitating communication between occupational health nurses and employees are also provided. PMID:26199294

  3. Understanding Fragmentation of Prostate Cancer Survivorship Care

    PubMed Central

    Skolarus, Ted A.; Zhang, Yun; Hollenbeck, Brent K.

    2016-01-01

    BACKGROUND Cancer survivors are particularly prone to the effects of a fragmented health care delivery system. The implications of fragmented cancer care across providers likely include greater spending and worse quality of care. For this reason, the authors measured relations between increasing fragmentation of cancer care, expenditures, and quality of care among prostate cancer survivors. METHODS A total of 67,736 patients diagnosed with prostate cancer between 1992 and 2005 were identified using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Using the Herfindahl-Hirschman Index and a measure of the average number of prostate cancer providers over time, patients were sorted into 3 fragmentation groups (low, intermediate, and high). The authors then examined annual per capita survivorship expenditures and a measure of quality (ie, repetitive prostate-specific antigen [PSA] testing within 30 days) according to their fragmentation exposure using multinomial logistic regression. RESULTS Patients with highly fragmented cancer care tended to be younger, white, and of higher socioeconomic status (all P < .001). Prostate cancer survivorship interventions were most common among patients with the highest fragmentation of care across providers (P < .001). After adjustment for clinical characteristics and prostate cancer survivorship interventions, higher degrees of fragmentation continued to be associated with repetitive PSA testing (13.6% for high vs 7.0% for low fragmentation; P < .001) and greater spending, particularly among patients not treated with androgen deprivation therapy. CONCLUSIONS Fragmented prostate cancer survivorship care is expensive and associated with potentially unnecessary services. Efforts to improve care coordination via current policy initiatives, electronic medical records, and the implementation of cancer survivorship tools may help to decrease fragmentation of care and mitigate downstream consequences for prostate cancer survivors. PMID:22370955

  4. Process utility from providing informal care: the benefit of caring.

    PubMed

    Brouwer, Werner B F; van Exel, N Job A; van den Berg, Bernard; van den Bos, Geertruidis A M; Koopmanschap, Marc A

    2005-09-28

    Though economics is usually outcome-oriented, it is often argued that processes matter as well. Utility is not only derived from outcomes, but also from the way this outcome is accomplished. Providing care on a voluntary basis may especially be associated with such process utility. In this paper, we discuss the process utility from providing informal care. We test the hypothesis that informal caregivers derive utility not only from the outcome of informal care, i.e. that the patient is adequately cared for, but also from the process of providing informal care. We present empirical evidence of process utility on the basis of a large sample of Dutch caregivers (n=950). We measure process utility as the difference in happiness between the current situation in which the care recipient is cared for by the caregiver and the hypothetical situation that someone else takes over the care tasks, all other things equal. Other background characteristics on patient and caregiver characteristics, objective and subjective caregiver burden and quality of life are also presented and related to process utility. Our results show that process utility exists and is substantial and therefore important in the context of informal care. Almost half of the caregivers (48.2%) derive positive utility from informal care and on average happiness would decline if informal care tasks were handed over to someone else. Multivariate regression analysis shows that process utility especially relates to caregiver characteristics (age, gender, general happiness, relation to patient and difficulties in performing daily activities) and subjective caregiver burden, whereas it also depends on the number of hours of care provided (objective burden). These results strengthen the idea of supporting the use of informal care, but also that of keeping a close eye on the position of carers. PMID:16098415

  5. Prostate cancer: palliative care and pain relief.

    PubMed

    Thompson, J C; Wood, J; Feuer, D

    2007-01-01

    Introduction Metastatic prostate cancer is incurable and causes significant morbidity. The focus of treatment should be on improving quality of life through appropriate oncological treatment and palliative care. The National Institute for Clinical Excellence guidelines for urological cancer recommends palliative care for all patients with prostate cancer, according to need. This paper outlines the principles of modern palliative care in patients with metastatic prostate cancer within the UK. Discussion We highlight the main physical symptoms encountered in metastatic prostate cancer and their management. We also introduce the UK Department of Health's 'End-of-Life Care Programme'. This initiative intends to improve the lives and deaths of all patients with incurable disease and should be a priority for all health care professionals, within any setting. Conclusion Clearly, we have addressed the management of metastatic prostate cancer within the UK setting, though any of these government initiatives may provide a resource and framework in other countries. PMID:17628024

  6. Should health care providers be accountable for patients' care experiences?

    PubMed

    Anhang Price, Rebecca; Elliott, Marc N; Cleary, Paul D; Zaslavsky, Alan M; Hays, Ron D

    2015-02-01

    Measures of patients' care experiences are increasingly used as quality measures in accountability initiatives. As the prominence and financial impact of patient experience measures have increased, so too have concerns about the relevance and fairness of including them as indicators of health care quality. Using evidence from the Consumer Assessment of Healthcare Providers and Systems (CAHPSÂź) surveys, the most widely used patient experience measures in the United States, we address seven common critiques of patient experience measures: (1) consumers do not have the expertise needed to evaluate care quality; (2) patient "satisfaction" is subjective and thus not valid or actionable; (3) increasing emphasis on improving patient experiences encourages health care providers and plans to fulfill patient desires, leading to care that is inappropriate, ineffective, and/or inefficient; (4) there is a trade-off between providing good patient experiences and providing high-quality clinical care; (5) patient scores cannot be fairly compared across health care providers or plans due to factors beyond providers' control; (6) response rates to patient experience surveys are low, or responses reflect only patients with extreme experiences; and (7) there are faster, cheaper, and more customized ways to survey patients than the standardized approaches mandated by federal accountability initiatives. PMID:25416601

  7. Palliative Care in Cancer

    MedlinePlus

    ... Role in Cancer Research Intramural Research Extramural Research Bioinformatics and Cancer NCI-Designated Cancer Centers Frederick National ... Role in Cancer Research Intramural Research Extramural Research Bioinformatics and Cancer NCI-Designated Cancer Centers Frederick National ...

  8. Women as providers of health care.

    PubMed

    1983-01-01

    Societies depend heavily on women for health care, yet women's own health needs are frequently neglected, their contributions to health development undervalued, and their working conditions ignored. The increasing recognition of the need for universally accessible primary health care and of people's right and duty to participate individually and collectively in their own care makes it vital to critically examine the role and status of women in its provision. A question which arises is whether the low status and prestige accorded to primary health stems from the fact that it is primarily women who provided it, or, rather, are women the main providers of such care because it is still regarded as unprestigious work and therefore to be left largely to women. Whatever the answer, the status and prestige of primary health care and the workers who provide it must be raised. To help address the problems and devise some solutions, the World Health Organization (WHO) convened consultations in 1980 and 1982. At the 1st consultation, priority issues concerning women as health care providers were identified and suggestions made for case studies and on analyses on specific issues. These were to be carried out in 17 developing and developed countries. The 2nd consultation brought together policy analysts and decision makers from the countries concerned who examined the findings and proposed concrete activities at the international and the national level. It became clear that any comprehensive strategy designed to raise the status of women who provide health care and make their workload less onerous must focus on the following elements: educational and training; attitudes about women; health education; policies and opportunities for employment; support systems; and infrastructure development. These elements are discussed separately here, yet it should be remembered that the participants in the consultation continually stressed their interdependence. Education of women for health work must be seen in the context of the type and length of the general education that they receive. The recruitment of women to training programs will require special efforts. Once women's self-esteem increases they are likely to receive more respect and consideration from men. To acquire this self-esteem, women must organize and support each other. Changes are called for in the attitudes towards each other of health care providers working in the formal and nonformal sectors. To provide health education for women is to train health educators for the community. Every plan for national development must include employment policies and strategies for their implementation. PMID:6649593

  9. Resource measurement by health care providers.

    PubMed

    Suver, J D; Neumann, B R

    1986-01-01

    The need to use health care resources effectively and efficiently has led to increased interest in developing a "should cost" approach to performance measurement. The development of appropriate standards and the separation of fixed costs into surrogate variable and capacity components can provide a useful tool for managers to measure performance. This article develops a framework for evaluating the utilization of fixed costs in providing output. PMID:10280908

  10. Personalized Cancer Care Conference

    PubMed Central

    ZĂ€nker, Kurt S.; Mihich, Enrico; Huber, Hans-Peter; Borresen-Dale, Anne-Lise

    2013-01-01

    The Oslo University Hospital (Norway), the K.G. Jebsen Centre for Breast Cancer Research (Norway), The Radiumhospital Foundation (Norway) and the Fritz-Bender-Foundation (Germany) designed under the conference chairmen (E. Mihich, K.S. ZĂ€nker, A.L. Borresen-Dale) and advisory committee (A. Borg, Z. Szallasi, O. Kallioniemi, H.P. Huber) a program at the cutting edge of “PERSONALIZED CANCER CARE: Risk prediction, early diagnosis, progression and therapy resistance.” The conference was held in Oslo from September 7 to 9, 2012 and the science-based presentations concerned six scientific areas: (1) Genetic profiling of patients, prediction of risk, late side effects; (2) Molecular profiling of tumors and metastases; (3) Tumor-host microenvironment interaction and metabolism; (4) Targeted therapy; (5) Translation and (6) Informed consent, ethical challenges and communication. Two satellite workshops on (i) Ion Ampliseq—a novel tool for large scale mutation detection; and (ii) Multiplex RNA ISH and tissue homogenate assays for cancer biomarker validation were additionally organized. The report concludes that individual risk prediction in carcinogenesis and/or metastatogenesis based on polygenic profiling may be useful for intervention strategies for health care and therapy planning in the future. To detect distinct and overlapping DNA sequence alterations in tumor samples and adjacent normal tissues, including point mutations, small insertions or deletions, copy number changes and chromosomal rearrangements will eventually make it possible to design personalized management plans for individualized patients. However, large individualized datasets need a new approach in bio-information technology to reduce this enormous data dimensionally to simply working hypotheses about health and disease for each individual. PMID:25562519

  11. Caring: Information for Family Day-Care Providers.

    ERIC Educational Resources Information Center

    California Univ., Berkeley. Cooperative Extension Service.

    This series of leaflets provides information for family day care providers on nine topics. Age differences and developmental stages are emphasized. The first topic concerns ways to help young children get along with others. Self-esteem is emphasized, and methods for helping children develop self-esteem are listed. The second leaflet discusses


  12. Better Baby Care: A Book for Family Day Care Providers.

    ERIC Educational Resources Information Center

    Nash, Margaret; Tate, Costella

    A resource for child caregivers providing family day care for infants and toddlers, this book is designed to provide information and suggestions in a format that is easy to follow, and in language that is easy to read. Chapter 1 gives tips on "baby-proofing" the home, as well as ideas for toys, equipment, and how to integrate a baby into the


  13. Review of Pesticide Education Materials for Health Care Providers Providing Care to Agricultural Workers

    ERIC Educational Resources Information Center

    Hiott, Ann E.; Quandt, Sara A.; Early, Julie; Jackson, David S.; Arcury, Thomas A.

    2006-01-01

    Context: Pesticide exposure is an important environmental and occupational health risk for agricultural workers and their families, but health care providers receive little training in it. Objective: To evaluate the medical resources available to providers caring for patients, particularly farmworkers, exposed to pesticides and to recommend a…

  14. Review of Pesticide Education Materials for Health Care Providers Providing Care to Agricultural Workers

    ERIC Educational Resources Information Center

    Hiott, Ann E.; Quandt, Sara A.; Early, Julie; Jackson, David S.; Arcury, Thomas A.

    2006-01-01

    Context: Pesticide exposure is an important environmental and occupational health risk for agricultural workers and their families, but health care providers receive little training in it. Objective: To evaluate the medical resources available to providers caring for patients, particularly farmworkers, exposed to pesticides and to recommend a


  15. The role of midlevel providers in cancer screening.

    PubMed

    Reed, C A; Selleck, C S

    1996-01-01

    Data indicate that midlevel providers are more likely to provide health promotion and disease prevention counseling, health education, and preventive health and screening services as well as use more community resources. Although the literature is sparse regarding cancer screening activities by midlevel providers, such activities are routinely taught in midlevel educational programs, and midlevel providers see these activities as consistent with their roles. Therefore, it is only logical to assume that use of midlevel providers, who have already been shown to focus on health promotion and disease prevention, would be an effective way to provide quality, cost-effective cancer screening. In fact, models of this sort exist around the United States at the present time, such as the one at Moffitt Cancer Center's Lifetime Cancer Screening Program in Tampa, Florida. In such programs, midlevel providers are successfully conducting comprehensive cancer screening activities. Outcome data from these programs have yet to be published, however. In a collaborative practice environment, the delivery of preventive care, including cancer screening activities, is best accomplished when both the physician and the midlevel provider agree on the importance of these screening activities and work together as a team to integrate these preventive health activities into their office practice. Office systems that are sensitive to patient preferences and that promote preventive care, such as protocols and checklists or health maintenance flowsheets, along with appropriate education tailored to patients' ages and to their social, cultural, and educational backgrounds also help to improve compliance with cancer screening guidelines. More than ever before, health care reform has been the focus of national debate. Most of the health care reform proposals that have been advanced recognize the importance of primary and preventive health care and the role that midlevel providers could and should be playing in such a system. As competent providers, NPs, CNMs, and PAs have the ability to enhance medicine's effectiveness in preventive care, through improved outreach and more thorough screening. PMID:8569292

  16. Providing high-quality care in primary care settings

    PubMed Central

    Beaulieu, Marie-Dominique; Geneau, Robert; Grande, Claudio Del; Denis, Jean-Louis; Hudon, Éveline; Haggerty, Jeannie L.; Bonin, Lucie; Duplain, Réjean; Goudreau, Johanne; Hogg, William

    2014-01-01

    Abstract Objective To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Design Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Setting Three regions of Quebec. Participants Health care professionals and staff of 5 PC practices. Methods Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. Main findings The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Conclusion Irrespective of their models, PC practices’ pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. PMID:24829023

  17. Cancer Quality Alliance: Blueprint for a better cancer care system.

    PubMed

    Rose, Christopher; Stovall, Ellen; Ganz, Patricia A; Desch, Christopher; Hewitt, Maria

    2008-01-01

    The Cancer Quality Alliance (CQA), a national alliance advocating for improvements in the quality of cancer care in America, presents a set of 5 case studies that depict a vision of quality cancer care and a "Blueprint" for actions to realize this vision. The CQA Blueprint case studies feature patients with soft tissue sarcoma, breast cancer, rectal cancer, and Hodgkin disease and focus on key phases in the cancer care trajectory: detection, diagnosis, treatment, post-treatment/survivorship, and end of life. Each case study begins with a patient summary, follows with a worst- and a best-case scenario, and concludes with a discussion section identifying "what went right" in the best case and "what went wrong" in the worst case. Steps to be taken by key stakeholders, for example, health care providers, insurers/payers, policy makers, and patients and families, are then outlined. By juxtaposing a worst- and best-case scenario, the cancer care case studies elucidate the origins of complex health care problems and clarify the actions needed to overcome them. The CQA will make the case studies available for use as teaching tools to give health care providers and patients themselves descriptions of how the health care system should work to achieve the ultimate benefit for an individual living with, through, and beyond a diagnosis of cancer. The CQA adopted the definition of quality health care of the Institute of Medicine, and the analysis of care provided in the discussion section of each case study is framed using 6 quality improvement aims identified in the Institute of Medicine's report, Crossing the Quality Chasm: A New Health System for the 21st Century. Health care quality may be judged according to its safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. PMID:18768677

  18. Frontiers of cancer care in Asia-Pacific region: cancer care in Australia

    PubMed Central

    Koh, ES; Do, VT; Barton, MB

    2008-01-01

    Cancer has a significant impact on the Australian community. One in three men and one in four women will develop cancer by the age of 75. The estimated annual health expenditure due to cancer in 2000-1 in Australia was $2.7 billion, representing 5.5% of the country’s total healthcare expenditure. An historical overview of the national cancer control strategies in Australia is provided. In males, the five most common cancers in order of decreasing incidence are: prostate cancer, colorectal cancer, lung cancer, melanoma and lymphoma, while for Australian women, breast cancer is the most common cancer. Key epidemiologic information about these common cancers, current management issues and comprehensive national clinical practice guidelines (where available) are highlighted. Aspects of skin cancer, a particularly common cancer in the Australian environment – with a focus on melanoma – are also included. Cancer outcomes in Australia, measured by selected outcomes, are among the best in the world. However, there is still evidence of health inequalities, especially among patients residing in regional and remote areas, the indigenous population and people from lower socio-economic classes. Limitations of current cancer care practices in Australia, including provision of oncology services, resources and other access issues, as well as suggested improvements for future cancer care, are summarised. Ongoing implementation of national and state cancer control plans and evaluation of their effectiveness will be needed to pursue the goal of optimal cancer care in Australia. PMID:21611000

  19. Translating genomics in cancer care.

    PubMed

    Bombard, Yvonne; Bach, Peter B; Offit, Kenneth

    2013-11-01

    There is increasing enthusiasm for genomics and its promise in advancing personalized medicine. Genomic information has been used to personalize health care for decades, spanning the fields of cardiovascular disease, infectious disease, endocrinology, metabolic medicine, and hematology. However, oncology has often been the first test bed for the clinical translation of genomics for diagnostic, prognostic, and therapeutic applications. Notable hereditary cancer examples include testing for mutations in BRCA1 or BRCA2 in unaffected women to identify those at significantly elevated risk for developing breast and ovarian cancers, and screening patients with newly diagnosed colorectal cancer for mutations in 4 mismatch repair genes to reduce morbidity and mortality in their relatives. Somatic genomic testing is also increasingly used in oncology, with gene expression profiling of breast tumors and EGFR testing to predict treatment response representing commonly used examples. Health technology assessment provides a rigorous means to inform clinical and policy decision-making through systematic assessment of the evidentiary base, along with precepts of clinical effectiveness, cost-effectiveness, and consideration of risks and benefits for health care delivery and society. Although this evaluation is a fundamental step in the translation of any new therapeutic, procedure, or diagnostic test into clinical care, emerging developments may threaten this standard. These include "direct to consumer" genomic risk assessment services and the challenges posed by incidental results generated from next-generation sequencing (NGS) technologies. This article presents a review of the evidentiary standards and knowledge base supporting the translation of key cancer genomic technologies along the continuum of validity, utility, cost-effectiveness, health service impacts, and ethical and societal issues, and offers future research considerations to guide the responsible introduction of NGS technologies into health care. It concludes that significant evidentiary gaps remain in translating genomic technologies into routine clinical practice, particularly in efficacy, health outcomes, cost-effectiveness, and health services research. These caveats are especially germane in the context of NGS, wherein efforts are underway to translate NGS results despite their limited accuracy, lack of proven efficacy, and significant computational and counseling challenges. Further research across these domains is critical to inform the effective, efficient, and equitable translation of genomics into cancer care. PMID:24225968

  20. Pediatric Primary Care Providers' Relationships with Mental Health Care Providers: Survey Results

    ERIC Educational Resources Information Center

    Pidano, Anne E.; Honigfeld, Lisa; Bar-Halpern, Miri; Vivian, James E.

    2014-01-01

    Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental…

  1. Pediatric Primary Care Providers' Relationships with Mental Health Care Providers: Survey Results

    ERIC Educational Resources Information Center

    Pidano, Anne E.; Honigfeld, Lisa; Bar-Halpern, Miri; Vivian, James E.

    2014-01-01

    Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental


  2. Follow-up Care After Cancer Treatment

    MedlinePlus

    ... Association of Cancer Online Resources, a cancer information system that offers access to electronic mailing lists and websites, provides a list of ... received (for example, type and dates of all surgeries; names and doses of all ... and other health professionals involved in treatment and follow-up care ...

  3. Severe Obesity in Cancer Care.

    PubMed

    Streu, Erin

    2016-05-01

    Increasing weight and body fat composition has an impact on cancer detection and staging. Obese women are less likely to engage in breast and cervical screening practices. Excessive adipose tissue makes physical assessment more difficult, and patients with a BMI greater than 35 kg/m2 may have deeper and wider pelvic structures, which make internal examinations problematic. A retrospective review of 324 primary surgical patients found that patients with a BMI greater than 40 kg/m2 are seven times less likely to undergo complete surgical staging for endometrial cancer compared with individuals with a BMI less than 40 kg/m2. In addition, healthcare provider bias against the need for screening, feelings of discomfort and embarrassment, as well as patient's fears of guilt, humiliation, and shame pose significant barriers to addressing the issue of obesity in clinical care with patients and family members. 
. PMID:27105188

  4. Biomarkers, Bundled Payments, and Colorectal Cancer Care

    PubMed Central

    Lynch, Patrick; Raju, Gottumukkala; Rodriguez, Alma; Burke, Thomas; Hafemeister, Lisa; Hawk, Ernest; Wu, Xifeng; DuBois, Raymond N.

    2012-01-01

    Changes in the management of cancers such as colorectal cancer (CRC) are urgently needed, as such cancers continue to be one of the most commonly diagnosed cancers; CRC accounts for 21% of all cancers and is responsible for mortalities second only to lung cancer in the United States. A comprehensive science-driven approach towards markedly improved early detection/screening to efficacious targeted therapeutics with clear diagnostic and prognostic markers is essential. In addition, further changes addressing rising costs, stemming from recent health care reform measures, will be brought about in part by changes in how care is reimbursed. For oncology, the advances in genomics and biomarkers have the potential to define subsets of patients who have a prognosis or response to a particular type of therapy that differs from the mean. Better definition of a cancer’s behavior will facilitate developing care plans tailored to the patient. One method under study is episode-based payment or bundling, where one payment is made to a provider organization to cover all expenses associated with a discrete illness episode. Payments will be based on the average cost of care, with providers taking on a risk for overutilization and outliers. For providers to thrive in this environment, they will need to know what care a patient will require and the costs of that care. A science-driven “personalized approach” to cancer care has the potential to produce better outcomes with reductions in the use of ineffectual therapies and costs. This promising scenario is still in the future, but progress is being made, and the shape of things to come for cancer care in the age of genomics is becoming clearer. PMID:22893787

  5. Models of cancer survivorship health care: moving forward.

    PubMed

    Oeffinger, Kevin C; Argenbright, Keith E; Levitt, Gill A; McCabe, Mary S; Anderson, Paula R; Berry, Emily; Maher, Jane; Merrill, Janette; Wollins, Dana S

    2014-01-01

    The population of cancer survivors in the United States and worldwide is rapidly increasing. Many survivors will develop health conditions as a direct or indirect consequence of their cancer therapy. Thus, models to deliver high-quality care for cancer survivors are evolving. We provide examples of three different models of survivorship care from a cancer center, a community setting, and a country-wide health care system, followed by a description of the ASCO Cancer Survivorship Compendium, a tool to help providers understand the various models of survivorship care available and integrate survivorship care into their practices in a way that fits their unique needs. PMID:24857078

  6. Teleradiotherapy Network: Applications and Feasibility for Providing Cost-Effective Comprehensive Radiotherapy Care in Low- and Middle-Income Group Countries for Cancer Patients

    PubMed Central

    Heuser, Michael; Samiei, Massoud; Shah, Ragesh; Lutters, Gerd; Bodis, Stephan

    2015-01-01

    Abstract Globally, new cancer cases will rise by 57% within the next two decades, with the majority in the low- and middle-income countries (LMICs). Consequently, a steep increase of about 40% in cancer deaths is expected there, mainly because of lack of treatment facilities, especially radiotherapy. Radiotherapy is required for more than 50% of patients, but the capital cost for equipment often deters establishment of such facilities in LMICs. Presently, of the 139 LMICs, 55 do not even have a radiotherapy facility, whereas the remaining 84 have a deficit of 61.4% of their required radiotherapy units. Networking between centers could enhance the effectiveness and reach of existing radiotherapy in LMICs. A teleradiotherapy network could enable centers to share and optimally utilize their resources, both infrastructure and staffing. This could be in the form of a three-tier radiotherapy service consisting of primary, secondary, and tertiary radiotherapy centers interlinked through a network. The concept has been adopted in some LMICs and could also be used as a “service provider model,” thereby reducing the investments to set up such a network. Teleradiotherapy networks could be a part of the multipronged approach to address the enormous gap in radiotherapy services in a cost-effective manner and to support better accessibility to radiotherapy facilities, especially for LMICs. PMID:25763906

  7. Optimizing cancer care through mobile health.

    PubMed

    Odeh, Bassel; Kayyali, Reem; Nabhani-Gebara, Shereen; Philip, Nada

    2015-07-01

    The survival rates for patients living with cancer are increasing, due to recent advances in detection, prevention and treatment. It has been estimated that there were 28 million cancer survivors around the world in 2012. In the UK, for patients diagnosed in 2007, it is predicted that more than half of them will survive their cancer for 5 years or more. A large majority of cancer survivors report unmet supportive care needs and distressing symptoms and adverse long-term consequences related to their cancer. Cancer management could be optimized to better meet patients demand through technology, including mobile health (m-Health). m-Health is defined as the use of mobile communications and network technologies for health care. m-Health can help both patients and health-care professionals and play an important part in managing and delivering cancer care including managing side effects, supporting drug adherence, providing cancer information, planning and follow up and detecting and diagnosing cancer. Health authorities have already published guidelines regulating m-Health to insure patient safety and improve the accountability of its applications. PMID:25649121

  8. Recommendations for Primary Care Provided by Psychiatrists.

    PubMed

    Sowers, Wesley; Arbuckle, Melissa; Shoyinka, Sosunmolu

    2016-05-01

    Recent studies have shown that people with severe mental illness have a dramatically lower life expectancy than the general population. Psychiatrists have not traditionally been very attentive to or involved with physical health issues and there has been growing emphasis on integrated care for physical and mental health and access to primary care for all members of the population. This paper examines the role of psychiatrists in the provision of primary care to the patients they treat. Some recommendations are offered for their involvement in the provision of primary care at three levels of complexity: Level 1-Universal Basic Psychiatric Primary Care; Level 2-Enhanced Psychiatric Primary Care; and Level 3-Fully Integrated Primary Care and Psychiatric Management. Some of the obstacles to the provision of primary care by psychiatrists are considered along with some suggestions for overcoming them. PMID:26803759

  9. The Patient Protection and Affordable Care Act: what every provider of gynecologic oncology care should know.

    PubMed

    Duska, Linda R; Engelhard, Carolyn L

    2013-06-01

    The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama in 2010. While initial implementation of the law began shortly thereafter, the full implementation will take place over the next few years. With respect to cancer care, the act was intended to make care more accessible, affordable, and comprehensive across different parts of the country. For our cancer patients and our practices, the ACA has implications that are both positive and negative. The Medicaid expansion and access to insurance exchanges are intended to increase the number of insured patients and thus improve access to care, but many states have decided to opt out of the Medicaid program and in these states access problems will persist. Screening programs will be put in place for insured patients but may supplant federally funded programs that are currently in place for uninsured patients and may not follow current screening guidelines. Both hospice and home health providers will be asked to provide more services with less funding, and quality measures, including readmission rates, will factor into reimbursement. Insured patients will have access to all phases of clinical trial research. There is a need for us as providers of Gynecologic Oncology care to be active in the implementation of the ACA in order to ensure that our patients and our practices can survive and benefit from the changes in health care reimbursement, with the ultimate goals of improving access to care and quality while reducing unsustainable costs. PMID:23500090

  10. How Do Health Care Providers Diagnose Klinefelter Syndrome?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose Klinefelter syndrome (KS)? Skip sharing on ... karyotype (pronounced care-EE-oh-type ) test. A health care provider will take a small blood or skin ...

  11. Mapping the risk perception and communication gap between different professions of healthcare providers in cancer care: a cross-sectional protocol

    PubMed Central

    Stub, Trine; Musial, Frauke; Quandt, Sara A; Arcury, Thomas A; Salamonsen, Anita; Kristoffersen, Agnete; Berntsen, Gro

    2015-01-01

    Introduction Studies show that patients with cancer who use complementary and alternative medicine (CAM) have a poorer survival prognosis than those who do not. It remains unclear whether this is due to a priori poorer prognosis that makes patients turn to CAM, or whether there is a factor associated with CAM use itself that influences the prognosis negatively. Healthcare providers should assist patients in safeguarding their treatment decision. However, the current non-communication between CAM and conventional providers leaves it up to the patients themselves to choose how to best integrate the two worlds of therapy. In this study, an interactive shared decision-making (SDM) tool will be developed to enable patients and health professionals to make safe health choices. Methods and analysis We will delineate, compare and evaluate perception and clinical experience of communication of risk situations among oncology experts, general practitioners and CAM practitioners. To accomplish this, we will develop a pilot and implement a large-scale survey among the aforementioned health professionals in Norway. Guided by the survey results, we will develop a ÎČ-version of a shared decision-making tool for healthcare providers to use in guiding patients to make safe CAM decisions. Ethics and dissemination Participants must give their informed and written consent before inclusion. They will be informed about the opportunity to drop out from the study followed by deletion of all data registered. The study needs no approval from The Regional Committee for Medical and Health Research Ethics because all participants are healthcare professionals. Results from this study will be disseminated in peer-reviewed medical journals. PMID:26338839

  12. Health Care Provider Physical Activity Prescription Intervention

    ERIC Educational Resources Information Center

    Josyula, Lakshmi; Lyle, Roseann

    2013-01-01

    Purpose: To examine the feasibility and impact of a health care provider’s (HCP) physical activity (PA) prescription on the PA of patients on preventive care visits. Methods: Consenting adult patients completed health and PA questionnaires and were sequentially assigned to intervention groups. HCPs prescribed PA using a written prescription only


  13. Youth Suicides Unknown to Psychiatric Care Providers.

    ERIC Educational Resources Information Center

    Runeson, Bo Sigurd

    1992-01-01

    Consecutive suicides (n=58) among adolescents and young adults, studied by psychological autopsy, were classified according to presence of previous psychiatric care. Fifteen of 16 subjects without previous care were males, 6 were diagnosed as having adjustment disorder related to recent event. Unemployment was less common, suicidal processes were


  14. 47 CFR 54.633 - Health care provider contribution.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 3 2014-10-01 2014-10-01 false Health care provider contribution. 54.633... (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Healthcare Connect Fund § 54.633 Health care provider contribution. (a) Health care provider contribution. All health...

  15. 47 CFR 54.633 - Health care provider contribution.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 3 2013-10-01 2013-10-01 false Health care provider contribution. 54.633... (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Healthcare Connect Fund § 54.633 Health care provider contribution. (a) Health care provider contribution. All health...

  16. CAM Provider Use and Expenditures by Cancer Treatment Phase

    PubMed Central

    Lafferty, William E.; Tyree, Patrick T.; Devlin, Sean M.; Andersen, M. Robyn; Diehr, Paula K.

    2008-01-01

    Objective To assess cancer patients’ utilization of complementary and alternative medical providers and the associated expenditures by specific treatment phases. Study Design Cross-sectional analysis of medical services utilization and expenditures during three therapeutic intervals: an initial treatment phase, continuing care, and end-of-life. Methods Analysis of an insurance claims database that had been matched to the Washington State SEER cancer registry. Results Of 2,900 registry-matched cancer patients 63.2% were female, the median age was 54 years, and 92.7% were white. Breast cancer was the most frequent diagnosis (52.7%), followed by prostate cancer (24.7%), lung cancer (10.1%), colon cancer (7.0%), and hematologic malignancies (5.6%). CAM provider using patients were 26.5% of the overall cohort (18.5% used chiropractors, 7.7% naturopathic physicians, 5.3% massage therapists, and 4.2% saw acupuncturists). The proportion of CAM using patients was similar during each treatment phase. All patients used some conventional care. Female gender, a breast cancer diagnosis, age, and white race were significant predictors of CAM use. Diagnosis of a musculoskeletal problem occurred at sometime during the study for 72.1% of cancer patients. CAM provider visits were 7.2% of total outpatient medical visits and 85.1% of CAM visits resulted in a musculoskeletal diagnosis. Expenditures for CAM providers were 0.3%, 1.0%, and 0.1% of all expenditures during the initial, continuing, and end-of-life phases respectively. Conclusion For cancer patients, musculoskeletal issues were the most commonly listed diagnosis made by a CAM provider. Although expenditures associated with CAM are a small proportion of the total, additional studies are necessary to determine the importance patients place on access to these services. PMID:18471036

  17. Cancer Patient Navigator Tasks across the Cancer Care Continuum

    PubMed Central

    Braun, Kathryn L.; Kagawa-Singer, Marjorie; Holden, Alan E. C.; Burhansstipanov, Linda; Tran, Jacqueline H.; Seals, Brenda F.; Corbie-Smith, Giselle; Tsark, JoAnn U.; Harjo, Lisa; Foo, Mary Anne; Ramirez, Amelie G.

    2011-01-01

    Cancer patient navigation (PN) programs have been shown to increase access to and utilization of cancer care for poor and underserved individuals. Despite mounting evidence of its value, cancer patient navigation is not universally understood or provided. We describe five PN programs and the range of tasks their navigators provide across the cancer care continuum (education and outreach, screening, diagnosis and staging, treatment, survivorship, and end-of-life). Tasks are organized by their potential to make cancer services understandable, available, accessible, affordable, appropriate, and accountable. Although navigators perform similar tasks across the five programs, their specific approaches reflect differences in community culture, context, program setting, and funding. Task lists can inform the development of programs, job descriptions, training, and evaluation. They also may be useful in the move to certify navigators and establish mechanisms for reimbursement for navigation services. PMID:22423178

  18. Providing and financing aged care in Australia

    PubMed Central

    Ergas, Henry; Paolucci, Francesco

    2011-01-01

    This article focuses on the provision and financing of aged care in Australia. Demand for aged care will increase substantially as a result of population aging, with the number of Australians aged 85 and over projected to increase from 400,000 in 2010 to over 1.8 million in 2051. Meeting this demand will greatly strain the current system, and makes it important to exploit opportunities for increased efficiency. A move to greater beneficiary co-payments is also likely, though its extent may depend on whether aged care insurance and other forms of pre-payment can develop. PMID:22312229

  19. 45 CFR 162.410 - Implementation specifications: Health care providers.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Implementation specifications: Health care... for Health Care Providers § 162.410 Implementation specifications: Health care providers. (a) A covered entity that is a covered health care provider must: (1) Obtain, by application if necessary,...

  20. 45 CFR 162.410 - Implementation specifications: Health care providers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Implementation specifications: Health care... for Health Care Providers § 162.410 Implementation specifications: Health care providers. (a) A covered entity that is a covered health care provider must: (1) Obtain, by application if necessary,...

  1. 45 CFR 162.410 - Implementation specifications: Health care providers.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Implementation specifications: Health care... for Health Care Providers § 162.410 Implementation specifications: Health care providers. (a) A covered entity that is a covered health care provider must: (1) Obtain, by application if necessary,...

  2. Perspectives of cancer survivors on the role of different healthcare providers in an integrated delivery system

    PubMed Central

    Chubak, Jessica; Aiello Bowles, Erin J.; Tuzzio, Leah; Ludman, Evette; Rutter, Carolyn M.; Reid, Robert J.; Wagner, Edward H.

    2014-01-01

    Purpose To describe patient perspectives on survivorship care one year after cancer diagnosis. Methods The study was conducted at an integrated healthcare delivery system in western Washington State. Participants were patients with breast, colorectal, and lung cancer who had enrolled in a randomized control trial (RCT) of oncology nurse navigation to improve early cancer care. Those alive and enrolled in the healthcare system one year after diagnosis were eligible for this analysis. Participants completed surveys by phone. Questions focused on receipt of treatment summaries and care plans; discussions with different providers; patient opinions on who does and should provide their care; and primary care providers’ (PCP) knowledge and skills related to caring for cancer survivors Results Of the 251 participants in the RCT, 230 (91.6%) responded to the 12-month phone survey and were included in this analysis; most (n=183, 79.6%) had breast cancer. The majority (84.8%) considered their cancer specialist (e.g., medical, radiation, surgical or gynecological oncologist) to be their main provider for cancer follow-up and most (69.4%) had discussed follow-up care with that provider. Approximately half of patients were uncertain how well their PCP communicated with the oncologist and how knowledgeable s/he was in caring for cancer survivors. Conclusions One year after diagnosis, cancer survivors continue to view cancer specialists as their main providers and are uncertain about their PCP’s skills and knowledge in managing their care. Our findings present an opportunity to help patients understand what their PCPs can and cannot provide in the way of cancer follow-up care. Implications for cancer survivors Additional research on care coordination and delivery is necessary to help cancer survivors manage their care between primary care and specialty providers. PMID:24352871

  3. Baseline Management Practices at Providers in Better Jobs Better Care

    ERIC Educational Resources Information Center

    Stott, Amy L.; Brannon, S. Diane; Vasey, Joseph; Dansky, Kathryn H.; Kemper, Peter

    2007-01-01

    High turnover and difficult recruitment of direct care workers are challenges for long-term care providers. This study reports the extent and variation of the use of management practices for direct care workers and their supervisors across four long-term care settings in the Better Jobs Better Care demonstration. Overall, there is limited use of


  4. [Supportive care in pancreatic cancer].

    PubMed

    Capodano, GĂ©raldine

    2015-03-01

    Pancreatic cancer is one of the most aggressive malignancy with an expected overall survival of less than one year in metastatic canes. Many refmactory symptoms may be present at diagnosis and must be adequaty managed to improve quality of life (and survival ?) of these patients This includes dedicated supportive care but also an early introduction of palliative care methods. The current manuscript details the mast common and problematic maaifestatiaas of pancreatic cancer including weight loss, anorexia, cachexia syndrome, pain management, venous thromboembolism, malignant biliary and gastric outlet obstruction. PMID:26016203

  5. Evaluating Primary Care Providers' Views on Survivorship Care Plans Generated by an Electronic Health Record System

    PubMed Central

    Donohue, SarahMaria; Sesto, Mary E.; Hahn, David L.; Buhr, Kevin A.; Jacobs, Elizabeth A.; Sosman, James M.; Andreason, Molly J.; Wiegmann, Douglas A.; Tevaarwerk, Amye J.

    2015-01-01

    Purpose: Survivorship care plans for cancer survivors may facilitate provider-to-provider communication. Primary care provider (PCP) perspectives on care plan provision and use are limited, especially when care plans are generated by an electronic health record (EHR) system. We sought to examine PCPs' perspectives regarding EHR-generated care plans. Methods: PCPs (N = 160) who were members of the Wisconsin Research and Education Network listserv received a sample 10-page plan (WREN cohort). PCPs (n = 81) who had or were currently seeing survivors enrolled onto one of our survivorship clinical trials received a copy of the survivor's personalized care plan (University of Wisconsin [UW] cohort). Both cohorts received a survey after reviewing the plan. All plans were generated within an EHR. Results: Forty-six and 26 PCPs participated in the WREN and UW cohorts, respectively. PCPs regarded EHR-generated plans as useful in coordinating care (88%), understanding treatments (94%), understanding treatment adverse effects (89%), and supporting clinical decisions (82%). Few felt using EHR-generated plans would disrupt clinic workflow (14%) or take too much time (11%). Most (89%) preferred receiving the plan via EHR. PCPs reported consistent provision (81%) and standard location in the medical record (89%) as key factors facilitating their use of survivorship care plans. Important facilitators of care plan use included a more abbreviated plan, ideally one to three pages (32%), and/or a plan specifically tailored to PCP use (57%). Conclusion: Plans were viewed as useful for coordinating care and making clinical decisions. However, PCPs desired shorter, clinician-oriented plans, accessible within an EHR and delivered and located in a standardized manner. PMID:25804989

  6. 29 CFR 825.125 - Definition of health care provider.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 3 2013-07-01 2013-07-01 false Definition of health care provider. 825.125 Section 825.125... Definition of health care provider. (a) The Act defines health care provider as: (1) A doctor of medicine or... doctor practices; or (2) Any other person determined by the Secretary to be capable of providing...

  7. 29 CFR 825.125 - Definition of health care provider.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 3 2014-07-01 2014-07-01 false Definition of health care provider. 825.125 Section 825.125... Definition of health care provider. (a) The Act defines health care provider as: (1) A doctor of medicine or... doctor practices; or (2) Any other person determined by the Secretary to be capable of providing...

  8. Quicker cancer care: reshaping patient pathways.

    PubMed

    Towler, Lucy

    2009-07-01

    A new pathway has been devised for patients with ovarian cancer who attend a day-care unit for chemotherapy. This pathway, which is provided by nurses and doctors, has reduced patients' waiting time for treatment. Its implementation shows, therefore, that good clinical leadership can effect positive change. PMID:19639906

  9. Altruism: a framework for caring and providing care.

    PubMed

    Gormley, K J

    1996-12-01

    The word altruism is derived from the Latin alteri huic meaning to this other and literally means to express a regard for others as a principle for action. Fung (1988) [JAMA, Vol. 260, No. 17, p. 2509] describes altruism as caring for no obvious reward other than the belief that someone else will benefit or avoid harm. Altruism represents an amalgamation of intrinsic and extrinsic factors which either permit or coerce individuals to take responsibility for or care for another and to sacrifice things dearly held. Traditionally the caring professions have been characterised by a self professed altruism, that is, a selfless service on behalf of or for others (Thompson et al., 1994, Nursing Ethics, Churchill Livingstone, Edinburgh). This paper examines the theoretical basis of altruistic care, drawing on significant contribution from the literature before proceeding to explore the pivotal role altruism plays in nursing practice and the current arrangements for health care provision within the United Kingdom. PMID:8970856

  10. Views of cancer care reviews in primary care: a qualitative study

    PubMed Central

    Adams, Eike; Boulton, Mary; Rose, Peter; Lund, Susi; Richardson, Alison; Wilson, Sue; Watson, Eila

    2011-01-01

    Background The Quality and Outcomes Framework (QOF) provides an incentive for practices to establish a cancer register and conduct a review with cancer patients within 6 months of diagnosis, but implementation is unknown. Aim To describe: (1) implementation of the QOF cancer care review; (2) patients' experiences of primary care over the first 3 years following a cancer diagnosis; (3) patients' views on optimal care; and (4) the views of primary care professionals regarding their cancer care. Design of study Qualitative study using thematic analysis and a framework approach. Setting Six general practices in the Thames Valley area. Method Semi-structured interviews with cancer patients and focus groups with primary care teams. Results Thirty-eight adults with 12 different cancer types were interviewed. Seventy-one primary care team members took part in focus groups. Most cancer care reviews are conducted opportunistically. Thirty-five patients had had a review; only two could recall this. Patients saw acknowledgement of their diagnosis and provision of general support as important and not always adequately provided. An active approach and specific review appointment would legitimise the raising of concerns. Primary care teams considered cancer care to be part of their role. GPs emphasised the importance of being able to respond to individual patients' needs and closer links with secondary care to facilitate a more involved role. Conclusion Patients and primary care teams believe primary care has an important role to play in cancer care. Cancer care reviews in their current format are not helpful, with considerable scope for improving practice in this area. An invitation to attend a specific appointment at the end of active treatment may aid transition from secondary care and improve satisfaction with follow-up in primary care. PMID:21439175

  11. How Do Health Care Providers Diagnose Prader-Willi Syndrome?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose Prader-Willi syndrome (PWS)? Skip sharing ... a "floppy" body and weak muscle tone, a health care provider may conduct genetic testing for Prader-Willi ...

  12. How Do Health Care Providers Diagnose Primary Ovarian Insufficiency (POI)?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose POI? Skip sharing on social media ... having periods for 4 months or longer, her health care provider may take these steps to diagnose the ...

  13. How Do Health Care Providers Diagnose Intellectual & Developmental Disabilities (IDDs)?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose IDDs? Skip sharing on social media ... 1 This type of test will help the health care provider examine the ability of a person to ...

  14. How Do Health Care Providers Diagnose Rett Syndrome?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose Rett syndrome? Skip sharing on social ... Rett syndrome may not always be present, so health care providers also need to evaluate the child's symptoms ...

  15. How Do Health Care Providers Diagnose Neural Tube Defects?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose neural tube defects? Skip sharing on ... AFP, as well as high levels of acetylcholinesterase; health care providers might conduct this test to confirm high ...

  16. How Do Health Care Providers Diagnose Turner Syndrome?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose Turner syndrome? Skip sharing on social media links Share this: Page Content Health care providers use a combination of physical symptoms and ...

  17. How Do Health Care Providers Diagnose Birth Defects?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose birth defects? Skip sharing on social ... to begin before health problems occur. Prenatal Screening Health care providers recommend that certain pregnant women, including those ...

  18. How Do Health Care Providers Diagnose Down Syndrome?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose Down syndrome? Skip sharing on social media links Share this: Page Content Health care providers can check for Down syndrome during pregnancy ...

  19. How Do Health Care Providers Diagnose Traumatic Brain Injury (TBI)?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose traumatic brain injury (TBI)? Skip sharing ... links Share this: Page Content To diagnose TBI, health care providers may use one or more tests that ...

  20. Ten Things Lesbians Should Discuss with Their Health Care Provider

    MedlinePlus

    ... for high blood pressure, cholesterol problems, and diabetes. Health care providers can also offer tips on quitting smoking, ... lesbians experience violence in their intimate relationships. However, health care providers do not ask lesbians about intimate partner ...

  1. How Do Health Care Providers Diagnose Osteogenesis Imperfecta?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose osteogenesis imperfecta (OI)? Skip sharing on ... Page Content If OI is moderate or severe, health care providers usually diagnose it during prenatal ultrasound at ...

  2. How Do Health Care Providers Diagnose Menkes Disease?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose Menkes disease? Skip sharing on social ... 3 months old. To diagnose Menkes disease, a health care provider will order blood tests to measure the ...

  3. How Do Health Care Providers Diagnose Cushing's Syndrome?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose Cushing’s syndrome? Skip sharing on social ... easily recognized when it is fully developed, but health care providers try to diagnose and treat it well ...

  4. How Do Health Care Providers Diagnose Menstrual Irregularities?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose menstrual irregularities? Skip sharing on social media links Share this: Page Content A health care provider diagnoses menstrual irregularities using a combination of ...

  5. How Do Health Care Providers Diagnose Adrenal Gland Disorders?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose adrenal gland disorders? Skip sharing on ... and urine tests. 1 Cushing’s Syndrome If a health care provider suspects Cushing’s syndrome, he or she may ...

  6. How Do Health Care Providers Diagnose Pregnancy Loss or Miscarriage?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose pregnancy loss or miscarriage? Skip sharing ... light spotting, or bleeding, she should contact her health care provider immediately. For diagnosis, the woman may need ...

  7. How Do Health Care Providers Diagnose Fragile X Syndrome?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose Fragile X syndrome? Skip sharing on social media links Share this: Page Content Health care providers often use a blood sample to diagnose ...

  8. Talking about Complementary and Alternative Medicine with your Health Care Provider: A workbook and tips

    Cancer.gov

    A workbook to help patients and doctors talk about the use of complementary and alternative medicine(CAM) during and after cancer care. Worksheets, tips, and resources are provided for patients and doctors to help track CAM use.

  9. Talking about complementary and alternative medicine with your health care provider: A workbook and Tips

    Cancer.gov

    A workbook to help patients and doctors talk about the use of complementary and alternative medicine(CAM) during and after cancer care. Worksheets, tips, and resources are provided for patients and doctors to help track CAM use.

  10. Talking about Complementary and Alternative Medicine with Health Care Provider: A Workbook and Tips

    Cancer.gov

    A workbook to help patients and doctors talk about the use of complementary and alternative medicine(CAM) during and after cancer care. Worksheets, tips, and resources are provided for patients and doctors to help track CAM use.

  11. Conditions of Caregiving, Provider Nurturance and Quality Care.

    ERIC Educational Resources Information Center

    Austin, Ann M. Berghout; Lindauer, Shelley L. Knudsen; Rodriguez, Ariel; Norton, Maria L.; Nelson, Farol A. Groutage

    1997-01-01

    Examined relationships of child care provider education, presence of children from economically strained homes, and program structure to providers' self-perception, nurturance, and caregiving conditions in 36 licensed family day care homes. Found that when provider self-perceptions were high, but day care clients experienced economic strain, the


  12. 45 CFR 162.410 - Implementation specifications: Health care providers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... covered entity that is a covered health care provider must: (1) Obtain, by application if necessary, an... would be a covered health care provider if it were a separate legal entity. A covered entity may obtain... health care provider that is not a covered entity may obtain, by application if necessary, an NPI...

  13. Quality of cancer follow-up care: a focus on Latina breast cancer survivors

    PubMed Central

    Ashing, Kimlin; Napoles, Anna

    2014-01-01

    Introduction Receiving quality cancer follow-up care influences survivorship outcomes. Among Latinas, breast cancer is the number one cause of cancer death; yet Latinas do not receive adequate follow-up care. This study examined quality of cancer follow-up care among Latina breast cancer survivors (BCS) and whether it differs by participant language and healthcare system variables (provider specialty, and medical setting). Methods Two hundred thirty-two (95 English-speaking Latina and 137 Spanish-speaking) Latina BCS were recruited from the California Cancer Registry, hospital cancer registries, and community agencies. Results English-speaking Latina BCS were more likely to report receiving cancer follow-up care at a doctor’s office (p<0.001). BCS without a regular place for cancer follow-up care were more likely to report not seeing a primary care provider (p<0.05) or cancer specialist (p<0.001) in the past 12 months. English-speaking Latina BCS (p<0.001), BCS who saw a cancer specialist in the past 12 months (p<0.001), and received follow-up care at a doctor’s office (p<0.05) reported higher quality of care. Speaking English, having seen a cancer specialist, and receiving follow-up care at a doctor’s office were independently associated with higher quality of care, explaining 44 % of the variance. Conclusions Our study findings suggest that examining the influence of ethnic and linguistic factors on quality of cancer follow-up care is necessary to address health disparities. Improved access to cancer follow-up care for Spanish-speaking Latina BCS is of particular concern. Implication of Cancer Survivors Identifying follow-up care needs of Latina BCS may contribute to providing high-quality care and improved survivorship outcomes. PMID:24563169

  14. Financial toxicity in cancer care.

    PubMed

    O'Connor, Jeremy M; Kircher, Sheetal M; de Souza, Jonas A

    2016-03-01

    The cost of cancer care is increasing, with important implications for the delivery of high-quality, patent-centered care. In the clinical setting, patents and physicians express a desire to discuss out-of-pocket costs. Nevertheless, both groups feel inadequately prepared to participate in these discussions, and perhaps not surprisingly, the integration of these discussions into clinical practice seems to be the exception rather than the rule. The resulting neglect of financial issues has the potential to cause unnecessary suffering for oncology patents. In this paper, we review the most relevant literature on financial toxicity in cancer care. In addition, we discuss potential predictors of financial toxicity, and the recent development of instruments to help clinicians and researchers quantify financial burden. PMID:27058866

  15. Cannabis in cancer care.

    PubMed

    Abrams, D I; Guzman, M

    2015-06-01

    Cannabis has been used in medicine for thousands of years prior to achieving its current illicit substance status. Cannabinoids, the active components of Cannabis sativa, mimic the effects of the endogenous cannabinoids (endocannabinoids), activating specific cannabinoid receptors, particularly CB1 found predominantly in the central nervous system and CB2 found predominantly in cells involved with immune function. Delta-9-tetrahydrocannabinol, the main bioactive cannabinoid in the plant, has been available as a prescription medication approved for treatment of cancer chemotherapy-induced nausea and vomiting and anorexia associated with the AIDS wasting syndrome. Cannabinoids may be of benefit in the treatment of cancer-related pain, possibly synergistic with opioid analgesics. Cannabinoids have been shown to be of benefit in the treatment of HIV-related peripheral neuropathy, suggesting that they may be worthy of study in patients with other neuropathic symptoms. Cannabinoids have a favorable drug safety profile, but their medical use is predominantly limited by their psychoactive effects and their limited bioavailability. PMID:25777363

  16. Expanding the School's Role as Care Provider.

    ERIC Educational Resources Information Center

    Baylor, Ellen C.; Snowden, Petra E.

    1992-01-01

    One elementary school located in a depressed area (Norfolk, Virginia) created a computerized service directory and referral system providing immediate, accurate information on available children's services. The principal or counselor accesses the database by indicating individual student characteristics, such as low achievement or family problems,


  17. The University as Health Care Provider.

    ERIC Educational Resources Information Center

    Trachtenberg, Stephen Joel

    1997-01-01

    University hospitals came into existence as an ancillary activity, providing future physicians with important educational experiences, then became established as an expected part of the institution. Technological advances and rising costs caused universities to sell hospitals, potentially changing their role in the educational system. Universities


  18. Teledermatology Consultations Provide Specialty Care for Farmworkers in Rural Clinics

    ERIC Educational Resources Information Center

    Vallejos, Quirina M.; Quandt, Sara A.; Feldman, Steven R.; Fleischer, Alan B., Jr.; Brooks, Thanh; Cabral, Gonzalo; Heck, Judy; Schulz, Mark R.; Verma, Amit; Whalley, Lara E.; Arcury, Thomas A.

    2009-01-01

    Context: Rural patients have limited access to dermatologic care. Farmworkers have high rates of skin disease and limited access to care. Purpose: This exploratory study assessed whether teledermatology consultations could help meet the needs of health care providers for farmworkers in rural clinics. Methods: Dermatologists provided 79


  19. 29 CFR 825.125 - Definition of health care provider.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... mental health conditions. ... 29 Labor 3 2010-07-01 2010-07-01 false Definition of health care provider. 825.125 Section 825.125... Definition of health care provider. (a) The Act defines “health care provider” as: (1) A doctor of...

  20. 29 CFR 825.125 - Definition of health care provider.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... mental health conditions. ... 29 Labor 3 2012-07-01 2012-07-01 false Definition of health care provider. 825.125 Section 825.125... Definition of health care provider. (a) The Act defines “health care provider” as: (1) A doctor of...

  1. Food Safety Training Needs of Child Care Providers.

    ERIC Educational Resources Information Center

    Murphy, Anne S.; And Others

    1995-01-01

    A sample of child-care centers and family day-care homes in Michigan was used to identify what care providers need to know about safe food handling. Their primary concern was to become informed about what causes food to become unsafe and how to prevent foodborne illnesses. Providers preferred printed materials to tapes or workshops. (AA)

  2. Preparing for an epidemic: cancer care in an aging population.

    PubMed

    Shih, Ya-Chen Tina; Hurria, Arti

    2014-01-01

    The Institute of Medicine's (IOM) Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population was charged with evaluating and proposing recommendations on how to improve the quality of cancer care, with a specific focus on the aging population. Based on their findings, the IOM committee recently released a report highlighting their 10 recommendations for improving the quality of cancer care. Based on those recommendations, this article highlights ways to improve evidence-based care and addresses rising costs in health care for older adults with cancer. The IOM highlighted three recommendations to address the current research gaps in providing evidence-based care in older adults with cancer, which included (1) studying populations which match the age and health-risk profile of the population with the disease, (2) legislative incentives for companies to include patients that are older or with multiple morbidities in new cancer drug trials, and (3) expansion of research that contributes to the depth and breadth of data available for assessing interventions. The recommendations also highlighted the need to maintain affordable and accessible care for older adults with cancer, with an emphasis on finding creative solutions within both the care delivery system and payment models in order to balance costs while preserving quality of care. The implementation of the IOM's recommendations will be a key step in moving closer to the goal of providing accessible, affordable, evidence-based, high-quality care to all patients with cancer. PMID:24857069

  3. Child Care Providers' Experiences Caring for Sick Children: Implications for Public Policy.

    ERIC Educational Resources Information Center

    Heymann, S. Jody; Vo, Phuong Hong; Bergstrom, Cara A.

    2002-01-01

    Examined the experiences of preschool and school-age child care providers regarding sick child care. Found that providers repeatedly described sick children whose health problems made it impossible to provide adequate care for sick and well children in their care. Findings pose international public health policy implications for child care and


  4. Cancer care decision making in multidisciplinary meetings.

    PubMed

    Dew, Kevin; Stubbe, Maria; Signal, Louise; Stairmand, Jeannine; Dennett, Elizabeth; Koea, Jonathan; Simpson, Andrew; Sarfati, Diana; Cunningham, Chris; Batten, Lesley; Ellison-Loschmann, Lis; Barton, Josh; Holdaway, Maureen

    2015-03-01

    Little research has been undertaken on the actual decision-making processes in cancer care multidisciplinary meetings (MDMs). This article was based on a qualitative observational study of two regional cancer treatment centers in New Zealand. We audiorecorded 10 meetings in which 106 patient cases were discussed. Members of the meetings categorized cases in varying ways, drew on a range of sources of authority, expressed different value positions, and utilized a variety of strategies to justify their actions. An important dimension of authority was encountered authority-the authority a clinician has because of meeting the patient. The MDM chairperson can play an important role in making explicit the sources of authority being drawn on and the value positions of members to provide more clarity to the decision-making process. Attending to issues of process, authority, and values in MDMs has the potential to improve cancer care decision making and ultimately, health outcomes. PMID:25281239

  5. Managing Health Care After Cancer Treatment: A Wellness Plan

    PubMed Central

    Moye, Jennifer; Langdon, Maura; Jones, Janice M.; Haggstrom, David; Naik, Aanand D.

    2015-01-01

    Many patients and health care providers lack awareness of both the existence of, and treatments for, lingering distress and disability after treatment. A cancer survivorship wellness plan can help ensure that any referral needs for psychosocial and other restorative care after cancer treatment are identified. PMID:25983534

  6. Logic Regression for Provider Effects on Kidney Cancer Treatment Delivery

    PubMed Central

    Banerjee, Mousumi; Filson, Christopher; Xia, Rong; Miller, David C.

    2014-01-01

    In the delivery of medical and surgical care, often times complex interactions between patient, physician, and hospital factors influence practice patterns. This paper presents a novel application of logic regression in the context of kidney cancer treatment delivery. Using linked data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program and Medicare we identified patients diagnosed with kidney cancer from 1995 to 2005. The primary endpoints in the study were use of innovative treatment modalities, namely, partial nephrectomy and laparoscopy. Logic regression allowed us to uncover the interplay between patient, provider, and practice environment variables, which would not be possible using standard regression approaches. We found that surgeons who graduated in or prior to 1980 despite having some academic affiliation, low volume surgeons in a non-NCI hospital, or surgeons in rural environment were significantly less likely to use laparoscopy. Surgeons with major academic affiliation and practising in HMO, hospital, or medical school based setting were significantly more likely to use partial nephrectomy. Results from our study can show efforts towards dismantling the barriers to adoption of innovative treatment modalities, ultimately improving the quality of care provided to patients with kidney cancer. PMID:24795774

  7. Difficult Children and Difficult Parents: Constructions by Child Care Providers

    ERIC Educational Resources Information Center

    Owens, Erica; Ring, Gail

    2007-01-01

    As more mothers of young children work, concerns about child care have gained prominence. Analyses of this topic typically address availability, safety, and costs of care, or the impact of care on children's "outcomes." When providers' input is included, it is generally used as an assessment tool to reinforce the researcher's conceptual framework.


  8. Asthma Information Handbook for Early Care and Education Providers

    ERIC Educational Resources Information Center

    California Childcare Health Program, 2004

    2004-01-01

    With proper care, most children with asthma can lead normal, active lives and can enter school with the same abilities as other children. For this purpose, the Asthma Information Packet for Early Care and Education Providers was designed to cover the following topics: (1) Basic information; (2) How to improve early care and education environments


  9. Proteomic Contributions to Personalized Cancer Care*

    PubMed Central

    Koomen, John M.; Haura, Eric B.; Bepler, Gerold; Sutphen, Rebecca; Remily-Wood, Elizabeth R.; Benson, Kaaron; Hussein, Mohamad; Hazlehurst, Lori A.; Yeatman, Timothy J.; Hildreth, Lynne T.; Sellers, Thomas A.; Jacobsen, Paul B.; Fenstermacher, David A.; Dalton, William S.

    2008-01-01

    Cancer impacts each patient and family differently. Our current understanding of the disease is primarily limited to clinical hallmarks of cancer, but many specific molecular mechanisms remain elusive. Genetic markers can be used to determine predisposition to tumor development, but molecularly targeted treatment strategies that improve patient prognosis are not widely available for most cancers. Individualized care plans, also described as personalized medicine, still must be developed by understanding and implementing basic science research into clinical treatment. Proteomics holds great promise in contributing to the prevention and cure of cancer because it provides unique tools for discovery of biomarkers and therapeutic targets. As such, proteomics can help translate basic science discoveries into the clinical practice of personalized medicine. Here we describe how biological mass spectrometry and proteome analysis interact with other major patient care and research initiatives and present vignettes illustrating efforts in discovery of diagnostic biomarkers for ovarian cancer, development of treatment strategies in lung cancer, and monitoring prognosis and relapse in multiple myeloma patients. PMID:18664563

  10. Providing care for critically ill surgical patients: challenges and recommendations.

    PubMed

    Tisherman, Samuel A; Kaplan, Lewis; Gracias, Vicente H; Beilman, Gregory J; Toevs, Christine; Byrnes, Matthew C; Coopersmith, Craig M

    2013-07-01

    Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed. PMID:23754675

  11. Risk-based health care, the cancer survivor, the oncologist, and the primary care physician.

    PubMed

    McCabe, Mary S; Partridge, Ann H; Grunfeld, Eva; Hudson, Melissa M

    2013-12-01

    Cancer survivors face substantial risks for morbidity, reduced quality of life, and premature mortality related to the cancer itself and/or the interventions undertaken to control cancer. Risk-based care that involves a personalized systematic plan of periodic screening, surveillance, and prevention relevant to the cancer experience is recommended to address the comprehensive health needs of the growing population of cancer survivors. Risk-based care and coordination between oncology and primary care providers have been identified as important metrics of quality cancer survivorship care. Various models of survivorship care, treatment summaries, and survivorship care plans have been promoted as methods to facilitate communication among providers across care transitions and improve survivor access to quality survivorship care. However, research supporting the feasibility of implementing these practices and their effectiveness in enhancing health outcomes is limited. This article reviews key concepts underpinning clinical and research initiatives endeavoring to improve access to quality care among long-term survivors and summarizes results of intervention studies implementing these elements in transitioning survivors from oncology to primary care providers for long-term follow-up care. PMID:24331199

  12. Sexual minority cancer survivors' satisfaction with care.

    PubMed

    Jabson, Jennifer M; Kamen, Charles S

    2016-01-01

    Satisfaction with care is important to cancer survivors' health outcomes. Satisfaction with care is not equal for all cancer survivors, and sexual minority (i.e., lesbian, gay, and bisexual) cancer survivors may experience poor satisfaction with care. Data were drawn from the 2010 LIVESTRONG national survey. The final sample included 207 sexual minority cancer survivors and 4,899 heterosexual cancer survivors. Satisfaction with care was compared by sexual orientation, and a Poisson regression model was computed to test the associations between sexual orientation and satisfaction with care, controlling for other relevant variables. Sexual minority cancer survivors had lower satisfaction with care than did heterosexual cancer survivors (B = -0.12, SE = 0.04, Wald χ(2) = 9.25, p< .002), even controlling for demographic and clinical variables associated with care. Sexual minorities experience poorer satisfaction with care compared to heterosexual cancer survivors. Satisfaction with care is especially relevant to cancer survivorship in light of the cancer-related health disparities reported among sexual minority cancer survivors. PMID:26577277

  13. Provider Characteristics Desired by African American Women in Prenatal Care

    PubMed Central

    Lori, Jody R.; Yi, Chin Hwa; Martyn, Kristy K.

    2012-01-01

    Purpose The purpose of this study was to describe provider characteristics African American pregnant women identified as important when interacting with their prenatal care providers in an outpatient office setting. Study Design and Method A descriptive qualitative design was used to explore provider characteristics desired by African American women receiving prenatal care at two inner-city hospital–based obstetric clinics. A total of 22 African American women between the ages of 19 and 28 years participated in the study. Findings Four major provider characteristic themes emerged from the data: (a) demonstrating quality patient–provider communication, (b) providing continuity of care, (c) treating the women with respect, and (d) delivering compassionate care. Discussion and Conclusion An overarching theme revealed by the data analysis was the desire by African American women in this study to have their prenatal providers know and remember them. They wanted their providers to understand the context of their lives from their prenatal interactions. Incorporating findings from this study to improve patient–provider interactions during prenatal care could provide an increased understanding of the many complex variables affecting African American women’s lives. Implications for Practice and Research Prenatal care provides an opportunity for African American women to develop a trusting relationship with a provider. Developing models of prenatal care congruent with the realities of African American women’s lives has the potential to improve patient–provider interactions and potentially affect birth outcomes. PMID:21191039

  14. Modeling Market Shares of Competing (e)Care Providers

    NASA Astrophysics Data System (ADS)

    van Ooteghem, Jan; Tesch, Tom; Verbrugge, Sofie; Ackaert, Ann; Colle, Didier; Pickavet, Mario; Demeester, Piet

    In order to address the increasing costs of providing care to the growing group of elderly, efficiency gains through eCare solutions seem an obvious solution. Unfortunately not many techno-economic business models to evaluate the return of these investments are available. The construction of a business case for care for the elderly as they move through different levels of dependency and the effect of introducing an eCare service, is the intended application of the model. The simulation model presented in this paper allows for modeling evolution of market shares of competing care providers. Four tiers are defined, based on the dependency level of the elderly, for which the market shares are determined. The model takes into account available capacity of the different care providers, in- and outflow distribution between tiers and churn between providers within tiers.

  15. Eye Care Providers' Attitudes Towards Tele-ophthalmology

    PubMed Central

    Ple-plakon, Patricia; Blachley, Taylor; Musch, David C.; Newman-Casey, Paula Anne; De Lott, Lindsey B.; Lee, Paul P.

    2015-01-01

    Abstract Background: The rapid rise of e-health and remote care systems will likely change the practice patterns of ophthalmologists. Although telemedicine practices are thriving in many specialties of medicine, telemedicine for ophthalmology has been limited primarily to asynchronous care for diabetic retinopathy. The goal of this research was to evaluate perspectives on and familiarity with telemedicine among eye care providers at a large tertiary-care medical center via an anonymous, descriptive survey. Results: In total, 58 eye care physicians completed surveys (response rates of 86% for physicians-in-training and 49% for faculty physicians, respectively). Although a majority of both faculty and physicians-in-training were willing to participate in telemedicine services, trainees were more likely to be willing to interpret photographs than faculty (p=0.04). Most respondents (71%) indicated that they did not use telemedicine. Over half had received photographs (via phone or e-mail) for interpretation from referring physicians (54%) or patients (56%) within the past 3 months. A majority of providers (82%) would be willing to participate in telemedicine for consultations and for interpreting photographs, but a majority (59%) had low confidence in remote care for providing an opinion on patient care. Conclusions: Most eye care providers viewed telemedicine as part of the future of eye care but were concerned about the use of telemedicine. Although most providers did not practice telemedicine, over half of them were comfortable managing eye care consultations (including patients' photographs) via the Internet. PMID:25635290

  16. Providing adolescent sexual health care in the pediatric emergency department: views of health care providers

    PubMed Central

    Miller, Melissa K.; Mollen, Cynthia J.; O’Malley, Donna; Owens, Rhea L.; Maliszewski, Genevieve A.; Goggin, Kathy; Patricia, Kelly

    2014-01-01

    Objective The purpose of this study was to explore health care providers’ (HCPs) attitudes and beliefs about adolescent sexual health care provision in the emergency department (ED) and to identify barriers to a role of a health educator-based intervention. Methods We conducted focused, semi-structured interviews of HCPs from the ED and Adolescent Clinic of a children’s hospital. The interview guide was based on the Theory of Planned Behavior and its constructs: attitudes, subjective norms, perceived behavioral control, and intention to facilitate care. We used purposive sampling and enrollment continued until themes were saturated. Interviews were recorded and transcribed. Transcripts were analyzed using directed content analysis. Results Twenty-nine interviews were required for saturation. Participants were 12 physicians, 12 nurses, 3 nurse practitioners and 2 social workers; the majority (83%) were female. Intention to facilitate care was influenced by HCP perception of 1) their professional role, 2) the role of the ED (focused vs. expanded care), and 3) need for patient safety. HCPs identified three practice referents: patients/families, peers and administrators, and professional organizations. HCPs perceived limited behavioral control over care delivery because of time constraints, confidentiality issues, and comfort level. There was overall support for a health educator and many felt the educator could help overcome barriers to care. Conclusion Despite challenges unique to the ED, HCPs were supportive of the intervention and perceived the health educator as a resource to improve adolescent care and services. Future research should evaluate efficacy and costs of a health educator in this setting. PMID:24457494

  17. Mexican American Males Providing Personal Care for Their Mothers

    ERIC Educational Resources Information Center

    Evans, Bronwynne C.; Belyea, Michael J.; Ume, Ebere

    2011-01-01

    We know little about Mexican American (MA) family adaptation to critical events in the informal caregiving experience but, in these days of economic and social turmoil, sons must sometimes step up to provide personal care for their aging mothers. This article compares two empirically real cases of MA males who provided such care, in lieu of a


  18. 33 CFR 55.13 - Family child care providers.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Guard child development centers. 33 CFR Ch. I (7-1-14 Edition) Coast Guard, DHS ... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Family child care providers. 55... PERSONNEL CHILD DEVELOPMENT SERVICES General § 55.13 Family child care providers. When appropriated...

  19. 33 CFR 55.13 - Family child care providers.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Guard child development centers. 33 CFR Ch. I (7-1-13 Edition) Coast Guard, DHS ... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Family child care providers. 55... PERSONNEL CHILD DEVELOPMENT SERVICES General § 55.13 Family child care providers. When appropriated...

  20. 33 CFR 55.13 - Family child care providers.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Guard child development centers. 33 CFR Ch. I (7-1-10 Edition) Coast Guard, DHS ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Family child care providers. 55... PERSONNEL CHILD DEVELOPMENT SERVICES General § 55.13 Family child care providers. When appropriated...

  1. 33 CFR 55.13 - Family child care providers.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Guard child development centers. 33 CFR Ch. I (7-1-12 Edition) Coast Guard, DHS ... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Family child care providers. 55... PERSONNEL CHILD DEVELOPMENT SERVICES General § 55.13 Family child care providers. When appropriated...

  2. 33 CFR 55.13 - Family child care providers.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Guard child development centers. 33 CFR Ch. I (7-1-11 Edition) Coast Guard, DHS ... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Family child care providers. 55... PERSONNEL CHILD DEVELOPMENT SERVICES General § 55.13 Family child care providers. When appropriated...

  3. Mexican American Males Providing Personal Care for Their Mothers

    ERIC Educational Resources Information Center

    Evans, Bronwynne C.; Belyea, Michael J.; Ume, Ebere

    2011-01-01

    We know little about Mexican American (MA) family adaptation to critical events in the informal caregiving experience but, in these days of economic and social turmoil, sons must sometimes step up to provide personal care for their aging mothers. This article compares two empirically real cases of MA males who provided such care, in lieu of a…

  4. The Role of Child Care Providers in Child Abuse Prevention

    ERIC Educational Resources Information Center

    Seibel, Nancy L.; Gillespie, Linda G.; Temple, Tabitha

    2008-01-01

    Child care providers are likely to be the professionals who most frequently interact with families with young children. Thus, infant and toddler child care providers are uniquely positioned to recognize and respond to families' needs for information and support. This article describes knowledge, skills, and strategies that support child care


  5. Protective skin care behaviors in cancer survivors

    PubMed Central

    Lau, S.C.M.; Chen, L.; Cheung, W.Y.

    2014-01-01

    Purpose Research suggests that physicians neglect preventive care for cancer survivors. A survivor’s self-motivation with respect to preventive care is unknown. Using protective skin care as a proxy, our aims were to characterize preventive care in cancer survivors and to identify factors associated with appropriate prevention. Methods Using data from the 2009 U.S. Health Information National Trends Survey, we compared preventive skin care patterns in cancer survivors and non-cancer patients. Primary endpoints were the use of sunscreens, long-sleeved shirts, hats, and shade. Results We identified 179 early cancer survivors (<5 years), 242 intermediate cancer survivors (5–10 years), 412 long-term cancer survivors (>10 years), and 5951 non-cancer patients. The use of sunscreens (60%), long-sleeved shirts (88%), hats (58%), and shade (68%) was suboptimal. Overall, cancer survivors were not more likely to adhere to preventive care (p = 0.89). A composite score showed a significant difference between the cancer survivor groups (p < 0.01) whereby intermediate survivors reported the best preventive practices. Conclusions A prior diagnosis of cancer does not appear to increase personal compliance with cancer prevention. Reasons for this poor engagement are not clear. Targeted strategies to increase self-motivation might improve preventive practices in cancer survivors. PMID:25089104

  6. Multidisciplinary care for patients with breast cancer.

    PubMed

    Hulvat, Melissa C; Hansen, Nora M; Jeruss, Jacqueline S

    2009-02-01

    The care of patients with breast cancer has become increasingly complex with advancements in diagnostic modalities, surgical approaches, and adjuvant treatments. A multidisciplinary approach to breast cancer care is essential to the successful integration of available therapies. This article addresses the key components of multidisciplinary breast cancer care, with a special emphasis on new and emerging approaches over the past 10 years in the fields of diagnostics, surgery, radiation, medical oncology, and plastic surgery. PMID:19186235

  7. Coping with Cancer - Survivorship Care for Children

    Cancer.gov

    Survivorship care for children who have been treated for cancer is important. Get your child's treatment summary, survivorship plan, and recommendation on follow-up care clinics. Learn about long-term and late effects.

  8. Opportunities to reduce cancer barriers: Community town halls and provider focus groups

    PubMed Central

    Rafie, Carlin; Cadet, Debbie L.; Ayers, Antoinette

    2012-01-01

    This paper presents the findings from town hall meetings held with community residents and focus groups with healthcare providers. A total of five town halls (N=139) were conducted. Four were conducted in English and a fifth was conducted in Spanish to obtain the input of the local Hispanic community. Surveys were provided to town hall participants to assess their perceptions of cancer and screening as well as their cancer screening behaviors. Participants were asked questions designed to determine local gaps and needs in health and cancer care, and their attitudes regarding breast cancer resources, education, treatment and clinical trials. Additionally, four focus groups (N=45) were held with a wide range of providers to obtain their perspectives on barriers to breast cancer screening, local cancer prevention and care, and clinical trials. Results indicate gaps in local resources and support services, particularly in terms of education and integrated care. PMID:23055135

  9. Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers

    ERIC Educational Resources Information Center

    Roberts, James R.; McCurdy, Leyla Erk

    2005-01-01

    These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health care providers, and outlines the environmental interventions


  10. Predictions of Children's Experiences with Latina Family Child Care Providers

    ERIC Educational Resources Information Center

    Zuniga, Stephen A.; Howes, Carollee

    2009-01-01

    Research Findings: Relatively little is known about the pre-academic experiences of Latino/a children in family child care. In this work we tested the extent to which previously established relations among provider characteristics, scaffolding and responsive behaviors, total quality (Family Day Care Rating Scale), and children's engagement in


  11. Cancer care scenario in Bangladesh

    PubMed Central

    Uddin, A. F. M. Kamal; Khan, Zohora Jameela; Islam, Johirul; Mahmud, AM

    2013-01-01

    Bangladesh is a developing country that is facing many challenges, especially in the health sector. Cancer management is a priority due to the current trend of increased incidence in this region. In this article, the current scenario of cancer in Bangladesh and its management with brief history is outlined. The combined effort of government and private sector is highlighted with the gradual progress in cancer management. Recent introduction of the state-of-the-art facilities and the training facilities for human resource development are also outlined. The existing challenges and cooperation from local NGOs and other overseas sources are also highlighted to provide an insight regarding possible ways to tackle these challenges to ensure a better future. PMID:24455570

  12. Provider perspectives on palliative care needs at a major teaching hospital.

    PubMed

    Llamas, K J; Llamas, M; Pickhaver, A M; Piller, N B

    2001-11-01

    Jericho Metropolitan Hospital (JMH) is a major Australian teaching hospital which lacked a designated palliative care service at the time this study was conducted. A questionnaire addressing palliative care service needs, and educational and support needs of staff, was sent to 267 multi-disciplinary oncology staff at JMH. A response rate of 83% was achieved. Staff identified a number of palliative care needs that were being particularly poorly addressed by existing services. These included: spiritual support, cultural needs, grief and bereavement support, pleasant surroundings, adequate privacy and facilities for families. The majority of respondents identified the following issues as critical problems in palliative care provision: lack of a designated palliative care service, lack of palliative care education of staff, unmanageable caseloads and inadequate physical facilities for the provision of care. Only 24% of respondents reported having had any palliative care education, and 92% of respondents expressed a need for further education. The majority of respondents (79%) expressed a need for improved staff support. There was a significant association between perceived need for improved support and professional discipline (chi2 = 31.33, P < 0.002), with medical staff being significantly less likely than other staff groups to report a need for improved support. Overall, the health providers surveyed identified major deficiencies in the provision of palliative care to cancer patients at JMH and in the palliative care education and support for staff caring for terminally ill cancer patients. The findings support the need for a designated palliative care service at JMH to improve the standard of care of dying cancer patients, and the need for improved palliative care education and support for staff. PMID:12403503

  13. Personalized Colon Cancer Care in 2010

    PubMed Central

    Catenacci, Daniel V.T.; Kozloff, Mark; Kindler, Hedy L.; Polite, Blase

    2011-01-01

    Colon cancer therapies have improved patient outcomes significantly over the last decades in both the adjuvant and metastatic settings. With the introduction of a number of novel agents, both traditional chemotherapies and biologically targeted agents, the need to identify subgroups that are likely and not likely to respond to a particular treatment regimen is paramount. This will allow patients who are likely to benefit to receive optimal care, while sparing those unlikely to benefit from unnecessary toxicity and cost. With the identification of several novel biomarkers and a variety of technologies to interrogate the genome, we are already able to rapidly study patient tumor or blood samples and normal tissues to generate a large dataset of aberrations within the cancer. How to digest this complex information to obtain accurate, reliable, and meaningful results that will allow us to provide truly personalized care for colon cancer patients is just starting to be addressed. In this article, we briefly review the history of colon cancer treatment, with an emphasis on current clinical standards that incorporate a ‘personalized medicine’ approach. We then review strategies which will potentially improve our ability to individualize therapy in the future. PMID:21421118

  14. Diarrhea - what to ask your health care provider - adult

    MedlinePlus

    What to ask your health care provider about diarrhea - adult; Loose stools - what to ask your health ... medicines, vitamins, herbs, or supplements I take cause diarrhea? Should I stop taking any of them? What ...

  15. 47 CFR 54.601 - Health care provider eligibility.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Defined Terms and... particular sites at any time prior to, or concurrently with, filing a request for services to...

  16. 47 CFR 54.601 - Health care provider eligibility.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Defined Terms and... particular sites at any time prior to, or concurrently with, filing a request for services to...

  17. Providers' Perceptions of Challenges in Obstetrical Care for Somali Women

    PubMed Central

    Lazar, Jalana N.; Johnson-Agbakwu, Crista E.; Davis, Olga I.; Shipp, Michele P.-L.

    2013-01-01

    Background. This pilot study explored health care providers' perceptions of barriers to providing health care services to Somali refugee women. The specific aim was to obtain information about providers' experiences, training, practices and attitudes surrounding the prenatal care, delivery, and management of women with Female Genital Cutting (FGC). Methods. Individual semi-structured interviews were conducted with 14 obstetricians/gynecologists and nurse midwives in Columbus, Ohio. Results. While providers did not perceive FGC as a significant barrier in itself, they noted considerable challenges in communicating with their Somali patients and the lack of formal training or protocols guiding the management of circumcised women. Providers expressed frustration with what they perceived as Somali patients' resistance to obstetrical interventions and disappointment with a perception of mistrust from patients and their families. Conclusion. Improving the clinical encounter for both patients and providers entails establishing effective dialogue, enhancing clinical and cultural training of providers, improving health literacy, and developing trust through community engagement. PMID:24223041

  18. Developing a web 2.0 diabetes care support system with evaluation from care provider perspectives.

    PubMed

    Lin, Yung-Hsiu; Chen, Rong-Rong; Guo, Sophie Huey-Ming; Chang, Hui-Yu; Chang, Her-Kun

    2012-08-01

    Diabetes is a life-long illness condition that many diabetic patients end up with related complications resulted largely from lacking of proper supports. The success of diabetes care relies mainly on patient's daily self-care activities and care providers' continuous support. However, the self-care activities are socially bounded with patient's everyday schedules that can easily be forgotten or neglected and the care support from providers has yet been fully implemented. This study develops a Web 2.0 diabetes care support system for patients to integrate required self-care activities with different context in order to enhance patient's care knowledge and behavior adherence. The system also supports care managers in a health service center to conduct patient management through collecting patient's daily physiological information, sharing care information, and maintaining patient-provider relationships. After the development, we evaluate the acceptance of the system through a group of nursing staffs. PMID:21369781

  19. How the Affordable Care Act will strengthen primary care and benefit patients, providers, and payers.

    PubMed

    Abrams, Melinda; Nuzum, Rachel; Mika, Stephanie; Lawlor, Georgette

    2011-01-01

    Although primary care is fundamental to health system performance, the United States has undervalued and underinvested in primary care for decades. This brief describes how the Affordable Care Act will begin to address the neglect of America's primary care system and, wherever possible, estimates the potential impact these efforts will have on patients, providers, and payers. The health reform law includes numerous provisions for improving primary care: temporary increases in Medicare and Medicaid payments to primary care providers; support for innovation in the delivery of care, with an emphasis on achieving better health outcomes and patient care experiences; enhanced support of primary care providers; and investment in the continued development of the primary care workforce. PMID:21261124

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

    PubMed Central

    Prabhu Das, Irene; Clauser, Steven; Petrelli, Nicholas; Salner, Andrew

    2010-01-01

    Quality cancer treatment depends upon careful coordination between multiple treatments and treatment providers, the exchange of technical information, and regular communication between all providers and physician disciplines involved in treatment. This article will examine a particular type of organizational structure purported to regularize and streamline the communication between multiple specialists and support services involved in cancer treatment: the multidisciplinary treatment care (MDC) team. We present a targeted review of what is known about various types of MDC team structures and their impact on the quality of treatment care, and we outline a conceptual model of the connections between team context, structure, process, and performance and their subsequent effects on cancer treatment care processes and patient outcomes. Finally, we will discuss future research directions to understand how MDC teams improve patient outcomes and how characteristics of team structure, culture, leadership, and context (organizational setting and local environment) contribute to optimal multidisciplinary cancer care. PMID:20386055

  1. Grassroots Organizing: A Handbook for Child Care Teachers and Family Child Care Providers. Revised Second Edition.

    ERIC Educational Resources Information Center

    Center for the Child Care Workforce, Washington, DC.

    The Center for the Child Care Workforce (formerly the Child Care Employee Project), has provided leadership for a nationwide grassroots effort called the Worthy Wage Campaign, an activist initiative to increase public awareness and to press for a public investment of child care funds directly targeted to improving child care jobs. This handbook


  2. Value of cancer care: ethical considerations for the practicing oncologist.

    PubMed

    Jagsi, Reshma; Sulmasy, Daniel P; Moy, Beverly

    2014-01-01

    The value of cancer care has emerged at the center of a national discourse on fiscal responsibility and resource allocation. The cost of cancer care is rising at a higher pace than any other area of health care. As we struggle to address this unsustainable rise in cancer expenditures, oncology providers are forced to examine our practice patterns and our contributions to the overall health care cost burden. This article provides an oncologist-centered examination of our duties to individual patients and how they may seem at odds with our duties to society. It also discusses how oncology providers can do their part to contain health care costs while honoring their professional obligation to do their best for each patient. PMID:24857095

  3. Nutrition in Cancer Care (PDQ)

    MedlinePlus

    ... A to Z List of Cancer Drugs Complementary & Alternative Medicine (CAM) Questions to Ask about Your Treatment Research ... Treatment Side Effects Clinical Trials Cancer Drugs Complementary & Alternative Medicine Coping Feelings & Cancer Adjusting to Cancer Self Image & ...

  4. Wound caring is more than wound care: the provider as a partner.

    PubMed

    Scherwitz, L W; Rountree, R; Delevitt, P

    1997-10-01

    We all know about the placebo effect, but what is it? When a patient "thinks" that he/she is being treated effectively they can improve. Patients who receive supportive interaction do better than those who are alone. These concepts suggest that the mind influences the body's response. This article will discuss the issues of the mind-body connection and its implications in patient care. The first part of this article will provide an overview of the landmark scientific information that validates this intricate relationship between the body and the mind. The second part of this article will focus on the professional practice of medicine and how improved interaction with the patient leads to better outcomes. When the provider becomes a partner with the patient, the results become synergistic. The third part of this article is written by a pervious cancer patient whose presence today is a testimonial to the success of the body/mind alliance and the provider-as-partner concept. She will present the patient's side of medical care. PMID:9369741

  5. Providing Culturally Congruent Care for Saudi Patients and their Families.

    PubMed

    Al Mutair, Abbas Saleh; Plummer, Virginia; O'Brien, Anthony Tony; Clerehan, Rosemary

    2013-10-19

    Abstract This article aims to increase an awareness of caring for Saudi families by non-Saudi nurses to improve their understanding of culturally competent care from a Saudi perspective. Healthcare providers have a duty of a care to deliver holistic and culturally specific health care to their patients. As a consequence of 'duty of care' obligations, healthcare providers must facilitate culturally congruent care for patients of diverse cultural backgrounds. For the Saudi family considerable cultural clashes may arise when Saudi patients are hospitalised and receive care from healthcare professionals who do not understand Islamic principles and Saudi cultural beliefs and values. The healthcare workforce in Saudi Arabia is a unique multicultural workforce that is mix of Saudi and significant other nationalities. Saudi nurses for example represent only 36.3% of the workforce in the different health sectors. Whilst the different ethnic and cultural background expatriate nurses represent 63.7% (Ministry of Health, 2010). This article also could increase the awareness of healthcare professionals caring for Arab and Muslims patients in another context in the world. PMID:24138356

  6. Effective Factors in Providing Holistic Care: A Qualitative Study

    PubMed Central

    Zamanzadeh, Vahid; Jasemi, Madineh; Valizadeh, Leila; Keogh, Brian; Taleghani, Fariba

    2015-01-01

    Background: Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses’ provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring. Materials and Methods: A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis) software. Results: Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits. Conclusion: Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring. PMID:26009677

  7. Optimizing Cancer Care Delivery through Implementation Science

    PubMed Central

    Adesoye, Taiwo; Greenberg, Caprice C.; Neuman, Heather B.

    2016-01-01

    The 2013 Institute of Medicine report investigating cancer care concluded that the cancer care delivery system is in crisis due to an increased demand for care, increasing complexity of treatment, decreasing work force, and rising costs. Engaging patients and incorporating evidence-based care into routine clinical practice are essential components of a high-quality cancer delivery system. However, a gap currently exists between the identification of beneficial research findings and the application in clinical practice. Implementation research strives to address this gap. In this review, we discuss key components of high-quality implementation research. We then apply these concepts to a current cancer care delivery challenge in women’s health, specifically the implementation of a surgery decision aid for women newly diagnosed with breast cancer. PMID:26858933

  8. Mexican-American Males Providing Personal Care for their Mothers

    PubMed Central

    Evans, Bronwynne C.; Belyea, Michael J.; Ume, Ebere

    2011-01-01

    We know little about Mexican-American (MA) family adaptation to critical events in the informal caregiving experience but, in these days of economic and social turmoil, sons must sometimes step up to provide personal care for their aging mothers. This article compares two empirically real cases of MA males who provided such care, in lieu of a female relative. The cases are selected from a federally-funded, descriptive, longitudinal, mixed methods study of 110 MA caregivers and their care recipients. In case-oriented research, investigators can generate propositions (connected sets of statements) that reflect their findings and conclusions, and can be tested against subsequent cases: Caregiving strain and burden in MA males may have more to do with physical and emotional costs than financial ones; MA males providing personal care for their mothers adopt a matter-of-fact approach as they act “against taboo”; and this approach is a new way to fulfill family obligations. PMID:21643486

  9. Surrogate pregnancy: a guide for Canadian prenatal health care providers.

    PubMed

    Reilly, Dan R

    2007-02-13

    Providing health care for a woman with a surrogate pregnancy involves unique challenges. Although the ethical debate surrounding surrogacy continues, Canada has banned commercial, but not altruistic, surrogacy. In the event of a custody dispute between a surrogate mother and the individual(s) intending to parent the child, it is unclear how Canadian courts would rule. The prenatal health care provider must take extra care to protect the autonomy and privacy rights of the surrogate. There is limited evidence about the medical and psychological risks of surrogacy. Whether theoretical concerns about these risks are clinically relevant remains unknown. In the face of these uncertainties, the prenatal health care provider should have a low threshold for seeking obstetrical, social work, ethical and legal support. PMID:17296962

  10. Strategies for providing cultural competent health care for Hmong Americans.

    PubMed

    Cobb, Torry Grantham

    2010-01-01

    In the early 1980's the United States gave the Hmong preferred refugee status and a large number immigrated to the U.S. The Hmong refugees brought with them their language, social structure and customs, religious beliefs and rituals as well as their health care beliefs and practices. They were uprooted from their community and social supports and now live where the culture, language and socioeconomics are vastly different. Despite having learned a great deal about the Hmong culture over the last three decades, providing culturally competent health care for this unique group continues to be a challenge. The purpose of this paper is to enumerate the barriers to providing health care to Hmong Americans and share strategies to respect Hmong culture when providing quality health care. Emphasis is placed on building relationships based on trust and mutual respect. Cultural exchange is encouraged as well as the need for basic cultural awareness. PMID:20860331

  11. Providing home care services in a for-profit environment.

    PubMed

    Shamansky, S L

    1988-06-01

    It is no surprise that politics and ideology will determine the future of home health and long-term care. Those same forces will also dictate whether home care services will become more or less dependent upon federal support. At the moment the prospects are not promising. Over the last several years our national reimbursement policies have pointed toward more and more stringent use of Medicare home health care benefits, despite the assumptions (and the data) that prospective payment systems might legitimately increase their use. The implementation of tight cost limits, consolidation to ten regional fiscal intermediaries, and increased claim denials have signaled home care agencies that cost containment is the aim of the present conservative administration. Private insurance companies, however, have begun to examine the prospects for long-term care and home care policies. Presently, most home care benefits are available through employment-based policies, which, of course, are nearly useless to the elderly, the major users of home care services. But what if businesses provided more comprehensive health care policies so that their employees could have better protection in the case of long-term illnesses? What if the giant corporation such as IBM, Xerox, General Electric, General Motors, and so forth, established programs to underwrite the cost of long-term care? What if private insurance companies attempted to spread the risks among thousands of policy holders so that long-term care insurance premiums were affordable to most older Americans? Rather than new sources of funding, it is more reasonable to expect that the financing of home care services will be reshaped by innovative reimbursement strategies. The future will probably bring prospective, resource-sensitive, or capitated schemes. There are no easy remedies. We must secure the participation of all sectors of our country--both public and private--in a cooperative endeavor. And at the same time we are struggling to reshape the home care financing system, we must continue the effort to reshape the delivery system itself, because the two go hand-in-glove. It is only then that we can begin to allay one of the major deficiencies of our present health care system--the enormous gap in providing and paying for home health care. PMID:3130617

  12. Coordinating care and treatment for cancer patients.

    PubMed

    Yip, Cheng Har; Samiei, Massoud; Cazap, Eduardo; Rosenblatt, Eduardo; Datta, Niloy Ranjan; Camacho, Rolando; Weller, David; Pannarunothai, Supasit; Goh, Cynthia; Black, Fraser; Kaur, Ranjit; Fitch, Margaret; Sutcliffe, Catherine; Sutcliffe, Simon

    2012-01-01

    Survival following a diagnosis of cancer is contingent upon an interplay of factors, some non-modifiable (e.g., age, sex, genetics) and some modifiable (e.g., volitional choices) but the majority determined by circumstance (personal, social, health system context and capacity, and health policy). Accordingly, mortality and survival rates vary considerably as a function of geography, opportunity, wealth and development. Quality of life is impacted similarly, such that aspects of care related to coordination and integration of care across primary, community and specialist environments; symptom control, palliative and end-of-life care for those who will die of cancer; and survivorship challenges for those who will survive cancer, differs greatly across low, middle and high-income resource settings. Session 3 of the 4th International Cancer Control Congress (ICCC-4) focused on cancer care and treatment through three plenary presentations and five interactive workshop discussions: 1) establishing, implementing, operating and sustaining the capacity for quality cancer care; 2) the role of primary, community, and specialist care in cancer care and treatment; 3) the economics of affordable and sustainable cancer care; 4) issues around symptom control, support, and palliative/end-of-life care; and 5) issues around survivorship. A number of recommendations were proposed relating to capacity-building (standards and guidelines, protocols, new technologies and training and deployment) for safe, appropriate evidence-informed care; mapping and analysis of variations in primary, community and specialist care across countries with identification of models for effective, integrated clinical practice; the importance of considering the introduction, or expansion, of evidence-supported clinical practices from the perspectives of health economic impact, the value for health resources expended, and sustainability; capacity-building for palliative, end-of-life care and symptom control and integration of these services into national cancer control plans; the need for public education to reduce the fear and stigma associated with cancer so that patients are better able to make informed decisions regarding follow-up care and treatment; and the need to recognize the challenges and needs of survivors, their increasing number, the necessity to integrate survivorship into cancer control plans and the economic and societal value of functional survival after cancer. Discussions highlighted that coordinated care and treatment for cancer patients is both a ' systems'challenge and solution, requiring the consideration of patient and family circumstances, societal values and priorities, the functioning of the health system (access, capacity, resources, etc.) and the importance assigned to health and illness management within public policy. PMID:22631594

  13. Providing continuity of care to a specific population

    PubMed Central

    Roy, Andréanne; Breton, Mylaine; Loslier, Julie

    2016-01-01

    Abstract Objective To analyze the factors that influence newly licensed family physicians in their decision to provide continuity of care to a specific primary care population. Design Mixed-methods study that included a self-administered online questionnaire for family physicians followed by individual interviews. Setting Monteregie, the second-most populated region of Quebec, with rural and urban areas. Participants All family physicians with 10 or fewer years of work experience who were practising in Monteregie were contacted (366 physicians). Of this group, 118 completed the online questionnaire (response rate of 32.2%). Of the respondents, 10 physicians with varied continuity of care profiles were selected for individual interviews. Main outcome measures The percentage of work time spent on continuity of care analyzed in conjunction with factors that support or present barriers to continuity of care at the contextual and organizational levels and for family physicians and patients. Results The main factors that facilitate continuity of care are the physician-patient relationship, interest in clinical continuity of care activities, positive role models, working alongside a nurse, and adequate access to resources, specifically mental health resources. The main barriers are the scope of administrative duties, interest in a comprehensive practice, a negative experience of continuity of care during training, a sense of inadequacy with respect to continuity of care, a heavy case load, and a lack of support in the first years of practice. Conclusion Possible ways to encourage newly licensed family physicians to provide continuity of care to a specific population are offered. Areas for improvement include medical training, administrative support, and human resources.

  14. Challenges having conversations about sexuality in ambulatory settings: part II--health care provider perspectives.

    PubMed

    Fitch, Margaret I; Beaudoin, Gerry; Johnson, Beverley

    2013-01-01

    Cancer treatment can have a significant impact on an individual's quality of life. In particular, body image and sexuality can be compromised. There is increasing evidence that conversations about these specific consequences are not happening often between cancer patients and health care providers, especially in busy ambulatory settings. This study was undertaken to explore the perspectives of cancer care providers regarding the conversations about sexuality that happen following a cancer diagnosis. There was a desire to understand more about the barriers that exist with regards to having this conversation in daily practice. Thirty-four cancer care professionals (nurses, physicians, social workers and radiation therapists) were interviewed to explore their experiences in having conversations about sexuality. Transcripts were subjected to a standard qualitative content and theme analysis. Six themes emerged from the analysis. Overall, participants acknowledged treatment can have an impact on a patient's sexuality. For the most part, any conversations about sexuality topics occurred during informed consent processes before treatment began or when a patient raised a question about a side effect. However, these conversations rarely covered more than the physical side effects and did not focus on the impact of those side effects on emotional and personal relationships or intimacy. Most providers waited for patients to raise any concerns and expressed their own personal discomfort and lack of training in holding these types of conversations. They perceived the conversations as difficult for themselves and for patients. The findings support the need to clarify role expectations for cancer nurses, as well as other members of the cancer care team, about patient care regarding sexuality, and the provision of education to support the expected role. PMID:24028036

  15. Defining Value in Cancer Care: AVBCC 2012 Steering Committee Report

    PubMed Central

    Beed, Gene; Owens, Gary M.; Benson, Al B.; Klein, Ira M.; Silver, Samuel M.; Beveridge, Roy A.; Malin, Jennifer; Sprandio, John D.; Deligdish, Craig K.; Mitchell, Matthew; Vogenberg, F. Randy; Fox, John; Newcomer, Lee N.

    2012-01-01

    Approximately 200 oncologists, payers, employers, managed care executives, pharmacy benefit managers, and other healthcare stakeholders convened in Houston, TX, on March 28–31, 2012, for the Second Annual Conference of the Association for Value-Based Cancer Care (AVBCC). The mission of the conference was to align the various perspectives around the growing need of defining value in cancer care and developing strategies to enhance patient outcomes. The AVBCC conference presented a forum for the various viewpoints from all the stakeholders across the cancer care continuum, featuring more than 20 sessions and symposia led by nearly 30 oncology leaders. The discussions focused on current trends and challenges in optimizing value in oncology by reducing or controlling cost while improving care quality and patient outcomes, introducing emerging approaches to management and tools that providers and payers are using to enhance cancer care collaboratively. The AVBCC Second Annual Conference was opened by a Steering Committee discussion of 11 panel members who attempted to define value in cancer care and articulated action steps that can help to implement value into cancer care delivery. The following summary represents highlights from the Steering Committee discussion, which was moderated by Gene Beed, MD, and Gary M. Owens, MD. PMID:24991320

  16. The expanding role of primary care in cancer control.

    PubMed

    Rubin, Greg; Berendsen, Annette; Crawford, S Michael; Dommett, Rachel; Earle, Craig; Emery, Jon; Fahey, Tom; Grassi, Luigi; Grunfeld, Eva; Gupta, Sumit; Hamilton, Willie; Hiom, Sara; Hunter, David; Lyratzopoulos, Georgios; Macleod, Una; Mason, Robert; Mitchell, Geoffrey; Neal, Richard D; Peake, Michael; Roland, Martin; Seifert, Bohumil; Sisler, Jeff; Sussman, Jonathan; Taplin, Stephen; Vedsted, Peter; Voruganti, Teja; Walter, Fiona; Wardle, Jane; Watson, Eila; Weller, David; Wender, Richard; Whelan, Jeremy; Whitlock, James; Wilkinson, Clare; de Wit, Niek; Zimmermann, Camilla

    2015-09-01

    The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise—from epidemiologists, psychologists, policy makers, and cancer specialists—has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to effect change are outlined. The strengths of primary care—its continuous, coordinated, and comprehensive care for individuals and families—are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development. PMID:26431866

  17. Palliative Care in Iran: Moving Toward the Development of Palliative Care for Cancer.

    PubMed

    Rassouli, Maryam; Sajjadi, Moosa

    2016-04-01

    Cancer is the third leading cause of death in Iran and its incidence has been increasing in recent years. Patients' quality of life is altered rather enormously due to cancer, which doubles the importance of and the need for providing palliative care in Iran. Although many steps have been taken toward the development and providing of palliative care in Iran, there is still a large gap between the status quo and the desirable state. This study presents the current state of palliative care for cancer patients and discusses the barriers, challenges and outlook of palliative care in Iran. If infrastructural projects that have recently been launched prove successful, proper advancement toward the providing of palliative care services in Iran will then not far on the horizon. PMID:25492970

  18. Supportive care after breast cancer surgery.

    PubMed

    Allinson, Veronica M; Dent, Jo

    Routine follow-up after treatment for breast cancer aims to monitor for recurrence, manage late effects of treatment and give patients information, support and reassurance. However, most symptoms of local recurrence are first identified by patients so time spent following up women who are essentially well may not be clinically beneficial or cost effective. To better use its resources, Calderdale and Huddersfield Foundation Trust developed a follow-up education programme for patients at low-to-moderate risk; after two years an audit showed it reduced overall patient anxiety and routine hospital appointments, maintained standards of care and provided patient with an effective support network. PMID:26012052

  19. Developing a service model that integrates palliative care throughout cancer care: the time is now.

    PubMed

    Partridge, Ann H; Seah, Davinia S E; King, Tari; Leighl, Natasha B; Hauke, Ralph; Wollins, Dana S; Von Roenn, Jamie Hayden

    2014-10-10

    Palliative care is a fundamental component of cancer care. As part of the 2011 to 2012 Leadership Development Program (LDP) of the American Society of Clinical Oncology (ASCO), a group of participants was charged with advising ASCO on how to develop a service model integrating palliative care throughout the continuum of cancer care. This article presents the findings of the LDP group. The group focused on the process of palliative care delivery in the oncology setting. We identified key elements for models of palliative care in various settings to be potentially equitable, sustainable, feasible, and acceptable, and here we describe a dynamic model for the integrated, simultaneous implementation of palliative care into oncology practice. We also discuss critical considerations to better integrate palliative care into oncology, including raising consciousness and educating both providers and the public about the importance of palliative care; coordinating palliative care efforts through strengthening affiliations and/or developing new partnerships; prospectively evaluating the impact of palliative care on patient and provider satisfaction, quality improvement, and cost savings; and ensuring sustainability through adequate reimbursement and incentives, including linkage of performance data to quality indicators, and coordination with training efforts and maintenance of certification requirements for providers. In light of these findings, we believe the confluence of increasing importance of incorporation of palliative care education in oncology education, emphasis on value-based care, growing use of technology, and potential cost savings makes developing and incorporating palliative care into current service models a meaningful goal. PMID:25199756

  20. Establishment of Pediatric Cardiac Intensive Care Advanced Practice Provider Services.

    PubMed

    Gilliland, Jill; Donnellan, Amy; Justice, Lindsey; Moake, Lindy; Mauney, Jennifer; Steadman, Page; Drajpuch, David; Tucker, Dawn; Storey, Jean; Roth, Stephen J; Koch, Josh; Checchia, Paul; Cooper, David S; Staveski, Sandra L

    2016-01-01

    The addition of advanced practice providers (APPs; nurse practitioners and physician assistants) to a pediatric cardiac intensive care unit (PCICU) team is a health care innovation that addresses medical provider shortages while allowing PCICUs to deliver high-quality, cost-effective patient care. APPs, through their consistent clinical presence, effective communication, and facilitation of interdisciplinary collaboration, provide a sustainable solution for the highly specialized needs of PCICU patients. In addition, APPs provide leadership, patient and staff education, facilitate implementation of evidence-based practice and quality improvement initiatives, and the performance of clinical research in the PCICU. This article reviews mechanisms for developing, implementing, and sustaining advance practice services in PCICUs. PMID:26714997

  1. Providing Children and Adolescents Opportunities for Social Interaction as a Standard of Care in Pediatric Oncology.

    PubMed

    Christiansen, Heather L; Bingen, Kristin; Hoag, Jennifer A; Karst, Jeffrey S; VelĂĄzquez-Martin, Blanca; Barakat, Lamia P

    2015-12-01

    Experiences with peers constitute an important aspect of socialization, and children and adolescents with cancer may experience reduced social interaction due to treatment. A literature review was conducted to investigate the evidence to support a standard of care evaluating these experiences. Sixty-four articles were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Moderate quality of evidence suggest that social interaction can be beneficial to increase knowledge, decrease isolation, and improve adjustment and constitute an important, unmet need. The evidence supports a strong recommendation for youth with cancer to be provided opportunities for social interaction following a careful assessment of their unique characteristics and preferences. PMID:26700923

  2. Tips and Tidbits: A Book for Family Day Care Providers.

    ERIC Educational Resources Information Center

    Gonzalez-Mena, Janet

    This book provides practical information and advice designed to help family day care providers solve problems they confront in their daily work with children. The book is organized into 7 sections. Part I, "Effective Ways to Change Unacceptable Behavior," offers recommendations about discipline, alternatives to punishment, modeling, and praise.


  3. The role of primary care providers in managing falls.

    PubMed

    Demons, Jamehl L; Duncan, Pamela W

    2014-01-01

    Falls threaten the ability of older adults to live independently in the community. Fortunately, national and state organizations have created tools that allow primary care providers to easily assess fall risk, and small changes in practice patterns can provide patients with the resources necessary to prevent falls, thus helping to reverse a costly, deadly epidemic. PMID:25237872

  4. Emergent Literacy in Family Child Care: Perceptions of Three Providers

    ERIC Educational Resources Information Center

    Walker, Sharryn Larsen

    2004-01-01

    Perceptions of emergent literacy by three family child care providers are described. These perceptions were gathered through ethnographic data collection techniques, including participant-observation, field notes, interviews, and document analysis. The providers described their understandings of emergent literacy through perceptions about


  5. Corruption in health-care systems and its effect on cancer care in Africa.

    PubMed

    Mostert, Saskia; Njuguna, Festus; Olbara, Gilbert; Sindano, Solomon; Sitaresmi, Mei Neni; Supriyadi, Eddy; Kaspers, Gertjan

    2015-08-01

    At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients. PMID:26248847

  6. The impact of primary care physicians on follow-up care of underserved breast cancer survivors

    PubMed Central

    Maly, Rose C.; Liu, Yihang; Diamant, Allison L.; Thind, Amardeep

    2014-01-01

    Purpose To investigate the impact of primary care physicians’ (PCP) involvement in the receipt of follow-up cancer preventive care after a breast cancer (BC) diagnosis among a low-income population. Methods Multiple logistic regression analyses were performed to identify potential factors associated with receipt of cancer preventive care among 579 low-income women with breast cancer. The main outcome variables were receipt of annual mammography, Pap smear in the past 2 years, and ever had colonoscopy for those who were at least 50 years old, at 36 months after BC diagnosis. The main independent variable was provider visit type in the past 12 months. Results Women with a PCP visit only or both PCP and surgeon/cancer specialist visits in the past 12 months were more likely to have had annual mammography (AOR=2.67, P=0.109; AOR=2.20, P=0.0008, respectively), a Pap smear in the past 2 years (AOR=2.90, P=0.04; AOR=2.24, P=0.009, respectively) and colonoscopy (AOR=2.99, P=0.041; AOR=2.17, P=0.026, respectively) than those who only visited surgeons/cancer specialists. Indeed, women who only saw a PCP for their follow-up care had the highest odds ratio to receive each clinical care service. Conclusions PCP’s involvement in the medical care of low-income BC survivors results in better follow-up cancer preventive care. Getting PCPs involved in cancer survivor care might be particularly pertinent for low-income populations because of lower costs and ease of access compared to cancer specialist-provided care. PMID:24204059

  7. Veterans with depression in primary care: provider preferences, matching, and care satisfaction.

    PubMed

    Waltz, Thomas J; Campbell, Duncan G; Kirchner, JoAnn E; Lombardero, Anayansi; Bolkan, Cory; Zivin, Kara; Lanto, Andrew B; Chaney, Edmund F; Rubenstein, Lisa V

    2014-12-01

    Primary care is often the first point of care for individuals with depression. Depressed patients often have comorbid alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD). Understanding variations in treatment preferences and care satisfaction in this population can improve care planning and outcomes. The design involved a cross-sectional comparison of veterans screening positive for depression. Veterans receiving primary care during the previous year were contacted (n = 10, 929) and were screened for depression using the PHQ-2/PHQ-9. Those with probable depression (n = 761) underwent a comprehensive assessment including screens for AUD and PTSD, treatment provider preferences, treatments received, and satisfaction with care. Treatment provider preferences differed based on specific mental health comorbidities, and satisfaction with care was associated with receipt of preferred care. Depressed veterans with comorbid PTSD were more likely to prefer care from more than one provider type (e.g., a psychiatrist and a primary care provider) and were more likely to receive treatment that matched their preferences than veterans without comorbid PTSD. Veterans receiving full or partial treatment matches affirmed satisfaction with care at higher rates, and veterans with comorbid PTSD were least satisfied when care did not match their preferences. Patient satisfaction with care is an increasingly important focus for health care systems. This study found significant variations in depressed patients' satisfaction with care in terms of treatment matching, particularly among those with comorbid PTSD. Delivery of care that matches patient treatment preferences is likely to improve depressed patient's satisfaction with the care provided. (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:25090611

  8. Strangulation forensic examination: best practice for health care providers.

    PubMed

    Faugno, Diana; Waszak, Daria; Strack, Gael B; Brooks, Melodie Ann; Gwinn, Casey G

    2013-01-01

    Strangulation is one of the most dangerous forms of interpersonal violence (IVP), yet it is often not reported and missed by the health care provider because of lack of visible injury. The victim of strangulation can have critical injuries and a late onset symptoms. Victims of IVP should be directly asked whether they were choked or whether during the assault they felt like they could not breathe because of pressure on their neck. The objective of this article is to summarize "best practice" for health care providers so that they are better prepared to care for victims who report a history of strangulation. A summary of how to perform a forensic examination of the strangled patient is provided along with important documentation takeaways and useful forms to ensure that the severity of the strangulation is assessed, that critical injuries are identified, and that all injuries and findings are accurately documented for legal proceedings. PMID:24176831

  9. Challenges of providing HIV care in general practice.

    PubMed

    Newman, Christy E; de Wit, John B F; Crooks, Levinia; Reynolds, Robert H; Canavan, Peter G; Kidd, Michael R

    2015-01-01

    As the management of HIV changes and demand for HIV health services in primary care settings increases, new approaches to engaging the general practice workforce with HIV medicine are required. This paper reports on qualitative research conducted with 47 clinicians who provide HIV care in general practice settings around Australia, including accredited HIV s100 prescribers as well as other GPs and general practice nurses. Balanced numbers of men and women took part; less than one-quarter were based outside of urban metropolitan settings. The most significant workforce challenges that participants said they faced in providing HIV care in general practice were keeping up with knowledge, navigating low caseload and regional issues, balancing quality care with cost factors, and addressing the persistent social stigma associated with HIV. Strategic responses developed by participants to address these challenges included thinking more creatively about business and caseload planning, pursuing opportunities to share care with specialist clinicians, and challenging prejudiced attitudes amongst patients and colleagues. Understanding and supporting the needs of the general practice workforce in both high and low HIV caseload settings will be essential in ensuring Australia has the capacity to respond to emerging priorities in HIV prevention and care. PMID:24581265

  10. An eHealth Application in Head and Neck Cancer Survivorship Care: Health Care Professionals' Perspectives

    PubMed Central

    van Uden-Kraan, Cornelia F; Peek, Niels; Cuijpers, Pim; Leemans, C René; Verdonck-de Leeuw, Irma M

    2015-01-01

    Background Although many cancer survivors could benefit from supportive care, they often do not utilize such services. Previous studies have shown that patient-reported outcomes (PROs) could be a solution to meet cancer survivors’ needs, for example through an eHealth application that monitors quality of life and provides personalized advice and supportive care options. In order to develop an effective application that can successfully be implemented in current health care, it is important to include health care professionals in the development process. Objective The aim of this study was to investigate health care professionals’ perspectives toward follow-up care and an eHealth application, OncoKompas, in follow-up cancer care that monitors quality of life via PROs, followed by automatically generated tailored feedback and personalized advice on supportive care. Methods Health care professionals involved in head and neck cancer care (N=11) were interviewed on current follow-up care and the anticipated value of the proposed eHealth application (Step 1). A prototype of the eHealth application, OncoKompas, was developed (Step 2). Cognitive walkthroughs were conducted among health care professionals (N=21) to investigate perceived usability (Step 3). Interviews were recorded, transcribed verbatim, and analyzed by 2 coders. Results Health care professionals indicated several barriers in current follow-up care including difficulties in detecting symptoms, patients’ perceived need for supportive care, and a lack of time to encourage survivors to obtain supportive care. Health care professionals expected the eHealth application to be of added value. The cognitive walkthroughs demonstrated that health care professionals emphasized the importance of tailoring care. They considered the navigation structure of OncoKompas to be complex. Health care professionals differed in their opinion toward the best strategy to implement the application in clinical practice but indicated that it should be incorporated in the HNC cancer care pathway to ensure all survivors would benefit. Conclusions Health care professionals experienced several barriers in directing patients to supportive care. They were positive toward the development and implementation of an eHealth application and expected it could support survivors in obtaining supportive care tailored to their needs. The cognitive walkthroughs revealed several points for optimizing the application prototype and developing an efficient implementation strategy. Including health care professionals in an early phase of a participatory design approach is valuable in developing an eHealth application and an implementation strategy meeting stakeholders’ needs. PMID:26489918

  11. Care providers' needs and perspectives on suffering and care in Bosnia and Herzegovina and Cambodia.

    PubMed

    McDonald, Laura; Mollica, Richard F; Douglas Kelley, Susan; Tor, Svang; Halilovic, Majda

    2012-01-01

    This exploratory study aimed to obtain insight into field-level care providers' views on suffering and healing as well as existing obstacles and needs related to providing care to their clients. This research provides a "snapshot" for a better understanding of existing care systems in two post-conflict settings. By identifying existing approaches to care and the needs of the care provider community, this research might be useful in guiding psychosocial assistance programming in post-conflict settings. Utilizing a semi-structured questionnaire, 45 care providers were interviewed, including local health care practitioners, traditional/ spiritual healers, and humanitarian relief workers, in Bosnia and Herzegovina and Cambodia. This study found that the majority of care providers in both settings perceived poverty and violence as significant causes and consequences of human suffering and, at the same time, felt ill-equipped in addressing these issues and related problems. Other issues that hindered these healers in providing care included: limited government/institutional support; lack of training; material resources and funding. Study findings point to a new framework for developing effective interventions and the need for further emphasis on supporting care providers in their work, and most specifically, in identifying and responding to poverty and violence. PMID:23331393

  12. We Are Not Babysitters: Family Child Care Providers Redefine Work and Care.

    ERIC Educational Resources Information Center

    Tuominen, Mary C.

    Drawing on in-depth interviews with 20 family child care providers of diverse race, ethnicity, immigrant status, and social class, this book explores the social, political, and economic forces and processes that draw women into the work of family child care. The articles dispel not only myths about why women choose to be family child care…

  13. Health in Day Care: A Guide for Day Care Providers in Massachusetts.

    ERIC Educational Resources Information Center

    Kendrick, Abby Shapiro, Ed.; Messenger, Katherine P., Ed.

    This reference manual and resource guide describes high standards for health policies and day care procedures that reflect current research and recommendations of experts. Chapters 1 and 2, which concern day care's role in health, cover health education in day care and the basics relating to policies, providers, and records. Chapters 3-5 concern


  14. Health in Day Care: A Guide for Day Care Providers in Massachusetts.

    ERIC Educational Resources Information Center

    Kendrick, Abby Shapiro, Ed.; Messenger, Katherine P., Ed.

    This reference manual and resource guide describes high standards for health policies and day care procedures that reflect current research and recommendations of experts. Chapters 1 and 2, which concern day care's role in health, cover health education in day care and the basics relating to policies, providers, and records. Chapters 3-5 concern…

  15. Transforming health care service delivery and provider selection.

    PubMed

    Reiner, Bruce I

    2011-06-01

    Commoditization pressures in medicine have risked transforming service provider selection from "survival of the fittest" to "survival of the cheapest." Quality- and safety-oriented mandates by the Institute of Medicine have led to the creation of a number of data-driven quality-centric initiatives including Pay for Performance and Evidence-Based Medicine. A synergistic approach to creating quantitative accountability in medical service delivery is through the creation of consumer-oriented performance metrics which provide patients with objective data related to individual service provider quality, safety, cost-efficacy, efficiency, and customer service. These performance metrics could in turn be customized to the individual preferences and health care needs of each individual patient, thereby providing an objective methodology for service provider selection while empowering health care consumers. PMID:21468775

  16. Care management redesign: increasing care manager time with patients and providers while improving metrics.

    PubMed

    Kowinsky, Amy; Greenhouse, Pamela K; Zombek, Victoria L; Rader, Sandra L; Reidy, Margaret E

    2009-09-01

    In many hospitals, addressing increasing financial and regulatory requirements has resulted in a decline in care managers' time spent communicating directly with patients, families, and healthcare providers. The authors discuss the redesign of a hospital care management model that increased the time care managers spend with patients, families, and other care professionals, while patient satisfaction increased, labor cost remained neutral, length of stay decreased, and the payment denial rate remained among the country's lowest. PMID:19745635

  17. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

    PubMed

    Runowicz, Carolyn D; Leach, Corinne R; Henry, N Lynn; Henry, Karen S; Mackey, Heather T; Cowens-Alvarado, Rebecca L; Cannady, Rachel S; Pratt-Chapman, Mandi L; Edge, Stephen B; Jacobs, Linda A; Hurria, Arti; Marks, Lawrence B; LaMonte, Samuel J; Warner, Ellen; Lyman, Gary H; Ganz, Patricia A

    2016-01-01

    Answer questions and earn CME/CNE The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made. CA Cancer J Clin 2016;43-73. © 2015 American Cancer Society. PMID:26641959

  18. Private Companies Providing Health Care Price Data: Who Are They and What Information do They Provide?

    PubMed Central

    Phillips, Kathryn A.; Labno, Anna

    2014-01-01

    Summary There is interest in making health care price information more transparent given the increase in enrollment in high-deductible and consumer-directed health plans, and as policy efforts intensify to engage consumers to obtain high value care. We examine the role of private companies that market price transparency tools, primarily to self-insured employers – an important yet understudied topic. What companies exist? How did they emerge? What information do they provide? Where do they get that information? How does the price and quality information provided compare across companies? PMID:25678764

  19. Agents for Change: Nonphysician Medical Providers and Health Care Quality

    PubMed Central

    Boucher, Nathan A; McMillen, Marvin A; Gould, James S

    2015-01-01

    Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization’s quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts. PMID:25663213

  20. Prostate cancer: palliative care and pain relief.

    PubMed

    Kaya, E; Feuer, D

    2004-01-01

    Metastatic prostate cancer is incurable, and both the disease and other comorbidities as well as side effects from treatments can be very disabling for patients who are generally elderly. Past reviews on palliative care in prostate cancer have tended to concentrate on methods of active intervention with palliative intent rather than the principles of palliative care in a broader context. This paper is intended to introduce the principles and practice of modern palliative care as applied to care of patients with prostate cancer. Current National Institute for Clinical Excellence guidelines for urological cancers recommends provision of palliative care for all patients with prostate cancer, according to need. Palliative care aims to improve the quality of life of patients and their families. It is a holistic and personal approach to patient care, consisting of patient centred multiprofessional teams. Symptoms such as pain, psychological, spiritual and social problems are given equal weighting and tackled simultaneously. When treating pain, hormonal manipulation, radiotherapy, chemotherapy and surgery should always be considered alongside analgesic therapy, with realistic aims in mind. Towards the end of life, palliative care for patients will generally increase in line with increasing symptoms and other problems. Achieving a peaceful and comfortable death for our patients should be a priority in hospitals. PMID:15356678

  1. Electronic cigarettes and thirdhand tobacco smoke: two emerging health care challenges for the primary care provider

    PubMed Central

    Kuschner, Ware G; Reddy, Sunayana; Mehrotra, Nidhi; Paintal, Harman S

    2011-01-01

    Primary care providers should be aware of two new developments in nicotine addiction and smoking cessation: 1) the emergence of a novel nicotine delivery system known as the electronic (e-) cigarette; and 2) new reports of residual environmental nicotine and other biopersistent toxicants found in cigarette smoke, recently described as “thirdhand smoke”. The purpose of this article is to provide a clinician-friendly introduction to these two emerging issues so that clinicians are well prepared to counsel smokers about newly recognized health concerns relevant to tobacco use. E-cigarettes are battery powered devices that convert nicotine into a vapor that can be inhaled. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS). The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. ENDS are not approved as smoking cessation devices. Primary care givers should anticipate being questioned by patients about the advisability of using e-cigarettes as a smoking cessation device. The term thirdhand smoke first appeared in the medical literature in 2009 when investigators introduced the term to describe residual tobacco smoke contamination that remains after the cigarette is extinguished. Thirdhand smoke is a hazardous exposure resulting from cigarette smoke residue that accumulates in cars, homes, and other indoor spaces. Tobacco-derived toxicants can react to form potent cancer causing compounds. Exposure to thirdhand smoke can occur through the skin, by breathing, and by ingestion long after smoke has cleared from a room. Counseling patients about the hazards of thirdhand smoke may provide additional motivation to quit smoking. PMID:21475626

  2. 45 CFR 162.410 - Implementation specifications: Health care providers.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Implementation specifications: Health care providers. 162.410 Section 162.410 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health...

  3. Theory in Practice: Helping Providers Address Depression in Diabetes Care

    ERIC Educational Resources Information Center

    Osborn, Chandra Y.; Kozak, Cindy; Wagner, Julie

    2010-01-01

    Introduction: A continuing education (CE) program based on the theory of planned behavior was designed to understand and improve health care providers' practice patterns in screening, assessing, and treating and/or referring patients with diabetes for depression treatment. Methods: Participants completed assessments of attitudes, confidence,


  4. Primary Care Providers' Views regarding Assessing and Treating Suicidal Patients

    ERIC Educational Resources Information Center

    Graham, Ryan D.; Rudd, M. David; Bryan, Craig J.

    2011-01-01

    Primary care providers (PCPs) usually do not explore patient suicidality during routine visits. Factors that predict PCP attitudes toward the assessment and treatment of suicidality were examined via an online survey of 195 practicing PCPs affiliated with medical schools in the United States. PCPs who perceived themselves as competent to work with


  5. Growing Healthy Bodies: Nutrition Education for Day Care Providers.

    ERIC Educational Resources Information Center

    Viebrock, Margaret A.; Berry, Holly

    This booklet discusses the important role that day care providers can play in ensuring that children eat healthy snacks and meals and learn good eating habits. Section one of the booklet examines snack foods, discusses the difference between nutritious and less-nutritious snacks, and recommends snack foods appropriate for different age groups.


  6. Talk with Your Health Care Provider about High Blood Pressure

    MedlinePlus

    ... Circulation Talk With Your Health Care Provider About High Blood Pressure Why is high blood pressure dangerous? Blood pressure is the force of blood ... and stays high over time, it is called hypertension (“Hi-pur-TEN-shun”). If it is not ...

  7. Family Day Care: How to Provide it in Your Home.

    ERIC Educational Resources Information Center

    Squibb, Betsy

    Tips, recommendations, ideas, and background information are offered to providers of family day care. After a brief discussion of licensing and registration and a listing of learning activities for young children at home, additional learning activities and materials are described that are considered appropriate for infants, toddlers, preschool…

  8. AIDS in Rural Areas: Challenges to Providing Care.

    ERIC Educational Resources Information Center

    Rounds, Kathleen A.

    1988-01-01

    Examined the development and provision of social services to persons with Acquired Immune Deficiency Syndrome (AIDS) and their families in rural areas and barriers to the delivery of care. Subjects (N=15) were persons who coordinated or provided services to AIDS victims. Found structural factors, confidentiality, fear of contagion, and homophobia


  9. Home Care Nursing Improves Cancer Symptom Management

    Cancer.gov

    Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.

  10. The cost of cancer care: Part II.

    PubMed

    Eagle, David

    2012-11-01

    The rising cost of cancer treatment competes with the availability of effective therapy as a limiting factor in our war on cancer. Specific programs are being developed that have the potential to slow the growth in spending on oncology care. The Affordable Care Act includes provisions for containing healthcare costs, such as accountable care organizations and the Independent Payment Advisory Board. Within oncology, specific programs have emerged, including clinical pathways, episode-of-care based payment arrangements, and the oncology medical home. All models of cost containment have strengths and weaknesses. Outside of the United States, explicit rationing exists' through national health technology assessment organizations. Excessive demands on physicians to limit spending at the bedside could potentially create conflicts with their professional responsibility to patients. While spending for cancer care in the US is high, its "worth" is ultimately a societal decision. Recent economic modeling suggests that we may be achieving value for the money we spend. PMID:23330356

  11. Communicating during care transitions for older hip fracture patients: family caregiver and health care provider's perspectives

    PubMed Central

    Glenny, Christine; Stolee, Paul; Sheiban, Linda; Jaglal, Susan

    2013-01-01

    Introduction Older hip fracture patients frequently require care across a variety of settings, from multiple individuals, including their family caregivers. We explored issues related to information sharing during transitional care for older hip fracture patients through the perspectives of both health care providers and family caregivers. Methods Thirty-five semi-structured interviews were conducted with family caregivers (n = 9) and health care providers (n = 26) of six hip fracture patients to gather perspectives on information sharing at each care transition, beginning with post-surgical discharge from acute care. Data were analysed using conventional qualitative content analysis methods using NVivo8 software. Results Both family caregivers and health care providers recognise that family caregivers' involvement has important benefits for patients, but this involvement is frequently limited by poor information sharing. Barriers include limited staff time, patient privacy regulations and lack of a clear structure to guide information sharing. Receiving, not offering, information was the focus of information sharing by both family caregivers and health care providers. Conclusions Specific barriers that lead to poor information sharing between family caregivers and health care providers have been identified in this study. Possible interventions to improve information sharing include encouraging communication with family caregivers as standard care practice, educational strategies and more effective use of health information systems and technologies. PMID:24198738

  12. Providing effective and preferred care closer to home: a realist review of intermediate care.

    PubMed

    Pearson, Mark; Hunt, Harriet; Cooper, Chris; Shepperd, Sasha; Pawson, Ray; Anderson, Rob

    2015-11-01

    Intermediate care is one of the number of service delivery models intended to integrate care and provide enhanced health and social care services closer to home, especially to reduce reliance on acute care hospital beds. In order for health and social care practitioners, service managers and commissioners to make informed decisions, it is vital to understand how to implement the admission avoidance and early supported discharge components of intermediate care within the context of local care systems. This paper reports the findings of a theory-driven (realist) review conducted in 2011-2012. A broad range of evidence contained in 193 sources was used to construct a conceptual framework for intermediate care. This framework forms the basis for exploring factors at service user, professional and organisational levels that should be considered when designing and delivering intermediate care services within a particular local context. Our synthesis found that involving service users and their carers in collaborative decision-making about the objectives of care and the place of care is central to achieving the aims of intermediate care. This pivotal involvement of the service user relies on practitioners, service managers and commissioners being aware of the impact that organisational structures at the local level can have on enabling or inhibiting collaborative decision-making and care co-ordination. Through all interactions with service users and their care networks, health and social care professionals should establish the meaning which alternative care environments have for different service users. Doing so means decisions about the best place of care will be better informed and gives service users choice. This in turn is likely to support psychological and social stability, and the attainment of functional goals. At an organisational level, integrated working can facilitate the delivery of intermediate care, but there is not a straightforward relationship between integrated organisational processes and integrated professional practice. PMID:25684035

  13. Improving communication between women and health care providers.

    PubMed

    Rogers, Paul G

    1987-07-01

    A wide range of resources are available to enhance the communication and education of women. The patient's attitude should connote a sense of rights as a patient and allow for the request of information from the health care provider without discomfort. Women should take the initiative in selecting their physicians and pharmacists, with recognition that a comfortable dialogue can be initiated and is essential to good health care.Self-education on a particular health condition before visiting the physician allows the patient to formulate questions to ask the physician. PMID:19313192

  14. Creating a continuum of care: integrating obstetricians and gynecologists in the care of young cancer patients

    PubMed Central

    Kong, Betty Y.; Skory, Robin M.; Woodruff, Teresa K.

    2011-01-01

    Cancer therapy can be lifesaving but significantly diminish female reproductive potential. This review provides an overview of the deleterious effects of cancer treatments on reproductive function, the fertility preservation options currently available for young women and the outcomes of pregnancy after cancer treatment. In addition, special considerations for women who are diagnosed with cancer during pregnancy are discussed. To optimize the continuum of care for the patient, new corridors of communication between obstetricians, gynecologists and oncology specialists must be developed to ensure the best outcomes for the patient, both in terms of cancer treatment and fertility preservation. PMID:22031251

  15. Providing care to children in times of war.

    PubMed

    Cole, Will; Edwards, Mary J; Burnett, Mark W

    2015-06-01

    The Geneva Conventions stipulate that an occupying power must ensure adequate health care delivery to noncombatants. Special emphasis is given to children, who are among the most vulnerable in a conflict zone. Whether short-term pediatric care should be provided by Military Treatment Facilities to local nationals for conditions other than combat-related injury is controversial. A review of 1,197 children without traumatic injury cared for during 10 years in Iraq and Afghanistan was conducted. Mortality rates were less than 1% among patients with surgical conditions and resource utilization was not excessive. In view of international humanitarian law and these outcomes, children with nontraumatic conditions can and should be considered for treatment at Military Treatment Facilities. The ability to correct the condition and availability of resources necessary to do so should be taken into account. PMID:26032375

  16. Health Care Providers and Dying Patients: Critical Issues in Terminal Care.

    ERIC Educational Resources Information Center

    Benoliel, Jeanne Quint

    1988-01-01

    Identifies three major areas of concern in relationship between health care providers and dying patients: (1) nature of difficulties and stresses associated with terminal care; (2) education of providers for work; and (3) influence of organizational structure and institutionalized values on services for dying patients and families. Reviews


  17. The ABCs of Safe and Healthy Child Care: A Handbook for Child Care Providers.

    ERIC Educational Resources Information Center

    Hale, Cynthia M.; Polder, Jacquelyn A.

    Recognizing the importance of maintaining a safe and healthy child care setting, this manual for home or center child care providers contains information and guidelines to help providers maintain child health and reduce sickness and injuries. Part 1, "Introduction," describes how diseases are spread and how to prevent and prepare for unintentional


  18. Making Home-Based Child Care Work for You: A Parent and Child Care Provider Handbook.

    ERIC Educational Resources Information Center

    McDonough-Abunassar, Holly

    At some point in many children's lives, parents are faced with the difficult question, "What about child care?" Intended for both parents and providers, this guide is designed to help parents decide whether family child care is suited to their needs, guiding them through the process of choosing a provider and allowing them a look behind the scenes


  19. Primary Care Providers' Perceptions of Home Diabetes Telemedicine Care in the IDEATel Project

    ERIC Educational Resources Information Center

    Tudiver, Fred; Wolff, L. Thomas; Morin, Philip C.; Teresi, Jeanne; Palmas, Walter; Starren, Justin; Shea, Steven; Weinstock, Ruth S.

    2007-01-01

    Context: Few telemedicine projects have systematically examined provider satisfaction and attitudes. Purpose: To determine the acceptability and perceived impact on primary care providers' (PCP) practices of a randomized clinical trial of the use of telemedicine to electronically deliver health care services to Medicare patients with diabetes in


  20. How do deployed health care providers experience moral injury?

    PubMed

    Gibbons, Susanne W; Shafer, Michaela; Hickling, Edward J; Ramsey, Gloria

    2013-01-01

    Combat deployments put health care providers in ethically compromising and morally challenging situations. A sample of recently deployed nurses and physicians provided narratives that were analyzed to better appreciate individual perceptions of moral dilemmas that arise in combat. Specific questions to be answered by this inquiry are: 1) How do combat deployed nurses and physicians make sense of morally injurious traumatic exposures? and 2) What are the possible psychosocial consequences of these and other deployment stressors? This narrative inquiry involves analysis of ten deployed military nurses' and physicians' aversive or traumatic experiences. Burke's dramatist pentad is used for structural narrative analysis of stories that confirm and illuminate the impact of war zone events such as betrayal, disproportionate violence, incidents involving civilians, and within-rank violence on military health care provider narrators. Results indicate cognitive dissonance and psychosocial sequelae related to moral and psychological stressors faced by military medical personnel. Discussion addresses where healing efforts should be focused. PMID:24407133

  1. Health care providers can prevent and treat PID.

    PubMed

    Lande, R E

    1994-01-15

    As many as 85% of women with untreated pelvic inflammatory disease (PID) become infertile, almost 20% endure chronic pelvic pain which can be so severe that it prevents women from doing their daily tasks, and the permanent scarring and narrowing of the fallopian tubes caused by the condition increases a woman's risk of having a life-threatening ectopic pregnancy by 7- to 10-fold. Since sexually transmitted diseases (STD) cause most cases of PID, the prompt and effective treatment of STDs as well as preventing future cases can greatly reduce the incidence of PID and its consequences. Women frequently first seek help in primary health care facilities for their ailments. Health care providers at such facilities, however, often erroneously assume that laboratory tests are needed to diagnose and treat women with STDs or lower abdominal pain. Valuable time is lost when such providers refer women unnecessarily to hospitals or STD clinics for diagnosis and treatment. Providers should instead diagnose and treat patients on the basis of groups of symptoms, or syndromes, rather than for specific STDs. This syndromic approach may require treatment for several STDs concurrently since several STDs may cause a particular syndrome. Some guidelines are presented for diagnosing and treating PID. Finally, providing treatment at the primary care level also allows the opportunity for the attending practitioners to encourage monogamy and provide clients with condoms for the prevention of future disease. PMID:12179215

  2. Primary Care of the Prostate Cancer Survivor.

    PubMed

    Noonan, Erika M; Farrell, Timothy W

    2016-05-01

    This summary of the American Cancer Society Prostate Cancer Survivorship Care Guidelines targets primary care physicians who coordinate care of prostate cancer survivors with subspecialists. Prostate cancer survivors should undergo prostate-specific antigen screening every six to 12 months and digital rectal examination annually. Surveillance of patients who choose watchful waiting for their prostate cancer should be conducted by a subspecialist. Any hematuria or rectal bleeding must be thoroughly evaluated. Prostate cancer survivors should be screened regularly for urinary incontinence and sexual dysfunction. Patients with predominant urge incontinence symptoms, which can occur after surgical and radiation treatments, may benefit from an anticholinergic agent. If there is difficulty with bladder emptying, a trial of an alpha blocker may be considered. A phosphodiesterase type 5 inhibitor can effectively treat sexual dysfunction following treatment for prostate cancer. Osteoporosis screening should occur before initiation of androgen deprivation therapy, and patients treated with androgen deprivation therapy should be monitored for anemia, metabolic syndrome, and vasomotor symptoms. Healthy lifestyle choices should be encouraged, including weight management, regular physical activity, proper nutrition, and smoking cessation. Primary care physicians should be vigilant for psychosocial distress, including depression, among prostate cancer survivors, as well as the potential impact of this distress on patients' family members and partners. PMID:27175954

  3. Customer-centered strategic diversification: specialty health care provider moves towards primary care.

    PubMed

    Clugston, M M

    1997-01-01

    A logistic regression model is used to analyze an OB/GYN'S move towards primary care. Current clients' use/no use response of the clinic as a primary care provider is the criterion variable. Predictor variables include new primary care services, expanded OB/GYN services, overall system utilization, and current insurance and physician status. Overall, only 37% of the clinic's current clients indicated they would utilize the clinic for primary care. Having a personal physician is a significant predictor of a client's decision to utilize the clinic's new primary care services. Other significant predictor variables are discussed. PMID:10179062

  4. Spirituality in Cancer Care (PDQ)

    MedlinePlus

    ... help with a patient's spiritual needs when setting goals and planning treatment. The health care team may help with a patient's spiritual needs in the following ways: Suggest goals and options for care that honor the patient's ...

  5. Multilevel factors affecting quality: examples from the cancer care continuum.

    PubMed

    Zapka, Jane; Taplin, Stephen H; Ganz, Patricia; Grunfeld, Eva; Sterba, Katherine

    2012-05-01

    The complex environmental context must be considered as we move forward to improve cancer care and, ultimately, patient and population outcomes. The cancer care continuum represents several care types, each of which includes multiple technical and communication steps and interfaces among patients, providers, and organizations. We use two case scenarios to 1) illustrate the variability, diversity, and interaction of factors from multiple levels that affect care quality and 2) discuss research implications and provide hypothetical examples of multilevel interventions. Each scenario includes a targeted literature review to illustrate contextual influences upon care and sets the stage for theory-informed interventions. The screening case highlights access issues in older women, and the survivorship case illustrates the multiple transition challenges faced by patients, families, and organizations. Example interventions show the potential gains of implementing intervention strategies that work synergistically at multiple levels. While research examining multilevel intervention is a priority, it presents numerous study design, measurement, and analytic challenges. PMID:22623591

  6. Multilevel Factors Affecting Quality: Examples From the Cancer Care Continuum

    PubMed Central

    Taplin, Stephen H.; Ganz, Patricia; Grunfeld, Eva; Sterba, Katherine

    2012-01-01

    The complex environmental context must be considered as we move forward to improve cancer care and, ultimately, patient and population outcomes. The cancer care continuum represents several care types, each of which includes multiple technical and communication steps and interfaces among patients, providers, and organizations. We use two case scenarios to 1) illustrate the variability, diversity, and interaction of factors from multiple levels that affect care quality and 2) discuss research implications and provide hypothetical examples of multilevel interventions. Each scenario includes a targeted literature review to illustrate contextual influences upon care and sets the stage for theory-informed interventions. The screening case highlights access issues in older women, and the survivorship case illustrates the multiple transition challenges faced by patients, families, and organizations. Example interventions show the potential gains of implementing intervention strategies that work synergistically at multiple levels. While research examining multilevel intervention is a priority, it presents numerous study design, measurement, and analytic challenges. PMID:22623591

  7. Providing primary health care with non-physicians.

    PubMed

    Chen, P C

    1984-04-01

    The definition of primary health care is basically the same, but the wide variety of concepts as to the form and type of worker required is largely due to variations in economic, demographic, socio-cultural and political factors. Whatever form it takes, in many parts of the developing world, it is increasingly clear that primary health care must be provided by non-physicians. The reasons for this trend are compelling, yet it is surprisingly opposed by the medical profession in many a developing country. Nonetheless, numerous field trials are being conducted in a variety of situations in several countries around the world. Non-physician primary health care workers vary from medical assistants and nurse practitioners to aide-level workers called village mobilizers, village volunteers, village aides and a variety of other names. The functions, limitations and training of such workers will need to be defined, so that an optimal combination of skills, knowledge and attitudes best suited to produce the desired effect on local health problems may be attained. The supervision of such workers by the physician and other health professionals will need to be developed in the spirit of the health team. An example of the use of non-physicians in providing primary health care in Sarawak is outlined. PMID:6497324

  8. Perception of primary care doctors and nurses about care provided to sickle cell disease patients

    PubMed Central

    Xavier Gomes, Ludmila MourĂŁo; de Andrade Barbosa, Thiago Luis; Souza Vieira, Elen DĂ©bora; Caldeira, AntĂŽnio Prates; de Carvalho Torres, HeloĂ­sa; Viana, Marcos Borato

    2015-01-01

    Objective To analyze the perception of primary care physicians and nurses about access to services and routine health care provided to sickle cell disease patients. Methods This descriptive exploratory study took a qualitative approach by surveying thirteen primary care health professionals who participated in a focus group to discuss access to services and assistance provided to sickle cell disease patients. The data were submitted to thematic content analysis. Results Access to primary care services and routine care for sickle cell disease patients were the categories that emerged from the analysis. Interaction between people with sickle cell disease and primary care health clinics was found to be minimal and limited mainly to scheduling appointments. Patients sought care from the primary care health clinics only in some situations, such as for pain episodes and vaccinations. The professionals noted that patients do not recognize primary care as the gateway to the system, and reported that they feel unprepared to assist sickle cell disease patients. Conclusion In the perception of these professionals, there are restrictions to accessing primary care health clinics and the primary care assistance for sickle cell disease patients is affected. PMID:26190428

  9. Time providing care outside visits in a home-based primary care program

    PubMed Central

    Pedowitz, Elizabeth J.; Ornstein, Katherine A.; Farber, Jeffrey; DeCherrie, Linda V.

    2016-01-01

    Background/Objectives Homebound elderly patients with chronic medical illnesses face multiple barriers to care. Primary care physicians (PCPs) devote a significant amount of time to care apart from actual office visits, but there is little quantification of such time by physicians who provide primary care in the home. This article assesses exactly how much time physicians in a large home based primary care (HBPC) program spend providing care outside of home visits. Unreimbursed time, as well as patient and provider-related factors that may contribute to that increased time, are considered. Design Mount Sinai Visiting Doctors (MSVD) providers filled out research forms for every interaction involving care provision outside of home visits. Data collected included: length of interaction, mode, nature, and whom the interaction was with for 3 weeks. Setting/Participants MSVD is an academic home-visit program in Manhattan, NY. All PCPs in MSVD (n=14) agreed to participate. Measurements Time data were analyzed using a comprehensive estimate and conservative estimates to quantify unbillable time. Results Data on 1151 interactions for 537 patients were collected. An average 8.2 hours/week were spent providing non-home visit care for a full-time provider. Using the most conservative estimates, 3.6 hours/week was estimated to be unreimbursed per full-time provider. No significant differences in interaction times were found among dementia vs. non-dementia patients, new vs. non-new patients, and primary-panel vs. covered patients. Conclusion Findings suggest that HBPC providers spend substantial time providing care outside home visits, much of which goes unrecognized in the current reimbursement system. These findings may help guide practice development and creation of new payment systems for HBPC and similar models of care. PMID:24802078

  10. Barriers to cancer care, perceived social support, and patient navigation services for Korean breast cancer patients.

    PubMed

    Lim, Jung-Won

    2015-01-01

    The present study aimed to examine the relationships among barriers to cancer care, perceived social support, and patient navigation services (PNS) for Korean breast cancer patients. For Korean breast cancer patients, PNS are comprised of five services, including emotional, financial, information, transportation, and disease management. The study findings demonstrated that transportation and disease management barriers were directly associated with PNS, whereas emotional and financial barriers were indirectly associated with PNS through perceived social support. The current study provides a preliminary Korean patient navigation model to identify how barriers to cancer care can be reduced through social support and PNS. PMID:25588096

  11. Teamwork: building healthier workplaces and providing safer patient care.

    PubMed

    Clark, Paul R

    2009-01-01

    A changing healthcare landscape requires nurses to care for more patients with higher acuity during their shift than ever before. These more austere working conditions are leading to increased burnout. In addition, patient safety is not of the quality or level that is required. To build healthier workplaces where safe care is provided, formal teamwork training is recommended. Formal teamwork training programs, such as that provided by the MedTeams group, TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), or participatory action research programs such as the Healthy Workplace Intervention, have decreased errors in the workplace, increased nurse satisfaction and retention rates, and decreased staff turnover. This article includes necessary determinants of teamwork, brief overviews of team-building programs, and examples of research programs that demonstrate how teamwork brings about healthier workplaces that are safer for patients. Teamwork programs can bring about these positive results when implemented and supported by the hospital system. PMID:19542973

  12. Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers

    PubMed Central

    2013-01-01

    Background Aboriginal Australians experience poorer outcomes from cancer compared to the non-Aboriginal population. Some progress has been made in understanding Aboriginal Australians’ perspectives about cancer and their experiences with cancer services. However, little is known of cancer service providers’ (CSPs) thoughts and perceptions regarding Aboriginal patients and their experiences providing optimal cancer care to Aboriginal people. Communication between Aboriginal patients and non-Aboriginal health service providers has been identified as an impediment to good Aboriginal health outcomes. This paper reports on CSPs’ views about the factors impairing communication and offers practical strategies for promoting effective communication with Aboriginal patients in Western Australia (WA). Methods A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal CSPs from across WA was conducted between March 2006 - September 2007 and April-October 2011. CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Thematic analysis was carried out. Our analysis was primarily underpinned by the socio-ecological model, but concepts of Whiteness and privilege, and cultural security also guided our analysis. Results CSPs’ lack of knowledge about the needs of Aboriginal people with cancer and Aboriginal patients’ limited understanding of the Western medical system were identified as the two major impediments to communication. For effective patient–provider communication, attention is needed to language, communication style, knowledge and use of medical terminology and cross-cultural differences in the concept of time. Aboriginal marginalization within mainstream society and Aboriginal people’s distrust of the health system were also key issues impacting on communication. Potential solutions to effective Aboriginal patient-provider communication included recruiting more Aboriginal staff, providing appropriate cultural training for CSPs, cancer education for Aboriginal stakeholders, continuity of care, avoiding use of medical jargon, accommodating patients’ psychosocial and logistical needs, and in-service coordination. Conclusion Individual CSPs identified challenges in cross-cultural communication and their willingness to accommodate culture-specific needs within the wider health care system including better communication with Aboriginal patients. However, participants’ comments indicated a lack of concerted effort at the system level to address Aboriginal disadvantage in cancer outcomes. PMID:24188503

  13. Developing Successful Models of Cancer Palliative Care Services

    PubMed Central

    Bakitas, Marie; Bishop, Margaret Firer; Caron, Paula; Stephens, Lisa

    2010-01-01

    Objectives This article describes successful institutionally-based programs for providing high quality palliative care to people with cancer and their family members. Challenges and opportunities for program development are also described. Data Sources Published literature from 2000 to present describing concurrent oncology palliative care clinical trials, standards and guidelines were reviewed. Conclusion Clinical trials have demonstrated feasibility and positive outcomes and formed the basis for consensus guidelines that support concurrent oncology palliative care models. Implications for nursing practice Oncology nurses should advocate for all patients with advanced cancer and their families to have access to concurrent oncology palliative oncology care from the time of diagnosis with a life-limiting cancer. PMID:20971407

  14. Music therapy in supportive cancer care

    PubMed Central

    Stanczyk, Malgorzata Monika

    2011-01-01

    The purpose of this paper is to show some aspects of music therapy application in cancer care and to present the integration of music therapy program into a continuous supportive cancer care for inpatients. A cancer diagnosis is one of the most feared and serious life events that causes stress in individuals and families. Cancer disrupts social, physical and emotional well-being and results in a range of emotions, including anger, fear, sadness, guilt, embarrassment and shame. Music therapy is a part of a complementary medicine program in supportive cancer care which accompanies medical treatment. There are many benefits of music therapy for cancer patients—interactive music therapy techniques (instrumental improvisation, singing) as well as receptive music therapy techniques (listening to recorded or live music, music and imaginary) can be used to improve mood, decrease stress, pain, anxiety level and enhance relaxation. Music therapy is an effective form of supporting cancer care for patients during the treatment process. It may be also basic for planning effective programs of rehabilitation to promote wellness, improve physical and emotional well-being and the quality of life. PMID:24376975

  15. Inequalities in breast cancer care and outcome.

    PubMed Central

    Richards, M.; Sainsbury, R.; Kerr, D.

    1997-01-01

    Comparisons across Europe suggest that survival from breast cancer is less good in the United Kingdom than in many countries. The care given in some UK breast cancer units is exemplary. However, it is difficult to escape the conclusion that a substantial number of women who present with breast cancer receive suboptimal care. Cancer registry-based studies have clearly demonstrated variations between surgeons and between hospitals in the management of early breast cancer. Although variations in surgical practice per se may have little impact on survival, there is evidence that differences in the use of systemic adjuvant therapy influence outcome. Five-year survival seems to be greater in women treated by surgeons seeing more than 30-50 new cases of breast cancer each year. This may be because such patients are more likely to be treated by a multidisciplinary team and to receive adjuvant therapy. Proposals that would increase the overall quality of breast cancer care and remove current inequalities must be carefully considered and should then be implemented. PMID:9303363

  16. Rapid-Learning System for Cancer Care

    PubMed Central

    Abernethy, Amy P.; Etheredge, Lynn M.; Ganz, Patricia A.; Wallace, Paul; German, Robert R.; Neti, Chalapathy; Bach, Peter B.; Murphy, Sharon B.

    2010-01-01

    Compelling public interest is propelling national efforts to advance the evidence base for cancer treatment and control measures and to transform the way in which evidence is aggregated and applied. Substantial investments in health information technology, comparative effectiveness research, health care quality and value, and personalized medicine support these efforts and have resulted in considerable progress to date. An emerging initiative, and one that integrates these converging approaches to improving health care, is “rapid-learning health care.” In this framework, routinely collected real-time clinical data drive the process of scientific discovery, which becomes a natural outgrowth of patient care. To better understand the state of the rapid-learning health care model and its potential implications for oncology, the National Cancer Policy Forum of the Institute of Medicine held a workshop entitled “A Foundation for Evidence-Driven Practice: A Rapid-Learning System for Cancer Care” in October 2009. Participants examined the elements of a rapid-learning system for cancer, including registries and databases, emerging information technology, patient-centered and -driven clinical decision support, patient engagement, culture change, clinical practice guidelines, point-of-care needs in clinical oncology, and federal policy issues and implications. This Special Article reviews the activities of the workshop and sets the stage to move from vision to action. PMID:20585094

  17. American Cancer Society Head and Neck Cancer Survivorship Care Guideline.

    PubMed

    Cohen, Ezra E W; LaMonte, Samuel J; Erb, Nicole L; Beckman, Kerry L; Sadeghi, Nader; Hutcheson, Katherine A; Stubblefield, Michael D; Abbott, Dennis M; Fisher, Penelope S; Stein, Kevin D; Lyman, Gary H; Pratt-Chapman, Mandi L

    2016-05-01

    Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society. PMID:27002678

  18. Care provision for older adults: who will provide?

    PubMed

    Mion, Lorraine C

    2003-01-01

    The aging of the baby boomers comes at a time of a growing nursing workforce shortage: registered nurses, nurse aides, and nursing faculty. Older adults have multiple physical, social, and psychological conditions, making the assessment, planning, and delivery of health care more complex than that of younger adults. Not surprisingly, this age group also utilizes the majority of health services in the country. Thus, most nurses will provide care to older adults in a variety of settings. However, the majority of nurses have little to no background in geriatric nursing. These multiple forces: aging population with complex needs, nursing work force shortage, and lack of geriatric knowledge, along with fewer resources, will have a grave impact on health care in this country in the near future. This article reviews issues related to an aging population, the projected nursing workforce shortage, and the lack of geriatric nursing education; it concludes with suggestions for future health care delivery to the geriatric population in the US PMID:12795630

  19. Provider's Constraints and Difficulties in Primary Health Care System

    PubMed Central

    Kumar, Pawan; Khan, Abdul Majeed; Inder, Deep; Anu

    2014-01-01

    Background: The contractualization of human resource in recent years has resulted into various human resource management issues. Objective: To explore the administrative and management issues of contractual model of human resource under primary health care system in Delhi. Materials and Methods: Comparative study was conducted on randomly selected sample of 333, comprised of Medical Officers, ANMs, Pharmacist and Laboratory Assistants and Technicians, both regular and contractual cadre. The data was collected using the semi-structured interview schedule and thematic content analysis was done. Results: The five major themes emerged in the analysis; these are (i) physical infrastructure, (ii) organization's working environment, (iii) privileges of staff, (iv) discontentment, (v) human resource development. Comparative analysis of themes between regular and contractual staff revealed significant differences in factors which are embedded into the organization's culture. Element of discontentment is high amongst contractual staff particularly for discrimination in job, undermining of authority, patient care relationship and privileges provided to regular staff. This reflects the area of dissatisfaction which varies between regular and contractual staff in the organization. Conclusion: If primary health care system fails to address genuine constraints of human resources of both regular and contractual cadre and perception of discrimination persists, it is bound to result into poor motivation for good performance in the system of health care. So, adopting good practices in human resource management keeping regular and contractual employees grievances at forefront are urgently needed to ensure the availability of adequately trained and motivated personnel's in health facilities. PMID:25161964

  20. Consumer satisfaction with primary care provider choice and associated trust

    PubMed Central

    Chu-Weininger, Ming Ying L; Balkrishnan, Rajesh

    2006-01-01

    Background Development of managed care, characterized by limited provider choice, is believed to undermine trust. Provider choice has been identified as strongly associated with physician trust. Stakeholders in a competitive healthcare market have competing agendas related to choice. The purpose of this study is to analyze variables associated with consumer's satisfaction that they have enough choice when selecting their primary care provider (PCP), and to analyze the importance of these variables on provider trust. Methods A 1999 randomized national cross-sectional telephone survey conducted of United States residential households, who had a telephone, had seen a medical professional at least twice in the past two years, and aged ≄ 20 years was selected for secondary data analyses. Among 1,117 households interviewed, 564 were selected as the final sample. Subjects responded to a core set of questions related to provider trust, and a subset of questions related to trust in the insurer. A previously developed conceptual framework was adopted. Linear and logistic regressions were performed based on this framework. Results Results affirmed 'satisfaction with amount of PCP choice' was significantly (p < .001) associated with provider trust. 'PCP's care being extremely effective' was strongly associated with 'satisfaction with amount of PCP choice' and 'provider trust'. Having sought a second opinion(s) was associated with lower trust. 'Spoke to the PCP outside the medical office,' 'satisfaction with the insurer' and 'insurer charges less if PCP within network' were all variables associated with 'satisfaction with amount of PCP choice' (all p < .05). Conclusion This study confirmed the association of 'satisfaction with amount of PCP choice' with provider trust. Results affirmed 'enough PCP choice' was a strong predictor of provider trust. 'Second opinion on PCP' may indicate distrust in the provider. Data such as 'trust in providers in general' and 'the role of provider performance information' in choice, though import in PCP choice, were not available for analysis and should be explored in future studies. Results have implications for rethinking the relationships among consumer choice, consumer behaviors in making trade-offs in PCP choice, and the role of healthcare experiences in 'satisfaction with amount of PCP choice' or 'provider trust.' PMID:17059611

  1. [Discharge data for surveillance of cancer care].

    PubMed

    Fedeli, Ugo

    2011-01-01

    The debate on the use of hospital discharge records in epidemiological studies focused in Italy on biased estimates of tumor incidence and survival produced through analyses of hospitalization data. By contrast, despite limitations in completeness and accuracy which may increase with the shift of delivered health care towards non-hospital settings, hospital discharge records are among the most useful - and still underused - tools for the evaluation of patterns of care in cancer patients. Such analyses are rarely carried out in Italy; a striking demonstration comes from cancer surgery which, with the exception of breast cancer surgery, has been the issue of few population-based studies. Experiences from the United States show how analyses of hospital discharge records, cancer registries data, their linked archives, as well as of hospital-based registries, can be effective and complementary tools for the surveillance of major patterns in cancer therapy. PMID:21628760

  2. Breast Cancer Survivors' Perceptions of Survivorship Care Options

    PubMed Central

    Mayer, Erica L.; Gropper, Adrienne B.; Neville, Bridget A.; Partridge, Ann H.; Cameron, Danielle B.; Winer, Eric P.; Earle, Craig C.

    2012-01-01

    Purpose As the number of breast cancer survivors increases, a durable model of comprehensive survivor care is needed, incorporating providers and/or visit types both within and outside of oncology. The objective of this study was to explore survivors' comfort with different clinician types or with a telephone/Internet-based virtual visit as components of survivorship care. Methods Breast cancer survivors participating in a general survivorship survey completed an additional breast cancer–specific questionnaire evaluating the self-perceived impact of follow-up visits to various clinician types, or follow-up by a virtual visit, on survival, worrying, and stress related to cancer. Results A total of 218 breast cancer survivors completed the questionnaire. Most favored medical oncologist follow-up visits over those with primary care physicians (PCPs) or nurse practitioners (NPs) in terms of reduced worrying about cancer (odds ratio [OR], 2.21; P < .001), reduced stress around the visit (OR, 1.40; P = .002), and improved effect on cancer survival (OR, 2.38; P < .001). However, the majority also displayed substantial comfort with both PCPs and NPs in the same domains. Patients rated a virtual visit as having a less favorable impact on cancer survival and cancer-related worrying compared with in-person visits with clinicians. Conclusion Breast cancer survivors are comfortable with both PCPs and NPs providing follow-up care, although they indicate a preference for medical oncologists. Given patients' negative impressions of a virtual visit, increased familiarity with and research investigating this emerging concept are needed. The NP-led survivorship clinic model, with increased guidance for PCPs, offers a promising route for improving quality of and satisfaction with survivor care. PMID:22162585

  3. Integrating palliative care into the trajectory of cancer care

    PubMed Central

    Hui, David; Bruera, Eduardo

    2016-01-01

    Over the past five decades, palliative care has evolved from serving patients at the end of life into a highly specialized discipline focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. A growing body of evidence is now available to inform the key domains in the practice of palliative care, including symptom management, psychosocial care, communication, decision-making, and end-of-life care. Findings from multiple studies indicate that integrating palliative care early in the disease trajectory can result in improvements in quality of life, symptom control, patient and caregiver satisfaction, quality of end-of-life care, survival, and costs of care. In this narrative Review, we discuss various strategies to integrate oncology and palliative care by optimizing clinical infrastructures, processes, education, and research. The goal of integration is to maximize patient access to palliative care and, ultimately, to improve patient outcomes. We provide a conceptual model for the integration of supportive and/or palliative care with primary and oncological care. We end by discussing how health-care systems and institutions need to tailor integration based on their resources, size, and the level of primary palliative care available. PMID:26598947

  4. Integrating palliative care into the trajectory of cancer care.

    PubMed

    Hui, David; Bruera, Eduardo

    2016-03-01

    Over the past five decades, palliative care has evolved from serving patients at the end of life into a highly specialized discipline focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. A growing body of evidence is now available to inform the key domains in the practice of palliative care, including symptom management, psychosocial care, communication, decision-making, and end-of-life care. Findings from multiple studies indicate that integrating palliative care early in the disease trajectory can result in improvements in quality of life, symptom control, patient and caregiver satisfaction, illness understanding, quality of end-of-life care, survival, and costs of care. In this narrative Review, we discuss various strategies to integrate oncology and palliative care by optimizing clinical infrastructures, processes, education, and research. The goal of integration is to maximize patient access to palliative care and, ultimately, to improve patient outcomes. We provide a conceptual model for the integration of supportive and/or palliative care with primary and oncological care. We also discuss how health-care systems and institutions need to tailor integration based on their resources, size, and the level of primary palliative care available. PMID:26598947

  5. We Are Not Babysitters: Family Child Care Providers Redefine Work and Care.

    ERIC Educational Resources Information Center

    Tuominen, Mary C.

    Drawing on in-depth interviews with 20 family child care providers of diverse race, ethnicity, immigrant status, and social class, this book explores the social, political, and economic forces and processes that draw women into the work of family child care. The articles dispel not only myths about why women choose to be family child care


  6. Family Child Care Health and Safety Checklist: A Packet for Family Child Care Providers [with Videotape].

    ERIC Educational Resources Information Center

    Kendrick, Abby Shapiro; Gravell, Joanne

    This checklist and accompanying video are designed to help family child care providers assess the health and safety of the child care home. The checklist includes suggestions for conducting the self-evaluation and for creating a safer, healthier home environment. The areas of the checklist are: your home, out of bounds areas, gates and guards,


  7. Payment system reform for health care providers in Korea.

    PubMed

    Kwon, Soonman

    2003-03-01

    Since its introduction in 1977, the national health insurance programme in Korea has paid health care providers on a fee-for-service basis. Regulated fee-for-service payment has resulted in an increased volume and intensity of medical care. It has also distorted the input mix of treatment because physicians have substituted more profitable and uninsured (no coverage) medical services for those with lower margins, as is evidenced by the sharp increase in the caesarean delivery rate. This paper examines two recent supply-side reforms in Korea: Diagnosis Related Group (DRG) and Resource-based Relative Value (RBRV). Since 1997, through a pilot programme covering a selected group of diseases for voluntarily participating health care institutions, the DRG-based prospective payment system has proven to be effective in containing cost with little negative effect on quality. RBRV-based payment was implemented in 2001, but led to an almost uniform increase in fees for physician services without a mechanism to control the volume and expenditure. Challenges and future issues in the reform of the payment system in Korea include the expansion of benefit coverage, quality monitoring and improvement, strategic plans to overcome the strong opposition of providers and the introduction of global budgeting. PMID:12582111

  8. Prostate cancer screening and health care system distrust in Philadelphia

    PubMed Central

    Yang, Tse-Chuan; Matthews, Stephen A.; Anderson, Roger T.

    2013-01-01

    Objective We aim to examine whether distrust of health care system (hereafter distrust) is associated with prostate cancer screening and whether different dimensions of distrust demonstrate similar relationships with prostate cancer screening. Method With data on 1,784 men aged 45–75 from the Philadelphia metropolitan area, we first applied factor analysis to generate factor scores capturing two distrust sub-scales: competence and values. We then implemented logistic regressions to estimate the relationships between distrust and prostate cancer screening, controlling for covariates related to demographics (e.g., race and age), socioeconomic status (e.g., poverty status and education), health care resources (e.g., insurance status), and health status (i.e., self-rated health). Results Without considering any other covariates, both competence and values distrust were negatively associated to the receipt of prostate cancer screening. After accounting for other covariates shown above, values distrust remained negatively associated with the odds of receiving prostate cancer screening (OR=0.89, 95% CI=[0.81, 0.98]) but competence distrust was not a significant predictor. Conclusions Values distrust was independently associated with prostate cancer screening. Macro-level change in the health care system may influence men’s health behaviors. Our findings suggested that efforts to make the health care system more transparent and enhanced communications between men and health providers may facilitate prostate cancer screening. PMID:23775208

  9. Contraceptive choice and patient compliance. The health care provider's challenge.

    PubMed

    Branden, P S

    1998-01-01

    Contraceptive compliance is a multifaceted issue that is influenced by many factors. These factors can directly affect the level of patient compliance, thereby affecting contraceptive method efficacy rates. A review of the literature reveals many studies about contraceptive compliance but a dearth of studies addressing how to change noncompliant behaviors. This article describes the contraceptive methods currently available and their efficacy rates. Patient characteristics and the components of compliance are described as they affect contraceptive efficacy and patient care. Suggestions are made for the use of alternative terminology to include adherence to or continuance of a contraceptive method. Health care providers should realize the impact they can have on a patient's education, decision-making process, and ultimate compliance with a contraceptive method. It is the patient, however, who ultimately makes the decision, either actively or passively, to comply or not and whether to have an unplanned pregnancy. PMID:9871380

  10. How Cancer Survivors Provide Support on Cancer-Related Internet Mailing Lists

    PubMed Central

    Lyons, Elizabeth J; Frydman, Gilles; Forlenza, Michael; Rimer, Barbara K

    2007-01-01

    Background Internet mailing lists are an important and increasingly common way for cancer survivors to find information and support. Most studies of these mailing lists have investigated lists dedicated to one type of cancer, most often breast cancer. Little is known about whether the lessons learned from experiences with breast cancer lists apply to other cancers. Objectives The aim of the study was to compare the structural characteristics of 10 Internet cancer-related mailing lists and identify the processes by which cancer survivors provide support. Methods We studied a systematic 9% sample of email messages sent over five months to 10 cancer mailing lists hosted by the Association of Cancer Online Resources (ACOR). Content analyses were used to compare the structural characteristics of the lists, including participation rates and members’ identities as survivors or caregivers. We used thematic analyses to examine the types of support that list members provided through their message texts. Results Content analyses showed that characteristics of list members and subscriber participation rates varied across the lists. Thematic analyses revealed very little “off topic” discussion. Feedback from listowners indicated that they actively modeled appropriate communication on their lists and worked to keep discussions civil and focused. In all lists, members offered support much more frequently than they requested it; survivors were somewhat more likely than caregivers to offer rather than to ask for support. The most common topics in survivors’ messages were about treatment information and how to communicate with health care providers. Although expressions of emotional support were less common than informational support, they appeared in all lists. Many messages that contained narratives of illness or treatment did not specifically ask for help but provided emotional support by reassuring listmates that they were not alone in their struggles with cancer. Survivors’ explicit expressions of emotional support tended to be messages that encouraged active coping. Such messages also provided senders with opportunities to assume personally empowering “helper” roles that supported self-esteem. Conclusions Many cancer survivors use the Internet to seek informational and emotional support. Across 10 lists for different cancers, informational support was the main communication style. Our finding of an emphasis on informational support is in contrast to most prior literature, which has focused on emotional support. We found the most common expressions of support were offers of technical information and explicit advice about how to communicate with health care providers. Topics and proportions of informational and emotional support differed across the lists. Our previous surveys of ACOR subscribers showed that they join the lists primarily to seek information; this qualitative study shows that they can and do find what they seek. They also find opportunities to play rewarding roles as support givers. PMID:17513283

  11. Finding Medical Care for Colorectal Cancer Symptoms: Experiences among Those Facing Financial Barriers

    ERIC Educational Resources Information Center

    Thomson, Maria D.; Siminoff, Laura A.

    2015-01-01

    Financial barriers can substantially delay medical care seeking. Using patient narratives provided by 252 colorectal cancer patients, we explored the experience of financial barriers to care seeking. Of the 252 patients interviewed, 84 identified financial barriers as a significant hurdle to obtaining health care for their colorectal cancer…

  12. Health care providers' perspectives on the provision of prenatal care to immigrants.

    PubMed

    Ng, Carita; Newbold, K Bruce

    2011-05-01

    In addition to facing barriers to health care and experiencing poor health status, immigrants to Canada and Sweden tend to have more negative birth outcomes than the native-born population, including low birth weight and perinatal mortality rates. Explored through interviews with health care professionals, including midwives, nurse practitioners, social workers and obstetrician gynaecologists, this paper evaluates their experiences in providing prenatal care to immigrants in Hamilton, Ontario, Canada. Results reveal the complexity of delivering care to immigrants, particularly with respect to expectations surrounding language, culture and type and professionalism of care. The paper concludes by discussing future research options and implications for the delivery of prenatal care to this population. PMID:21390947

  13. Family Child Care Providers’ Compliance With State Physical Activity Regulations, Delaware Child Care Provider Survey, 2011

    PubMed Central

    Leng, Sarah Williams

    2013-01-01

    Introduction Delaware is one state that has implemented comprehensive child care regulations to foster healthy dietary and physical activity behaviors of young children. This study describes the Delaware family child care environment and providers’ knowledge of and compliance with physical activity regulations. We analyzed the data to determine characteristics associated with predictors of knowledge of and compliance with these regulations. Methods A random stratified sample of 663 licensed Delaware family child care providers was mailed a survey on family child care characteristics and providers’ awareness and practices of the child care regulations. Three logistic regression models were used to explore the association between provider characteristics and their knowledge of and compliance with the regulations. Results Ultimately, 313 of the 663 eligible family child care providers participated in the survey (47.2% response rate). Controlling for covariates, we found that family child care providers’ education level was significantly associated with knowledge of the physical activity regulation. Another model showed that family child care providers with larger amounts of outdoor space were more likely to report compliance with the recommendation for unstructured physical activity than those without this described space (odds ratio, 2.45). A third model showed a significant association between available indoor space for all activities including running and reported greater compliance with the recommendation for structured physical activity than was reported by caregivers with less indoor space (odds ratio, 11.2). Conclusion To provide the recommended levels of physical activity for children in child care, the available physical space environment is an important area of focus for advocates of physical activity recommendations within the family child care environment. PMID:23845175

  14. Barriers and facilitators of adolescent behavioral health in primary care: Perceptions of primary care providers.

    PubMed

    Bitar, George W; Springer, Paul; Gee, Robert; Graff, Chad; Schydlower, Manuel

    2009-12-01

    Several major policy reports describe the central role of primary care in improving the delivery of behavioral health care services to children and adolescents. Although primary care providers are uniquely positioned to provide these services, numerous obstacles hinder the integration of these services, including time, clinic management and organization issues, training, and resources. Although many of these obstacles have been described in the literature, few studies have investigated these issues from the first-person perspective of front-line providers. The purpose of this study, therefore, is to provide an in-depth description of primary care providers' attitudes and perceptions of adolescent behavioral health care across a diversity of primary care settings (i.e., Federally Qualified Health Center [FQHC], FQHC-Look Alike, school-based, military). Sixteen focus groups were conducted at 5 primary care clinics. Thematic analysis was used to analyze the focus group data. Obstacles to integration are presented as well as strategies to overcome these challenges, using training and education, working groups, and community collaboratives. PMID:20047357

  15. Challenges in providing culturally-competent care to patients with metastatic brain tumours and their families.

    PubMed

    Longo, Lianne; Slater, Serena

    2014-01-01

    Being diagnosed with a metastatic brain tumour can be devastating as it is characterized by very low cure rates, as well as significant morbidity and mortality. Given the poor life expectancy and progressive disability that ensues, patients and family members experience much turmoil, which includes losses that bring about changes to family roles, routines and relationships. Crisis and conflict are common during such major disruptions to a family system, as individual members attempt to make sense of the illness experience based on cultural and spiritual beliefs, past experiences and personal philosophies. It is imperative health care providers strive towards increased awareness and knowledge of how culture affects the overall experience of illness and death in order to help create a mutually satisfactory care plan. Providing culturally-competent care entails the use of proper communication skills to facilitate the exploration of patient and family perspectives and allows for mutual decision making. A case study will illustrate the challenges encountered in providing culturally-competent care to a woman with brain cancer and her family. As the patient's health declined, the family entered into a state of crisis where communication between family members and health care professionals was strained; leading to conflict and sub-optimal outcomes. This paper will address the ethical dilemma of providing culturally-competent care when a patient's safety is at risk, and the nursing implications of upholding best practices in the context of differing beliefs and priorities. PMID:25265763

  16. Providing support to caregivers and self-care.

    PubMed

    Kalibala, S

    1999-01-01

    The evolution of HIV/AIDS care has resulted in a wide range of caregivers who work out of public and private hospital facilities, nongovernmental organizations (NGOs) and community-based facilities. Others are volunteers and community health and social workers based at facilities or community sites. Many caregivers are family members or part of a client's close social network. Additionally, people living with HIV/AIDS (PHA) themselves engage in self-care and provide support to other PHA through support groups. In the best-case scenario the services of these caregivers are sometimes provided free of charge at one site by a specialized NGO. In many cases, however, a person wishing to gain access to care and social services may need an understanding how the systems and procedures of various institutions operate. Many PHA are unprepared for the administrative, financial, and legal barriers that they may encounter. To cope with this need, a new type of support service called the "buddy" system has emerged. Buddies are individuals who are less directly involved with, but who know about HIV/AIDS, the services available and the rights of PHA. A buddy is close enough for the PHA to approach, has sufficient time to devote to him/her and can be asked almost everything. The article on the Rio de Janeiro Buddy Project provides an example of a project for gay men in Brazil. In other parts of the world where the buddy system is non-existent, the PHA must often rely on support provided by family and friends. PMID:12349766

  17. Spiritual Care Training Provided to Healthcare Professionals: A Systematic Review.

    PubMed

    Paal, Piret; Helo, Yousef; Frick, Eckhard

    2015-03-01

    This systematic review was conducted to assess the outcomes of spiritual care training. It outlines the training outcomes based on participants' oral/written feedback, course evaluation and performance assessment. Intervention was defined as any form of spiritual care training provided to healthcare professionals studying/working in an academic and/or clinical setting. An online search was conducted in MEDLINE, EMBASE, CINAHL, Web of Science, ERIC, PsycINFO, ASSIA, CSA, ATLA and CENTRAL up to Week 27 of 2013 by two independent investigators to reduce errors in inclusion. Only peer-reviewed journal articles reporting on training outcomes were included. A primary keyword-driven search found 4912 articles; 46 articles were identified as relevant for final analysis. The narrative synthesis of findings outlines the following outcomes: (1) acknowledging spirituality on an individual level, (2) success in integrating spirituality in clinical practice, (3) positive changes in communication with patients. This study examines primarily pre/post-effects within a single cohort. Due to an average study quality, the reported findings in this review are to be seen as indicators at most. Nevertheless, this review makes evident that without attending to one'the repeliefs and needs, addressing spirituality in patients will not be forthcoming. It also demonstrates that spiritual care training may help to challenge the spiritual vacuum in healthcare institutions. PMID:26162203

  18. Outcomes of Hepatitis C Treatment by Primary Care Providers

    PubMed Central

    Arora, Sanjeev; Thornton, Karla; Murata, Glen; Deming, Paulina; Kalishman, Summers; Dion, Denise; Parish, Brooke; Burke, Thomas; Pak, Wesley; Dunkelberg, Jeffrey; Kistin, Martin; Brown, John; Jenkusky, Steven; Komaromy, Miriam; Qualls, Clifford

    2013-01-01

    Background The Extension for Community Healthcare Outcomes (ECHO) model was developed to improve access to care for complex health problems such as hepatitis C virus (HCV) infection for underserved populations. Using videoconferencing technology, ECHO trains primary care providers to treat complex diseases. Methods A prospective cohort study compared treatment of HCV at the University of New Mexico (UNM) HCV clinic to treatment by primary care clinicians at 21 ECHO sites in rural areas and prisons in New Mexico. A total of 407 treatment naive patients with chronic HCV were enrolled. The primary end point was a sustained viral response (SVR). Results The rate of SVR was 57.5% (84/146) for patients treated at UNM and 58.2% (152 /261) at ECHO sites (P=0.89); difference between SVR rates 0.7% (95% CI -9.2%, 10.7%). In genotype 1 infection the SVR rate was 45.8% (38 /83) at UNM and 49.7% (73 /147) at ECHO sites (P=0.57). Serious adverse events occurred in 13.7% of the UNM HCV clinic cohort and 6.9% of the ECHO cohort. Conclusions This study demonstrates that the ECHO model is an effective way to treat HCV in underserved communities. Implementation of this model would allow other states and nations to treat more patients with HCV. PMID:21631316

  19. A primer on EVA for health care providers.

    PubMed

    Grant, James L

    2007-01-01

    Unlike accounting earnings, economic profit (EVA) is a measure of a company's true earnings because it fully "accounts" for the costs of all forms of financing, including debt and equity. In the EVA view, a company is not truly profitable unless it earns a return on capital that bests the opportunity cost of capital. That being said, the question addressed here is how to measure the economic profit of providers in the health care sector, which is largely comprised of not-for-profit organizations such as clinics, laboratories, and hospitals. PMID:19175230

  20. CAM and cancer care: champions for integration.

    PubMed

    Mackereth, Peter A; Stringer, Jacqui

    2005-02-01

    The paper reviews challenges and developments in the integration of complementary therapies in cancer care. These issues are examined by reflecting on papers published in CTNM in the last 10 years by champions of CAM in cancer care. Given the aim of the journal to encourage an inclusive readership, multidisciplinary and user perspectives are included. The paper argues for better information, improved service provision and CAM choices in public healthcare, leadership support, funded research and audit, and user and non-users views. PMID:15984224

  1. [Palliative Care for Non-cancer Patients].

    PubMed

    Ikegaki, Junichi

    2016-03-01

    Although palliative care has been developed and implemented as care for cancer pain, it is holistic care for suffering that includes physical, psychosocial and spiritual pain of life-threatening illness. It turned out that non-cancer patients in the end-stage are also suffering from various pain that should be treated as cancer patients. Trajectories of illness in non-cancer patients are with more gradual decline than those of cancer patients with steady progression and it is often difficult to make decision about end-of-life. The purpose of advance care planning was originally to help describe legal documents. This process is proved to contribute to improving QOL of patients and their families to discuss preference, hope, economic problems, spiritual question as well as medical treatment In Japan guideline of decision making process in end-of-life stage has been established. A program of communication training in end-of-life discussion has been made. Under current situation some comments on the role of anesthesiologists are also mentioned. PMID:27097506

  2. American Cancer Society Colorectal Cancer Survivorship Care Guidelines.

    PubMed

    El-Shami, Khaled; Oeffinger, Kevin C; Erb, Nicole L; Willis, Anne; Bretsch, Jennifer K; Pratt-Chapman, Mandi L; Cannady, Rachel S; Wong, Sandra L; Rose, Johnie; Barbour, April L; Stein, Kevin D; Sharpe, Katherine B; Brooks, Durado D; Cowens-Alvarado, Rebecca L

    2015-01-01

    Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in both men and women and second leading cause of cancer death when men and women are combined in the United States (US). Almost two-thirds of CRC survivors are living 5 years after diagnosis. Considering the recent decline in both incidence and mortality, the prevalence of CRC survivors is likely to increase dramatically over the coming decades with the increase in rates of CRC screening, further advances in early detection and treatment and the aging and growth of the US population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short-term and long-term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns after treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long-term care of CRC survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk-based health care for CRC survivors who have completed active therapy. PMID:26348643

  3. Provider and clinic cultural competence in a primary care setting.

    PubMed

    Paez, Kathryn A; Allen, Jerilyn K; Carson, Kathryn A; Cooper, Lisa A

    2008-03-01

    A multilevel approach that enhances the cultural competence of clinicians and healthcare systems is suggested as one solution to reducing racial/ethnic disparities in healthcare. The primary objective of this cross-sectional study was to determine if there is a relationship between the cultural competence of primary care providers and the clinics where they work. Forty-nine providers from 23 clinics in Baltimore, Maryland and Wilmington, Delaware, USA completed an on-line survey which included items assessing provider and clinic cultural competence. Using simple linear regression, it was found that providers with attitudes reflecting greater cultural motivation to learn were more likely to work in clinics with a higher percent of nonwhite staff, and those offering cultural diversity training and culturally adapted patient education materials. More culturally appropriate provider behavior was associated with a higher percent of nonwhite staff in the clinic, and culturally adapted patient education materials. Enhancing provider and clinic cultural competence may be synergistic strategies for reducing healthcare disparities. PMID:18164114

  4. Provider and Clinic Cultural Competence in a Primary Care Setting

    PubMed Central

    Paez, Kathryn A; Allen, Jerilyn K; Carson, Kathryn A; Cooper, Lisa A

    2008-01-01

    A multilevel approach that enhances the cultural competence of clinicians and healthcare systems is suggested as one solution to reducing racial/ethnic disparities in healthcare. The primary objective of this cross-sectional study was to determine if there is a relationship between the cultural competence of primary care providers and the clinics where they work. Forty-nine providers from 23 clinics in Baltimore, Maryland and Wilmington, Delaware, USA. completed an on-line survey which included items assessing provider and clinic cultural competence. Using simple linear regression, it was found that providers with attitudes reflecting greater cultural motivation to learn were more likely to work in clinics with a higher percent of nonwhite staff, and those offering cultural diversity training and culturally adapted patient education materials. More culturally appropriate provider behavior was associated with a higher percent of nonwhite staff in the clinic, and culturally adapted patient education materials. Enhancing provider and clinic cultural competence may be synergistic strategies for reducing healthcare disparities. PMID:18164114

  5. Integrating dietary supplements into cancer care.

    PubMed

    Frenkel, Moshe; Abrams, Donald I; Ladas, Elena J; Deng, Gary; Hardy, Mary; Capodice, Jillian L; Winegardner, Mary F; Gubili, J K; Yeung, K Simon; Kussmann, Heidi; Block, Keith I

    2013-09-01

    Many studies confirm that a majority of patients undergoing cancer therapy use self-selected forms of complementary therapies, mainly dietary supplements. Unfortunately, patients often do not report their use of supplements to their providers. The failure of physicians to communicate effectively with patients on this use may result in a loss of trust within the therapeutic relationship and in the selection by patients of harmful, useless, or ineffective and costly nonconventional therapies when effective integrative interventions may exist. Poor communication may also lead to diminishment of patient autonomy and self-efficacy and thereby interfere with the healing response. To be open to the patient's perspective, and sensitive to his or her need for autonomy and empowerment, physicians may need a shift in their own perspectives. Perhaps the optimal approach is to discuss both the facts and the uncertainty with the patient, in order to reach a mutually informed decision. Today's informed patients truly value physicians who appreciate them as equal participants in making their own health care choices. To reach a mutually informed decision about the use of these supplements, the Clinical Practice Committee of The Society of Integrative Oncology undertook the challenge of providing basic information to physicians who wish to discuss these issues with their patients. A list of leading supplements that have the best suggestions of benefit was constructed by leading researchers and clinicians who have experience in using these supplements. This list includes curcumin, glutamine, vitamin D, Maitake mushrooms, fish oil, green tea, milk thistle, Astragalus, melatonin, and probiotics. The list includes basic information on each supplement, such as evidence on effectiveness and clinical trials, adverse effects, and interactions with medications. The information was constructed to provide an up-to-date base of knowledge, so that physicians and other health care providers would be aware of the supplements and be able to discuss realistic expectations and potential benefits and risks. PMID:23439656

  6. Improving education and resources for health care providers.

    PubMed Central

    Paul, M; Welch, L

    1993-01-01

    Workers and citizens are turning increasingly to the health care system for information about occupational and environmental reproductive hazards, yet most primary care providers and specialists know little about the effects of occupational/environmental toxicants on the reproductive system or how to evaluate and manage patients at potential risk. Although it is unrealistic to expect all clinicians to become experts in this area, practitioners should know how to take a basic screening history, identify patients at potential risk, and make appropriate referrals. At present, occupational and environmental health issues are not well integrated into health professional education in the United States, and clinical information and referral resources pertaining to reproductive hazards are inadequate. In addressing these problems, the conference "Working Group on Health Provider Education and Resources" made several recommendations that are detailed in this report. Short-term goals include enhancement of existing expertise and resources at a regional level and better integration of information on occupational/environmental reproductive hazards into curricula, meetings, and publications of medical and nursing organizations. Longer term goals include development of a comprehensive, single-access information and referral system for clinicians and integration of occupational and environmental medicine into formal health professional education curricula at all levels. PMID:8243391

  7. Psychiatric care for patients with breast cancer.

    PubMed

    Koh, K B

    1999-10-01

    Psychiatric management of patients with breast cancer, as well as women's emotional reactions to all phases of breast cancer, were reviewed. These patients face two major losses; one is the physical loss of part of the body and a threat to life, and the other is the loss of femininity. The patients are also likely to suffer from various psychiatric problems including anxiety and depression. Oncologists should be alert to each patient's emotional reactions and potential psychiatric problems, and if necessary, should refer them to a psychiatrist. A combination of psychotherapeutic, behavioural, and pharmacologic techniques is available for the care of patients with breast cancer. Psychotherapeutic modalities include individual therapy, family therapy, group therapy, and self-help treatment. The author divided individual therapy into general and specific treatment. General treatment deals with a crisis-intervention and cognitive-behavioral approach, whereas specific treatment deals with issues relevant to patients with breast cancer. Some of the therapeutic processes were illustrated in a case report. These guidelines will contribute to the relief and prevention of emotional suffering stemming from an encounter with the most common form of cancer in women. Also, proper and effective care for patients with breast cancer requires combined use of a variety of therapeutic modalities as well as a multi-disciplinary approach including psychiatric care. PMID:10565263

  8. RECONSIDERING THE TEAM CONCEPT: EDUCATIONAL IMPLICATIONS FOR PATIENT-CENTERED CANCER CARE

    PubMed Central

    Haidet, Paul; Fecile, Mary Lynn; West, Heather F.; Teal, Cayla R.

    2009-01-01

    Patient-centered cancer care has become a priority in the oncology field. Increasing efforts to train oncologists in communication skills have led to a growing literature on patient-centered cancer education. In addition, systems approaches have led to an increased emphasis on the concept of teams as an organizing framework for cancer care. In this essay, we examine issues involved in educating teams to provide patient-centered cancer care. In the process, we question the applicability of a tightly coordinated ‘team’ concept, and suggest the concept of a ‘care community’ as a more achievable ideal for the way that cancer care is commonly delivered. We discuss the implications that this has for cancer communication education, and propose three principles to guide the development of educational interventions aimed at increasing patient-centeredness in cancer care delivery systems. PMID:19850437

  9. Modelling catchment areas for secondary care providers: a case study.

    PubMed

    Jones, Simon; Wardlaw, Jessica; Crouch, Susan; Carolan, Michelle

    2011-09-01

    Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating the catchment area of a planned new hospital, the extra level of detail provided by the gravity model may prove necessary. However, in virtually all other applications, the Proportional Flow method produced the optimal model for catchment populations in Manchester, based on several criteria: it produced the smallest RMS error; it addressed cross-boundary flows; the data used to create the catchment was readily available to SCPs; and it was simpler to reproduce than the gravity model method. Further work is needed to address how the Proportional Flow method can be used to reflect service redesign and handle OAs with zero or low activity. A next step should be the rolling out of the method across England and looking at further drill downs of data such as catchment by Healthcare Resource Group (HRG) rather than specialty level. PMID:21455707

  10. Improving outcomes in lung cancer: the value of the multidisciplinary health care team

    PubMed Central

    Denton, Eve; Conron, Matthew

    2016-01-01

    Lung cancer is a major worldwide health burden, with high disease-related morbidity and mortality. Unlike other major cancers, there has been little improvement in lung cancer outcomes over the past few decades, and survival remains disturbingly low. Multidisciplinary care is the cornerstone of lung cancer treatment in the developed world, despite a relative lack of evidence that this model of care improves outcomes. In this article, the available literature concerning the impact of multidisciplinary care on key measures of lung cancer outcomes is reviewed. This includes the limited observational data supporting improved survival with multidisciplinary care. The impact of multidisciplinary care on other benchmark measures of quality lung cancer treatment is also examined, including staging accuracy, access to diagnostic investigations, improvements in clinical decision making, better utilization of radiotherapy and palliative care services, and improved quality of life for patients. Health service research suggests that multidisciplinary care improves care coordination, leading to a better patient experience, and reduces variation in care, a problem in lung cancer management that has been identified worldwide. Furthermore, evidence suggests that the multidisciplinary model of care overcomes barriers to treatment, promotes standardized treatment through adherence to guidelines, and allows audit of clinical services and for these reasons is more likely to provide quality care for lung cancer patients. While there is strengthening evidence suggesting that the multidisciplinary model of care contributes to improvements in lung cancer outcomes, more quality studies are needed. PMID:27099511

  11. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

    PubMed

    Runowicz, Carolyn D; Leach, Corinne R; Henry, N Lynn; Henry, Karen S; Mackey, Heather T; Cowens-Alvarado, Rebecca L; Cannady, Rachel S; Pratt-Chapman, Mandi L; Edge, Stephen B; Jacobs, Linda A; Hurria, Arti; Marks, Lawrence B; LaMonte, Samuel J; Warner, Ellen; Lyman, Gary H; Ganz, Patricia A

    2016-02-20

    The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for Clinicians and Journal of Clinical Oncology. Copyright © 2015 American Cancer Society and American Society of Clinical Oncology. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Cancer Society or the American Society of Clinical Oncology. PMID:26644543

  12. Preventive Care in Older Cancer Survivors

    PubMed Central

    Lowenstein, Lisa M.; Ouellet, Jennifer Andreozzi; Dale, William; Fan, Lin; Mohile, Supriya Gupta

    2016-01-01

    Objective To study factors that influence receipt of preventive care in older cancer survivors. Methods We analyzed a nationally representative sample of 12,458 older adults from the 2003 Medicare Current Beneficiary Survey. Factors associated with non-receipt of preventive care were explored among cancer and non-cancer survivors, using logistic regression. Results Among cancer survivors, 1,883 were diagnosed >one year at survey completion. A cancer history was independently associated with receipt of mammogram (AOR=1.57, 95%CI=1.34–1.85), flu shot (AOR=1.33, 95%CI=1.16–1.53), measurement of total cholesterol in the previous six months (AOR=1.20, 95%CI=1.07–1.34), pneumonia vaccination (AOR=1.33, 95%CI=1.18–1.49), bone mineral density (BMD) testing (AOR=1.38, 95%CI=1.21–1.56) and lower endoscopy (AOR=1.46, 95%CI=1.29–1.65). However, receipt of preventive care was not optimal among older cancer survivors with only 51.2% of female cancer survivors received a mammogram, 63.8% of all cancer survivors received colonoscopy, and 42.5% had BMD testing. Among cancer survivors, factors associated with non-receipt of mammogram included age ≄85 years (AOR=0.43, 95%CI=0.26–0.74) and scoring ≄three points on the Vulnerable Elders Survey-13 (AOR=0.94, 95%CI=0.80–1.00). Factors associated with non-receipt of colonoscopy included low education (AOR=0.43, 95%CI=0.27–0.68) and rural residence (AOR=0.51, 95%CI=0.34–0.77). Factors associated with non-receipt of BMD testing included age ≄70 (AOR=0.59, 95%CI=0.39–0.90), African American race (AOR=0.51, 95%CI=0.27–0.95), low education (AOR=0.23, 95%CI=0.14–0.38) and rural residence (AOR=0.43, 95%CI=0.27–0.70). Conclusion Although older cancer survivors are more likely to receive preventive care services than other older adults, the prevalence of receipt of preventive care services is low. PMID:25547206

  13. The oncology palliative care clinic at the Princess Margaret Cancer Centre: an early intervention model for patients with advanced cancer.

    PubMed

    Hannon, Breffni; Swami, Nadia; Pope, Ashley; Rodin, Gary; Dougherty, Elizabeth; Mak, Ernie; Banerjee, Subrata; Bryson, John; Ridley, Julia; Zimmermann, Camilla

    2015-04-01

    Several recently published randomized controlled trials have demonstrated the benefits of early palliative care involvement for patients with advanced cancer. In the oncology outpatient setting, palliative care clinics are an ideal site for the provision of early, collaborative support, which can be maintained throughout the cancer trajectory. Despite this, access to ambulatory palliative care clinics is limited, even at tertiary cancer centres. Existing programs for outpatient palliative care are variable in scope and are not well described in the literature. We describe the development and expansion of an outpatient palliative care clinic at the Princess Margaret Cancer Centre, Toronto, Canada, demonstrating how the clinic functions at a local and regional level. This clinic served as the intervention for a recent large cluster-randomized trial of early palliative care. The model for this service can be adapted by other palliative care programs that aim to provide early, integrated oncology care. PMID:25281230

  14. Assessing and Enhancing Health Care Providers' Response to Domestic Violence

    PubMed Central

    LeppÀkoski, Tuija; Paavilainen, Eija

    2014-01-01

    This study aimed to examine possible changes from 2008 to 2012 in the skills of health care staff in identifying and intervening in domestic violence (DV). A longitudinal descriptive study design with volunteer samples (baseline; n = 68, follow-up; n = 100) was used to acquire information regarding the present state and needs of the staff in practices related to DV. The results of the baseline survey were used as a basis for planning two interventions: staff training and drafting practical guidelines. Information was collected by questionnaires from nurses, physicians, and social workers and supplemented by responses from the interviews. The data were analysed using both quantitative and qualitative methods. A chi-square test was used to test the statistical significance of the data sets. In addition, participants' quotes are used to describe specific phenomena or issues. The comparison showed that overall a small positive change had taken place between the study periods. However, the participants were aware of their own shortcomings in identifying and intervening in DV. Changes happen slowly, and administrative support is needed to sustain such changes. Therefore, this paper offers recommendations to improve health care providers' response to DV. Moreover, there is a great need for evaluating the training programme used. PMID:24864205

  15. NIH scientists provide new insight into rare kidney cancer

    Cancer.gov

    NIH scientists have discovered a unique feature of a rare, hereditary form of kidney cancer that may provide a better understanding of its progression and metastasis, possibly laying the foundation for the development of new targeted therapies.

  16. A Review and Characterization of the Various Perceptions of Quality Cancer Care

    PubMed Central

    Colosia, Ann D; Peltz, Gerson; Pohl, Gerhardt; Liu, Esther; Copley-Merriman, Kati; Khan, Shahnaz; Kaye, James A

    2011-01-01

    BACKGROUND It is important to maintain high-quality cancer care while reducing spending. This requires an understanding of how stakeholders define “quality.” The objective of this literature review was to understand the perceptions patients, physicians, and managed care professionals have about quality cancer care, especially chemotherapy. METHODS A computerized literature search was conducted for articles concerning quality cancer care in patients who received chemotherapy. Among >1100 identified sources, 25 presented interviews/survey results from stakeholders. RESULTS Patients defined quality cancer care as being treated well by providers, having multiple treatment options, and being part of the decision-making process. Waiting to see providers, having problems with referrals, going to different locations for treatment, experiencing billing inaccuracies, and navigating managed care reimbursement negatively affected patients' quality-of-care perceptions. Providers perceived quality cancer care as making decisions based on the risks-benefits of specific chemotherapy regimens and patients' health status rather than costs. Providers objected to spending substantial time interacting with payers instead of delivering care to patients. Payers must control the costs of cancer care but do not want an adversarial relationship with providers and patients. Payers' methods of managing cancer more efficiently involved working with providers to develop assessment and decision-assist tools. CONCLUSIONS Delivering quality cancer care is increasingly difficult because of the shortage of oncologists and rising costs of chemotherapy agents, radiation therapy, and imaging tests. The definition of quality cancer care differed among stakeholders, and healthcare reform must reflect these various needs to maintain and improve quality while controlling costs. Cancer 2011. © 2010 American Cancer Society PMID:20939015

  17. Improving the quality of head and neck cancer care.

    PubMed

    Weber, Randal S

    2007-12-01

    The 2001 report by the Institute of Medicine (IOM) titled Crossing the Quality Chasm: A New Health System for the 21st Century highlighted the gap that exists between what we know to be effective, beneficial care and the care that is often delivered to an individual patient.(1) In the report, the IOM stated, "Between the health care we have and the care we could have lies not just a gap, but a chasm."(1)((p1)) The report, signifying a national initiative to improve the quality of care in the United States, articulated the following 6 aims for a new health care system: (1) to increase the safety of health care by avoiding injuries to patients through care intended to help them; (2) to provide effective services based on scientific knowledge and to avoid services of no proven benefit; (3) to deliver individualized treatment respectful of and responsive to the patient's preferences, needs, and values; (4) to deliver timely care by reducing wait times and harmful delays; (5) to increase efficiency by not wasting equipment, supplies, ideas, and energy; and (6) to deliver care that is equitable and does not vary by personal characteristics, patient sex, ethnicity, geography, and social economic status. The IOM also recognized a need to optimize quality cancer care in the United States. PMID:18086958

  18. Vietnamese Health Care Providers' Preferences Regarding Recommendation of HPV Vaccines.

    PubMed

    Asiedu, Gladys B; Breitkopf, Carmen Radecki; Kremers, Walter K; Ngo, Quang V; Nguyen, Nguyen V; Barenberg, Benjamin J; Tran, Vinh D; Dinh, Tri A

    2015-01-01

    Physician recommendation is an important predictor of HPV vaccine acceptance; however, physician willingness and preferences regarding HPV vaccination may be influenced by factors including patient age, vaccine type, and cost. A cross-sectional survey was administered to a convenience sample of health care providers in Da Nang, Vietnam, to evaluate awareness, perceptions about HPV and HPV vaccines, and willingness to vaccinate a female patient. Willingness to vaccinate was evaluated using a full-factorial presentation of scenarios featuring the following factors: vaccine cost (free vs 1,000,000 VND), patient age (12, 16, or 22 years), and HPV vaccine type (bivalent vs quadrivalent). Responses from 244 providers were analyzed; providers had a mean age of 34±11.9 years; a majority were female, married, and had children of their own. Thirty-six percent specialized in obstetrics/gynecology and 24% were providers in family medicine. Of the three factors considered in conjoint analysis, vaccine cost was the most important factor in willingness to vaccinate, followed by patient age, and vaccine type. The most favorable scenario for vaccinating a female patient was when the vaccine was free, the patient was 22 years of age, and the HPV4 vaccine was described. In multivariable analysis, older age, being a physician, being married, and having children were all associated with increased willingness to recommend HPV vaccination (p<0.05). Provider willingness is an important aspect of successful HPV vaccination programs; identifying preferences and biases in recommendation patterns will highlight potential areas for education and intervention. PMID:26163611

  19. Learning to deal constructively with troubled conscience related to care providers' perceptions of not providing sufficient activities for residents.

    PubMed

    Ericson-Lidman, Eva; Strandberg, Gunilla

    2015-04-01

    The aim of this study was to illuminate an intervention process to assist care providers in municipal care of older people to constructively deal with their troubled conscience generated from their perceived shortcomings about not providing sufficient activities for residents. The study design was grounded in participatory action research. Twelve care providers and their manager participated in intervention sessions. Content analysis was used to analyze the transcriptions. By sharing their experiences with each other, care providers became aware of, and confirmed in one another, what types of activities were meaningful for residents and actions were taken to provide such activities. The importance of being attentive and relying on residents' responses, that is, providing person-centered activities, was found to be satisfying to residents and eased the care providers' troubled conscience. An enlightened conscience can be an important asset, which may prevent ill-health and improve quality of care. PMID:24021209

  20. [Update of breast cancer in primary care (IV/V)].

    PubMed

    Álvarez-Hernåndez, C; Brusint, B; Vich, P; Díaz-García, N; Cuadrado-Rouco, C; Hernåndez-García, M

    2015-01-01

    Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family physicians must thoroughly understand this pathology in order to optimize the health care services and make the best use of available resources, for these patients. A series of 5 articles on breast cancer is presented below. It is based on a review of the scientific literature over the last 10 years. This fourth article deals with the treatment of the disease, the role of the primary care physician, and management of major complications. This summary report aims to provide a current and practical review about this problem, providing answers to family doctors and helping them to support their patients and care for them throughout their illness. PMID:24837185

  1. Patient-Provider Communication and Cancer Screening among Unmarried Women

    PubMed Central

    Politi, Mary C.; Clark, Melissa A.; Rogers, Michelle L.; McGarry, Kelly; Sciamanna, Chris N.

    2008-01-01

    Objectives: Unmarried women are less likely than married women to receive recommended cancer screenings. Patient-provider communication is a consistent predictor of cancer screening among women. The purpose of this study was to investigate the relationship between patient-provider communication, barriers to cancer screening, and on-schedule breast and cervical cancer screening (BCCS) among unmarried women. Methods: Data were from the Cancer Screening Project for Women, a 2003-2005 survey examining cancer screening practices. We computed polytomous logistic regression models to examine the relationship between communication (communication about tests, communication about sexual and intimate relationships), barriers to screening, and on-schedule BCCS among unmarried women. Results: A total of 630 women were enrolled, and 605 women completed the baseline questionnaire. Overall, more than 60% reported on-schedule BCCS. More than half reported that their providers communicated about BCCS most or all of the time. Fewer than half communicated about sexual history and intimate relationships. Women who reported that their providers communicated about screening tests and their sexual and intimate relationships were more likely to be on-schedule for BCCS. Conclusion: Patient-provider communication in multiple areas may encourage women to remain on-schedule for their recommended cancer screenings. Longitudinal research should be conducted to examine whether communication predicts BCCS, and to examine how patient and provider characteristics may influence communication in order to promote adherence to screening guidelines for unmarried women. Practice Implications: Comprehensive communication that goes beyond information about screening tests may impact adherence to cancer screening guidelines. PMID:18723307

  2. Measuring stigma among health care and social service providers: The HIV/AIDS Provider Stigma Inventory.

    PubMed

    Rutledge, Scott Edward; Whyte, James; Abell, Neil; Brown, Kristin M; Cesnales, Nicole I

    2011-11-01

    Initial validation of the HIV/AIDS Provider Stigma Inventory (HAPSI), piloted on a sample of 174 nursing students, supported the psychometric qualities of a suite of measures capturing tendencies to stigmatize and discriminate against people living with HIV/AIDS (PLHA). Derived from social psychology and mindfulness theories, separate scales addressing awareness, acceptance, and action were designed to include notions of labeling, stereotyping, outgrouping, and discriminating. These were enhanced to capture differences associated with personal characteristics of PLHA that trigger secondary stigma (e.g., sexual orientation, injection drug use, multiple sex partners) and fears regarding instrumental and symbolic stigma. Reliabilities were strong (coefficients α for 16 of 19 resulting measures ranged from 0.80 to 0.98) and confirmatory factor analyses indicated good model fit for two multidimensional (Awareness and Acceptance) and one unidimensional (Action) measure. Evidence of convergent construct validity supported accuracy of primary constructs. Implications for training and professional socialization in health care are discussed. PMID:21967495

  3. An Action Plan for Translating Cancer Survivorship Research Into Care

    PubMed Central

    Smith, Tenbroeck; de Moor, Janet S.; Glasgow, Russell E.; Khoury, Muin J.; Hawkins, Nikki A.; Stein, Kevin D.; Rechis, Ruth; Parry,, Carla; Leach, Corinne R.; Padgett, Lynne; Rowland, Julia H.

    2014-01-01

    To meet the complex needs of a growing number of cancer survivors, it is essential to accelerate the translation of survivorship research into evidence-based interventions and, as appropriate, recommendations for care that may be implemented in a wide variety of settings. Current progress in translating research into care is stymied, with results of many studies un- or underutilized. To better understand this problem and identify strategies to encourage the translation of survivorship research findings into practice, four agencies (American Cancer Society, Centers for Disease Control and Prevention, LIVE STRONG Foundation, National Cancer Institute) hosted a meeting in June, 2012, titled: “Biennial Cancer Survivorship Research Conference: Translating Science to Care.” Meeting participants concluded that accelerating science into care will require a coordinated, collaborative effort by individuals from diverse settings, including researchers and clinicians, survivors and families, public health professionals, and policy makers. This commentary describes an approach stemming from that meeting to facilitate translating research into care by changing the process of conducting research—improving communication, collaboration, evaluation, and feedback through true and ongoing partnerships. We apply the T0-T4 translational process model to survivorship research and provide illustrations of its use. The resultant framework is intended to orient stakeholders to the role of their work in the translational process and facilitate the transdisciplinary collaboration needed to translate basic discoveries into best practices regarding clinical care, self-care/management, and community programs for cancer survivors. Finally, we discuss barriers to implementing translational survivorship science identified at the meeting, along with future directions to accelerate this process. PMID:25249551

  4. Damage control and point of injury care: extending the care continuum to military prehospital providers.

    PubMed

    Hetzler, Michael R

    2012-01-01

    Damage control principles are well founded, well proven, and have been incorporated into many specialties of clinical care in both military and civilian practice. Theories regarding hemostatic and hypovolemic resuscitation and preventing the Lethal Triad have had profound effects on the survival of wounded during the present conflicts. As we continue to refine these practices, implementation of this theory should be extended to military prehospital providers. The impacts of damage control practices from those providing initial treatment could complete the continuity of care, prime patients for additional success, and affect overall morbidity and mortality. The basic tenets of damage control theory are easily transferred to the Role I provider in the field and may even address their unique requirements more appropriately. Understanding the working concept of damage control would improve decision-making skills in both therapeutics and evacuation while managing casualties in the uncontrolled environment of combat. Military prehospital damage control differs greatly from in-hospital use, in that the principles must incorporate both medical and tactical considerations for care of the wounded. Introducing damage control principles to established casualty care guidelines will recognize and unite an often underappreciated level of care into a successful practice. PMID:22427043

  5. Transitions: A Guide to Teens Getting Older and Changing Health Care Providers

    MedlinePlus

    ... Transitions: A Guide to Getting Older and Changing Health Care Providers (HCP’s) Posted under Health Guides . Updated 8 ... can help me plan my transition to adult health care? Your pediatrician or other health care provider Your ...

  6. New ways to provide community aged care services.

    PubMed

    Taylor, Chris; Donoghue, Jed

    2015-09-01

    This paper will focus on the provision of community aged care services via 'direct payments' and 'social enterprise'. These are two solutions that were not fully considered by the Productivity Commission as a way to make the provision of community aged care more sustainable in Australia. The empowerment component of social enterprise activities and 'direct payments' have the potential to generate improvements in the community aged care system. PMID:25827360

  7. Cancer care quality measures: diagnosis and treatment of colorectal cancer.

    PubMed Central

    Patwardhan, Meenal B; Samsa, Gregory P; McCrory, Douglas C; Fisher, Deborah A; Mantyh, Christopher R; Morse, Michael A; Prosnitz, Robert G; Cline, Kathryn E; Gray, Rebecca N

    2006-01-01

    OBJECTIVES To identify measures that are currently available to assess the quality of care provided to patients with colorectal cancer (CRC), and to assess the extent to which these measures have been developed and tested. DATA SOURCES Published and unpublished measures identified through a computerized search of English-language citations in MEDLINE (1966-January 2005), the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse; through review of reference lists contained in seed articles, all included articles, and relevant review articles; and through searches of the grey literature (institutional or government reports, professional society documents, research papers, and other literature, in print or electronic format, not controlled by commercial publishing interests). Sources for grey literature included professional organization websites and the Internet. REVIEW METHODS Measures were selected by reviewers according to standardized criteria relating to each question, and were then rated according to their importance and usability, scientific acceptability, and extent of testing; each domain was rated from 1 (poor) to 5 (ideal). RESULTS We identified a number of well-developed and well-tested CRC-related quality-of-care measures, both general process-of-care measures (on a broader scale) and technical measures (pertaining to specific details of a procedure). At least some process measures are available for diagnostic imaging, staging, surgical therapy, adjuvant chemotherapy, adjuvant radiation therapy, and colonoscopic surveillance. Various technical measures were identified for quality of colonoscopy (e.g., cecal intubation rate, complications) and staging (adequate lymph node retrieval and evaluation). These technical measures were guideline-based and well developed, but less well tested, and the linkage between them and patient outcomes, although intuitive, was not always explicitly provided. For some elements of the care pathway, such as operative reports and chemotherapy reports, no technical measures were found. CONCLUSIONS Some general process measures have a stronger evidence base than others. Those based on guidelines have the strongest evidence base; those derived from basic first principles supported by some research findings are relatively weaker, but are often sufficient for the task at hand. A consistent source of tension is the distinction between the clinically derived fine-tuning of the definition of a quality measure and the limitations of available data sources (which often do not contain sufficient information to act on such distinctions). Although some excellent technical measures were found, the overall development of technical measures seems less advanced than that of the general process measures. PMID:17764215

  8. Addressing sexual dysfunction in colorectal cancer survivorship care

    PubMed Central

    Averyt, Jennifer C.

    2014-01-01

    Despite the high prevalence of sexual dysfunction in survivors of colorectal cancer, studies have shown that patients and providers rarely discuss how these symptoms may be influencing overall quality of life. The type and severity of symptoms of sexual dysfunction can vary greatly depending on the type of colorectal cancer and treatment, and assessment of sexual dysfunction is key to understanding how patients may be affected by these symptoms. Although patients would like to discuss these issues with their provider, they are often reluctant to ask questions about sexual functioning during appointments. Likewise, health care providers may hesitate to address sexual dysfunction due to time limitations or lack of knowledge regarding treatment of sexual problems. Health care providers can facilitate discussion of sexual dysfunction by (I) assessing sexual functioning throughout treatment; (II) initiating discussions about symptoms of sexual dysfunction at each appointment; and (III) maintaining adequate referral resources for treatment of sexual dysfunction. PMID:25276411

  9. Providing indigent care: strategic issues in management, marketing and ethics.

    PubMed

    Summers, J

    1986-08-01

    Uncompensated cares poses considerable management, marketing and ethical challenges to health care managers. A variety of responses are examined which offer the possibility of reducing the need for inpatient care and the cost of that care as well as for the enhancement of the organization's positioning in the marketing and sales environment. Some of the programs will require support from local community agencies or employers, but others will be quite feasible without such support. Additionally, the programs build on sensitivity to the hospital mission as opposed to turning away from it. PMID:10301007

  10. Training mid-level providers on palliative care: bringing advanced directives and symptom assessment and management to community oncology practices.

    PubMed

    Lesperance, Mary; Shannon, Robert; Pumphrey, Phyllis K; Dunbar, Erin; Genther, Renee; Coleman, C Lynn; Tabano, Margaret; Maurer, Jennifer; Vazquez, Adrienne; Capp, Elizabeth; McMillan, Jessica; Wilkerson, Katie; Robbins, Gerald; Phillips, Dorothy Green; Howick, Priscilla; Solaun, Catherine; Sloan, Jeff; ColĂłn-Otero, Gerardo

    2014-05-01

    Palliative care services are not available in most outpatient oncology practices. A program training 11 mid-level providers from oncology practices on advanced directive discussions and supportive symptom assessment and management performed by palliative care specialists was completed. A follow-up session 9 months later identified barriers to implementation. Of the 11 mid-level providers, 8 participated in the follow-up session, and 9 of the 11 providers implemented advanced directive's discussions and symptom assessment and management for patients with metastatic cancer. Main barriers included uncertainties about reimbursement, patients' lack of knowledge about palliative care, and lack of access to supportive services. This program successfully promoted advanced directive discussions and supportive/palliative care symptom assessment and management to community oncology practices, which will hopefully translate into improved quality of life for patients with metastatic cancer. PMID:23616274

  11. Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide.

    PubMed

    Buchbinder, Mara; Lassiter, Dragana; Mercier, Rebecca; Bryant, Amy; Lyerly, Anne Drapkin

    2016-01-01

    Much of the debate on conscience has addressed the ethics of refusal: the rights of providers to refuse to perform procedures to which they object and the interests of the patients who might be harmed by their refusals. But conscience can also be a positive force, grounding decision about offering care. PMID:27120281

  12. The oncologist's role in care of the dying cancer patient.

    PubMed

    Lacey, Judith; Sanderson, Christine

    2010-01-01

    Caring for dying patients is challenging for oncologists, but a crucial aspect of cancer care. It requires highly developed communication skills and an understanding of prognostication at the end of life, which can potentially be improved by training and use of appropriate tools. Psychosocial concerns are as important as physical symptoms. Specific strategies for supporting dying patients are evolving, including dignity therapy and other meaning-based therapies. Symptoms affecting dying patients' comfort, including pain, dyspnea, delirium, and terminal secretions, require different clinical management as death approaches. Equally important is the ability to discuss transitions in goals of care from cure to comfort and supporting families and patients to make wise decisions without feeling they have been abandoned. Involving a palliative care team supports both oncologists and patients by providing whole-person assessment and care and excellent symptom control and can offer bereavement services to follow up family members after death. PMID:20890152

  13. Spirituality in cancer care at the end of life.

    PubMed

    Ferrell, Betty; Otis-Green, Shirley; Economou, Denice

    2013-01-01

    There is a compelling need to integrate spirituality into the provision of quality palliative care by oncology professionals. Patients and families report the importance of spiritual, existential, and religious concerns throughout the cancer trajectory. Leading palliative care organizations have developed guidelines that define spiritual care and offer recommendations to guide the delivery of spiritual services. There is growing recognition that all team members require the skills to provide generalist spiritual support. Attention to person-centered, family-focused oncology care requires the development of a health care environment that is prepared to support the religious, spiritual, and cultural practices preferred by patients and their families. These existential concerns become especially critical at end of life and following the death for family survivors. Oncology professionals require education to prepare them to appropriately screen, assess, refer, and/or intervene for spiritual distress. PMID:24051617

  14. The integration of healing into conventional cancer care in the UK.

    PubMed

    Lorenc, Ava; Peace, Brenda; Vaghela, Chandrika; Robinson, Nicola

    2010-11-01

    Healing encompasses Reiki, therapeutic touch and healing touch, and is often used by cancer patients to supplement their health care, but the extent of healing provision in conventional cancer care is unknown. This study used snowball sampling to map the healing provision in UK conventional cancer care settings. Sixty-seven individuals at 38 centres were identified who provided healing within conventional care, 16 NHS-based. Less than half were paid or had specialist cancer training. Self-referral was the usual route to healing, followed by hospital nurse referral. Healing was perceived as well accepted and useful by healers. Providing healing in conventional cancer care may improve patient empowerment and choice. Despite the value to patients, staff and healers, many services receive little financial support. Exchange of information and communication on referral possibilities between healers and conventional staff needs to be improved. Voluntary healer self-regulation will facilitate the safe incorporation of healing into conventional care. PMID:20920808

  15. [Breast cancer update in primary care: (V/V)].

    PubMed

    DĂ­az GarcĂ­a, Noiva; Cuadrado Rouco, Carmen; Vich, Pilar; Alvarez-Hernandez, Cristina; Brusint, Begoña; Redondo MargĂŒello, Esther

    2015-03-01

    Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family physicians ought to know thoroughly this pathology to optimize the health care services for these patients making the best use of available resources. A series of five articles on breast cancer is presented below. It is based on a review of the scientific literature over the last ten years. In this final section, the social, psychological, occupational and family issues related to the disease will be reviewed, as well as presenting some special situations of breast cancer, including breast cancer in men, during pregnancy and last stages of life. This summary report aims to provide a current and practical review about this disease, providing answers to family doctors and helping them to be by the patients for their benefit throughout their illness. PMID:25002350

  16. Providing Perinatal Mental Health Services in Pediatric Primary Care

    ERIC Educational Resources Information Center

    Talmi, Ayelet; Stafford, Brian; Buchholz, Melissa

    2009-01-01

    After birth, newborns and their caregivers are seen routinely and frequently in pediatric primary care settings. The close succession of visits in the first few months of life puts pediatric primary care professionals in a unique position to enhance infant mental health by developing strong relationships with caregivers, supporting babies and


  17. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

    PubMed Central

    Bodenheimer, Thomas; Sinsky, Christine

    2014-01-01

    The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff. PMID:25384822

  18. From triple to quadruple aim: care of the patient requires care of the provider.

    PubMed

    Bodenheimer, Thomas; Sinsky, Christine

    2014-01-01

    The Triple Aim-enhancing patient experience, improving population health, and reducing costs-is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff. PMID:25384822

  19. Not Babysitting: Work Stress and Well-Being for Family Child Care Providers

    ERIC Educational Resources Information Center

    Gerstenblatt, Paula; Faulkner, Monica; Lee, Ahyoung; Doan, Linh Thy; Travis, Dnika

    2014-01-01

    Family child care providers contend with a number of work stressors related to the dual roles of operating a small business and providing child care in their home. Research has documented many sources of work related stress for family child care providers; however, research examining family child care providers' experiences outside of the


  20. Not Babysitting: Work Stress and Well-Being for Family Child Care Providers

    ERIC Educational Resources Information Center

    Gerstenblatt, Paula; Faulkner, Monica; Lee, Ahyoung; Doan, Linh Thy; Travis, Dnika

    2014-01-01

    Family child care providers contend with a number of work stressors related to the dual roles of operating a small business and providing child care in their home. Research has documented many sources of work related stress for family child care providers; however, research examining family child care providers' experiences outside of the…

  1. Capitalizing on the ‘teachable’ moment to promote healthy dietary changes among cancer survivors: the perspectives of healthcare providers

    PubMed Central

    Coa, Kisha I.; Smith, Katherine Clegg; Klassen, Ann C.; Caulfield, Laura E.; Helzlsouer, Kathy; Peairs, Kim; Shockney, Lillie

    2014-01-01

    Purpose Although cancer is often thought of as a teachable moment, many cancer survivors do not adhere to behavioral recommendations that might improve their health. This study explored healthcare providers’ perspectives on the importance and feasibility of addressing behavior change, specifically healthy diet, with cancer survivors. Methods In-depth interviews were conducted with 33 healthcare providers who care for posttreatment survivors of breast cancer, prostate cancer, and non-Hodgkin’s lymphoma. Interviews were analyzed thematically. Results Healthcare providers emphasized the strength of evidence linking diet/obesity to recurrence in their assessment of the importance of promoting dietary change among their survivor patients. Cancer specialists (e.g., oncologists, surgeons) generally brought up dietary change with patients if they considered the evidence to be strong. In contrast, primary care providers viewed health promotion as important for all patients, and reported treating cancer survivor patients the same as others when it came to making dietary recommendations. There was a lack of consensus among providers on the best timing to bring up behavior change. Providers described specific subgroups of patients who they saw as more motivated to make behavior changes, and patient barriers to making dietary changes. Conclusions Healthcare providers can play an important role in promoting healthy diet among cancer survivors. As the evidence base around diet and cancer recurrence/prognosis grows, it is important that this information is communicated to providers. Strategies such as incorporating behavior change messages into survivor care plans may help standardize recommendations to survivors. PMID:25160494

  2. Chiropractors as Primary Spine Care Providers: precedents and essential measures

    PubMed Central

    Erwin, W. Mark; Korpela, A. Pauliina; Jones, Robert C.

    2013-01-01

    Chiropractors have the potential to address a substantial portion of spinal disorders; however the utilization rate of chiropractic services has remained low and largely unchanged for decades. Other health care professions such as podiatry/chiropody, physiotherapy and naturopathy have successfully gained public and professional trust, increases in scope of practice and distinct niche positions within mainstream health care. Due to the overwhelming burden of spine care upon the health care system, the establishment of a ‘primary spine care provider’ may be a worthwhile niche position to create for society’s needs. Chiropractors could fulfill this role, but not without first reviewing and improving its approach to the management of spinal disorders. Such changes have already been achieved by the chiropractic profession in Switzerland, Denmark, and New Mexico, whose examples may serve as important templates for renewal here in Canada. PMID:24302774

  3. REACH-Meharry community-campus partnership: developing culturally competent health care providers.

    PubMed

    Fort, Jane G; McClellan, Linda

    2006-05-01

    An important national health care effort is elimination of racial and ethnic disparities in six specific conditions: infant mortality, cancer screening and management, cardiovascular disease, diabetes, human immunodeficiency virus infection, and child and adult immunizations. To address this concern, several health entities in Nashville, Tennessee responded to a grant initiative from the Centers for Disease Control and Prevention to develop a Racial and Ethnic Approaches to Community Health (REACH) demonstration project. The resulting award is the Nashville REACH 2010 Project, charged to develop sustainable methods to reduce and, in time, eliminate racial and ethnic disparities in cardiovascular disease and diabetes in the North Nashville community, where mortality rates of these diseases are substantially higher than in other parts of the county. As one of its many interests, the project included potential health care providers to receive and disseminate messages about disease prevention and health education. The present paper describes the community-campus partnership between the Nashville REACH 2010 project and the post-baccalaureate program of Meharry Medical College, a partnership that enfolded Meharry's pre-professional health care students into the community-based participatory service research project to increase the awareness and sensitivity of future minority health care providers to issues in minority and poor, underserved populations and to increase potential providers' familiarity with the processes involved in community-based participatory research. PMID:16809876

  4. Expectations in the care of lung cancer.

    PubMed

    Lilenbaum, Rogerio; Leighl, Natasha B; Neubauer, Marcus

    2015-01-01

    One of the main challenges oncologists face in the care of patients with lung cancer is the decision to incorporate new clinical trial data into routine clinical practice. Beyond the question of statistical significance, which is a more objective metric, are the results meaningful and applicable to a broader population? Furthermore, in an era of value care, do the results justify a potential increase in costs? This article discusses the main points that clinicians consider in their decision-making process and illustrates the arguments with real-life examples. PMID:25993205

  5. [Care for terminal cancer patients at general practitioner office].

    PubMed

    Jovanović, Aleksandar; Jurković, Ljiljanka; Zlata, Ozvacić; Gluhak, Ines; Soldo, Dragan

    2007-02-01

    The final goal of palliative care is symptom relief and improving the quality of life. Around 70% of cencer patients suffer pain. Therapy and care provided for dying cancer patients by general practitioners at Dugave-Travno GP Office were investigated. Medical records of 70 cancer patients were collected and analyzed. Sixty-seven patients had died. A total of 76 cancers at 22 various sites were diagnosed. There were 79 associated diseases diagnosed in 44 patients, along 43 diseases related to malignant disease in 26 patients. Physicians provided home nursing for 30 patients. In 66 cases family provided support. Physicians collaborated with community health nurses in 38 cases. A total of 66 patients were using analgesic therapy, 37 patients continuously, and 48 patients for up to one year. In 56 patients analgesic drugs were administered orally, in 25 parenterally, in 16 rectally, and in 21 patients transdermally. Physicians prescribed opioid therapy in 55 patients: codeine in 2, tramadol in 46, pentazocine in 7, methadone in 5, Kapanol in 15 and fentanyl in 21 patients. Sixty patients received adjuvant drug therapy. A total of 59 patients were hospitalized in terminal stage of the disease. Study results showed a high rate of associated diseases and diseases related to malignant disease in cancer patients. The collaboration between general practitioners and family members was satisfactory. Community health services should be improved, and the World Health Organization guidelines on palliative care, management of malignant pain in particular, should be more thoroughly followed. PMID:17593643

  6. Challenges of Providing Confidential Care to Adolescents in Urban Primary Care: Clinician Perspectives

    PubMed Central

    McKee, M. Diane; Rubin, Susan E.; Campos, Giselle; O’Sullivan, Lucia F.

    2011-01-01

    PURPOSE Clinician time alone with an adolescent has a major impact on disclosure of risk behavior. This study sought to describe primary care clinicians’ patterns of delivering time alone, decision making about introducing time alone to adolescents and their parents, and experiences delivering confidential services. METHODS We undertook qualitative interviews with 18 primary care clinicians in urban health centers staffed by specialists in pediatrics, family medicine, and adolescent medicine. RESULTS The annual preventive care visit is the primary context for provision of time alone with adolescents; clinicians consider the parent-child dynamic and the nature of the chief complaint for including time alone during visits for other than preventive care. Time constraints are a major barrier to offering time alone more frequently. Clinicians perceive that parental discomfort with time alone is rare. Many clinicians wrestle with internal conflict about providing confidential services to adolescents with serious health threats and regard their role as facilitating adolescent-parent communication. Health systems factors can interfere with delivery of confidential services, such as inconsistent procedures for determining whether unaccompanied youth would be seen. CONCLUSION Despite competing time demands, clinicians report commitment to offering time alone during preventive care visits and infrequently offer it at other times. Experienced clinicians can gain skills in the art of managing complex relationships between adolescents and their parents. Office systems should be developed that enhance the consistency of delivery of confidential services. PMID:21242559

  7. Cancer patients with oral mucositis: challenges for nursing care1

    PubMed Central

    AraĂșjo, Sarah Nilkece Mesquita; Luz, Maria Helena Barros AraĂșjo; da Silva, Grazielle Roberta Freitas; Andrade, Elaine Maria Leite Rangel; Nunes, LĂ­vio CĂ©sar Cunha; Moura, Renata Oliveira

    2015-01-01

    OBJECTIVE: to analyze nursing care provided to cancer patients with oral mucositis based on the Nursing Process (NP). METHOD: this exploratory, descriptive, cross-sectional and quantitative study was conducted with 213 patients undergoing chemotherapy and/or radiotherapy in two cancer facilities: one philanthropic and one private service. RESULTS: the participants were mainly female, aged 45.8 years old on average, with up to 11 years of schooling and income of up to one times the minimum wage. Severe mucositis was related to chemotherapy associated with radiotherapy. Only 25.3% of the patients reported having received guidance from nurses during their treatment concerning self-care. The perceptions of patients regarding quality of care did not significantly differ between the private and public facilities. The basic human needs mainly affected were comfort, eating, and hygiene. Based on this finding, one NP was established listing the diagnoses, interventions and expected results to establish an ideal, though individualized, standard of nursing care to be provided to these patients. CONCLUSION: to understand oral mucositis is crucial to establish nursing care that includes prevention based on the implementation of an oral care plan. PMID:26039297

  8. Strategies for improving corporate philanthropy toward health care providers.

    PubMed

    Petroshius, S M; Crocker, K E; West, J S; Wu, B T; Wolfe, T

    1993-01-01

    The authors report the results of a survey examining corporate donation behavior relative to the health care industry. The findings suggest that, despite the poor economic conditions of recent years, companies have continued to make substantial contributions--particularly to the health care industry--and that the single most identifiable factor influencing the availability of funds in any given year was the company's expected earnings in that year. Additionally, the authors suggest criteria that influence whether a company donates to a particular organization as well as the expected benefits and methods of recognizing donations. Finally, they discuss preferred solicitation methods along with marketing implications for the health care industry. PMID:10131729

  9. Derivative financial instruments and nonprofit health care providers.

    PubMed

    Stewart, Louis J; Owhoso, Vincent

    2004-01-01

    This article examines the extent of derivative financial instrument use among US nonprofit health systems and the impact of these financial instruments on their cash flows, reported operating results, and financial risks. Our examination is conducted through a case study of New Jersey hospitals and health systems. We review the existing literature on interest rate derivative instruments and US hospitals and health systems. This literature describes the design of these derivative financial instruments and the theoretical benefits of their use by large health care provider organizations. Our contribution to the literature is to provide an empirical evaluation of derivative financial instruments usage among a geographically limited sample of US nonprofit health systems. We reviewed the audited financial statements of the 49 community hospitals and multi-hospital health systems operating in the state of New Jersey. We found that 8 percent of New Jersey's nonprofit health providers utilized interest rate derivatives with an aggregate principle value of $229 million. These derivative users combine interest rate swaps and caps to lower the effective interest costs of their long-term debt while limiting their exposure to future interest rate increases. In addition, while derivative assets and liabilities have an immaterial balance sheet impact, derivative related gains and losses are a material component of their reported operating results. We also found that derivative usage among these four health systems was responsible for generating positive cash flows in the range of 1 percent to 2 percent of their total 2001 cash flows from operations. As a result of our admittedly limited samples we conclude that interest rate swaps and caps are effective risk management tools. However, we also found that while these derivative financial instruments are useful hedges against the risks of issuing long-term financing instruments, they also expose derivative users to credit, contract termination and interest rate volatility risks. In conclusion, we find that these financial instruments can also generate negative as well as positive cash flows and have both a positive and negative impact on reported operating results. PMID:15839528

  10. Nurses' perceptions around providing palliative care for long-term care residents with dementia.

    PubMed

    Kaasalainen, Sharon; Brazil, Kevin; Ploeg, Jenny; Martin, Lori Schindel

    2007-01-01

    Providing palliative care for residents with dementia in long-term care (LTC) settings is problematic due to their declining verbal abilities and related challenges. The goal of this study was to explore nurses' perceptions around providing palliative care for such residents. Using a qualitative descriptive design, data were gathered from focus groups at three LTC facilities. Participants represented all levels of nursing staff. Concepts that emerged from the data were labelled, categorized, and coded in an iterative manner. Nurses appraise residents' general deterioration as a main factor in deciding that a resident is palliative. Nurses often employ creative strategies using limited resources to facilitate care, but are challenged by environmental restrictions and insufficient educational preparation. However, nurses said they do not wish for residents to be transferred to a hospice setting, as they wish to grieve with residents and their family members. Nurses aim to facilitate a "good death" for residents with dementia, while trying to manage multiple demands and deal with environmental issues. Supportive and educational initiatives are needed for nursing staff and families of dying residents. PMID:18069438

  11. Women and managed care: satisfaction with provider choice, access to care, plan costs and coverage.

    PubMed

    Wyn, R; Collins, K S; Brown, E R

    1997-01-01

    This article reports on differences in satisfaction with provider choice, access to care, and plan costs and coverage between women enrolled in fee-for-service and those in managed car plans. It also examines differences in satisfaction, access, and costs and coverage between higher and lower income women and between those in reported fair or poor health and those in excellent or good health, among women in managed care plans. The data for this study are from The Commonwealth Fund's 1994 Managed Care Survey, which included 1,544 women with employer- or union-sponsored insurance in Boston, Los Angeles, and Miami. The study found that women in managed care were less satisfied with provider choice and access to services, but more satisfied with out-of-pocket costs for services and the range of services covered. Both low-income women and those in fair to poor health reported more problems with access barriers than did either higher income women or those in excellent or good health. PMID:9127994

  12. Process of diffusing cancer survivorship care into oncology practice.

    PubMed

    Tessaro, Irene; Campbell, Marci K; Golden, Shannon; Gellin, Mindy; McCabe, Mary; Syrjala, Karen; Ganz, Patricia A; Jacobs, Linda; Baker, Scott; Miller, Kenneth D; Rosenstein, Donald L

    2013-06-01

    The LIVESTRONG Centers of Excellence were funded to increase the effectiveness of survivorship care in oncology practice. This study describes the ongoing process of adopting and implementing survivorship care using the framework of the diffusion of innovation theory of change. Primary data collection included telephone interviews with 39 members from the eight centers and site visits. Organizational characteristics, overall progress, and challenges for implementation were collected from proposals and annual reports. Creating an awareness of cancer survivorship care was a major accomplishment (relative advantage). Adoption depended on the fit within the cancer center (compatibility), and changed over time based on trial and error (trialability). Implementing survivorship care within the existing culture of oncology and breaking down resistance to change was a lengthy process (complexity). Survivorship care became sustainable as it became reimbursed, and more new patients were seen (observability). Innovators and early adopters were crucial to success. Diffusion of innovation theory can provide a strategy to evaluate adoption and implementation of cancer survivorship programs into clinical practice. PMID:24073165

  13. Palliative care in patients with lung cancer

    PubMed Central

    Farbicka, Paulina

    2013-01-01

    Lung cancer accounts for 12% of all cancers and has the highest annual rate of mortality in men and women. The overall aim is cure or prolongation of life without evidence of disease. Almost 60% of patients at the moment of diagnosis are not eligible for radical treatment. Therefore soothing and supportive treatment is the only treatment of choice. Patients with lung cancer who have symptoms of dyspnea, chronic cough, severe pain, exhaustion and cachexia syndrome, fear and depression and significantly reduced physical and intellectual activities are qualified for inpatient or home palliative care. Knowledge about various methods used in palliative treatment allows one to alleviate symptoms that occur in an advanced stage of disease with an expected short survival period. Methods of oncological treatment that are often used in patients with advanced lung cancer include radiotherapy and chemotherapy. Drawing attention to the earlier implementation of palliative care is an objective of research carried out during recent years. Advances in surgical and conservative treatment of these patients have contributed to better outcomes and longer survival time. PMID:24596508

  14. Marketing a Resource and Referral Resource Room to Child Care Providers and Parents.

    ERIC Educational Resources Information Center

    Eder, Sandra

    Recognizing the importance of providing parents and child care providers with current information on early childhood education, care, and support, this practicum project evaluated the design and implementation of a 10-week strategy to market a child care resource and referral agency resource room to child care providers and parents. Observations,


  15. 45 CFR 162.406 - Standard unique health identifier for health care providers.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Standard unique health identifier for health care... for Health Care Providers § 162.406 Standard unique health identifier for health care providers. (a) Standard. The standard unique health identifier for health care providers is the National...

  16. When Health Care Providers May Communicate About You with Your Family, Friends, or Others Involved in Your Care

    MedlinePlus

    ... TO THE HIPAA P RIVACY R ULE : When Health Care Providers May Communicate About You with Your Family, ... doctors, nurses, pharmacies, hospitals, nursing homes, and other health care providers to protect the privacy of your health ...

  17. Leveraging state cancer registries to measure and improve the quality of cancer care: a potential strategy for California and beyond.

    PubMed

    Hiatt, Robert A; Tai, Caroline G; Blayney, Douglas W; Deapen, Dennis; Hogarth, Michael; Kizer, Kenneth W; Lipscomb, Joseph; Malin, Jennifer; Phillips, Stephen K; Santa, John; Schrag, Deborah

    2015-05-01

    Despite recent increased attention to healthcare performance and the burden of disease from cancer, measures of quality of cancer care are not readily available. In 2013, the California HealthCare Foundation convened an expert workgroup to explore the potential for leveraging data in the California Cancer Registry (CCR), one of the world's largest population-based cancer registries, for measuring and improving the quality of cancer care. The workgroup assessed current registry operations, the value to be gained by linking CCR data with health insurance claims or encounter data and clinical data contained in health system electronic health records, and potential barriers to these linkages. The workgroup concluded that: 1) The CCR mandate should be expanded to include use of its data for quality of cancer care measurement and public reporting; and 2) a system should be developed to support linkage of registry data with both claims data and provider electronic health record data. PMID:25766400

  18. Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care

    Cancer.gov

    Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care, a 2010 workshop sponsored by the Epidemiology and Genomics Research Program.

  19. 75 FR 13595 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-22

    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the Consolidated Omnibus Budget Reconciliation Act (COBRA) and Other Health Care... Administration, Department of Labor. ACTION: Notice of the availability of the Model Health Care...

  20. 75 FR 2562 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-15

    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the Consolidated Omnibus Budget Reconciliation Act (COBRA) and Other Health Care... Administration, Department of Labor. ACTION: Notice of the Availability of the Model Health Care...

  1. 75 FR 26276 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-11

    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the Consolidated Omnibus Budget Reconciliation Act (COBRA) and Other Health Care... Administration, Department of Labor. ACTION: Notice of the Availability of the Model Health Care...

  2. Routine Prenatal Care Visits by Provider Specialty in the United States, 2009-2010

    MedlinePlus

    ... the National Technical Information Service NCHS Routine Prenatal Care Visits by Provider Specialty in the United States, ... ambulatory obstetric care The percentage of routine prenatal care visits at which women saw non-ob/gyn ...

  3. Electronic health records (EHRs): supporting ASCO's vision of cancer care.

    PubMed

    Yu, Peter; Artz, David; Warner, Jeremy

    2014-01-01

    ASCO's vision for cancer care in 2030 is built on the expanding importance of panomics and big data, and envisions enabling better health for patients with cancer by the rapid transformation of systems biology knowledge into cancer care advances. This vision will be heavily dependent on the use of health information technology for computational biology and clinical decision support systems (CDSS). Computational biology will allow us to construct models of cancer biology that encompass the complexity of cancer panomics data and provide us with better understanding of the mechanisms governing cancer behavior. The Agency for Healthcare Research and Quality promotes CDSS based on clinical practice guidelines, which are knowledge bases that grow too slowly to match the rate of panomic-derived knowledge. CDSS that are based on systems biology models will be more easily adaptable to rapid advancements and translational medicine. We describe the characteristics of health data representation, a model for representing molecular data that supports data extraction and use for panomic-based clinical research, and argue for CDSS that are based on systems biology and are algorithm-based. PMID:24857080

  4. Cancer Survivorship Care Plans: What Can Be Learned From Hospital Discharge Summaries?

    PubMed Central

    Nekhlyudov, Larissa; Schnipper, Jeffrey L.

    2012-01-01

    The Institute of Medicine panel on cancer survivorship recommended that all patients with cancer and their primary care providers receive a written survivorship care plan that summarizes their initial treatment and provides guidance on post-treatment management. Cancer survivorship care plans aim to improve coordination of care and communication between providers as their patients transition from oncology to primary care settings. As such, survivorship care plans share similarities with hospital discharge summaries, focusing on improving the transition from inpatient to outpatient settings. In this article, we explore potential lessons that may be learned from hospital discharge summaries, which may be used to facilitate the development, implementation, and testing of survivorship care plans. PMID:22548007

  5. Cancer care management through a mobile phone health approach: key considerations.

    PubMed

    Mohammadzadeh, Niloofar; Safdari, Reza; Rahimi, Azin

    2013-01-01

    Greater use of mobile phone devices seems inevitable because the health industry and cancer care are facing challenges such as resource constraints, rising care costs, the need for immediate access to healthcare data of types such as audio video texts for early detection and treatment of patients and increasing remote aids in telemedicine. Physicians, in order to study the causes of cancer, detect cancer earlier, act in prevention measures, determine the effectiveness of treatment and specify the reasons for the treatment ineffectiveness, need to access accurate, comprehensive and timely cancer data. Mobile devices provide opportunities and can play an important role in consulting, diagnosis, treatment, and quick access to health information. There easy carriage make them perfect tools for healthcare providers in cancer care management. Key factors in cancer care management systems through a mobile phone health approach must be considered such as human resources, confidentiality and privacy, legal and ethical issues, appropriate ICT and provider infrastructure and costs in general aspects and interoperability, human relationships, types of mobile devices and telecommunication related points in specific aspects. The successful implementation of mobile-based systems in cancer care management will constantly face many challenges. Hence, in applying mobile cancer care, involvement of users and considering their needs in all phases of project, providing adequate bandwidth, preparation of standard tools that provide maximum mobility and flexibility for users, decreasing obstacles to interrupt network communications, and using suitable communication protocols are essential. It is obvious that identifying and reducing barriers and strengthening the positive points will have a significant role in appropriate planning and promoting the achievements of mobile cancer care systems. The aim of this article is to explain key points which should be considered in designing appropriate mobile health systems in cancer care as an approach for improving cancer care management. PMID:24175759

  6. Talking about Complementary and Alternative Medicine with Your Health Care Providers: A Workbook and Tips

    MedlinePlus

    ... Medicine Talking about Complementary and Alternative Medicine with Health Care Providers: A Workbook and Tips U.S. DEPARTMENT OF ... is designed to help you talk with your health care provider(s) about your complementary and alternative medicine (CAM) ...

  7. American Society of Clinical Oncology guidance statement: the cost of cancer care.

    PubMed

    Meropol, Neal J; Schrag, Deborah; Smith, Thomas J; Mulvey, Therese M; Langdon, Robert M; Blum, Diane; Ubel, Peter A; Schnipper, Lowell E

    2009-08-10

    Advances in early detection, prevention, and treatment have resulted in consistently falling cancer death rates in the United States. In parallel with these advances have come significant increases in the cost of cancer care. It is well established that the cost of health care (including cancer care) in the United States is growing more rapidly than the overall economy. In part, this is a result of the prices and rapid uptake of new agents and other technologies, including advances in imaging and therapeutic radiology. Conventional understanding suggests that high prices may reflect the costs and risks associated with the development, production, and marketing of new drugs and technologies, many of which are valued highly by physicians, patients, and payers. The increasing cost of cancer care impacts many stakeholders who play a role in a complex health care system. Our patients are the most vulnerable because they often experience uneven insurance coverage, leading to financial strain or even ruin. Other key groups include pharmaceutical manufacturers that pass along research, development, and marketing costs to the consumer; providers of cancer care who dispense increasingly expensive drugs and technologies; and the insurance industry, which ultimately passes costs to consumers. Increasingly, the economic burden of health care in general, and high-quality cancer care in particular, will be less and less affordable for an increasing number of Americans unless steps are taken to curb current trends. The American Society of Clinical Oncology (ASCO) is committed to improving cancer prevention, diagnosis, and treatment and eliminating disparities in cancer care through support of evidence-based and cost-effective practices. To address this goal, ASCO established a Cost of Care Task Force, which has developed this Guidance Statement on the Cost of Cancer Care. This Guidance Statement provides a concise overview of the economic issues facing stakeholders in the cancer community. It also recommends that the following steps be taken to address immediate needs: recognition that patient-physician discussions regarding the cost of care are an important component of high-quality care; the design of educational and support tools for oncology providers to promote effective communication about costs with patients; and the development of resources to help educate patients about the high cost of cancer care to help guide their decision making regarding treatment options. Looking to the future, this Guidance Statement also recommends that ASCO develop policy positions to address the underlying factors contributing to the increased cost of cancer care. Doing so will require a clear understanding of the factors that drive these costs, as well as potential modifications to the current cancer care system to ensure that all Americans have access to high-quality, cost-effective care. PMID:19581533

  8. 25 CFR 20.507 - What requirements must foster care providers meet?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.507 What requirements must foster care providers meet? If a child needs foster care, the social services worker must select care that... contain an approved current home study. (c) An off-reservation foster home, or residential care...

  9. 25 CFR 20.507 - What requirements must foster care providers meet?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.507 What requirements must foster care providers meet? If a child needs foster care, the social services worker must select care that... contain an approved current home study. (c) An off-reservation foster home, or residential care...

  10. 25 CFR 20.507 - What requirements must foster care providers meet?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.507 What requirements must foster care providers meet? If a child needs foster care, the social services worker must select care that... contain an approved current home study. (c) An off-reservation foster home, or residential care...

  11. Regulation, Subsidy Receipt and Provider Characteristics: What Predicts Quality in Child Care Homes?

    ERIC Educational Resources Information Center

    Raikes, H.A.; Raikes, H.H.; Wilcox, B.

    2005-01-01

    Far less is known about predictors of quality for family child care homes than for child care centers. The current study of 120 randomly-selected family child care providers in four Midwestern states examined distal, state policy-level variables (family child care regulations and the concentration of children cared for who received public child


  12. Asian Pacific elders. Implications for health care providers.

    PubMed

    Douglas, K C; Fujimoto, D

    1995-02-01

    Asian Pacific Islanders are a diverse group that include recent immigrants as well as long-term residents. They may be isolated or unsettled in their relationships with their own families and unfamiliar with Western medical care and thought. Medical care should take into consideration unique features of their traditional health benefits, traditional medications, prevalence of medical problems, pharmacokinetics and pharmacodynamics, diet, health risks, and health promotion. Although they cannot be homogenized into one tidy bundle, certain commonalities apply, and are addressed. PMID:7720022

  13. [Update of breast cancer in Primary Care (II/V)].

    PubMed

    Brusint, B; Vich, P; Ávarez-HernĂĄndez, C; Cuadrado-Rouco, C; DĂ­az-GarcĂ­a, N; Redondo-MargĂŒello, E

    2014-10-01

    Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family doctors need to thoroughly understand this disease in order to optimize the health care services for these patients, making the best use of available resources. A series of 5 articles on breast cancer is presented below. It is based on a review of the scientific literature over the last 10 years. The second one deals with population screening and its controversies, screening in high-risk women, and the current recommendations. This summary report aims to provide a current and practical review about this problem, providing answers to family doctors, and helping them to be able to care for their patients for their benefit throughout their illness. PMID:24953002

  14. The global cancer genomics consortium's third annual symposium: from oncogenomics to cancer care

    PubMed Central

    Costa, Luis; Casimiro, Sandra; Gupta, Sudeep; Knapp, Stefan; Pillai, M.Radhakrishna; Toi, Masakazu; Badwe, Rajendra; Carmo-Fonseca, Maria; Kumar, Rakesh

    2014-01-01

    The Global Cancer Genomics Consortium (GCGC) is a cohesive network of oncologists, cancer biologists and structural and genomic experts residing in six institutions from Portugal, United Kingdom, Japan, India, and United States. The team is using its combined resources and infrastructures to address carefully selected, shared, burning questions in cancer medicine. The Third Annual Symposium was organized by the Institute of Molecular Medicine, Lisbon Medical School, Lisbon, Portugal, from September 18 to 20, 2013. To highlight the benefits and limitations of recent advances in cancer genomics, the meeting focused on how to better translate our gains in oncogenomics to cancer patients while engaging our younger colleagues in cancer medicine at-large. Over two hundreds participants actively discussed some of the most recent advances in the areas cancer genomics, transcriptomics and cancer system biology and how to best apply such knowledge to cancer therapeutics, biomarkers discovery and drug development, and an essential role played by bio-banking throughout the process. In brief, the GCGC symposium provided a platform for students and translational cancer researchers to share their excitement and worries as we are beginning to translate the gains in oncogenomics to a better cancer patient treatment.

  15. Turning the Tables on Assistance: Elderly as Care Providers.

    ERIC Educational Resources Information Center

    Prohaska, Thomas R.; McAuley, William J.

    Past attention has focused on the role of the elderly as recipients rather than receivers of help. To examine the proportion and characteristics of older community residents involved in care-giving, data used were from the 1979 "Statewide Survey of Older Virginians," aged 60 and older (N=2,146). Of the 10 types of helping activities studied, 5…

  16. [Pregnancy in adolescence description and analysis of care provided].

    PubMed

    de Caminha, NĂĄira Oliveira; Freitas, Lydia Vieira; Lima, ThaĂ­s Marques; Gomes, Linicarla FabĂ­ole de Souza; Herculano, Marta Maria Soares; Damasceno, Ana Kelve de Castro

    2012-09-01

    This work is aimed at describing and analyzing prenatal care to teenage women through the Brazilian Prenatal and Birth Humanization Program (BPBHP). It's a descriptive quantitative study conducted between March and July 2009 based on a form and interview with 200 teenage women during the postpartum period in a maternity ward of Sistema Unico de SatĂșde (Brazilian Unified Health System), which is considered a reference in obstetric care. The young women received prenatal care through the public service (96.4%) which began during the first trimester (47.4%), they didn't have the minimum medical appointments required (52.6%), took iron supplements (96.9%), received tetanus immunization (80.5%) and didn't have enough orientation (46.0%). The laboratory tests were performed during their first medical appointment (80.0%), but only a third were repeated in the third trimester. Therefore, the BPBHP doesn't meet all the standards set by the MinistĂ©io da SaĂșde (Ministry of Health), and there are improvements to be made in the early service phase, ongoing care, demand for second exam samples and availability of orientation. PMID:23405812

  17. Rural and Urban Hospitals' Role in Providing Inpatient Care, 2010

    MedlinePlus

    ... once in NHDS. Because of the complex multistage design of NHDS, the survey data must be inflated or weighted to produce national estimates. Estimates of inpatient care presented in this report exclude newborns. More details about the design of NHDS have been published elsewhere ( 16 ). Differences ...

  18. Finding Medical Care for Colorectal Cancer Symptoms: Experiences among Those Facing Financial Barriers

    ERIC Educational Resources Information Center

    Thomson, Maria D.; Siminoff, Laura A.

    2015-01-01

    Financial barriers can substantially delay medical care seeking. Using patient narratives provided by 252 colorectal cancer patients, we explored the experience of financial barriers to care seeking. Of the 252 patients interviewed, 84 identified financial barriers as a significant hurdle to obtaining health care for their colorectal cancer


  19. Perspectives from the frontlines: palliative care providers' expectations of Canada's compassionate care benefit programme.

    PubMed

    Giesbrecht, Melissa; Crooks, Valorie A; Williams, Allison

    2010-11-01

    Recognising their valuable role as key informants, this study examines the perspectives of front-line palliative care providers (FLPCP) regarding a social benefit programme in Canada designed to support family caregivers at end-of-life, namely the Compassionate Care Benefit (CCB). The CCB's purpose is to provide income assistance and job security to family caregivers who take temporary leave from employment to care for a dying family member. Contributing to an evaluative study that aims to provide policy-relevant recommendations about the CCB, this analysis draws on semi-structured interviews undertaken in 2007/2008 with FLPCPs (n = 50) from across Canada. Although participants were not explicitly asked during interviews about their expectations of the CCB, thematic content analysis revealed 'expectations' as a key finding. Through participants' discussions of their knowledge of and familiarity with the CCB, specific expectations were identified and grouped into four categories: (1) temporal; (2) financial; (3) informational; and (4) administrative. Findings demonstrate that participants expect the CCB to provide: (1) an adequate length of leave time from work, which is reflective of the uncertain nature of caregiving at end-of-life; (2) adequate financial support; (3) information on the programme to be disseminated to FLPCPs so that they may share it with others; and (4) a simple, clear, and quick application process. FLPCPs hold unique expertise, and ultimately the power to shape uptake of the CCB. As such, their expectations of the CCB contribute valuable knowledge from which relevant policy recommendations can be made to better meet the needs of family caregivers and FLPCPs alike. PMID:20584086

  20. Medicaid Personal Care Services for Children with Intellectual Disabilities: What Assistance Is Provided? When Is Assistance Provided?

    ERIC Educational Resources Information Center

    Elliot, Timothy R.; Patnaik, Ashweeta; Naiser, Emily; Fournier, Constance J.; McMaughan, Darcy K.; Dyer, James A.; Phillips, Charles D.

    2014-01-01

    We report on the nature and timing of services provided to children with an intellectual disability (ID) identified by a new comprehensive assessment and care planning tool used to evaluate children's needs for Medicaid Personal Care Services (PCS) in Texas. The new assessment procedure resulted from a legal settlement with the advocacy


  1. Need for Global Partnership in Cancer Care: Perceptions of Cancer Care Researchers Attending the 2010 Australia and Asia Pacific Clinical Oncology Research Development Workshop

    PubMed Central

    Lyerly, H. Kim; Abernethy, Amy P.; Stockler, Martin R.; Koczwara, Bogda; Aziz, Zeba; Nair, Reena; Seymour, Lesley

    2011-01-01

    Purpose: To understand the diversity of issues and the breadth of growing clinical care, professional education, and clinical research needs of developing countries, not typically represented in Western or European surveys of cancer care and research. Methods: A cross-sectional survey was conducted of the attendees at the 2010 Australia and Asia Pacific Clinical Oncology Research Development workshop (Queensland, Australia) about the most important health care questions facing the participant's home countries, especially concerning cancer. Results: Early-career oncologists and advanced oncology trainees from a region of the world containing significant low- and middle-income countries reported that cancer is an emerging health priority as a result of aging of the population, the impact of diet and lifestyle, and environmental pollution. There was concern about the capacity of health care workers and treatment facilities to provide cancer care and access to the latest cancer therapies and technologies. Although improving health care delivery was seen as a critical local agenda priority, focusing on improved cancer research activities in this select population was seen as the best way that others outside the country could improve outcomes for all. Conclusions: The burden of cancer will increase dramatically over the next 20 years, particularly in countries with developing and middle-income economies. Cancer research globally faces significant barriers, many of which are magnified in the developing country setting. Overcoming these barriers will require partnerships sensitive and responsive to both local and global needs. PMID:22211131

  2. A value framework in head and neck cancer care.

    PubMed

    de Souza, Jonas A; Seiwert, Tanguy Y

    2014-01-01

    The care of head and neck squamous cell carcinoma has greatly evolved over the past 30 years. From single modality to a multidisciplinary care, there has also been a concurrent increase in treatment intensity, resulting, at many times, in more zealous regimens that patients must endure. In this article, we apply Porter's value model as a framework to balance survival, toxicities, cost, and trade-offs from a patient's perspective in head and neck cancer. This model defines value as the health outcome per dollar achieved. Domains and outcomes that are important to patients, including not only survival or short-term quality of life, but also functional outcomes, recovery, sustainability of recovery, and the lasting consequences of therapy are included in this framework. Other outcomes that are seldom measured in head and neck cancer, such as work disability and financial toxicities, are also included and further discussed. Within this value model and based on evidence, we further discuss de-escalation of care, intensity-modulated radiation therapy, newer surgical methods, and enhancements in the process of care as potential approaches to add value for patients. Finally, we argue that knowing the patient's preferences is essential in the value discussion, as the attribute that will ultimately provide the most value to the individual patient with head and neck cancer. PMID:24857117

  3. Uncompensated care provided by private practice physicians in Florida.

    PubMed Central

    Kilpatrick, K E; Miller, M K; Dwyer, J W; Nissen, D

    1991-01-01

    While a great deal of attention has been paid in recent years to establishing the magnitude and characteristics of uncompensated care in hospitals, comparatively little research has been undertaken to study physician uncompensated care. This article reports the results of a prospective patient-specific study of uncompensated care in Florida. Of 4,042 cases examined, 26.2 percent had charges voluntarily reduced below the usual and customary charge at the time of service. However, only 13.5 percent of those reductions were attributed to charity. Overall, 10.4 percent of the total billed amount was left unresolved. When payment source was considered, it was found that self-pay patients accounted for 30.6 percent of the cases but accounted for 52.0 percent of the unresolved amounts. Further analysis indicated that the self-pay patients were 35.5 times more likely to leave an outstanding balance than individuals with some type of insurance coverage. Odds of unresolved balances were also calculated as a function of income, specialty type, practice size, and type of visit. PMID:1669686

  4. Providing primary health care through integrated microfinance and health services in Latin America.

    PubMed

    Geissler, Kimberley H; Leatherman, Sheila

    2015-05-01

    The simultaneous burdens of communicable and chronic non-communicable diseases cause significant morbidity and mortality in middle-income countries. The poor are at particular risk, with lower access to health care and higher rates of avoidable mortality. Integrating health-related services with microfinance has been shown to improve health knowledge, behaviors, and access to appropriate health care. However, limited evidence is available on effects of fully integrating clinical health service delivery alongside microfinance services through large scale and sustained long-term programs. Using a conceptual model of health services access, we examine supply- and demand-side factors in a microfinance client population receiving integrated services. We conduct a case study using data from 2010 to 2012 of the design of a universal screening program and primary care services provided in conjunction with microfinance loans by Pro Mujer, a women's development organization in Latin America. The program operates in Argentina, Bolivia, Mexico, Nicaragua, and Peru. We analyze descriptive reports and administrative data for measures related to improving access to primary health services and management of chronic diseases. We find provision of preventive care is substantial, with an average of 13% of Pro Mujer clients being screened for cervical cancer each year, 21% receiving breast exams, 16% having a blood glucose measurement, 39% receiving a blood pressure measurement, and 46% having their body mass index calculated. This population, with more than half of those screened being overweight or obese and 9% of those screened having elevated glucose measures, has major risk factors for diabetes, high blood pressure, and cardiovascular disease without intervention. The components of the Pro Mujer health program address four dimensions of healthcare access: geographic accessibility, availability, affordability, and acceptability. Significant progress has been made to meet basic health needs, but challenges remain to ensure that health care provided is of reliable quality to predictably improve health outcomes over time. PMID:25792337

  5. A National Initiative for Women and Healthcare Providers: CDC’s Inside Knowledge: Get the Facts About Gynecologic Cancer Campaign

    PubMed Central

    Rim, Sun Hee; Polonec, Lindsey; Stewart, Sherri L.; Gelb, Cynthia A.

    2015-01-01

    The Inside Knowledge: Get the Facts About Gynecologic Cancer campaign raises awareness of the five main types of gynecologic cancer: cervical, ovarian, uterine, vaginal, and vulvar. It encourages women to pay attention to their bodies and know what is normal for them so they can recognize the warning signs of gynecologic cancers and seek medical care. This report provides an overview of the development of this national campaign. PMID:21933006

  6. Family Child Care Providers' Perspectives regarding Effective Professional Development and Their Role in the Child Care System: A Qualitative Study

    ERIC Educational Resources Information Center

    Lanigan, Jane D.

    2011-01-01

    This study examines family child care providers' perspectives regarding effective professional development and their role in the early learning and care system. Four focus groups were conducted annually for 3 years involving a total of 54 licensed family child care providers. Supportive social relationships emerged as an important dimension of


  7. Children with Special Needs in Family Day Care Homes: A Handbook for Family Day Care Home Providers.

    ERIC Educational Resources Information Center

    de la Brosse, Beatrice

    The guide offers information to family day care providers who desire to expand their knowledge of early childhood development in order to work with infants and young children with special needs in their day care settings. The first of four chapters answers common questions and concerns of day care providers, describes children with special needs


  8. Trauma-Informed Medical Care: A CME Communication Training for Primary Care Providers

    PubMed Central

    Green, Bonnie L.; Saunders, Pamela A.; Power, Elizabeth; Dass-Brailsford, Priscilla; Schelbert, Kavitha Bhat; Giller, Esther; Wissow, Larry; Hurtado-de-Mendoza, Alejandra; Mete, Mihriye

    2014-01-01

    BACKGROUND AND OBJECTIVES: Trauma exposure predicts mental disorders, medical morbidity, and healthcare costs. Yet trauma-related impacts have not received sufficient attention in primary care provider (PCP) training programs. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), and evaluated its efficacy. METHODS: We randomized PCPs to training or wait-list (delay) conditions; waitlist groups were trained after reassessment. The primary outcome assessing newly acquired skills was a patient-centeredness score derived from Roter Interactional Analysis System ratings of 90 taped visits between PCPs and standardized patients (SPs). PCPs were Family Medicine residents (n=17) and community physicians (n=13; 83% Family Medicine specialty), from four sites in the Washington DC metropolitan area. RESULTS: Immediately trained PCPs trended toward a larger increase in patient-centeredness than did the delayed PCPs (p < .09), with a moderate effect size (.66). The combined trained PCP groups showed a significant increase in patient-centeredness pre to post training, p < .01, Cohen’s D = .61. CONCLUSIONS: This is a promising approach to supporting relationship-based trauma-informed care among PCPs to help promote better patient health and higher compliance with medical treatment plans. PMID:25646872

  9. Developing NaviCanPlan: A Mobile Web Resource Locator for Cancer Providers and Survivors.

    PubMed

    Vollmer Dahlke, Deborah; Kellstedt, Debra; Weinberg, Armin D

    2015-12-01

    As of January, 2012, an estimated 13.7 million persons are living as cancer survivors. This population is expected to grow to nearly 18 million by 2022. While their treatment may be considered successful, many cancer survivors experience long-term physical, emotional, and psychosocial late effects of treatment. Our focus was on community-based cancer care-both rural and urban-as almost 90% of cancer care occurs in community settings, where a full complement of supportive healthcare professionals may not be available. This study describes the results of stakeholder engagement and the feedback processes used to create NaviCanPlan, a mobile web resource locator designed to educate and inform both providers and survivors in finding health-related services, often in noncancer center settings. Individual interviews with survivors and providers regarding resource needs to address a variety of physical and psychosocial late effects were supplemented with site visits, web-based polling, and webinars discussions. Overall, the results indicated a need for a programmatic approach to providing education about community, medical, and nonmedical resources for providers and survivors. Design and content criteria for a web-based mobile resource locator were defined, articulated, and implemented. PMID:25519250

  10. Breast Cancer Survivorship Care: Targeting a Colorectal Cancer Education Intervention.

    PubMed

    Homan, Sherri G; Yun, Shumei; Stewart, Bob R; Armer, Jane M

    2015-01-01

    Breast cancer survivors are at risk of developing a second primary cancer. Colorectal cancer (CRC) is one of the leading second primary cancers, and it is often preventable. We developed a multi-component educational tool to inform and encourage women breast cancer survivors to engage in CRC screening. To assess the strengths and weakness of the tool and to improve the relevancy to the target audience, we convened four focus groups of women breast cancer survivors in Missouri. We also assessed the potential impact of the tool on the knowledge, attitudes, and beliefs regarding CRC and collected information on the barriers to CRC screening through pre- and post-focus groups' questionnaires. A total of 43 women breast cancer survivors participated and provided very valuable suggestions on design and content to update the tool. Through the process and comparing pre- and post-focus group assessments, a significantly higher proportion of breast cancer survivors strongly agreed or agreed that CRC is preventable (78.6% vs. 96.9%, p = 0.02) and became aware that they were at a slightly increased risk for CRC (18.6% vs. 51.7%, p = 0.003). The most cited barrier was the complexity of preparation for colonoscopy. PMID:26258794

  11. Breast Cancer Survivorship Care: Targeting a Colorectal Cancer Education Intervention

    PubMed Central

    Homan, Sherri G.; Yun, Shumei; Stewart, Bob R.; Armer, Jane M.

    2015-01-01

    Breast cancer survivors are at risk of developing a second primary cancer. Colorectal cancer (CRC) is one of the leading second primary cancers, and it is often preventable. We developed a multi-component educational tool to inform and encourage women breast cancer survivors to engage in CRC screening. To assess the strengths and weakness of the tool and to improve the relevancy to the target audience, we convened four focus groups of women breast cancer survivors in Missouri. We also assessed the potential impact of the tool on the knowledge, attitudes, and beliefs regarding CRC and collected information on the barriers to CRC screening through pre- and post-focus groups’ questionnaires. A total of 43 women breast cancer survivors participated and provided very valuable suggestions on design and content to update the tool. Through the process and comparing pre- and post-focus group assessments, a significantly higher proportion of breast cancer survivors strongly agreed or agreed that CRC is preventable (78.6% vs. 96.9%, p = 0.02) and became aware that they were at a slightly increased risk for CRC (18.6% vs. 51.7%, p = 0.003). The most cited barrier was the complexity of preparation for colonoscopy. PMID:26258794

  12. An explorative study of experiences of healthcare providers posing as simulated care receivers in a 'care-ethical' lab.

    PubMed

    Vanlaere, Linus; Timmermann, Madeleine; Stevens, Marleen; Gastmans, Chris

    2012-01-01

    In recent approaches to ethics, the personal involvement of health care providers and their empathy are perceived as important elements of an overall ethical ability. Experiential working methods are used in ethics education to foster, inter alia, empathy. In 2008, the care-ethics lab 'sTimul' was founded in Flanders, Belgium, to provide training that focuses on improving care providers' ethical abilities through experiential working simulations. The curriculum of sTimul focuses on empathy sessions, aimed at care providers' empathic skills. The present study provides better insight into how experiential learning specifically targets the empathic abilities of care providers. Providing contrasting experiences that affect the care providers' self-reflection seems a crucial element in this study. Further research is needed to provide more insight into how empathy leads to long-term changes in behaviour. PMID:22140188

  13. Pancreatic cancer-improved care achievable.

    PubMed

    Buanes, Trond A

    2014-08-14

    Pancreatic adenocarcinoma is one of the most aggressive cancers, and the decline in mortality observed in most other cancer diseases, has so far not taken place in pancreatic cancer. Complete tumor resection is a requirement for potential cure, and the reorganization of care in the direction of high patient-volume centers, offering multimodal treatment, has improved survival and Quality of Life. Also the rates and severity grade of complications are improving in high-volume pancreatic centers. One of the major problems worldwide is underutilization of surgery in resectable pancreatic cancer. Suboptimal investigation, follow up and oncological treatment outside specialized centers are additional key problems. New chemotherapeutic regimens like FOLFIRINOX have improved survival in patients with metastatic disease, and different adjuvant treatment options result in well documented survival benefit. Neoadjuvant treatment is highly relevant, but needs further evaluation. Also adjuvant immunotherapy, in the form of vaccination with synthetic K-Ras-peptides, has been shown to produce long term immunological memory in cytotoxic T-cells in long term survivors. Improvement in clinical outcome is already achievable and further progress is expected in the near future for patients treated with curative as well as palliative intention. PMID:25132756

  14. Mind-body practices in cancer care.

    PubMed

    Chaoul, Alejandro; Milbury, Kathrin; Sood, Anil K; Prinsloo, Sarah; Cohen, Lorenzo

    2014-12-01

    Being diagnosed with a life-threatening disease such as cancer and undergoing treatment can cause unwanted distress and interferes with quality of life. Uncontrolled stress can have a negative effect on a number of biological systems and processes leading to negative health outcomes. While some distress is normal, it is not benign and must be addressed, as failure to do so may compromise health and QOL outcomes. We present the evidence for the role of stress in cancer biology and mechanisms demonstrating how distress is associated with worse clinical outcomes. The National Comprehensive Cancer Network states that all patients be screened with the single-item distress thermometer and to also indicate the source of distress and to get appropriate referral. In addition to the many conventional approaches for managing distress from the fields of psychology and psychiatry, many patients are seeking strategies to manage their distress that are outside conventional medicine such as mind-body techniques. Mind-body techniques such as meditation, yoga, tai chi, and qigong have been found to lower distress and lead to improvements in different aspects of quality of life. It is essential that the standard of care in oncology include distress screening and the delivery of different techniques to help patients manage the psychosocial challenges of diagnosis and treatment of cancer. PMID:25325936

  15. Mind-Body Practices in Cancer Care

    PubMed Central

    Chaoul, Alejandro; Milbury, Kathrin; Sood, Anil K.; Prinsloo, Sarah; Cohen, Lorenzo

    2015-01-01

    Being diagnosed with a life threatening disease such as cancer and undergoing treatment can cause unwanted distress and interferes with quality of life. Uncontrolled stress can have a negative effect on a number of biological systems and processes leading to negative health outcomes. While some distress is normal, it is not benign and must be addressed, as failure to do so may compromise health and QOL outcomes. We present the evidence for the role of stress in cancer biology and mechanisms demonstrating how distress is associated with worse clinical outcomes. The National Comprehensive Cancer Network states that all patients be screened with the single-item Distress Thermometer and to also indicate the source of distress and to get appropriate referral. In addition to the many conventional approaches for managing distress from the fields of psychology and psychiatry, many patients are seeking strategies to manage their distress that are outside conventional medicine such as mind-body techniques. Mind-body techniques such as meditation, yoga, tai chi, and qigong have been found to lower distress and lead to improvements in different aspects of quality of life. It is essential that the standard of care in oncology include distress screening and the delivery of different techniques to help patients manage the psychosocial challenges of diagnosis and treatment of cancer. PMID:25325936

  16. Pancreatic cancer-improved care achievable

    PubMed Central

    Buanes, Trond A

    2014-01-01

    Pancreatic adenocarcinoma is one of the most aggressive cancers, and the decline in mortality observed in most other cancer diseases, has so far not taken place in pancreatic cancer. Complete tumor resection is a requirement for potential cure, and the reorganization of care in the direction of high patient-volume centers, offering multimodal treatment, has improved survival and Quality of Life. Also the rates and severity grade of complications are improving in high-volume pancreatic centers. One of the major problems worldwide is underutilization of surgery in resectable pancreatic cancer. Suboptimal investigation, follow up and oncological treatment outside specialized centers are additional key problems. New chemotherapeutic regimens like FOLFIRINOX have improved survival in patients with metastatic disease, and different adjuvant treatment options result in well documented survival benefit. Neoadjuvant treatment is highly relevant, but needs further evaluation. Also adjuvant immunotherapy, in the form of vaccination with synthetic K-Ras-peptides, has been shown to produce long term immunological memory in cytotoxic T-cells in long term survivors. Improvement in clinical outcome is already achievable and further progress is expected in the near future for patients treated with curative as well as palliative intention. PMID:25132756

  17. [Collaboration with specialists and regional primary care physicians in emergency care at acute hospitals provided by generalists].

    PubMed

    Imura, Hiroshi

    2016-02-01

    A role of acute hospitals providing emergency care is becoming important more and more in regional comprehensive care system led by the Ministry of Health, Labour and Welfare. Given few number of emergent care specialists in Japan, generalists specializing in both general internal medicine and family practice need to take part in the emergency care. In the way collaboration with specialists and regional primary care physicians is a key role in improving the quality of emergency care at acute hospitals. A pattern of collaborating function by generalists taking part in emergency care is categorized into four types. PMID:26915241

  18. Improving access to cancer guidelines: feedback from health care professionals

    PubMed Central

    Sahota, I.S.; Kostaras, X.; Hagen, N.A.

    2015-01-01

    Purpose We examined access to locally developed and other available clinical practice guidelines (cpgs) for the management of cancer and evaluated how to improve uptake. Methods A 12-question online survey was administered to 772 members of 12 multidisciplinary tumour teams in a Canadian provincial oncology program. The teams are composed of physicians, surgeons, nurses, allied health professionals, and researchers involved in the provision of cancer care across the province. Many of these individuals construct or provide input into the provincial cpgs. The questionnaires were administered online and were completed voluntarily. Results Responses were received from 232 individuals, a response rate of 30.1%. Most respondents (75.1%) indicated they actively referenced cpgs for cancer treatment. Of the 177 respondents who identified barriers to cpg access, 24.9% said that the cause was being too busy; 24.3% and 22.6% cited the user-unfriendliness of the Web site and a lack of awareness about the cpgs. When asked about innovative changes that could be made to improve access, the creation of cpg summary documents was identified as the most effective change (46.3%). The creation of summary documents was ranked highest by physicians, surgeons, and nurses. Conclusions Clinical practice guidelines are important tools for standardizing treatment protocols and improving outcomes in health care systems, but support for their use is variable among health care professionals. We have identified barriers to—and potential mitigating strategies for—more widespread access to cpgs by the various health professions involved in cancer care. Local creation of succinct and easily accessible cpgs was identified as the single most effective way to enhance access by health care professionals. PMID:26715871

  19. Influenza vaccination and decisional conflict among regulated and unregulated direct nursing care providers in long-term-care homes.

    PubMed

    Sullivan, Shannon M; Pierrynowski-Gallant, Donna; Chambers, Larry; O'Connor, Annette; Bowman, Sherry; McNeil, Shelly; Strang, Robert; Knoefel, Frank

    2008-02-01

    The purpose of this study was to determine whether direct nursing care providers have decisional conflict about receiving influenza vaccinations and characteristics associated with decisional conflict. The researchers used a self-administered questionnaire mailed to direct nursing care providers in two long-term-care organizations. Most direct nursing care providers in both organizations (80% and 93%, respectively) intended to get the influenza vaccine. Unregulated direct nursing care providers had more decisional conflict than regulated providers, especially related to feeling uninformed about the pros and cons of influenza vaccination. Unclear valuing of the pros and cons of influenza vaccination was related to the age of the direct care providers in both organizations. Decisional conflict and influenza vaccination practices may be determined, in part, by age and by the culture of a health care organization. A decision aid to improve knowledge and clarify values may improve decision quality and increase influenza vaccination rates. PMID:18306650

  20. Integrating genetic and genomic information into effective cancer care in diverse populations

    PubMed Central

    Fashoyin-Aje, L.; Sanghavi, K.; Bjornard, K.; Bodurtha, J.

    2013-01-01

    This paper provides an overview of issues in the integration of genetic (related to hereditary DNA) and genomic (related to genes and their functions) information in cancer care for individuals and families who are part of health care systems worldwide, from low to high resourced. National and regional cancer plans have the potential to integrate genetic and genomic information with a goal of identifying and helping individuals and families with and at risk of cancer. Healthcare professionals and the public have the opportunity to increase their genetic literacy and communication about cancer family history to enhance cancer control, prevention, and tailored therapies. PMID:24001763

  1. Primary care professionals providing non-urgent care in hospital emergency departments

    PubMed Central

    Khangura, Jaspreet K; Flodgren, Gerd; Perera, Rafael; Rowe, Brian H; Shepperd, Sasha

    2014-01-01

    Background In many countries emergency departments (EDs) are facing an increase in demand for services, long-waits and severe crowding. One response to mitigate overcrowding has been to provide primary care services alongside or within hospital EDs for patients with non-urgent problems. It is not known, however, how this impacts the quality of patient care, the utilisation of hospital resources, or if it is cost-effective. Objectives To assess the effects of locating primary care professionals in the hospital ED to provide care for patients with non-urgent health problems, compared with care provided by regular Emergency Physicians (EPs), Search methods We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialized register; Cochrane Central Register of Controlled Trials (The Cochrane library, 2011, Issue 4), MEDLINE (1950 to March 21 2012); EMBASE (1980 to April 28 2011); CINAHL (1980 to April 28 2011); PsychINFO (1967 to April 28 2011); Sociological Abstracts (1952 to April 28 2011); ASSIA (1987 to April 28 2011); SSSCI (1945 to April 28 2011); HMIC (1979 to April 28 2011), sources of unpublished literature, reference lists of included papers and relevant systematic reviews. We contacted experts in the field for any published or unpublished studies, and hand searched ED conference abstracts from the last three years. Selection criteria Randomised controlled trials, non-randomised studies, controlled before and after studies and interrupted time series studies that evaluated the effectiveness of introducing primary care professionals to hospital EDs to attend to non-urgent patients, as compared to the care provided by regular EPs. Data collection and analysis Two reviewers independently extracted data and assessed the risk of bias for each included study. We contacted authors of included studies to obtain additional data. Dichotomous outcomes are presented as risk ratios (RR) with 95% confidence intervals (CIs) and continuous outcomes are presented as mean differences (MD) with 95% CIs. Pooling was not possible due to heterogeneity. Main results Three non randomised controlled studies involving a total of 11 203 patients, 16 General Practioners (GPs), and 52 EPs, were included. These studies evaluated the effects of introducing GPs to provide care to patients with non-urgent problems in the ED, as compared to EPs for outcomes such as resource use. The quality of evidence for all outcomes in this review was low, primarily due to the non-randomised design of included studies. The outcomes investigated were similar across studies; however there was high heterogeneity (I2>86%). Differences across studies included the triage system used, the level of expertise and experience of the medical practitioners and type of hospital (urban teaching, suburban community hospital). Two of the included studies report that GPs used significantly fewer healthcare resources than EPs, with fewer blood tests (RR 0.22; 95%CI: 0.14 to 0.33; N=4641; RR 0.35; 95%CI 0.29 to 0.42; N=4684), x-rays (RR 0.47; 95% CI 0.41 to 0.54; N=4641; RR 0.77 95% CI 0.72 to 0.83; N=4684), admissions to hospital (RR 0.33; 95% CI 0.19 to 0.58; N=4641; RR 0.45; 95% CI 0.36 to 0.56; N=4684) and referrals to specialists (RR 0.50; 95% CI 0.39 to 0.63; N=4641; RR 0.66; 95% CI 0.60 to 0.73; N=4684). One of the two studies reported no statistically significant difference in the number of prescriptions made by GPs compared with EPs, (RR 0.95 95% CI 0.88 to 1.03; N=4641), while the other showed that GPs prescribed significantly more medications than EPs (RR 1.45 95% CI 1.35 to 1.56; N=4684). The results from these two studies showed marginal cost savings from introducing GPs in hospital EDs. The third study (N=1878) failed to identify a significant difference in the number of blood tests ordered (RR 0.96; 95% CI 0.76 to 1.2), x-rays (RR 1.07; 95%CI 0.99 to 1.15), or admissions to hospital (RR 1.11; 95% CI 0.70 to 1.76), but reported a significantly greater number of referrals to specialists (RR 1.21; 95% CI 1.09 to 1.33) and prescriptions (RR 1.12; 95% CI 1.01 to 1.23) made by GPs as compared with EPs. No data were reported on patient wait-times, length of hospital stay, or patient outcomes, including adverse effects or mortality. Authors’ conclusions Overall, the evidence from the three included studies is weak, as results are disparate and neither safety nor patient outcomes have been examined. There is insufficient evidence upon which to draw conclusions for practice or policy regarding the effectiveness and safety of care provided to non-urgent patients by GPs versus EPs in the ED to mitigate problems of overcrowding, wait-times and patient flow. PMID:23152213

  2. How Do Health Care Providers Diagnose Preeclampsia, Eclampsia, and HELLP Syndrome?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose preeclampsia, eclampsia, and HELLP syndrome? Skip ... social media links Share this: Page Content A health care provider should check a pregnant woman's blood pressure ...

  3. Talk With Your Health Care Provider About Taking Aspirin to Prevent Heart Attack

    MedlinePlus

    ... Heart and Circulation For Men Talk With Your Health Care Provider About Taking Aspirin to Prevent Heart Attacks ... strokes. Please see the brochure Talk with Your Health Care Provider About Taking Aspirin to Prevent Strokes for ...

  4. Talk With Your Health Care Provider About Taking Aspirin to Prevent Strokes

    MedlinePlus

    ... Heart and Circulation For Women Talk With Your Health Care Provider About Taking Aspirin to Prevent Strokes Did ... attacks. Please see the brochure Talk with Your Health Care Provider About Taking Aspirin to Prevent Heart Attacks ...

  5. How Do Health Care Providers Diagnose Precocious Puberty and Delayed Puberty?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose precocious puberty & delayed puberty? Skip sharing ... and analyzing his or her medical history, a health care provider may perform tests to diagnose precocious puberty, ...

  6. Choosing a Primary Health Care Provider (PCP): A Guide for Young Men

    MedlinePlus

    ... Conditions Nutrition & Fitness Emotional Health Choosing a Primary Health Care Provider (PCP): General Information Posted under Health Guides . ... needs. How do I find the names of health care providers? Here are some ways to find a ...

  7. Choosing a Primary Health Care Provider (PCP): A Guide for Young Women

    MedlinePlus

    ... Conditions Nutrition & Fitness Emotional Health Choosing a Primary Health Care Provider (PCP): General Information Posted under Health Guides . ... needs. How do I find the names of health care providers? You should first make a list of ...

  8. Evaluation of health care services provided for older adults in primary health care centers and its internal environment

    PubMed Central

    Alhamdan, Adel A.; Alshammari, Sulaiman A.; Al-Amoud, Maysoon M.; Hameed, Tariq A.; Al-Muammar, May N.; Bindawas, Saad M.; Al-Orf, Saada M.; Mohamed, Ashry G.; Al-Ghamdi, Essam A.; Calder, Philip C.

    2015-01-01

    Objectives: To evaluate the health care services provided for older adults by primary health care centers (PHCCs) in Riyadh, Kingdom of Saudi Arabia (KSA), and the ease of use of these centers by older adults. Methods: Between October 2013 and January 2014, we conducted a descriptive cross-sectional study of 15 randomly selected PHCCs in Riyadh City, KSA. The evaluation focused on basic indicators of clinical services offered and factors indicative of the ease of use of the centers by older adults. Evaluations were based upon the age-friendly PHCCs toolkit of the World Health Organization. Results: Coverage of basic health assessments (such as blood pressure, diabetes, and blood cholesterol) was generally good. However, fewer than half of the PHCCs offered annual comprehensive screening for the common age-related conditions. There was no screening for cancer. Counseling on improving lifestyle was provided by most centers. However, there was no standard protocol for counseling. Coverage of common vaccinations was poor. The layout of most PHCCs and their signage were good, except for lack of Braille signage. There may be issues of access of older adults to PHCCs through lack of public transport, limited parking opportunities, the presence of steps, ramps, and internal stairs, and the lack of handrails. Conclusions: Clinical services and the internal environment of PHCCs can be improved. The data will be useful for health-policy makers to improve PHCCs to be more age-friendly. PMID:26318467

  9. Talk with Your Health Care Provider about High Cholesterol

    MedlinePlus

    ... you do? Always ask your provider what your cholesterol numbers are and write them down. Discuss these ... provider may prescribe medicine to help lower your cholesterol. y y Take your medicine every day, or ...

  10. Sun-care product advertising in parenting magazines: what information does it provide about sun protection?

    PubMed

    Kang, Hannah; Walsh-Childers, Kim

    2014-01-01

    This study analyzed the content of sun-care product advertisements in five major U.S. parenting magazines with high circulation: Family Circle, Parents, Family Fun, Parenting (Early Years), and Parenting (School Years). The study examined what information sun-care product advertisements tell parents about skin cancer prevention and about sunscreen use for themselves or for their children based on the Health Belief Model concepts of perceived benefits and perceived barriers. Results showed that the most commonly mentioned benefit of the product was that it blocks ultraviolet A (UVA) and ultraviolet B (UVB) rays. One-third of the ads promoted the product's effectiveness in overcoming four of the barriers that prevent people from using sunscreens: eye irritation, skin irritation, an unpleasant smell, and the need to reapply sunscreen too often or after physical activity. However, only a few of the ads provided information about the consequences of unprotected sun exposure or mentioned methods of sun protection or skin cancer prevention other than sunscreen use. We discuss the implications of these messages for parents' ability to understand correctly how to protect their children from damaging sun exposure. PMID:23066971

  11. It’s who you know: patient-sharing, quality, and costs of cancer survivorship care

    PubMed Central

    Pollack, Craig Evan; Frick, Kevin D.; Herbert, Robert J.; Blackford, Amanda L.; Neville, Bridget A.; Wolff, Antonio C.; Carducci, Michael A; Earle, Craig C.; Snyder, Claire F.

    2014-01-01

    Purpose Cancer survivors frequently receive care from a large number of physicians, creating challenges for coordination. We sought to explore whether cancer survivors whose providers have more patients in common (e.g. shared-patients) tend to have higher quality and lower cost care. Methods We performed a retrospective cohort study of 8661 patients diagnosed with loco-regional breast, prostate, or colorectal cancer. We examined survivorship care from Days 366 to 1095 following their cancer diagnosis. Our primary independent variable was “care density”, a novel metric of the extent to which a patient’s providers share patients with one another. Our outcome measures were health care utilization, quality metrics, and costs. Results In adjusted analyses, we found that patients with high care density—indicating high levels of patient-sharing among their providers—had significantly lower rates of hospitalization (OR 0.87, 95% CI 0.75–1.00) and higher odds of an eye examination for diabetes (OR 1.31, 95%CI 1.03–1.66) compared to patients with low care density. High care density was not associated with emergency department visits, avoidable outcomes, lipid profile following an angina diagnosis, or odds of glycosylated hemoglobin testing for diabetes. Patients with high care density had significantly lower total costs of care over 24 months (Beta coefficient −$2,116, 95%CI −$3107 to −$1125) along with lower inpatient and outpatient costs. Conclusion Cancer survivors treated by physicians who share more patients with one another tend to have some higher aspects of quality and lower cost care. Implications of cancer survivors If validated, care density may be a useful indicator for monitoring care coordination among cancer survivors and potentially targeting interventions that seek to improve care delivery. PMID:24578154

  12. Preventing Overdiagnosis and Overtreatment: Just the Next Step in the Evolution of Breast Cancer Care.

    PubMed

    Mukhtar, Rita A; Wong, Jasmine M; Esserman, Laura J

    2015-06-01

    The problem of overdiagnosis and overtreatment has been highlighted in breast cancer and many other cancer types, most notably prostate cancer. Addressing this problem presents an opportunity to continue the evolution of breast cancer care. Advances in technology, such as molecular subtyping, have increased the understanding of breast cancer biology and the range of associated behavior, and have provided tools that allow greater personalization of treatment. This article identifies 3 areas of breast cancer care where opportunity currently exists to refine management strategies and help decrease overtreatment and overdiagnosis: the use of adjuvant-external beam radiation in invasive breast cancer, the application of aggressive treatment for all ductal carcinoma in situ, and the authors' approach to breast cancer screening. Personalizing treatment based on patient and tumor characteristics holds promise for minimizing harms and maximizing benefits. This approach will allow continual improvement and ultimately result in providing the right treatment for each patient. PMID:26085389

  13. Patient and provider characteristics associated with colorectal, breast, and cervical cancer screening among Asian Americans

    PubMed Central

    Thompson, Caroline A.; Gomez, Scarlett Lin; Chan, Albert; Chan, John K.; McClellan, Sean R.; Chung, Sukyung; Olson, Cliff; Nimbal, Vani; Palaniappan, Latha P.

    2014-01-01

    BACKGROUND Routinely recommended screening for breast, cervical, and colorectal cancers can significantly reduce mortality from these types of cancer, yet screening is underutilized among Asians. Surveys rely on self-report and often are underpowered for analysis by Asian ethnicities. Electronic health records include validated (as opposed to recall-based) rates of cancer screening. In this paper we seek to better understand cancer screening patterns in a population of insured Asian Americans. METHODS We calculated rates of compliance with cervical, breast, and colorectal cancer screening among Asians from an EHR population, and compared them to non-Hispanic whites. We performed multivariable modeling to evaluate potential predictors (at the provider- and patient- level) of screening completion among Asian patients. RESULTS Aggregation of Asian subgroups masked heterogeneity in screening rates. Asian Indians and Native Hawaiians and Pacific Islanders had the lowest rates of screening in our sample, well below that of non-Hispanic whites. In multivariable analyses, screening completion was negatively associated with patient-physician language discordance for mammography (OR:0.81 95% CI:0.71–0.92) and colorectal cancer screening (OR:0.79 CI:0.72–0.87) and positively associated with patient-provider gender concordance for mammography (OR:1.16 CI:1.00–1.34) and cervical cancer screening (OR:1.66 CI:1.51–1.82). Additionally, patient enrollment in online health services increased mammography (OR:1.32 CI:1.20–1.46) and cervical cancer screening (OR:1.31 CI:1.24–1.37). CONCLUSIONS Language- and gender- concordant primary care providers, and culturally tailored online health resources may help improve preventive cancer screening in Asian patient populations. IMPACT This study demonstrates how use of EHR data can inform investigations of primary prevention practices within the healthcare delivery setting. PMID:25368396

  14. Barriers to Cervical Cancer Screening in Rural Kenya: Perspectives from a Provider Survey.

    PubMed

    Rosser, Joelle I; Hamisi, Sabina; Njoroge, Betty; Huchko, Megan J

    2015-08-01

    Although cervical cancer is highly preventable through screening, it remains the number one cause of cancer-related death in Kenyan women due to lack of funding and infrastructure for prevention programs. In 2012, Family AIDS Care and Education Services in partnership with the Kenya Ministry of Health began offering free screening at eleven rural health facilities. We sought to explore why screening coverage remains low at some sites. We examined the barriers to screening through a survey of 106 healthcare staff. The most frequently cited barriers to service delivery included staffing shortages, lack of trained staff, insufficient space, and supply issues. The patient barriers commonly perceived by the staff included inadequate knowledge, wait time, discomfort with male providers, and fear of pain with the speculum exam. Despite multilateral efforts to implement cervical cancer screening, staff face significant challenges to service provision and increased education is needed for both providers and patients. PMID:25677728

  15. Physician Perspectives on Providing Primary Medical Care to Adults with Autism Spectrum Disorders (ASD)

    ERIC Educational Resources Information Center

    Warfield, Marji Erickson; Crossman, Morgan K.; Delahaye, Jennifer; Der Weerd, Emma; Kuhlthau, Karen A.

    2015-01-01

    We conducted in-depth case studies of 10 health care professionals who actively provide primary medical care to adults with autism spectrum disorders. The study sought to understand their experiences in providing this care, the training they had received, the training they lack and their suggestions for encouraging more physicians to provide this…

  16. Primary Care Providers' Perceptions of and Experiences with an Integrated Healthcare Model

    ERIC Educational Resources Information Center

    Westheimer, Joshua M.; Steinley-Bumgarner, Michelle; Brownson, Chris

    2008-01-01

    Objective and Participants: The authors examined the experiences of primary care providers participating in an integrated healthcare service between mental health and primary care in a university health center. In this program, behavioral health providers work collaboratively with primary care providers in the treatment of students. Participants


  17. 76 FR 51381 - Supplemental Awards to Seven Unaccompanied Alien Shelter Care Providers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-18

    ... Care Providers AGENCY: Office of Refugee Resettlement, ACF, HHS. ACTION: The Office of Refugee... Shelter Care Providers. CFDA Number: 93.676. Statutory Authority: Awards announced in this notice are... supplement grants to seven unaccompanied alien shelter care providers for a total of $5,016,218....

  18. Physician Perspectives on Providing Primary Medical Care to Adults with Autism Spectrum Disorders (ASD)

    ERIC Educational Resources Information Center

    Warfield, Marji Erickson; Crossman, Morgan K.; Delahaye, Jennifer; Der Weerd, Emma; Kuhlthau, Karen A.

    2015-01-01

    We conducted in-depth case studies of 10 health care professionals who actively provide primary medical care to adults with autism spectrum disorders. The study sought to understand their experiences in providing this care, the training they had received, the training they lack and their suggestions for encouraging more physicians to provide this


  19. 47 CFR 54.613 - Limitations on supported services for rural health care providers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... health care providers. 54.613 Section 54.613 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers § 54.613 Limitations on supported services for rural health care providers. (a) Upon submitting...

  20. 47 CFR 54.613 - Limitations on supported services for rural health care providers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... health care providers. 54.613 Section 54.613 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers § 54.613 Limitations on supported services for rural health care providers. (a) Upon submitting...

  1. 47 CFR 54.613 - Limitations on supported services for rural health care providers.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... health care providers. 54.613 Section 54.613 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers § 54.613 Limitations on supported services for rural health care providers. (a) Upon submitting...

  2. Virtual Dementia Tour helps sensitize health care providers.

    PubMed

    Beville, P K

    2002-01-01

    A review of the literature on sensitivity training among caregivers for the elderly revealed that no programs focused specifically on the cognitive changes that occur due to aging. Second Wind Dreams, a national nonprofit organization committed to improving society's perception of aging, conducted a study in which degenerative physical symptoms common for this population, such as impaired vision and motor skills, were simulated in a group of 146 subjects who worked in the field of elder care to give them a broader sense of the patient's perspective. Overwhelmingly, participants in the study came away with heightened awareness of the plight of confused elders and a strong sense that the high behavioral expectations caregivers have for dementia patients are unrealistic and need to change. PMID:12083349

  3. Lessons Learned from Home Visiting with Home-Based Child Care Providers

    ERIC Educational Resources Information Center

    McCabe, Lisa A.; Peterson, Shira M.; Baker, Amy C.; Dumka, Marsha; Brach, Mary Jo; Webb, Diana

    2011-01-01

    Caring for Quality and Partners in Family Child Care are home visiting programs designed to improve the quality of home-based child care. This article describes the experiences of two different home visitors to demonstrate how programs such as these can help providers improve the overall quality of care, increase children's development, and lead


  4. Lessons Learned from Home Visiting with Home-Based Child Care Providers

    ERIC Educational Resources Information Center

    McCabe, Lisa A.; Peterson, Shira M.; Baker, Amy C.; Dumka, Marsha; Brach, Mary Jo; Webb, Diana

    2011-01-01

    Caring for Quality and Partners in Family Child Care are home visiting programs designed to improve the quality of home-based child care. This article describes the experiences of two different home visitors to demonstrate how programs such as these can help providers improve the overall quality of care, increase children's development, and lead…

  5. Turning the Lens Inward: Cultural Competence and Providers' Values in Health Care Decision Making

    ERIC Educational Resources Information Center

    Chettih, Mindy

    2012-01-01

    The population of older adults in the United States is growing in size and diversity, presenting challenges to health care providers and patients in the context of health care decision making (DM), including obtaining informed consent for treatment, advance care planning, and deliberations about end-of-life care options. Although existing


  6. Turning the Lens Inward: Cultural Competence and Providers' Values in Health Care Decision Making

    ERIC Educational Resources Information Center

    Chettih, Mindy

    2012-01-01

    The population of older adults in the United States is growing in size and diversity, presenting challenges to health care providers and patients in the context of health care decision making (DM), including obtaining informed consent for treatment, advance care planning, and deliberations about end-of-life care options. Although existing…

  7. Rural Suicide Rates and Availability of Health Care Providers

    ERIC Educational Resources Information Center

    Fiske, Amy; Gatz, Margaret; Hannell, Eric

    2005-01-01

    Suicide rates are higher in rural than in urban areas in the United States. One explanation that is frequently offered is scarcity of health and mental health treatment providers in rural areas. The current study tested whether number of providers per capita would explain differences in urban and rural suicide rates within the counties of


  8. Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study)

    PubMed Central

    Beckett, Kate; Earthy, Sarah; Sleney, Jude; Barnes, Jo; Kellezi, Blerina; Barker, Marcus; Clarkson, Julie; Coffey, Frank; Elder, Georgina; Kendrick, Denise

    2014-01-01

    Objective To explore views of service providers caring for injured people on: the extent to which services meet patients’ needs and their perspectives on factors contributing to any identified gaps in service provision. Design Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers’ views were elicited through semistructured interviews. Data were analysed using thematic analysis. Setting Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. Participants 40 service providers from a range of disciplines. Results Service providers described two distinct models of trauma care: an ‘ideal’ model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a ‘real’ model based on the realities of National Health Service (NHS) practice. Participants’ ‘ideal’ model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, ‘real’ care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients’ needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Conclusions Service providers envisage an ‘ideal’ model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between ‘real’ and ‘ideal’ care. Using service provider views to inform service design and delivery could enhance the quality, patient experience and outcomes of care. PMID:25005598

  9. [Update of breast cancer in Primary Care (III/V)].

    PubMed

    Álvarez Hernåndez, C; Vich Pérez, P; Brusint, B; Cuadrado Rouco, C; Díaz García, N; Robles Díaz, L

    2014-01-01

    Breast cancer is a prevalent disease with implications in all aspects of patientś life, therefore, family doctors must know this pathology in depth, in order to optimize the health care provided to these patients with the best available resources. This series of five articles on breast cancer is based on a review of the scientific literature of the last ten years. This third article will review the clinical context and the staging and prognostic factors of the disease. This summary report aims to provide a global, current and practical review about this problem, providing answers to family doctors and helping them to be by the patients for their benefit throughout their illness. PMID:24953699

  10. Assessing Gynecologic and Breast Cancer Survivors’ Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors)

    PubMed Central

    Hill, Emily K.; Sandbo, Stacey; Abramsohn, Emily; Makelarski, Jennifer; Wroblewski, Kristen; Wenrich, Emily Rose; McCoy, Stacy; Temkin, Sarah M.; Yamada, S. Diane; Lindau, Stacy Tessler

    2010-01-01

    Objectives To identify patterns of female cancer survivors’ interest in receiving care for sexual concerns. Methods Survey and medical record data were collected June 2008 to March 2009 from 261 gynecologic and breast cancer patients. Logistic regression was used to estimate the effect of age and months since treatment on interest in receiving sexual health care. Results Participants’ mean age was 55 years (range 21–88). Only 7% had recently sought medical help for sexual issues, yet 41.6% were interested in receiving care. More than 30% responded that they would be likely to see a physician to address sexual matters and 35% of all women were willing to be contacted if a formal program was offered. When compared to older women (>65 years), younger women (18–47 years) were significantly more likely to report interest in receiving care to address sexual issues (OR 2.94, 95% CI 1.14–7.54), to see a physician to address sexual matters (OR 4.51, 95% CI 1.51–13.43) and more willing to be contacted for a formal program (AOR 5.00, 95% CI 1.63–15.28). Compared to those currently in treatment, women who last received treatment more than 12 months prior were significantly more interested in receiving care (AOR 2.02, 95% CI 1.02–4.01) and more willing to be contacted (AOR 2.49, 95% CI 1.18–5.26). Conclusions More than 40% of survivors expressed interest in receiving sexual health care, but few had ever sought such care. There is an unmet need for attention to sexual concerns among women with gynecologic and breast cancer. PMID:21656742

  11. Vascular Endothelial Growth Factor Inhibitor-Induced Hypertension: Basics for Primary Care Providers

    PubMed Central

    Escalante, Carmen P.; Zalpour, Ali

    2011-01-01

    Frequently, primary care providers continue to manage the overall medical care of cancer patients. With newer and often more potent antitumor agents, patients may present to their local physicians with drug-induced toxicities such as hypertension induced by vascular endothelial growth factor (VEGF) inhibitors. It is imperative that these healthcare providers are aware of basic aspects of this drug class, as its use has increased significantly in the last several years. Uncontrolled or malignant hypertension due to these agents should be recognized readily and treated early to prevent more severe outcomes. This overview provides a brief background on the role of VEGF and angiogenesis in tumor metabolism as well as theories of the mechanism of VEGF inhibitors and hypertension. Helpful clinical practice aspects including the types of inhibitors used in the United States and their pharmacologic characteristics will be discussed. Also, diagnosis and treatment of hypertension induced by vascular endothelial growth factors are reviewed. A summary of key aspects of this drug class and hypertension is included. PMID:21629798

  12. Patient choice, mobility and competition among health care providers.

    PubMed

    Brekke, Kurt R; Gravelle, Hugh; Siciliani, Luigi; Straume, Odd Rune

    2014-01-01

    Policymakers are increasingly designing policies that encourage patient choice and therefore mobility across providers. Since prices are regulated (fixed) in most countries, providers need to compete on quality to attract patients. This chapter reviews the current theoretical and empirical literature on patient choice and quality competition in health markets. The theoretical literature identifies key factors affecting incentives to provide quality. These include: altruistic motives, cost structure, number of providers, demand responsiveness, GP gatekeeping, degree of specialization, profit constraints and soft budgets. We also review the theoretical literature on choice across different countries (e.g. within the EU) or regions within the same countries. The chapter reviews selected empirical studies that investigate whether demand responds to quality and waiting times, the role of patient's mobility and the effect of competition on quality. PMID:24864380

  13. How Do Health Care Providers Diagnose Phenylketonuria (PKU)?

    MedlinePlus

    ... clinical trials, guidance for clinical researchers Health Education Campaigns & Programs Safe to Sleep, Media-Smart Youth, Maternal/Child Health Education Program NICHD Publications Order/print info for the public, providers, educators, researchers Scientific Research Planning Scientific activities, ...

  14. How Do Health Care Providers Diagnose Bacterial Vaginosis (BV)?

    MedlinePlus

    ... clinical trials, guidance for clinical researchers Health Education Campaigns & Programs Safe to Sleep, Media-Smart Youth, Maternal/Child Health Education Program NICHD Publications Order/print info for the public, providers, educators, researchers Scientific Research Planning Scientific activities, ...

  15. How Do Health Care Providers Diagnose Polycystic Ovary Syndrome (PCOS)?

    MedlinePlus

    ... clinical trials, guidance for clinical researchers Health Education Campaigns & Programs Safe to Sleep, Media-Smart Youth, Maternal/Child Health Education Program NICHD Publications Order/print info for the public, providers, educators, researchers Scientific Research Planning Scientific activities, ...

  16. Educational strategies for targeted retention of nonphysician health care providers.

    PubMed Central

    Hafferty, F W; Goldberg, H I

    1986-01-01

    This study examined the impact of a community-based, totally decentralized training program on the likelihood that graduates would establish their first practice within predefined and limited geographic regions. We found that when students in a physician assistant/nurse practitioner program received their preclinical and terminal training (preceptorship) in a region geographically proximate to their home residence, the likelihood that they would establish their first practice in that region was greatly increased. Similar results were found for students who took their preclinical training away from their home region but returned there for terminal training. Three additional training pathways were identified as being associated with markedly lower rates of regionally based graduate retention. Discriminant analysis was used to compare the relative impact of training and personal variables on retention. The educational process itself was found to be the single most important predictor of graduate retention. When structural variables were controlled, personal variables such as marital status, age, or sex had no predictive capabilities. With appropriate attention to the structural components of training--particularly terminal training (preceptorship)--experiences, PAs and NPs can be targeted to specific and relatively focused areas of medical need. These data suggest that several decentralized training strategies exist for physician assistants and nurse practitioners that would contribute to meeting health care delivery needs in chronically underserved areas. PMID:2872189

  17. Benchmarking facilities providing care: An international overview of initiatives

    PubMed Central

    Thonon, Frédérique; Watson, Jonathan; Saghatchian, Mahasti

    2015-01-01

    We performed a literature review of existing benchmarking projects of health facilities to explore (1) the rationales for those projects, (2) the motivation for health facilities to participate, (3) the indicators used and (4) the success and threat factors linked to those projects. We studied both peer-reviewed and grey literature. We examined 23 benchmarking projects of different medical specialities. The majority of projects used a mix of structure, process and outcome indicators. For some projects, participants had a direct or indirect financial incentive to participate (such as reimbursement by Medicaid/Medicare or litigation costs related to quality of care). A positive impact was reported for most projects, mainly in terms of improvement of practice and adoption of guidelines and, to a lesser extent, improvement in communication. Only 1 project reported positive impact in terms of clinical outcomes. Success factors and threats are linked to both the benchmarking process (such as organisation of meetings, link with existing projects) and indicators used (such as adjustment for diagnostic-related groups). The results of this review will help coordinators of a benchmarking project to set it up successfully. PMID:26770800

  18. Survival Strategies for Michigan's Health Care Safety Net Providers

    PubMed Central

    Jacobson, Peter D; Dalton, Vanessa K; Berson-Grand, Julie; Weisman, Carol S

    2005-01-01

    Objective To understand key adaptive strategies considered by health care safety net organizations serving uninsured and underinsured populations in Michigan. Data Sources/Study Setting Primary data collected through interviews at community-based free clinics, family planning clinics, local public health departments, and Federally Qualified Health Centers from 2002 to 2003. Research Design In each of six service areas in Michigan, we conducted a multiple-site case study of the four organizations noted above. We conducted interviews with the administrator, the medical or clinical director, the financial or marketing director, and a member of the board of directors. We interviewed 74 respondents at 20 organizations. Principal Findings Organizations perceive that unmet need is expanding faster than organizational capacity; organizations are unable to keep up with demand. Other threats to survival include a sicker patient population and difficulty in retaining staff (particularly nurses). Most clinics are adopting explicit business strategies to survive. To maintain financial viability, clinics are: considering or implementing fees; recruiting insured patients; expanding fundraising activities; reducing services; or turning away patients. Collaborative strategies, such as partnerships with hospitals, have been difficult to implement. Clinics are struggling with how to define their mission given the environment and threats to survival. Conclusions Adaptive strategies remain a work in progress, but will not be sufficient to respond to increasing service demands. Increased federal funding, or, ideally, a national health insurance program, may be the only viable option for expanding organizational capacity. PMID:15960698

  19. [Internationalized medical care services increase need of health care providers to improve English communication skills].

    PubMed

    Yang, Chia-Ling

    2011-02-01

    English is the most important language used in international communication. Nurses today have significantly more opportunities to come into contact with clients of different nationalities. Therefore, English communication abilities are a critical to the effective care of foreign clients. Miscommunication due to language barriers can endanger the health and safety of foreign clients and hinder their access to healthcare resources. Basic English communicate skills allow nurses to better understand the feelings of foreign clients and to affect their satisfaction with healthcare services provided. The majority of clinical nurses in Taiwan are inadequately prepared to communicate with foreign clients or use English when delivering nursing care services. Although English is not an official language in Taiwan, strengthening English communication skills is necessary for Taiwan's healthcare service system. Faced with increasing numbers of foreign clients in their daily work, first-line nursing staffs need more training to improve English proficiency. In order to do so, support from the hospital director is the first priority. The second priority is to motivate nursing staffs to learn English; the third is to incorporate different English classes into the medical system and schedule class times to meet nurse scheduling needs; and the fourth is to establish international medical wards, with appropriate incentives in pay designed to attract and retain nursing staff proficient in English communication. PMID:21328212

  20. Technology Diffusion and Prostate Cancer Quality of Care

    PubMed Central

    Schroeck, Florian R.; Kaufman, Samuel R.; Jacobs, Bruce L.; Skolarus, Ted A.; Zhang, Yun; Hollenbeck, Brent K.

    2014-01-01

    Objective To evaluate the association of technological capacity with prostate cancer quality of care. Technological capacity was conceptualized as a market’s ability to provide prostate cancer treatment with new technology, including robotic prostatectomy and intensity-modulated radiotherapy (IMRT). Methods In this retrospective cohort study, we used data from the Surveillance Epidemiology and End Results (SEER) – Medicare linked database from 2004–2009 to identify men with newly diagnosed prostate cancer (n=46,274). We measured technological capacity as the number of providers performing robotic prostatectomy or IMRT per population in a healthcare market. We used multilevel logistic regression to assess the association of technological capacity with receiving quality care according to a set of nationally endorsed quality measures, while adjusting for patient and market characteristics. Results Overall, our findings were mixed with only subtle differences in quality of care when comparing high-tech to low-tech markets. High robotic prostatectomy capacity was associated with better adherence to some quality measures, such as avoiding unnecessary bone scans (79.8% vs. 73.0%, p=0.003) and having follow-up with urologists (67.7% vs. 62.6%, p=0.023). However, for most measures, neither high robotic prostatectomy nor high IMRT capacity were associated with significant increases in adherence rates. In fact, for one measure (treatment by a high-volume provider), high IMRT capacity was associated with lower performance (23.4% vs. 28.5%, p<0.001). Conclusion Our findings suggest that new technology is not clearly associated with higher quality of care. To improve quality, more specific efforts will be needed. PMID:25443905

  1. [The Home Care Doctor Today is "STRIKE" - Considering Care of Terminal Stage Patients with Cancer through a Case Report].

    PubMed

    Ogihara, Miyoko; Yamaoka, Keita; Fujimaki, Yoko; Watanabe, Mutsuko; Hirohara, Masayoshi; Kushida, Kazuki

    2015-12-01

    Although many patients wish to remain in their familiar home environment while undergoing cancer treatment, many obstacles prevent a patient from receiving cancer care at home. With early-stage cancer, the patients may better accept the diagnosis and have a greater will to fight the illness. However as time proceeds, progression or recurrence of cancer may occur, and eventually, proactive treatments will not be available. This progression results in great physical and mental strain on the patients and their family. At all stages of such progression, opportunities exist for a care provider to assist with overcoming potential obstacles by openly communicating with the patients, talking through the patients' experiences, and understanding their feelings. However, on diagnosis, cancer patients must often face the reality that they have very little time left to live. When transiting medical care from their long-trusted hospital to a home care base, a new physician must be selected and other decisions related to their care must be quickly made. Transferring responsibility to a good home care provider can greatly influence a patient's emotional state. This paper reports one such case in which the patients died in their homes with the best comfort and possible outcome. PMID:26809394

  2. Why are employers prodding health-care providers to adopt new management systems?: reducing the cost of health care.

    PubMed

    De Feo, Joseph A

    2004-01-01

    Increasingly concerned about the escalating costs of health-care insurance coverage, the quality of health-care delivery, and the escalating costs of delivering clinical services, employers are taking action. They are prodding health-care providers and insurers to adopt breakthrough management systems aimed at reducing costs related to poorly performing services and processes--and at the same time improving clinical outcomes. Doing this will require all members of the health-care value chain to work together to improve each and every process and procedure, whether clinical or administrative. This development presents formidable challenges to all health-care providers, insurers, employees, and patients. PMID:15085703

  3. Provider network replaces 'old way' of managed care.

    PubMed

    1997-06-01

    The provider-sponsored Yellowstone Community Health Plan in Billings, MT, has discovered success by breaking many of the traditional rules in setting up a capitated insurance product. Key is to hold all parties accountable and to dissolve historic communication barriers. PMID:10167564

  4. Pathways of Adult Children Providing Care to Older Parents

    ERIC Educational Resources Information Center

    Barnett, Amanda E.

    2013-01-01

    Guided by life course and stress process theory, this study investigated pathways of adult child caregivers' family (caregiving, marital, parenting) and nonfamily (employment) roles. Eight waves of data from the Health and Retirement Study were analyzed for 1,300 adult child caregivers. Latent class analysis provided strong evidence for a 4-class


  5. Mental health provider perspectives regarding integrated medical care for patients with serious mental illness.

    PubMed

    Kilbourne, Amy M; Greenwald, Devra E; Bauer, Mark S; Charns, Martin P; Yano, Elizabeth M

    2012-11-01

    Integrated care for medical conditions is essential for persons with serious mental illness (SMI). This qualitative study describes mental health provider perspectives regarding barriers and facilitators of integrated care for patients with SMI. We interviewed providers from a national sample of Veterans Health Administration facilities that scored in the top or bottom percentile in medical care quality. Providers from high-performing sites reported substantial in-person contacts with general medical providers, while providers from low-performing sites reported stigma and limited communication with medical providers as major concerns. Interventions to improve mental health and medical provider communication may facilitate integrated care for persons with SMI. PMID:21735302

  6. 42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Medical or other remedial care provided by licensed... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.60 Medical or other remedial care provided by licensed practitioners. (a) “Medical care...

  7. 42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Medical or other remedial care provided by licensed... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.60 Medical or other remedial care provided by licensed practitioners. (a) “Medical care...

  8. 42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Medical or other remedial care provided by licensed... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.60 Medical or other remedial care provided by licensed practitioners. (a) “Medical care...

  9. 42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Medical or other remedial care provided by licensed... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.60 Medical or other remedial care provided by licensed practitioners. (a) “Medical care...

  10. 42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Medical or other remedial care provided by licensed... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.60 Medical or other remedial care provided by licensed practitioners. (a) “Medical care...

  11. Family Members Providing Home-Based Palliative Care to Older Adults: The Enactment of Multiple Roles

    ERIC Educational Resources Information Center

    Clemmer, Sarah J.; Ward-Griffin, Catherine; Forbes, Dorothy

    2008-01-01

    Canadians are experiencing increased life expectancy and chronic illness requiring end-of-life care. There is limited research on the multiple roles for family members providing home-based palliative care. Based on a larger ethnographic study of client-family-provider relationships in home-based palliative care, this qualitative secondary analysis


  12. 77 FR 72738 - Contracts and Provider Agreements for State Home Nursing Home Care

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-06

    ... AFFAIRS 38 CFR Part 51 RIN 2900-AO57 Contracts and Provider Agreements for State Home Nursing Home Care... agreements with State homes for the nursing home care of certain disabled veterans. This rulemaking is required to implement a change in law that revises how VA will pay for care provided to these veterans...

  13. Health reforms as examples of multilevel interventions in cancer care.

    PubMed

    Flood, Ann B; Fennell, Mary L; Devers, Kelly J

    2012-05-01

    To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation's health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform. PMID:22623600

  14. Health Reforms as Examples of Multilevel Interventions in Cancer Care

    PubMed Central

    Fennell, Mary L.; Devers, Kelly J.

    2012-01-01

    To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation’s health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform. PMID:22623600

  15. Public Perception of Cancer Care in Poland and Austria

    PubMed Central

    JÈ©drzejewski, Mariusz; Thallinger, Christiane; Mrozik, Magda; Kornek, Gabriela; Zielinski, Christoph

    2015-01-01

    Background. We compared the public perception of cancer care in Poland and Austria. Both countries are members of the European Union (EU) but reflect two extremes in health-related per capita spending. Recently, the EUROCARE-5 study reported on very discrepant cancer outcomes between the two countries. Methods. A one-time survey was conducted to compare the public perception of cancer treatment in Poland and Austria. In total, 3,649 subjects, representing the general population, cancer patients, and cancer patients’ family members, were surveyed. Results. In both countries, cancer was considered the most challenging problem of the health care system, and health care was indicated as the most important issue influencing political election decisions. Polish compared with Austrian cancer patients gave a significantly lower positive assessment of overall cancer treatment efficacy and detection methods. Cancer cure rates estimated by Polish and Austrian citizens were 29% and 44%, respectively. The majority of all citizens interviewed thought that cancer patients should have access to all available registered cancer drugs. However, only 18% of Poles versus 62% of Austrians agreed with the notion that the available cancer treatment in their countries is of a standard comparable to that of other EU countries. Consequently, 24% of Poles and 7% of Austrians identified financial status, age, gender, and residence as factors influencing the availability of cancer treatments. Conclusion. In both countries, cancer is considered the most challenging problem of the health care system, and health care issues may strongly influence decisions for political elections. Vast differences in the two populations’ perceptions of cancer care reflect actual cancer outcomes and the national per capita spending on health-related issues. PMID:25520325

  16. Time To Talk with Your Health Care Providers: 4 Tips to Start the Conversation

    MedlinePlus

    ... Y Z 4 Tips: Start Talking With Your Health Care Providers About Complementary Health Approaches Share: When patients ... fully informed and can help patients make wise health care decisions. Here are 4 tips to help you ...

  17. State Variability in Supply of Office-based Primary Care Providers: United States, 2012

    MedlinePlus

    ... State Variability in Supply of Office-based Primary Care Providers: United States, 2012 Recommend on Facebook Tweet ... During the last decade, the supply of primary care physicians was lower than the supply of specialty ...

  18. Nurse Navigators in Early Cancer Care: A Randomized, Controlled Trial

    PubMed Central

    Wagner, Edward H.; Ludman, Evette J.; Aiello Bowles, Erin J.; Penfold, Robert; Reid, Robert J.; Rutter, Carolyn M.; Chubak, Jessica; McCorkle, Ruth

    2014-01-01

    Purpose To determine whether a nurse navigator intervention improves quality of life and patient experience with care for people recently given a diagnosis of breast, colorectal, or lung cancer. Patients and Methods Adults with recently diagnosed primary breast, colorectal, or lung cancer (n = 251) received either enhanced usual care (n = 118) or nurse navigator support for 4 months (n = 133) in a two-group cluster randomized, controlled trial with primary care physicians as the units of randomization. Patient-reported measures included the Functional Assessment of Cancer Therapy–General (FACT-G) Quality of Life scale, three subscales of the Patient Assessment of Chronic Illness Care (PACIC), and selected subscales from a cancer adaptation of the Picker Institute's patient experience survey. Self-report measures were collected at baseline, 4 months, and 12 months. Automated administrative data were used to assess time to treatment and total health care costs. Results There were no significant differences between groups in FACT-G scores. Nurse navigator patients reported significantly higher scores on the PACIC and reported significantly fewer problems with care, especially psychosocial care, care coordination, and information, as measured by the Picker instrument. Cumulative costs after diagnosis did not differ significantly between groups, but lung cancer costs were $6,852 less among nurse navigator patients. Conclusion Compared with enhanced usual care, nurse navigator support for patients with cancer early in their course improves patient experience and reduces problems in care, but did not differentially affect quality of life. PMID:24276777

  19. Challenges in volunteering from cancer care volunteers perspectives.

    PubMed

    Kamaludin, Kauthar Mohamad; Muhammad, Mazanah; Wahat, Nor Wahiza Abdul; Ibrahim, Rahimah

    2013-01-01

    The involvement of non-government organizations (NGOs) and support groups has helped strengthen public health services in addressing cancer care burden. Owing to the contribution of volunteers in cancer care, this article documents a qualitative study that examined challenges in attracting and retaining cancer care volunteers as part of the effort to develop a volunteer recruitment model. Data were collected through three focus group discussions involving 19 cancer support group members in Malaysia. Findings of the study revealed that mobility and locality appeared to be significant in Malaysian context, while the need for financial support and time flexibility are challenges faced by cancer support groups to attract and retain volunteers. The findings imply that cancer care initiatives can benefit from more local volunteers but at the same time these volunteers require flexibility and financial support to sustain their engagement. PMID:24083746

  20. Diet and Nutrition in Cancer Survivorship and Palliative Care

    PubMed Central

    Bazzan, Anthony J.; Newberg, Andrew B.; Cho, William C.; Monti, Daniel A.

    2013-01-01

    The primary goal of palliative cancer care is typically to relieve suffering and improve quality of life. Most approaches to diet in this setting have focused only on eating as many calories as possible to avoid cachexia. However, as the concept of palliative care has evolved to include all aspects of cancer survivorship and not just end of life care, there is an increasing need to thoughtfully consider diet and nutrition approaches that can impact not only quality of life but overall health outcomes and perhaps even positively affect cancer recurrence and progression. In this regard, there has been a recent emphasis in the literature on nutrition and cancer as an important factor in both quality of life and in the pathophysiology of cancer. Hence, the primary purpose of this paper is to review the current data on diet and nutrition as it pertains to a wide range of cancer patients in the palliative care setting. PMID:24288570

  1. [Palliative Care for Rectal Cancer Complicated with Gastric Cancer].

    PubMed

    Furukawa, Takeshi; Takahashi, Hitoshi; Tanaka, Kei; Muto, Takaaki

    2015-11-01

    Medical advancements have led to an increase in the number of elderly people. However, standard treatments may sometimes be difficult to use in elderly people. Here, we report the case of an elderly patient with rectal and gastric cancer who refused radical surgery. The patient was an 83-year-old man who had type-2 diabetes, hypertension, hyperuricemia, mitral valve regurgitation, and mild dementia. Furthermore, he was blind in both eyes owing to glaucoma. He first visited our hospital in 2005. In 2010, he was diagnosed with anemia, but he refused a thorough examination; however, he did consent to take iron supplements. In July 2011, he consulted our hospital for symptoms of frequent diarrhea, and agreed to an examination. After colonoscopy, he was diagnosed with rectal cancer that was becoming obstructive. There were no metastases to other organs, but he was also diagnosed with gastric cancer. As he and his family refused radical surgery, a stoma was constructed. After the operation, he received palliative care but died in September 2013. PMID:26805335

  2. Clinician Roles in Early Integrated Palliative Care for Patients with Advanced Cancer: A Qualitative Study

    PubMed Central

    Park, Elyse R.; Greer, Joseph A.; Jackson, Vicki A.; Jacobsen, Juliet C.; Gallagher, Emily R.; Temel, Jennifer S.

    2014-01-01

    Abstract Background: Early palliative care provides better quality of life, increased prognostic awareness, and even improved survival for patients with advanced cancer but how the integrated care model achieves these outcomes has not been completely explained. Methods: To better understand the clinical approach to early outpatient care from the clinicians' perspective, we conducted focus groups with the palliative care clinicians who had participated in a randomized trial of early palliative care for metastatic lung cancer. Results: Clinicians described their role in providing early palliative care as having three distinct roles in the outpatient setting: (1) managing symptoms to improve functional status and as a bridge to other issues; (2) engaging patients in emotional work to facilitate coping, accepting, and planning; and (3) interpreting the oncologist for the patient and the patient for the oncologist. Conclusions: These data lay the foundation for developing training programs for clinicians in early integrated palliative care. PMID:25390467

  3. Lung Cancer Assistant: a hybrid clinical decision support application for lung cancer care.

    PubMed

    Sesen, M Berkan; Peake, Michael D; Banares-Alcantara, Rene; Tse, Donald; Kadir, Timor; Stanley, Roz; Gleeson, Fergus; Brady, Michael

    2014-09-01

    Multidisciplinary team (MDT) meetings are becoming the model of care for cancer patients worldwide. While MDTs have improved the quality of cancer care, the meetings impose substantial time pressure on the members, who generally attend several such MDTs. We describe Lung Cancer Assistant (LCA), a clinical decision support (CDS) prototype designed to assist the experts in the treatment selection decisions in the lung cancer MDTs. A novel feature of LCA is its ability to provide rule-based and probabilistic decision support within a single platform. The guideline-based CDS is based on clinical guideline rules, while the probabilistic CDS is based on a Bayesian network trained on the English Lung Cancer Audit Database (LUCADA). We assess rule-based and probabilistic recommendations based on their concordances with the treatments recorded in LUCADA. Our results reveal that the guideline rule-based recommendations perform well in simulating the recorded treatments with exact and partial concordance rates of 0.57 and 0.79, respectively. On the other hand, the exact and partial concordance rates achieved with probabilistic results are relatively poorer with 0.27 and 0.76. However, probabilistic decision support fulfils a complementary role in providing accurate survival estimations. Compared to recorded treatments, both CDS approaches promote higher resection rates and multimodality treatments. PMID:24990290

  4. Lung Cancer Assistant: a hybrid clinical decision support application for lung cancer care

    PubMed Central

    Sesen, M. Berkan; Peake, Michael D.; Banares-Alcantara, Rene; Tse, Donald; Kadir, Timor; Stanley, Roz; Gleeson, Fergus; Brady, Michael

    2014-01-01

    Multidisciplinary team (MDT) meetings are becoming the model of care for cancer patients worldwide. While MDTs have improved the quality of cancer care, the meetings impose substantial time pressure on the members, who generally attend several such MDTs. We describe Lung Cancer Assistant (LCA), a clinical decision support (CDS) prototype designed to assist the experts in the treatment selection decisions in the lung cancer MDTs. A novel feature of LCA is its ability to provide rule-based and probabilistic decision support within a single platform. The guideline-based CDS is based on clinical guideline rules, while the probabilistic CDS is based on a Bayesian network trained on the English Lung Cancer Audit Database (LUCADA). We assess rule-based and probabilistic recommendations based on their concordances with the treatments recorded in LUCADA. Our results reveal that the guideline rule-based recommendations perform well in simulating the recorded treatments with exact and partial concordance rates of 0.57 and 0.79, respectively. On the other hand, the exact and partial concordance rates achieved with probabilistic results are relatively poorer with 0.27 and 0.76. However, probabilistic decision support fulfils a complementary role in providing accurate survival estimations. Compared to recorded treatments, both CDS approaches promote higher resection rates and multimodality treatments. PMID:24990290

  5. Examining Health Care Costs: Opportunities to Provide Value in the Intensive Care Unit.

    PubMed

    Chang, Beverly; Lorenzo, Javier; Macario, Alex

    2015-12-01

    As health care costs threaten the economic stability of American society, increasing pressures to focus on value-based health care have led to the development of protocols for fast-track cardiac surgery and for delirium management. Critical care services can be led by anesthesiologists with the goal of improving ICU outcomes and at the same time decreasing the rising cost of ICU medicine. PMID:26610628

  6. Obstacles To Enhancing the Learning Environments of Infants in Day Care: An Evaluation of Problems Perceived by Day Care Providers.

    ERIC Educational Resources Information Center

    Chambliss, Catherine

    This study focused on creating a liaison between day care providers and college developmental psychology researchers with the intent that day care providers would be able to share discoveries and develop expertise in challenging infants appropriately to encourage development. The project was collaborated on by college students and faculty; the day


  7. Human trafficking: Role of oral health care providers.

    PubMed

    Nuzzolese, E

    2014-11-01

    Trafficking in human beings is a modern form of slavery and is a well-known phenomenon throughout the European Union and beyond. After drug dealing and the weapons industry, human trafficking is the second largest criminal activity in the world today and it is a growing crime. The aim of governmental and non-governmental agencies, which are either directly or indirectly involved in combating trafficking in human beings, is the identification and referral of victims of trafficking and also to encourage self-referrals. Identification is the most important step to provide protection and assistance to victims of trafficking. Victims often have a variety of physical and mental health needs, including psychological trauma, injuries from violence, head and neck trauma, sexually transmitted infections and other gynaecological problems, dental/oral problems and have poor nutrition. The author's experience in the field of community dentistry in presented within. Volunteer dental services are offered to non-European Union patients held in a centre for asylum seekers in Bari (Italy). Dental professionals can, in fact, contribute to the identification, assistance and protection of trafficked persons, as well as offering forensic services to assist the police investigation in order to identify crimes and find the criminal organizations behind them. As for domestic violence and child abuse cases, there are ethical concerns involved in the identification and protection of the trafficked persons, as well as the need for interdisciplinary work and awareness. Adequate training in behavioural science and intercultural learning is paramount in order to avoid misunderstandings and increase sensitivity. PMID:25557409

  8. [Integration of nutritional care into cancer treatment: need for improvement].

    PubMed

    Joly, Caroline; Jacqueline-Ravel, Nathalie; Pugliesi-Rinaldi, Angela; Bigler-Perrotin, Lucienne; Chikhi, Marinette; Dietrich, Pierre-Yves; Dulguerov, Pavel; Miralbell, Raymond; Picard-Kossovsky, Michel; Seium, Yodit; Thériault, Michel; Pichard, Claude

    2011-11-16

    Progresses in cancer treatment transformed cancer into a chronic disease associated with growing nutritional problems. Poor nutritional status of cancer patients worsens morbidity, mortality, overall cost of care and decreases patients' quality of life, oncologic treatments tolerance and efficacy. These adverse effects lead to treatment modifications or interruptions, reducing the chances to control or cure cancer. Implementation of an interdisciplinary and longitudinal integration of nutritional care and nutritional information into cancer treatment (The OncoNut Program) could prevent or treat poor nutritional status and its adversely side effects. PMID:22400355

  9. Cancer patient-centered home care: a new model for health care in oncology

    PubMed Central

    Tralongo, Paolo; FerraĂč, Francesco; Borsellino, NicolĂČ; Verderame, Francesco; Caruso, Michele; Giuffrida, Dario; Butera, Alfredo; Gebbia, Vittorio

    2011-01-01

    Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients’ needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients’ needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective. PMID:21941445

  10. Cancer risk assessment for the primary care physician.

    PubMed

    Korde, Larissa A; Gadalla, Shahinaz M

    2009-09-01

    Cancer is the second leading cause of death in the United States. Cancer risk assessment can be divided into two major categories: assessment of familial or genetic risk and assessment of environmental factors that may be causally related to cancer. Identification of individuals with a suspected heritable cancer syndrome can lead to additional evaluation and to interventions that can substantially decrease cancer risk. Special attention should also be paid to potentially modifiable cancer risk factors in the course of advising primary care patients regarding a healthy lifestyle. Clinical guidelines, targeting both genetic and modifiable cancer risk factors, are available and can facilitate the application of these health care principles in the primary care setting. PMID:19616151

  11. A Health Services Research Agenda for Cellular, Molecular and Genomic Technologies in Cancer Care

    PubMed Central

    Wideroff, Louise; Phillips, Kathryn A.; Randhawa, Gurvaneet; Ambs, Anita; Armstrong, Katrina; Bennett, Charles L.; Brown, Martin L.; Donaldson, Molla S.; Follen, Michele; Goldie, Sue J.; Hiatt, Robert A.; Khoury, Muin J.; Lewis, Graham; McLeod, Howard L.; Piper, Margaret; Powell, Isaac; Schrag, Deborah; Schulman, Kevin A.; Scott, Joan

    2009-01-01

    Background In recent decades, extensive resources have been invested to develop cellular, molecular and genomic technologies with clinical applications that span the continuum of cancer care. Methods In December 2006, the National Cancer Institute sponsored the first workshop to uniquely examine the state of health services research on cancer-related cellular, molecular and genomic technologies and identify challenges and priorities for expanding the evidence base on their effectiveness in routine care. Results This article summarizes the workshop outcomes, which included development of a comprehensive research agenda that incorporates health and safety endpoints, utilization patterns, patient and provider preferences, quality of care and access, disparities, economics and decision modeling, trends in cancer outcomes, and health-related quality of life among target populations. Conclusions Ultimately, the successful adoption of useful technologies will depend on understanding and influencing the patient, provider, health care system and societal factors that contribute to their uptake and effectiveness in ‘real-world’ settings. PMID:19367091

  12. The supply of physicians and care for breast cancer in Ontario and California, 1998 to 2006

    PubMed Central

    Gorey, Kevin M.; Luginaah, Isaac N.; Hamm, Caroline; Balagurusamy, Madhan; Holowaty, Eric J.

    2011-01-01

    Introduction We examined the differential effects of the supply of physicians on care for breast cancer in Ontario and California. We then used criteria for optimum care for breast cancer to estimate the regional needs for the supply of physicians. Methods Ontario and California registries provided 951 and 984 instances of breast cancer diagnosed between 1998 and 2000 and followed until 2006. These cohorts were joined with the supply of county-level primary care physicians (PCPs) and specialists in cancer care and compared on care for breast cancer. Results Significant protective PCP thresholds (7.75 to ≄ 8.25 PCPs per 10 000 inhabitants) were observed for breast cancer diagnosis (odds ratio [OR] 1.62), receipt of adjuvant radiotherapy (OR 1.64) and 5-year survival (OR 1.87) in Ontario, but not in California. The number of physicians seemed adequate to optimize care for breast cancer across diverse places in California and in most Ontario locations. However, there was an estimated need for 550 more PCPs and 200 more obstetrician–gynecologists in Ontario’s rural and small urban areas. We estimated gross physician surpluses for Ontario’s 2 largest cities. Conclusion Policies are needed to functionally redistribute primary care and specialist physicians. Merely increasing the supply of physicians is unlikely to positively affect the health of Ontarians. PMID:21453604

  13. Chronic cancer: bringing palliative care into the conversation.

    PubMed

    Gerbino, Susan

    2014-01-01

    Palliative care is a treatment model that aims to relieve patient suffering and improve quality of life, and is essential for those living with chronic cancer. However, most palliative care referrals are made as a last resort when all other treatment options have failed. This article argues that social workers have an important role in early palliative care discussions because of their unique skill set. Techniques for early introduction of palliative care are addressed, as are ways for empowering patient advocacy. A case narrative of a young woman with chronic cancer is included as an example of the need for ongoing palliative care conversations. PMID:24405240

  14. Cultural perceptions in cancer care among African-American and Caucasian patients.

    PubMed Central

    Matsuyama, Robin K.; Grange, Christina; Lyckholm, Laurie J.; Utsey, Shawn O.; Smith, Thomas J.

    2007-01-01

    PURPOSE: This exploratory study examined perceptions and beliefs of African Americans and Caucasians related to cancer care. Understanding belief systems and cultures optimizes cancer treatment and care delivery to ethnic minority individuals. PATIENTS AND METHODS: Focus groups were conducted with 39 African-American and Caucasian cancer patients. Data analysis included whole group analysis with a team of five researchers. RESULTS: Regardless of ethnicity, cancer patients share many of the same emotions and experiences, and want complete information and quality care. Differences were also apparent. African-American participants were more likely to report increased religious behaviors, believe that healthcare providers demonstrate care with simple actions and provision of practical assistance, and use church and community information sources. Caucasian participants were more likely to report spiritual but not overtly religious changes, and depend on healthcare providers for information. CONCLUSION: Understanding how culture colors perceptions, communication and information requirements is critical to providing effective care to ethnically diverse cancer patients. Findings have implications for professionals understanding ways patients seek information, the role of spirituality and religion in care, and ways healthcare providers demonstrate care. PMID:17987914

  15. Enhancing Shared Decision Making Through Carefully Designed Interventions That Target Patient And Provider Behavior.

    PubMed

    Tai-Seale, Ming; Elwyn, Glyn; Wilson, Caroline J; Stults, Cheryl; Dillon, Ellis C; Li, Martina; Chuang, Judith; Meehan, Amy; Frosch, Dominick L

    2016-04-01

    Patient-provider communication and shared decision making are essential for primary care delivery and are vital contributors to patient experience and health outcomes. To alleviate communication shortfalls, we designed a novel, multidimensional intervention aimed at nudging both patients and primary care providers to communicate more openly. The intervention was tested against an existing intervention, which focused mainly on changing patients' behaviors, in four primary care clinics involving 26 primary care providers and 300 patients. Study results suggest that compared to usual care, both the novel and existing interventions were associated with better patient reports of how well primary care providers engaged them in shared decision making. Future research should build on the work in this pilot to rigorously examine the comparative effectiveness and scalability of these interventions to improve shared decision making at the point of care. PMID:27044959

  16. Patient-centered care in lung cancer: exploring the next milestones.

    PubMed

    Ben-Arye, Eran; Samuels, Noah

    2015-10-01

    In this editorial, the authors comment on a recently published review paper by Molassiotis et al. on the developments made over the past 40 years in supportive care for patients with lung cancer. During this period, a paradigm shift promoting patient-centered care (PCC) has led to an important change in the approach of supportive cancer care, from a purely disease-centered approach, measuring survival-related outcomes, to recognizing the importance of quality of life outcomes as well. This change of understanding in supportive and palliative care for patients with lung cancer can be further advanced through the understanding that there is a need to address bio-psycho-spiritual concerns and health belief models, within the context of the family socio-cultural environment, for both patients and their caregivers. There is also a need to address the psycho-spiritual effects of cancer on those health care professionals treating patients with lung cancer, in order to reduce compassion fatigue and increase resilience. Future directions for supportive care for patients with lung cancer may include the development of a patient-tailored treatment approach, assisted by the integration of a multidisciplinary team of health care providers and evidence-based complementary medicine practices, within conventional supportive care practice. PMID:26629435

  17. Patient-centered care in lung cancer: exploring the next milestones

    PubMed Central

    Samuels, Noah

    2015-01-01

    In this editorial, the authors comment on a recently published review paper by Molassiotis et al. on the developments made over the past 40 years in supportive care for patients with lung cancer. During this period, a paradigm shift promoting patient-centered care (PCC) has led to an important change in the approach of supportive cancer care, from a purely disease-centered approach, measuring survival-related outcomes, to recognizing the importance of quality of life outcomes as well. This change of understanding in supportive and palliative care for patients with lung cancer can be further advanced through the understanding that there is a need to address bio-psycho-spiritual concerns and health belief models, within the context of the family socio-cultural environment, for both patients and their caregivers. There is also a need to address the psycho-spiritual effects of cancer on those health care professionals treating patients with lung cancer, in order to reduce compassion fatigue and increase resilience. Future directions for supportive care for patients with lung cancer may include the development of a patient-tailored treatment approach, assisted by the integration of a multidisciplinary team of health care providers and evidence-based complementary medicine practices, within conventional supportive care practice. PMID:26629435

  18. Knowledge, attitudes, and practices regarding cervical cancer and screening among Ethiopian health care workers

    PubMed Central

    Kress, Catherine M; Sharling, Lisa; Owen-Smith, Ashli A; Desalegn, Dawit; Blumberg, Henry M; Goedken, Jennifer

    2015-01-01

    Background Though cervical cancer incidence has dramatically decreased in resource rich regions due to the implementation of universal screening programs, it remains one of the most common cancers affecting women worldwide and has one of the highest mortality rates. The vast majority of cervical cancer-related deaths are among women that have never been screened. Prior to implementation of a screening program in Addis Ababa University-affiliated hospitals in Ethiopia, a survey was conducted to assess knowledge of cervical cancer etiology, risk factors, and screening, as well as attitudes and practices regarding cervical cancer screening among women’s health care providers. Methods Between February and March 2012 an anonymous, self-administered survey to assess knowledge, attitudes, and practices related to cervical cancer and its prevention was distributed to 334 health care providers at three government hospitals in Addis Ababa, Ethiopia and three Family Guidance Association clinics in Awassa, Adama, and Bahir Dar. Data were analyzed using SPSS software and chi-square test was used to test differences in knowledge, attitudes, and practices across provider type. Results Overall knowledge surrounding cervical cancer was high, although awareness of etiology and risk factors was low among nurses and midwives. Providers had no experience performing cervical cancer screening on a routine basis with <40% having performed any type of cervical cancer screening. Reported barriers to performing screening were lack of training (52%) and resources (53%); however the majority (97%) of providers indicated cervical cancer screening is an essential part of women’s health care. Conclusion There is a clear need among women’s health care providers for education regarding cervical cancer etiology, risk factors and for training in low-tech, low-cost screening methods. Meeting these needs and improving the infrastructure necessary to implement appropriate screening programs is essential to reduce the burden of cervical cancer in Ethiopia. PMID:26261427

  19. Employer Child Care Providers Stalled, but Optimistic: Fourteenth Annual Status Report on Employer Child Care

    ERIC Educational Resources Information Center

    Neugebauer, Roger

    2005-01-01

    The ten largest employer child care management organizations, as a group, reported a zero growth rate in 2004. This year of no growth follows two years in which the sector grew by only 4% per year. This contrasts dramatically with the fast expansion period for employer child care, 1996 through 2000, when the sector grew at an annual rate of 10%.


  20. California Early Care and Education Workforce Study: Licensed Family Child Care Providers Statewide, 2006

    ERIC Educational Resources Information Center

    Whitebook, Marcy; Sakai, Laura; Kipnis, Fran; Lee, Yuna; Bellm, Dan; Speiglman, Richard; Almaraz, Mirella; Stubbs, LaToya; Tran, Paulina

    2006-01-01

    This report presents the results of First 5 California's 2004 statewide and regional study of the early care and education (ECE) workforce in licensed family child care. The goal of the study was to collect information on the characteristics of this workforce (i.e., educational background and potential need and demand for professional


  1. "Delays" in diagnosis: a misleading concept, yet providing opportunities for advancing clinical care.

    PubMed

    Barr, Ronald D

    2014-04-01

    Delay in diagnosis is a pejorative term for an interval better described as lag time, a period of considerable concern to health care administrators, providers, and consumers, receiving attention in numerous countries over many years. The general assumption that the longer the lag time the poorer the prospect for survival is not supported by the evidence that points to a more complex relationship. In some instances shorter lag times are associated with longer survival and in others correlate with shorter survival; in many instances there is no clear relationship. The associations between numerous demographic variables, such as the patient's age and the nature of the first health care contact, and lag time account for no more than 20% of the variance in this interval. It appears that more important determinants are the biology of the tumor and its related clinical behavior. Nevertheless, to minimize anxiety in patients and families, every effort should be made to reach a timely diagnosis. With the exceptions of retinoblastoma and malignant melanoma, campaigns to enhance public awareness have met with limited success with regard to reducing lag times in children and adolescents with cancer, indicating a challenge worthy of international attention. PMID:24390444

  2. Medication risk communication with cancer patients in a Middle East cancer care setting

    PubMed Central

    Wilbur, Kerry; Al-Okka, Maha; Jumaat, Ebaa; Eissa, Nesma; Elbashir, Merwa; Al-Yafei, Sumaya M Al Saadi

    2016-01-01

    Purpose Cancer treatments are frequently associated with adverse effects, but there may be a cultural reluctance by care providers to be forthcoming with patients regarding these risks for fear of promoting nonadherence. Conversely, research in a number of countries indicates high levels of patient desire for this information. We sought to explore cancer patient experiences, satisfaction, and preferences for medication risk communication in a Middle East care setting. Methods We developed and administered a ten-item questionnaire (Arabic and English) to a convenience sample of consenting adult patients receiving treatment at the National Center for Cancer Care and Research in Qatar. Results One hundred and forty-three patients were interviewed. Most (88%) stated that the level of side effect information they received was sufficient, with physicians (86%) followed by pharmacists (39%) as the preferred sources. The majority (97%) agreed that knowing about possible side effects would help them recognize and manage the reaction, and 92% agreed that it would help them understand how to minimize or prevent the risks. Eighteen percent indicated that this information would make them not want to take treatment. Two-thirds (65%) had previously experienced intolerance to their cancer treatment regimen. Conclusion Most patients surveyed expressed preference for the details of possible side effects they may encounter in their treatment. However, one in five considered such information a factor for nonadherence, indicating the need for patient-specific approaches when communicating medication risks. PMID:27175061

  3. More than Motherhood: Reasons for Becoming a Family Day Care Provider

    ERIC Educational Resources Information Center

    Armenia, Amy B.

    2009-01-01

    This article examines motivations for entering family day care work as they relate to responsibilities of motherhood and the prominence of these motivations for the women providing day care within and across groups of workers. Using data from a large-scale representative survey of family day care workers in Illinois, the author examines the range…

  4. Provider Perspectives about Latino Patients: Determinants of Care and Implications for Treatment

    ERIC Educational Resources Information Center

    Valdez, Carmen R.; Dvorscek, Michael J.; Budge, Stephanie L.; Esmond, Sarah

    2011-01-01

    Primary care settings are the gateway through which the majority of Latinos access care for their physical and mental health concerns. This study explored the perspectives of primary care providers concerning their Latino patients, in particular issues affecting their patients' access to and utilization of services. Interviews were conducted with


  5. 76 FR 32815 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-06

    ... Conditions Including Health Care-Acquired Conditions; Final Rule #0;#0;Federal Register / Vol. 76 , No. 108... Adjustment for Provider-Preventable Conditions Including Health Care-Acquired Conditions AGENCY: Centers for... section 2702 of the Patient Protection and Affordable Care Act which directs the Secretary of Health...

  6. 21 CFR 203.11 - Applications for reimportation to provide emergency medical care.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... emergency medical care. 203.11 Section 203.11 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Applications for reimportation to provide emergency medical care. (a) Applications for reimportation for emergency medical care shall be submitted to the director of the FDA District Office in the district...

  7. 21 CFR 203.11 - Applications for reimportation to provide emergency medical care.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... emergency medical care. 203.11 Section 203.11 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Applications for reimportation to provide emergency medical care. (a) Applications for reimportation for emergency medical care shall be submitted to the director of the FDA District Office in the district...

  8. 21 CFR 203.11 - Applications for reimportation to provide emergency medical care.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... emergency medical care. 203.11 Section 203.11 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Applications for reimportation to provide emergency medical care. (a) Applications for reimportation for emergency medical care shall be submitted to the director of the FDA District Office in the district...

  9. 21 CFR 203.11 - Applications for reimportation to provide emergency medical care.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... emergency medical care. 203.11 Section 203.11 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Applications for reimportation to provide emergency medical care. (a) Applications for reimportation for emergency medical care shall be submitted to the director of the FDA District Office in the district...

  10. 21 CFR 203.11 - Applications for reimportation to provide emergency medical care.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... emergency medical care. 203.11 Section 203.11 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Applications for reimportation to provide emergency medical care. (a) Applications for reimportation for emergency medical care shall be submitted to the director of the FDA District Office in the district...

  11. The Effect of Home Caregiving Program for Family Members Providing Care for Chronically Ill Relative Client

    ERIC Educational Resources Information Center

    Mohammed, Hussein Jassim; Kamel, Andaleeb Abu

    2015-01-01

    Health care systems in many countries are moving towards outpatient care in which family members are central in providing care for patients with life-threatening illness. Family members and friends haven't knowledge and skills to become caregivers as many studies found that, the need to involve in such program to enhance their ability to be


  12. 25 CFR 20.507 - What requirements must foster care providers meet?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... contain an approved current home study. (c) An off-reservation foster home, or residential care facility... 25 Indians 1 2011-04-01 2011-04-01 false What requirements must foster care providers meet? 20.507... ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.507 What requirements must...

  13. 25 CFR 20.507 - What requirements must foster care providers meet?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... contain an approved current home study. (c) An off-reservation foster home, or residential care facility... 25 Indians 1 2010-04-01 2010-04-01 false What requirements must foster care providers meet? 20.507... ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.507 What requirements must...

  14. More than Motherhood: Reasons for Becoming a Family Day Care Provider

    ERIC Educational Resources Information Center

    Armenia, Amy B.

    2009-01-01

    This article examines motivations for entering family day care work as they relate to responsibilities of motherhood and the prominence of these motivations for the women providing day care within and across groups of workers. Using data from a large-scale representative survey of family day care workers in Illinois, the author examines the range


  15. 76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-21

    ... medical charges associated with non-VA outpatient care, provided under 38 CFR 17.52 or 17.120. 75 FR 78901.... See 75 FR 78901. We explained: Home Health Care and Hospice Care he pricing methodology adopted by... amended Sec. 17.56. See 75 FR 7218 (Feb. 18, 2010); 75 FR 78901. We need not repeat them here. Indeed,...

  16. Mapping a Research Agenda for Home Care Safety: Perspectives from Researchers, Providers, and Decision Makers

    ERIC Educational Resources Information Center

    Macdonald, Marilyn; Lang, Ariella; MacDonald, Jo-Anne

    2011-01-01

    The purpose of this qualitative interpretive design was to explore the perspectives of researchers, health care providers, policy makers, and decision makers on key risks, concerns, and emerging issues related to home care safety that would inform a line of research inquiry. Defining safety specifically in this home care context has yet to be…

  17. Caring for Children in Your Home: A Business Guide for Unregulated Providers. Redleaf Business Series.

    ERIC Educational Resources Information Center

    Copeland, Tom

    Addressed to individuals providing unregulated child care in their homes, this booklet presents basic recordkeeping and tax rules. The booklet discusses the following topics: (1) child care regulations, focusing on the benefits of being regulated; (2) the business of child care, listing possible tax deductions; (3) the tax consequences of caring


  18. Mapping a Research Agenda for Home Care Safety: Perspectives from Researchers, Providers, and Decision Makers

    ERIC Educational Resources Information Center

    Macdonald, Marilyn; Lang, Ariella; MacDonald, Jo-Anne

    2011-01-01

    The purpose of this qualitative interpretive design was to explore the perspectives of researchers, health care providers, policy makers, and decision makers on key risks, concerns, and emerging issues related to home care safety that would inform a line of research inquiry. Defining safety specifically in this home care context has yet to be


  19. Professional caregivers' perceptions of providing information to parents of children with cancer.

    PubMed

    Ringnér, Anders; Jansson, Lilian; Graneheim, Ulla H

    2011-01-01

    Information has been described as a critical part of the care for parents of children with cancer, but not much is known about how caregivers makes decisions about informing parents. This study aims to illuminate professional caregivers' perceptions of providing information to parents of children with cancer. Twenty caregivers at a Swedish pediatric oncology ward participated in four focus group interviews. The interviews were transcribed verbatim and subjected to qualitative content analysis. Two themes were found: Matching the amount of information to the parents' needs concerned situations where the amount of information provided according to the caregivers' assessment is deemed too small, appropriate, or too large. Navigating through a vague structure dealt with a disrupted setting, unclear responsibilities within the team, difficult timing, unintelligible information, and underused tools for communication. Implications for intervention development are discussed. PMID:20841445

  20. Socioeconomic Considerations and Shared-Care Models of Cancer Care for Older Adults.

    PubMed

    Dale, William; Chow, Selina; Sajid, Saleha

    2016-02-01

    Older adults with cancer require a geriatrics approach to treatment. Such an approach targets appropriate treatments based on physiologic, not chronologic, age. Patients older than 65 years of age constitute the largest group of patients with cancer, making them the most expensive group of patients with cancer, especially with the advent of expensive new treatments with minimal impact on overall survival. Geriatric assessment, combined with targeted inventions, can optimize the value propositions in caring for older patients with cancer. Over the past 20 years, geriatric oncology care models have emerged applying these care principles in clinical practice. PMID:26614859