Shared decision-making about treatment for colorectal cancer: The perspective of older patients
|
|
- Harry Reeves
- 7 years ago
- Views:
Transcription
1 Shared decision-making about treatment for colorectal cancer: The perspective of older patients Dr Jaqualyn Moore, Dr Karen Gillett, Harriet Watson, Claire McGilly, Dr Cath Taylor
2 Background Shared decision making (SDM) The White Paper, Equity and Excellence: Liberating the NHS set out the Government s plan for a patient centred National Health Service based on the principle of shared decision making: no decision about me without me (DOH, 2010, p. 13). SDM is a process whereby: patients are actively involved in shared decision making and supported by healthcare professionals to make fully informed choices about investigations, treatment and care that reflect what is important to them. (NICE, 2012)
3 Older Adults and colorectal cancer Approximately 40,000 new cases of colorectal cancer each year in UK Almost 75% occur in people over 65 (Cancer Research UK, 2014) Half of people with colorectal cancer survive for at least 5 years but older people have a worse prognosis than younger patients (Dekker, 2011) Older people increasingly likely to have multiple health problems, lack social support and find travel difficult (DOH, 2012) Most common treatment is surgery (80%) but may also receive chemotherapy after surgery (Cancer Research UK, 2014)
4 What existing research tells us UK cancer survival rates for older people are the worst in Europe (Moller et al, 2011) Overall cancer survival rates are improving but less so for people aged 74 to 84 and survival for 85+ is getting worse (Moller et al, 2011) Cancer clinical trials often exclude older people on the basis of age or morbidity (Seymour et al. 2011) Older people less likely to have their symptoms fully investigated and are less likely to be referred for essential treatment (British Geriatric Society, 2011 survey of 200 geriatricians) Lack of research into the influences of emotional and social factors on treatment decision making (Tariman et al, 2010) Often incongruence between family and patient if family make decisions on part of patient (Siminoff et al, 2006) A UK survey of medical oncology trainees (n=64) found that 21% confident of ability to treat older patients compared to 81% confident to treat younger patients (Kalsi et al, 2013)
5 Treatment decision making Patients should have the opportunity to make informed decisions about care and treatment in partnership with health professionals and families (NICE, 2011: Guidelines for colorectal Cancer Treatment) Diagnosis and treatment of colorectal cancer involves discussion of bodily functions and invasive procedures Intensive cancer treatment improves clinical outcomes but potentially decreases quality of life (DOH. 2012) Patients may focus initially on being cancer free and getting through surgery rather than longer term implications (Park et al, 2014) Post cancer treatment there may be uncertainty about future, change in bowel function and altered body image
6 Treatment decision making contd. Dekker et al. (2011) compared population survival data for 9397 patients with colorectal cancer in the Netherlands. They found that patients over 75 tended to present later, have more comorbidity, receive less aggressive treatment, and be more likely to discontinue treatment early If older patients survived the first year, they had the same cancer related survival as younger patients (Dekker et al. 2011)
7 Basis for this research Matthias et al. (2013) argue that a tendency of research into SDM to focus on easily observable aspects of the decision making process which misses the complexity Johnson (2012) recommends research to develop an understanding of the treatment decision-making process for older patients to facilitate the provision of relevant information and support Strohschein et al. (2011) suggest research needs to focus on the patient s actual experience of health related decisions and on understanding the structure, content, influencing factors, and consequences of patient decision making itself
8 The missing piece? Geriatrician? Family Other Health Professionals GPs Patient perspective Oncologists Surgeons Guidelines /Protocols
9 Study aim To understand the experience of treatment decision making from the perspective of the older person with colorectal cancer
10 Eligibility Inclusion criteria Age: We purposively selected patients from the young old (65-74), old (75-84) and older old (85+) age ranges Diagnosis of potentially curative colorectal cancer Patients who had the option of treatment With recent experience of treatment decision making (past 18 months) Those who health care professionals judged to have the capacity to give informed consent to participate in research
11 Study participants by age/gender Age Male Female Totals Totals
12 Methodology Qualitative interview study Patient and public involvement study, information sheet and topic guide reviewed by patient research group Beating Bowel Cancer Proportionate Review - NHS Research Ethics Committee Potential participants initially approached by Colorectal Clinical Nurse Specialist and given information sheet Contacted by researcher who answered questions and if they wanted to go ahead arranged time for interview Interviews conducted in person or by telephone Interviews lasted between 35 and 90 minutes
13 Framework approach to analysis (Ritchie & Lewis, 2003) Data management and interpretation sequential with the aim of ordering data to facilitate interpretation Initial themes based on topic guide Interpretation involved: 1. Thematic analysis and categorisation e.g.. Information sources, outcomes of shared decision making 2. Explanatory analysis e.g. Factors influencing the decision made, what influences the way people feel about the decision made
14 Findings Factors influencing decisions Previous experience of treatment (especially chemotherapy) Fears about treatment (chemotherapy, colostomy, ileostomy) Age I have had a good life Previous experience having cancer Family history of cancer It was inevitable Family wishes Concerns about own ability to cope Wanting to live Quality of life don t want to be sick and bald Happy to trust the consultant to make the right decision Comorbidity
15 Treatment pathways after diagnosis No treatment Surgery Further treatment No further treatment patients choice No further treatment medical decision Patient sometimes unaware of decision making process happy with decision Patient more aware of decision making process happy with decision Patient less clear about decision making process not always happy with decision
16 Treatment pathways after diagnosis No treatment Further treatment Patient less aware of decision making process happy with decision 'I have no family which is a terrible disadvantage in this situation and I wouldn t Surgerywish that on anybody, you really need either a supportive partner or family or something because No further you are out No there further in the wilderness treatment and all my treatment friends that I patients spoke to choice were very medical against decision my ideas, they thought I should have the operation which of course upset me Patient more aware of more decision than making ever. I just wanted decision to making somebody process happy to say with you must process do not what s always decision happy with decision right for you (Julia, 79) Patient less clear about
17 Treatment pathways after diagnosis No treatment Further treatment Surgery If you want to hang around a bit you ve got to No further No further go along treatment with what the treatment hospital patients says choice (Alan 79 medical decision married) Patient sometimes unaware of decision making process happy with decision Patient more aware of decision making process happy with decision Patient less clear about decision making process not always happy with decision
18 Treatment pathways after diagnosis No treatment Surgery There is no way they did anything Further I did not treatment want them to do (Amy 84, widowed) No further treatment patients choice No further treatment medical decision Patient less aware of decision making process happy with decision Patient more aware of decision making process happy with decision Patient less clear about decision making process not always happy with decision
19 Treatment pathways after diagnosis No treatment Surgery They said I am not well enough to stand chemotherapy and so the position is I am left as I am. I don t feel very happy about that I think about the end all the time (Iris, 83. Single) Further treatment Patient less aware of decision making process happy with decision No further treatment patients choice Patient more aware of decision making process happy with decision No further treatment medical decision Patient less clear about decision making process not always happy with decision
20 Factors influencing feelings about decision Family support Prognosis Effects of cancer and treatment Ownership of the decision Social support Overall health Medical follow up (or lack of)
21 Limitations??geriatrician Family Other health professionals GPs Patient perspective Oncologists surgeons Guidelines /protocols
22 Conclusion and what next? Many older people have clear ideas about what treatments are acceptable to them Most older people are cognitively intact and able to make their own decisions We were unable to answer the question posed by Macmillan Cancer Support regarding don t offer or don t want. However, we found a number of our participants did not want treatment What next? Exploring the older person s preconceptions of chemotherapy
23 References Cancer Research UK (2014) Treating Bowel Cancer at documents/generalcontent/treating-bowel-cancer.pdf (accessed 19th August 2014). Dekker, J., van den Broek, C., Bastiaannet, E., van de Geest, L., Tollenaar, R, and Liefers, G. (2011) Importance of the First Postoperative Year in the Prognosis of Elderly Colorectal Cancer Patients Annals of Surgical Oncology, 18: Department of Health (2012) The Impact of Patient Age on Clinical Decision Making in Oncology, (accessed 19th August 2014). Kalsi, T.; Payne, S.; Brodie, H.; Mansi, J.; Wang, Y.; Harari, D. (2013) Are the UK oncology trainees adequately informed about the needs of older people with cancer? British Journal of Cancer, 108 (10): MacMillan Cancer Support (2012) The Age Old Excuse: The under treatment of older cancer patient at Documents/GetInvolved/Campaigns/AgeOldExcuse/AgeOldExcuseReport-MacmillanCancerSupport.pdf (accessed 19th August 2014). Matthias, M., Salyers, M., Frankel, R. (2013) Re-thinking shared decision-making: Context matters, Patient Education and Counseling, 91 (2): Moller, H., Flatt, G., Moran, A (2011) High cancer mortality rates in the elderly in the UK, Cancer Epidemiology, 35 (5): NICE (2011) Colorectal cancer: The diagnosis and management of colorectal cancer, NICE guidelines [CG131] NICE (2012) Shared decision making: Quality statement at experience/shareddecisionmaking.jsp (accessed 19th August 2014). Park, J., Neuman, H., Bennett, A., Polskin, L., Phang, P., Wong, W., Temple, L. (2014) Patient expectations of functional outcomes after rectal cancer surgery: a qualitative study, Diseases of the Colon and Rectum, 57 (2): Seymour, M., Thompson, L., Wasan, H., Middleton, G., Brewster, A., Shepherd, S., O Mahony, S., Maughan, T., Parmar, M., Langley, R. (2011) Chemotherapy options in elderly and frail patients with metastatic colorectal cancer (MRC FOCUS2): an open-label, randomised factorial trial, Lancet; 377 (9779): Siminoff, L., Rose, J., Zhang, A., Zyzanski, S. (2006) Measuring discord in treatment decision-making; progress toward development of a cancer communication and decision-making assessment tool, Psycho-Oncology, 15 (6), Strohschein, F., Bergman, H., Carnevale, F., Loiselle, C. (2011) Patient decision making among older individuals with cancer, Qualitative Health Research, 21 (7): Tariman, J., Berry, D., Cochrane, B., Doorenbos, A., Schepp, K. (2010) Preferred and actual participation roles during health care decision making in persons with cancer: a systematic review, Annals of Oncology, 21 (6):
24 Contact details/for more information Dr Karen Gillett +44 (0)
Treatment of colon cancer
Treatment of colon cancer This information is an extract from the booklet, Understanding colon cancer. You may find the full booklet helpful. We can send you a copy free see page 5. Contents How treatment
More informationService delivery interventions
Service delivery interventions S A S H A S H E P P E R D D E P A R T M E N T O F P U B L I C H E A L T H, U N I V E R S I T Y O F O X F O R D CO- C O O R D I N A T I N G E D I T O R C O C H R A N E E P
More informationA guide to prostate cancer clinical trials
1 A guide to prostate cancer clinical trials In this fact sheet: What is a clinical trial? Why are trials done? What are trials looking into at the moment? How are clinical trials done? Should I take part
More informationUnderstanding Clinical Trials
Understanding Clinical Trials The UK Clinical Research Collaboration (UKCRC) is a partnership of organisations working to establish the UK as a world leader in clinical research, by harnessing the power
More informationBOWEL CANCER. The doctor has explained that you have a growth or tumour, in your bowel or rectum and could be cancer.
Patient and Carer Information BOWEL CANCER Please read this leaflet carefully. It is important that you take note of any instructions or advice given. If you have any questions or problems that are not
More informationImproving survival and Clinical Trials Janyne Afseth Lecturer Edinburgh Napier University
Improving survival and Clinical Trials Janyne Afseth Lecturer Edinburgh Napier University Aims Identify the factors which may link to improved survival to clinical trials in cancer Describe some of impact
More informationBristol Hospital Cancer Care Center 2015 Annual Report
Bristol Hospital Cancer Care Center 2015 Annual Report 2015 Annual Report Cancer Care Center At every point along the path, our team is there, keeping the focus on the most important team member - the
More informationMS Learn Online Feature Presentation Invisible Symptoms in MS Featuring Dr. Rosalind Kalb
Page 1 MS Learn Online Feature Presentation Invisible Symptoms in MS Featuring Dr. Rosalind Kalb >>Kate Milliken: Hello, I m Kate Milliken, and welcome to MS Learn Online. No two people have exactly the
More informationCancer Survival - How Long Do People Survive?
A research briefing paper by Macmillan Cancer Support Introduction Key findings 3 People with cancer are surviving longer 4 Median survival time has seen dramatic improvement for some cancers 5 Median
More informationSurvey to Doctors in England End of Life Care Report prepared for The National Audit Office
Survey to Doctors in England End of Life Care Report prepared for The National Audit Office 1 2008, medeconnect Table of Contents 1 SUMMARY OF FINDINGS... 3 2 INTRODUCTION... 5 3 RESEARCH OBJECTIVES AND
More informationAre there typical trajectories of social, psychological and spiritual needs in patients with lung cancer and severe heart failure?
Are there typical trajectories of social, psychological and spiritual needs in patients with lung cancer and severe heart failure? Scott A Murray, St Columba s Professor of Primary Palliative Care Marilyn
More informationA career in Geriatric Medicine
British Geriatrics Society for better health in old age A career in Geriatric Medicine A guide for doctors considering a career in Geriatric Medicine (newly qualified/ Foundation Programme/ ST1/ST2 doctors)
More informationSquamous Cell Carcinoma of Anal Canal Treatment Guidelines
May 2009 Squamous Cell Carcinoma of Anal Canal Treatment Guidelines Presented at Cancer Committee: August 6, 2009 By Shelly Smits, RHIT, CCS, CTR Conclusions by Ian Thompson, MD Data Source: Cancer registry
More informationForeword 4 Executive summary The case for action Barriers to treatment What needs to change Innovation in services Conclusion and recommendations
02 Contents Foreword 4 Executive summary 5 The case for action 7 Barriers to treatment 9 What needs to change 13 Innovation in services 16 Conclusion and recommendations 19 References 20 3 Foreword Time
More informationThe Doctor-Patient Relationship
The Doctor-Patient Relationship It s important to feel at ease with your doctor. How well you are able to talk with your doctor is a key part of getting the care that s best for you. It s also important
More informationLiving with dying Patients and carers experiences of living with lung cancer. Dr Donna Fitzsimons, Lesley Rutherford & Jill McAuley
Living with dying Patients and carers experiences of living with lung cancer Dr Donna Fitzsimons, Lesley Rutherford & Jill McAuley Study Aims To explore the experiences of patients living with lung cancer.
More informationGuideline for the Follow Up of Patients Following Treatment for Breast Cancer
Guideline for the Follow Up of Patients Following Treatment for Breast Cancer Date Approved by Network Governance July 2012 Date for Review July 2015 Page 1 of 6 1 Scope of the Guideline This guideline
More informationLife after treatment for Lung Cancer
Oxford University Hospitals NHS Trust Life after treatment for Lung Cancer A guide for patients and their carers Introduction Treatment for Lung Cancer can be very varied depending on the stage and type
More informationCalifornia HealthCare Foundation Education materials for patients with advanced cancer
California HealthCare Foundation Education materials for patients with advanced cancer The California HealthCare Foundation (CHCF) commissioned research to explore options around the development of patient
More informationNational Bowel Cancer Audit Report 2008 Public and Executive Summary
National Bowel Cancer Audit Report 2008 Public and Executive Summary Prepared in association with: Healthcare Quality Improvement Partnership HQIP Association of Coloproctology of Great Britain and Ireland
More informationBetter bowel cancer care in Scotland
Better bowel cancer care in Scotland October 2013 Page 1 of 27 Contents Table of Figures 3 Foreword 4 Executive summary and recommendations 5 Introduction 7 Incidence, mortality and survival rates for
More informationAssessing equity of use and outcome of hip replacement surgery using PROMs data. Jenny Neuburger, King s Fund Conference 22 nd November 2012
Assessing equity of use and outcome of hip replacement surgery using PROMs data Jenny Neuburger, King s Fund Conference 22 nd November 2012 Structure of talk 1. Patient pathway points at which in differences
More informationQuick Facts about Appendix Cancer
Quick Facts about Appendix Cancer What is the appendix? The appendix is a pouch-like tube attached to the first part of the large intestine (cecum). The appendix is about 10 centimetres long and has no
More informationNavigation and Cancer Rehabilitation
Navigation and Cancer Rehabilitation Messina Corder, RN, BSN, MBA Manager, MWHC Regional Cancer Center Regina Kenner, RN Cancer Navigator, MWHC Regional Cancer Center Cancer Action Coalition of Virginia
More informationPRIMARY LUNG CANCER TREATMENT
PRIMARY LUNG CANCER TREATMENT Cancer Care Pathways Directorate Tailored Information in Cancer Care (TICC) Sir Anthony Mamo Oncology Centre December 2014 Contents About this booklet 1 Types of Lung Cancer
More informationHow do I find the best place to get treatment for my lymphoma?
Produced November 2010 Next revision due November 2012 How do I find the best place to get treatment for my lymphoma? Introduction Fortunately this is not a question that patients with cancers of the blood
More informationTracing the impacts of public dialogue projects supported by Sciencewise
Tracing the impacts of public dialogue projects supported by Sciencewise: Recruiting participants for health research March 2016 Page 1 of 6 Recruiting participants for health research Key facts Date August
More informationGuide to Abdominal or Gastroenterological Surgery Claims
What are the steps towards abdominal surgery? Investigation and Diagnosis It is very important that all necessary tests are undertaken to investigate the patient s symptoms appropriately and an accurate
More informationOVARIAN CANCER TREATMENT
OVARIAN CANCER TREATMENT Cancer Care Pathways Directorate Tailored Information in Cancer Care (TICC) Sir Anthony Mamo Oncology Centre National Cancer Plan May 2015 Contents About this booklet 1 The Ovaries
More informationPhysical therapy for patients dying at home of chronic obstructive pulmonary disease A Qualitative Study
Physical therapy for patients dying at home of chronic obstructive pulmonary disease A Qualitative Study D.M. Keesenberg, Pt, student Science for physical therapy Physical therapy practice Zwanenzijde,
More informationHow treatment is planned Giving your consent The benefits and disadvantages of treatment Second opinion
Treatment overview for lung cancer This information is an extract from the booklet Understanding lung cancer. You may find the full booklet helpful. We can send you a free copy see page 5. Contents How
More informationThe Scottish Public Services Ombudsman Act 2002
Scottish Public Services Ombudsman The Scottish Public Services Ombudsman Act 2002 Investigation Report UNDER SECTION 15(1)(a) SPSO 4 Melville Street Edinburgh EH3 7NS Tel 0800 377 7330 SPSO Information
More informationPharmacists improving care in care homes
The Royal Pharmaceutical Society believes that better utilisation of pharmacists skills in care homes will bring significant benefits to care home residents, care homes providers and the NHS. Introduction
More informationLaparoscopic Surgery for Endometrial Cancer: A Phenomenological Study of Patient Experience
Laparoscopic Surgery for Endometrial Cancer: A Phenomenological Study of Patient Experience Cathy Hughes Patient Safety Lead for Cancer National Patient Safety Agency Study Aim To describe women s perspectives
More informationNHS. Percutaneous endoscopic colostomy. National Institute for Health and Clinical Excellence. Issue date: March 2006
NHS National Institute for Health and Clinical Excellence Issue date: March 2006 Percutaneous endoscopic colostomy Understanding NICE guidance information for people considering the procedure, and for
More informationParkinson s Disease: Factsheet
Parkinson s Disease: Factsheet Tower Hamlets Joint Strategic Needs Assessment 2010-2011 Executive Summary Parkinson s disease (PD) is a progressive neuro-degenerative condition that affects a person s
More informationPREPARING FOR YOUR STOMA REVERSAL
PREPARING FOR YOUR STOMA REVERSAL Information Leaflet Your Health. Our Priority. Page 2 of 6 Introduction- What you need to know As part of your bowel operation you may have had a temporary stoma formed.
More informationGuide to Private Medical Insurance
Guide to Private Medical Insurance Contents About the Exeter 4 Why private medical insurance? 5 Product highlights 6 Cover and benefits 10 Getting the right premium 15 How to apply 16 Claims overview 21
More informationStocktake of access to general practice in England
Report by the Comptroller and Auditor General Department of Health and NHS England Stocktake of access to general practice in England HC 605 SESSION 2015-16 27 NOVEMBER 2015 4 Key facts Stocktake of access
More informationCancer research in the Midland Region the prostate and bowel cancer projects
Cancer research in the Midland Region the prostate and bowel cancer projects Ross Lawrenson Waikato Clinical School University of Auckland MoH/HRC Cancer Research agenda Lung cancer Palliative care Prostate
More informationEvidence to The Commission on Assisted Dying 23 rd February 2011
Evidence to The Commission on Assisted Dying 23 rd February 2011 My name is Suzy Croft and I am Senior Social Worker at St. John s Hospice, the hospice for Central London. I am a member of the Association
More informationCancer and Advance Care Planning
Cancer and Advance Care Planning You ve been diagnosed with cancer. Now what? You have a lot to think about and it can be difficult to know where to start. One important thing you should think about is
More informationPSA Testing for Prostate Cancer An information sheet for men considering a PSA Test
PSA Testing for Prostate Cancer An information sheet for men considering a PSA Test What is the aim of this leaflet? Prostate cancer is a serious condition. The PSA test, which can give an early indication
More informationLiving well with dementia: A National Dementia Strategy. Accessible Summary. National Dementia Strategy. Putting People First
Living well with dementia: A National Dementia Strategy Accessible Summary National Dementia Strategy Putting People First National Dementia Strategy Accessible Summary This booklet is an accessible version
More informationBreast Cancer Care & Research
Breast Cancer Care & Research Professor John FR Robertson University of Nottingham Nottingham City Hospital Breast Cancer (BC) 15,000 BC deaths in the UK each year 20% female cancer deaths 5% all female
More informationImpact of Breast Cancer Genetic Testing on Insurance Issues
Impact of Breast Cancer Genetic Testing on Insurance Issues Prepared by the Health Research Unit September 1999 Introduction The discoveries of BRCA1 and BRCA2, two cancer-susceptibility genes, raise serious
More informationBreast Cancer Pathway
Breast Cancer Pathway Risk Stratified Follow Up Dr Dorothy Goddard, Associate Medical Director for Cancer Macmillan Consultant Medical Advisor Survivorship What is risk stratified follow up? Refers to
More informationScreening for Prostate Cancer
Screening for Prostate Cancer It is now clear that screening for Prostate Cancer discovers the disease at an earlier and more curable stage. It is not yet clear whether this translates into reduced mortality
More informationSIOG Guidelines Update 2014 Prostate Cancer. Dr Helen Boyle Centre Léon Bérard SIOG meeting 25 October 2014,Lisbon
SIOG Guidelines Update 2014 Prostate Cancer Dr Helen Boyle Centre Léon Bérard SIOG meeting 25 October 2014,Lisbon Droz JP, Aapro M, Balducci L, Boyle H, Van den Broeck T, Cathcart P, Dickinson L, Efstathiou
More informationColon and Rectal Cancer
Colon and Rectal Cancer What is colon or rectal cancer? Colon or rectal cancer is the growth of abnormal cells in your large intestine, which is also called the large bowel. The colon is the last 5 feet
More informationA practical guide to living with and after cancer. Front Cover
A practical guide to living with and after cancer Front Cover 2 What to do after cancer treatment ends 10 top tips After cancer treatment, it helps to know what to expect and where you can get further
More informationCardio-Pulmonary Resuscitation (CPR): A Decision Aid For. KGH Patients And Their Families
Cardio-Pulmonary Resuscitation (CPR): A Decision Aid For KGH Patients And Their Families The goal of this pamphlet is to provide information about cardiopulmonary resuscitation (CPR) so you can be adequately
More informationBreast cancer treatment for elderly women: a systematic review
Breast cancer treatment for elderly women: a systematic review Gerlinde Pilkington Rumona Dickson Anna Sanniti Funded by the NCEI and POI Elderly people less likely to receive chemotherapy than younger
More informationHow internal communications saved lives.
How internal communications saved lives. The story of the West of Scotland Cancer Awareness Project Bowel Cancer Campaign 31 January 2007 Authors Lisa Cohen, Project Manager, West of Scotland Cancer Awareness
More informationPSA Testing 101. Stanley H. Weiss, MD. Professor, UMDNJ-New Jersey Medical School. Director & PI, Essex County Cancer Coalition. weiss@umdnj.
PSA Testing 101 Stanley H. Weiss, MD Professor, UMDNJ-New Jersey Medical School Director & PI, Essex County Cancer Coalition weiss@umdnj.edu September 23, 2010 Screening: 3 tests for PCa A good screening
More informationCOMMISSIONING. for ULTRA-RADICAL SURGERY ADVANCED OVARIAN CANCER
COMMISSIONING for ULTRA-RADICAL SURGERY in ADVANCED OVARIAN CANCER WHY THIS MUST HAPPEN PERSPECTIVE COMMISSIONING FOR WHO, FOR WHAT? Biological Basis Surgical Basis International and national standards
More informationDr. Tushna Vandrevala, Kingston University, UK
"Providing end of life care to people with dementia in a care home: Are care home staff at risk of emotional burnout? : A Qualitative Study Dr. Tushna Vandrevala, Kingston University, UK Photo Credit:
More informationInova. Breast Care Institute
Inova Breast Care Institute At the Inova Breast Care Institute, our commitment is to provide expert care for you, every step of the way. Our multidisciplinary team of more than 80 experts provides a full
More informationSupportive Care For Patients With High-Grade Glioma (primary brain tumours) Dr Susan Catt & Professor Lesley Fallowfield
Supportive Care For Patients With High-Grade Glioma (primary brain tumours) Dr Susan Catt & Professor Lesley Fallowfield Partners Mr Giles Critchley Consultant Neurosurgeon Hurstwood Park Neurological
More informationQuestions to ask your doctor. about Prostate Cancer and selecting a treatment facility
Questions to ask your doctor about Prostate Cancer and selecting a treatment facility The Basics Establishing an open dialogue with a doctor provides you with the opportunity to learn specific information
More informationColorectal cancer. A guide for journalists on colorectal cancer and its treatment
Colorectal cancer A guide for journalists on colorectal cancer and its treatment Contents Contents 2 3 Section 1: Colorectal cancer 4 i. What is colorectal cancer? 4 ii. Causes and risk factors 4 iii.
More informationHosts. Palliative Care vs. Hospice Care
Hosts Anees MD Associate Professor of Surgical Oncology Francine Foss MD Professor of Medical Oncology Palliative Care vs. Hospice Care Guest Experts: Jennifer, MD Associate Professor of Medical Oncology;
More informationMS Learn Online Feature Presentation Pediatric MS: Partnering with Your Child s School Featuring Maria Milazzo, N.P., CPNP
Page 1 MS Learn Online Feature Presentation Pediatric MS: Partnering with Your Child s School Featuring >>Kate Milliken: Hello, I m Kate Milliken, and welcome to MS Learn Online. Parents of children with
More informationHealth care rationing in the UK: the situation today
Health care rationing in the UK: the situation today Joanna Coast Conference on priority setting in health care, Vasterås, Sweden, October 2011 Thoughts UK health care system Recent changes Current UK
More informationOncology Nurses: Leveraging an Underutilized Communication Resource in Cancer Treatment Planning
Oncology Nurses: Leveraging an Underutilized Communication Resource in Cancer Treatment Planning Surgery Inpatient Care Chemotherapy Radiation Therapy Home Care MARIE BAKITAS, DNSc, APRN, FAAN ASSOCIATE
More informationDETERMINING RESEARCH PRIORITIES FOR CANCER SURVIVORSHIP: CONSULTATION AND EVIDENCE REVIEW EXECUTIVE SUMMARY
DETERMINING RESEARCH PRIORITIES FOR CANCER SURVIVORSHIP: CONSULTATION AND EVIDENCE REVIEW EXECUTIVE SUMMARY Alison Richardson Julia Addington-Hall Daniel Stark Claire Foster Ziv Amir Michael Sharpe Commissioned
More informationEvaluating the ENAT : reconciling findings from a mixed methods study
School of Healthcare FACULTY OF MEDICINE AND HEALTH Evaluating the ENAT : reconciling findings from a mixed methods study Professor Claire A Hale School of Healthcare University of Leeds On behalf of the
More informationHealth and Care Experience Survey 2013/14 Results for Arran Medical Group- Arran
Results for Arran Medical Group The Medical Centre Lamlash Isle of Arran KA27 8NS This report gives a summary of the results of the for. The survey was sent to 329 people registered with the practice.
More informationWhat is new in Geriatric Oncology? The geriatric perspective
What is new in Geriatric Oncology? The geriatric perspective Marie-Claire Van Nes, MA, MD, MBA Head of the Department of Geriatric Medicine, CHR de la Citadelle, Liège, Belgium The experience at our hospital
More informationSalisbury Lung Cancer Service (1 of 5)
Salisbury Lung Cancer Service (1 of 5) i If you need this information in another language or medium (audio, large print, etc) please contact Customer Care on 0800 374 208 email: customercare@ salisbury.nhs.uk.
More informationINNOVATIVE 5-STAR SERIOUS ILLNESS COVER
INNOVATIVE 5-STAR SERIOUS ILLNESS COVER FROM VITALITYLIFE VITALITY.CO.UK/LIFE YOU RE UP TO TWICE 1 AS LIKELY TO GET A PAYOUT FROM OUR SERIOUS ILLNESS COVER THAN YOU ARE FROM A TYPICAL CRITICAL ILLNESS
More informationInformation Pathway. The emotional impact of a myeloma diagnosis. Coping with a diagnosis of myeloma
Information Pathway Myeloma UK Broughton House 31 Dunedin Street Edinburgh EH7 4JG Tel: + 44 (0) 131 557 3332 Fax: + 44 (0) 131 557 9785 Myeloma Infoline 0800 980 3332 www.myeloma.org.uk Charity No. SC
More informationColorectal Cancer Care A Cancer Care Map for Patients
Colorectal Cancer Care A Cancer Care Map for Patients Understanding the process of care that a patient goes through in the diagnosis and treatment of colorectal cancer in BC. Colorectal Cancer Care Map
More informationAdvanced Prostate Cancer Treatments
Advanced Prostate Cancer Treatments Guest Expert: Kevin, DO Associate Professor of Medical Oncology, Yale Cancer Center www.wnpr.org www.yalecancercenter.org Welcome to Yale Cancer Center Answers with
More informationFact sheet 9. Screening for ovarian cancer
Fact sheet 9 Screening for ovarian cancer Ovacome is a national charity providing advice and support to women with ovarian cancer. We give information about symptoms, diagnosis, treatment, research and
More informationAugust Is Palliative Care and Cancer Pain Awareness Month
August Is Palliative Care and Cancer Pain Awareness Month What Is Palliative Care? Palliative care is a growing research area that focuses on improving the quality of life of all people living with cancer,
More informationExample 1 is the Chart Audit Form. A few comments about the items are:
Dear Colleague: We appreciate your interest in the Pain Audit Tools developed and used at the City of Hope Medical Center. Attached for your information and use are three examples. Example 1 is the Chart
More informationA Guide to Clinical Trials
A Guide to Clinical Trials For young people with cancer and their parents Children s Cancer and Leukaemia Group www.cclg.org.uk Original booklet produced in conjunction with the CCLG Patient Advocacy Committee.
More informationMRC Autism Research Forum Interventions in Autism
MRC Autism Research Forum Interventions in Autism Date: 10 July 2003 Location: Aim: Commonwealth Institute, London The aim of the forum was to bring academics in relevant disciplines together, to discuss
More informationPushing the possibilities: Consumers and health professionals co-design web videos on breast cancer
Pushing the possibilities: Consumers and health professionals co-design web videos on breast cancer Chris Walsh (Deputy Chair) Rowena Mortimer (Secretary) Jenny Williams (Committee Member) National Psycho
More informationTalking With Your Doctor About Multiple Myeloma: A guide to making the most of your healthcare visits
There s a lot to think about and many important decisions to make when you or someone you care for has multiple myeloma. It s important to have an ongoing conversation with your healthcare team throughout
More informationAlaska Comprehensive Cancer Control Plan 2011-15
Alaska Comprehensive Cancer Control Plan 2011-15 Alaska Comprehensive Cancer Plan 2011-2015 STATE of ALASKA Department of Health and Social Services ALASKA Comprehensive Cancer Partnership Prevention Promotion
More informationThe National Survey of People with Diabetes
The National Survey of People with Diabetes Jenny Harris, Alice McGee, Fiona Andrews, John Souza and Kerry Sproston Prepared for the Healthcare Commission Sept 007 P488 Contents EXECUTIVE SUMMARY... ABOUT
More informationCritical Care Rehabilitation Service Using the model of a generic rehabilitation assistant
Critical Care Rehabilitation Service Using the model of a generic rehabilitation assistant Lisa Salisbury, Research Physiotherapist, The University of Edinburgh. Leanne Dow, Generic Rehabilitation Assistant,
More informationCancer Care Coordinator (CCC) services in colon cancer: economic evaluation using discrete event simulation modelling n
Cancer Care Coordinator (CCC) services in colon cancer: economic evaluation using discrete event simulation modelling n Presenter: Rachel Webber-Foster Co-authors: Lucie Collinson, Giorgi Kvizhinadze,
More informationEGG DONOR CONTRACTS: CONCERNS OF RECIPIENTS AND CONCERNS OF DONORS
EGG DONOR CONTRACTS: CONCERNS OF RECIPIENTS AND CONCERNS OF DONORS Sanford M. Benardo Founder and President, Northeast Assisted Fertility Group MR. BENARDO: I do not have a PowerPoint presentation for
More informationQuality standard Published: 11 June 2015 nice.org.uk/guidance/qs89
Pressure ulcers Quality standard Published: 11 June 2015 nice.org.uk/guidance/qs89 NICE 2015. All rights reserved. Contents Introduction... 6 Why this quality standard is needed... 6 How this quality standard
More informationBREAST CANCER AWARENESS FOR WOMEN AND MEN by Samar Ali A. Kader. Two years ago, I was working as a bedside nurse. One of my colleagues felt
Ali A. Kader, S. (2010). Breast cancer awareness for women and men. UCQ Nursing Journal of Academic Writing, Winter 2010, 70 76. BREAST CANCER AWARENESS FOR WOMEN AND MEN by Samar Ali A. Kader Two years
More informationTREATING LUNG CANCER AT VA PITTSBURGH HEALTHCARE SYSTEM A HERO S GUIDE
Providing the best in cancer care for Veterans TREATING LUNG CANCER AT VA PITTSBURGH HEALTHCARE SYSTEM A HERO S GUIDE VA Pittsburgh s state-of-the-art TomoTherapy machine, which delivers radiation to patients.
More informationREGULATIONS FOR THE POSTGRADUATE DIPLOMA IN PSYCHO-ONCOLOGY (PDipPsycho-oncology)
535 REGULATIONS FOR THE POSTGRADUATE DIPLOMA IN PSYCHO-ONCOLOGY (PDipPsycho-oncology) (See also General Regulations) M.105 Admission requirements To be eligible for admission to the programme leading to
More informationA guide for employers
A guide for employers Contents 01 Contents A guide for employers 02 Discrimination the new law explained 05 Other relevant legisltation 13 02 The Equality Act 2010 and cancer how it affects you A guide
More informationMesothelioma Priority Setting Partnership. PROTOCOL November 2013
Mesothelioma Priority Setting Partnership PROTOCOL November 2013 Purpose The purpose of this protocol is to set out the aims, objectives and commitments of the Mesothelioma Priority Setting Partnership
More informationColon Cancer vs. Rectal Cancer: What is the Difference? Webcast March 31, 2010 Karen Horvath, M.D., F.A.C.S. Introduction
Colon Cancer vs. Rectal Cancer: What is the Difference? Webcast March 31, 2010 Karen Horvath, M.D., F.A.C.S. Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle
More informationPsychological Issues in Cancer Survivorship. Dr Andy Ashley Clinical Psychologist South Worcestershire Specialist Palliative Care, 2015
Psychological Issues in Cancer Survivorship Dr Andy Ashley Clinical Psychologist South Worcestershire Specialist Palliative Care, 2015 Introduction Cancer deaths are due to fall dramatically by 2030 with
More informationFinal Version Two (Sept 2014) Eastern Cheshire Clinical Commissioning Group NHS Funded Treatment for Subfertility Policy
Final Version Two (Sept 2014) Eastern Cheshire Clinical Commissioning Group NHS Funded Treatment for Subfertility Policy NHS FUNDED TREATMENT FOR SUBFERTILITY ELIGIBILITY CRITERIA Table of Contents 1.
More informationMetastatic Melanoma What You Need to Know
ESSENTIALS Metastatic Melanoma Metastatic Melanoma What You Need to Know If you have metastatic melanoma, you may feel as though your life has been turned upside down. It s a serious disease, but patients
More informationHosts. New Methods for Treating Colorectal Cancer
Hosts Anees Chagpar MD Associate Professor of Surgical Oncology Francine MD Professor of Medical Oncology New Methods for Treating Colorectal Cancer Guest Expert: Scott, MD Associate Professor in the Department
More informationQUALITY ACCOUNT 2015-16
QUALITY ACCOUNT 2015-16 CONTENTS Part 1 Chief Executive s statement on quality... 3 Vision, purpose, values and strategic aims... 4 Part 2 Priorities for improvement and statement of assurance... 5 2.1
More information