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Strategies and implementation outcomes of HPV-based cervical screening studies to prevent cervical cancer in India: A systematic review 印度基于 HPV 的宫颈癌筛查研究的策略和实施成果:系统综述。
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-11-06 DOI: 10.1016/j.jcpo.2024.100513
Anu Mary Oommen , Maleeha Ashfaq , Anne George Cherian , Ana Machado Colling , Arianis Tatiana Ramirez , Tessa Saunders , Pravin Singarayar , Vinotha Thomas , Anitha Thomas , Tobey Ann Marcus , Ruby Angeline Pricilla , Claire Nightingale , Julia ML Brotherton

Background

As Indian states consider HPV testing for cervical screening, there is a need to review evidence from prior studies to inform program design and evaluate implementation research gaps.

Design

We conducted a systematic review of original articles in Medline, Embase, Global Health and Web of Science, published from 2000 to May 4, 2024. Articles describing use of HPV as a primary cervical screening test in India, in either community-based programs for the general population, or among women living with HIV, were included. We describe approaches to invitation, education, screening, and follow-up, and map determinants and outcomes to the RE-AIM and the Consolidated Framework for Implementation Research frameworks.

Results

Of 71 included articles (51 unique studies), 19 reported on screening among women living with HIV, while 52 were community-based (general population of women). Self-collection was offered by 15 studies and was acceptable to most screened women. Community-based programs were mainly facility or outreach-based, with three studies offering only home-based self-collection, including one that integrated with cardiovascular risk screening. Studies from northeastern and tribal populations were scarce. Only one self-collection study used a screen and treat (at second visit) approach, but did not report follow-up, while none offered immediate treatment following a point-of-care test.

Conclusions

Community-based HPV testing, including self-collection, is feasible in India, with more research needed among underrepresented populations. Further implementation research is needed on integrating HPV screening with existing health systems, feasibility of HPV test and treat models and genotyping triage, to improve follow-up in low resource settings.
背景:印度各邦正在考虑将 HPV 检测用于宫颈筛查:随着印度各邦考虑将 HPV 检测用于宫颈筛查,有必要回顾以往研究的证据,为项目设计提供参考,并评估实施方面的研究差距:我们对 2000 年至 2024 年 5 月 4 日期间在 Medline、Embase、Global Health 和 Web of Science 上发表的原创文章进行了系统性回顾。这些文章介绍了在印度的社区项目中将 HPV 作为宫颈癌筛查的主要检测方法,无论是针对普通人群,还是针对感染 HIV 的女性。我们描述了邀请、教育、筛查和随访的方法,并将决定因素和结果映射到 RE-AIM 和实施研究综合框架:结果:在收录的 71 篇文章(51 项独特的研究)中,19 篇报告了对感染 HIV 的女性进行筛查的情况,52 篇报告了基于社区(普通女性人群)的筛查情况。有 15 项研究提供了自我采集服务,大多数接受筛查的妇女都能接受。以社区为基础的项目主要以设施或外联为基础,有三项研究仅提供家庭自采服务,其中一项与心血管风险筛查相结合。来自东北部和部落人群的研究很少。只有一项自我采集研究采用了筛查和治疗(第二次就诊时)的方法,但没有报告后续情况,也没有一项研究在护理点检测后提供即时治疗:结论:在印度,以社区为基础的 HPV 检测(包括自我采集)是可行的,但需要在代表性不足的人群中开展更多研究。还需要进一步研究如何将HPV筛查与现有医疗系统相结合、HPV检测和治疗模式的可行性以及基因分型分流,以改善低资源环境下的随访。
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引用次数: 0
Improving cancer outcomes through enhanced leadership and strategy training for cancer healthcare professionals – A course developed by the European School of Oncology (ESO), the European Cancer Organization (ECO) and Sharing Progress in Cancer Care (SPCC) 通过加强对癌症医护专业人员的领导力和战略培训来提高癌症治疗效果--这是由欧洲肿瘤学院(ESO)、欧洲癌症组织(ECO)和癌症护理共享进展(SPCC)共同开发的课程。
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-11-05 DOI: 10.1016/j.jcpo.2024.100517
Razvan Andrei Popescu , Richard Sullivan , Ajay Aggarwal , Bruna Bianca Lopes David , Olga Valciņa , Maha al Sendi , Mark Lawler , Andreas Charalambous , Matti Aapro , Corinne Hall , Alexandru Eniu , Peter Selby
Leadership as a key building block of a health system plays a crucial role in achieving high performance and helps deliver change and shape the policy agenda and its implementation. Echoing the emerging need for effective leaders in Oncology, the “Improving Cancer Outcomes and Leadership Course” was developed jointly by the European School of Oncology (ESO), the European Cancer Organization (ECO) and Sharing Progress in Cancer Care (SPCC). The course was offered as a hybrid event online and in Warsaw in June 2022. It aimed to introduce early and mid–career cancer healthcare professionals of all disciplines and professions to the expertise required to develop strategic plans, support and collaborate in relevant applied health research, develop implementation approaches and acquire the skill sets required to support leadership and change management within their countries and regions. A total of 47 participants, mainly from Europe, participated and prepared ‘case discussions’ of organisational challenges or projects aiming to improve health care in their regions. These were deliberated and further developed in 3 break out groups. A qualitative evaluation of the course impact performed 2 years after the course showed that most participants remained in contact with each other, the majority had implemented learnings from the course to help improve cancer outcomes, 87 % had further developed their projects that were presented during the breakout sessions and of those 89 % felt that the discussions that were held during course had actively helped them to develop and potentially apply these projects. Finally, 77 % have thought of or initiated a different project than the one they discussed during the course, based on ideas coming from the discussions during or after the course. Here we describe the course, give three examples of topics discussed in Warsaw and present plans for the future.
领导力作为医疗系统的重要组成部分,在实现高绩效方面发挥着至关重要的作用,并有助于实现变革、制定政策议程及其实施。欧洲肿瘤学院(ESO)、欧洲癌症组织(ECO)和 "分享癌症治疗进展"(SPCC)联合开发了 "提高癌症治疗效果和领导力课程",以满足肿瘤学领域对高效领导者的新需求。该课程于 2022 年 6 月在华沙以在线和混合活动的形式举办。课程旨在向所有学科和专业的职业生涯早期和中期癌症医疗保健专业人员介绍制定战略计划、支持和合作开展相关应用健康研究、制定实施方法以及掌握在其所在国家和地区支持领导力和变革管理所需的技能所需的专业知识。共有 47 名与会者(主要来自欧洲)参加了会议,并准备了 "案例讨论",内容涉及组织面临的挑战或旨在改善本地区医疗服务的项目。这些讨论在 3 个分组讨论中得到了审议和进一步发展。课程结束两年后,对课程影响进行的定性评估显示,大多数学员仍保持联系,大多数学员已将从课程中学到的知识用于帮助改善癌症治疗效果,87%的学员进一步发展了他们在分组讨论中提出的项目,其中 89% 的学员认为课程期间进行的讨论积极帮助了他们发展和应用这些项目。最后,77% 的学员在课程期间或课程结束后,根据讨论中提出的想法,考虑或启动了与他们在课程期间讨论的项目不同的项目。在此,我们将对课程进行介绍,举出三个在华沙讨论过的话题的例子,并提出未来的计划。
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引用次数: 0
Income disparities have a significant impact on thyroid cancer recurrence and survival 收入差距对甲状腺癌复发和存活率有重大影响
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-10-21 DOI: 10.1016/j.jcpo.2024.100511
Mohammad H. Hussein , Julia A. McGee , Luu Alexandria , Michelle M. Tsang , Manal S. Fawzy , Eman A. Toraih , Emad Kandil

Purpose

Income inequality profoundly impacts cancer outcomes, yet its specific effects on thyroid cancer remain unclear. Elucidating the influence of socioeconomic disparities is imperative to advance health equity and optimize patient care. This study evaluates associations between median household income and thyroid cancer recurrence and survival using national cancer registry data.

Methods

139,302 thyroid cancer patients undergoing surgery from 2000 to 2019 were analyzed from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were categorized by median annual household income at the county level (> or <$75,000). Multivariable regression determined the impact of income on recurrence and overall mortality.

Results

Higher-income patients had 26 % lower recurrence odds (OR 0.74, 95 %CI 0.55–0.99, p=0.042) and longer median survival (18.1 vs 17.7 years, p<0.001) compared to lower-income patients. On multivariate analysis, high income remained an independent predictor of reduced mortality after adjusting for demographics, tumor factors, and treatment (adjusted HR=0.84, 95 %CI=0.81–0.87, p<0.001). Cancer-directed surgery (HR=0.28, 95 %CI=0.26–0.30, p<0.001) and radioactive iodine (HR=0.69, 95 %CI=0.66–0.71, p<0.001) were associated with lower mortality risk.

Conclusions

Income disparities have a significant influence on thyroid cancer outcomes, including lower recurrence and reduced mortality. Targeting socioeconomic inequity could substantially reduce recurrence, improve survival, and promote health equity for all patients.
目的:收入不平等会对癌症的治疗结果产生深远影响,但其对甲状腺癌的具体影响仍不清楚。阐明社会经济差异的影响对于促进健康公平和优化患者护理至关重要。本研究利用全国癌症登记数据评估了家庭收入中位数与甲状腺癌复发和生存率之间的关系。方法:研究人员从监测、流行病学和最终结果(SEER)数据库中分析了2000-2019年间接受手术的139302名甲状腺癌患者。根据县级家庭年收入中位数对患者进行分类(> 或 结果:高收入患者的复发几率低26%(OR 0.74,95%CI 0.55-0.99,p=0.042),中位生存期长(18.1年 vs 17.7年,p结论:收入差距对甲状腺癌的治疗效果有重大影响,包括降低复发率和死亡率。针对社会经济方面的不平等可大大降低复发率,提高生存率,促进所有患者的健康公平。
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引用次数: 0
An assessment of cancer centre level designation and guideline adherent care in those with rectal cancer: A population based retrospective cohort study 评估直肠癌患者的癌症中心级别指定和遵循指南的护理:基于人群的回顾性队列研究。
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-10-18 DOI: 10.1016/j.jcpo.2024.100510
Sunil V. Patel , Tyler McKechnie , Chad McClintock , Weidong Kong , Clare Bankhead , Christopher M. Booth , Carl Heneghan , Ameer Farooq

Background

Institutions providing care to individuals with cancer are organized based on available resources and treatments offered. It is presumed that increasing levels of care will result in improved quality of care and outcomes. The objective is to determine whether Cancer Level Designation is associated with guideline adherent care and/or survival.

Methods

This is a retrospective study of individuals within the Ontario Rectal Cancer Cohort, a population-level database including all adults undergoing surgical resection for rectal cancer between 2010 – 2019 were included in Ontario, Canada. The primary exposure was Cancer Centre Level Designation as defined by Cancer Care Ontario (i.e., Level 1/2 = regional cancer center; Level 3 = affiliate cancer center; Level 4 = satellite cancer center). The primary outcomes were guideline adherent care and survival. Associations were determined using one-way analysis of variances and a multivariable Cox proportional hazards model.

Results

12,399 patients were included with 54 % from a Level 1/2 centre, 33 % from a Level 3 centre and 13 % from a Level 4+ centre. All assessed aspects of guideline adherent care were associated with cancer centre level designation. Unadjusted 5-year overall survival was associated with cancer centre level designation (Level 1/2 79.5 % vs. Level 3 79.1 % vs. Level 4/non-designated 75.4 %, P = 0.003). Adjusted Cox Proportional Hazard Analysis for overall survival found the following: Level 4/5 HR 1.11 (95 %CI 0.99 – 1.25); Level 3 HR 1.01 (95 % CI 0.93 – 1.11); Level 1/2 1 [Referent group].

Conclusions

Increasing Cancer Centre Level Designation was associated with higher likelihood of receiving the appropriate investigations and treatments in those with rectal cancer and may also be associated with survival.

Policy Summary

Future work should consider the centralization of complex rectal cancer care as well as quality improvement initiatives aimed at enhancing guideline adherent care across all centres managing rectal cancer.
背景:为癌症患者提供护理的机构是根据可用资源和所提供的治疗方法来组织的。据推测,护理级别的提高将导致护理质量和效果的改善。本研究的目的是确定癌症级别指定是否与遵循指南的护理和/或生存有关:这是一项对安大略省直肠癌队列(Ontario Rectal Cancer Cohort)中的个体进行的回顾性研究,该队列是一个人口级数据库,包括加拿大安大略省在 2010 - 2019 年间接受直肠癌手术切除的所有成年人。主要暴露指标是安大略省癌症护理中心(Cancer Care Ontario)定义的癌症中心级别(即1/2级=区域癌症中心;3级=附属癌症中心;4级=卫星癌症中心)。主要结果是遵循指南的护理和存活率。采用单因素方差分析和多变量考克斯比例危险模型确定相关性:共纳入12399名患者,其中54%来自1/2级中心,33%来自3级中心,13%来自4+级中心。所有接受评估的指南依从性护理都与癌症中心的级别有关。未经调整的5年总生存率与癌症中心的级别指定有关(1/2级79.5% vs. 3级79.1% vs. 4级/非指定75.4%,P = 0.003)。调整后的总生存率Cox比例危险分析结果如下:4/5 级 HR 1.11 (95%CI 0.99 - 1.25);3 级 HR 1.01 (95%CI 0.93 - 1.11);1/2 级 1 [参照组]:癌症中心等级的提高与直肠癌患者接受适当检查和治疗的可能性增加有关,也可能与生存率有关。政策摘要:今后的工作应考虑将复杂的直肠癌治疗集中起来,并采取质量改进措施,以提高所有直肠癌治疗中心遵守指南的治疗水平。
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引用次数: 0
Spending on anticancer drugs among Medicare beneficiaries: Analyzing predictors of drug expenditures 医疗保险受益人的抗癌药物支出:分析药物支出的预测因素。
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-10-16 DOI: 10.1016/j.jcpo.2024.100509
Ashley Nee , Alyson Haslam , Vinay Prasad

Objective

To evaluate the factors associated with Medicare spending on newly approved anticancer drugs in the US from 2012 through 2021.

Patient and methods

Using a cross-sectional analysis, we searched US FDA new oncology drug approvals (2012–2021). We analyzed clinical attributes and institutional factors influencing the annual cost of new anticancer drugs in the US. Annual treatment cost was calculated based on average spending per beneficiary from the Centers for Medicare and Medicaid Services, with product factors sourced from the FDA’s annual New Drug Therapy Approval reports and drug package inserts at the time of approval.

Results

Over a ten-year period, 112 new anticancer drugs were approved, of which 97 met the study's criteria. A significant majority, 93 %, received expedited development designations from the FDA. At the time of approval, 40 % of these drugs had data on progression-free survival, and 19 % had data on overall survival; 29 % were first-in-class. The study found a significant relationship between the year of approval and factors associated with the size of the treatment population. No statistically significant relationship was found between the clinical value of a drug and its price.

Conclusions

Spending on anticancer drugs by Medicare are predominantly determined by reference pricing and the size of the anticipated treatment population, without an association with therapeutic value. The study advocates for reforms in reimbursement mechanisms for drugs lacking comparator arms and greater transparency for patients treated with these drugs.
目的:评估 2012 年至 2021 年美国新批准的抗癌药物医疗保险支出的相关因素:评估 2012 年至 2021 年美国新批准的抗癌药物医疗保险支出的相关因素:通过横断面分析,我们检索了美国 FDA 批准的新抗肿瘤药物(2012-2021 年)。我们分析了影响美国抗癌新药年度成本的临床属性和机构因素。年治疗成本根据医疗保险和医疗补助服务中心(Centers for Medicare and Medicaid Services)提供的每位受益人的平均支出计算,产品因素则来自美国食品与药物管理局(FDA)的年度新药治疗审批报告和批准时的药品包装说明书:十年间,共有 112 种抗癌新药获得批准,其中 97 种符合研究标准。其中绝大多数(93%)获得了美国食品及药物管理局的加速开发指定。在获得批准时,其中 40% 的药物拥有无进展生存期数据,19% 的药物拥有总生存率数据;29% 的药物属于一类新药。研究发现,批准年份与治疗人群规模的相关因素之间存在显著关系。在药物的临床价值和价格之间没有发现明显的统计学关系:医疗保险对抗癌药物的支出主要取决于参考定价和预期治疗人群的规模,而与治疗价值无关。该研究提倡对缺乏参照物的药物进行报销机制改革,并为接受这些药物治疗的患者提供更大的透明度。
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引用次数: 0
Barriers to identifying and addressing health-related social needs in cancer care: Patient and patient navigator perspectives 在癌症护理中识别和解决与健康相关的社会需求的障碍:患者和患者导航员的观点。
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-09-30 DOI: 10.1016/j.jcpo.2024.100508
Tilicea Henry , Michael Hayes , Caroline D. Eisele , Susan Veldheer , Sophia I. Allen , Brianna Hoglen , Kenneth R. Houser , Eugene J. Lengerich , Sol M. Rodriguez-Colon , Amy C. Jenkins , Andrea L. Hobkirk

Background

The study aimed to gain insight into the experiences of patients with cancer and survivors regarding the integration of social needs assessment into their care, while also gathering perspectives from patient navigators on the barriers to obtaining and utilizing social needs information during cancer care, which taken together may influence cancer care policies. By comparing the perspectives of patients and navigators, the study sought to inform best practices for integrating, identifying, and addressing social needs to improve patient experiences and outcomes.

Methods

We conducted qualitative interviews and self-report surveys involving patients with cancer, providers, and patient navigators or care coordinators, seeking their insights and firsthand experiences related to health-related social needs in cancer care. Interviews were transcribed, separated into memos of main themes based on deductive coding, and further analyzed for new emergent themes using inductive coding.

Results

The present analysis focuses solely on the perspectives of 20 patient navigators and 21 patients. Qualitative analyses revealed two overarching themes: Theme 1: Personal and health system-related factors may create barriers for patients to disclose health-related social needs information during cancer care; and Theme 2: When social needs are identified, it is best practice to acknowledge and address social needs through referrals, resources, timely follow-up, and continued care coordination. Key barriers include individual beliefs and attitudes, concerns regarding privacy and sensitivity of questions, uncertainties about the outcomes of disclosing information, and patient-provider relationships and trust.

Conclusion

Drawing upon the perspectives of patients and patient navigators provided valuable insight into the challenges associated with acquiring information on social needs. Their viewpoints presented feasible solutions to overcome barriers through early acknowledgment of patient needs, timely resource provision, and maintaining consistent follow-up actions. Additionally, it enhanced understanding of the pivotal role patient navigators play in oncology, serving as crucial links between screening for health-related social needs and addressing individual patient requirements.

Policy Summary

The policies and policy improvements our paper seeks to impact include: inequalities in cancer care and health-related social needs of cancer.
研究背景该研究旨在深入了解癌症患者和幸存者在将社会需求评估纳入其护理过程中的经验,同时收集患者导航员对在癌症护理过程中获取和利用社会需求信息的障碍的看法,综合起来可能会影响癌症护理政策。通过比较患者和导航员的观点,该研究试图为整合、识别和解决社会需求的最佳实践提供信息,以改善患者的体验和治疗效果:我们对癌症患者、医疗服务提供者、患者导航员或护理协调员进行了定性访谈和自我报告调查,以寻求他们对癌症护理中与健康相关的社会需求的见解和第一手经验。访谈内容均已转录,并在演绎编码的基础上将其分为主要主题备忘录,然后使用归纳编码进一步分析新出现的主题:本分析只侧重于 20 名患者导航员和 21 名患者的观点。定性分析揭示了两个首要主题:主题 1:个人和医疗系统相关因素可能会对患者在癌症护理期间披露与健康相关的社会需求信息造成障碍;主题 2:当社会需求被确定后,最好的做法是通过转诊、资源、及时跟进和持续的护理协调来承认和解决社会需求。主要障碍包括个人信仰和态度、对隐私和问题敏感性的担忧、对披露信息结果的不确定性以及患者与医疗服务提供者之间的关系和信任:从患者和患者导航员的角度出发,我们可以深入了解与获取社会需求信息相关的挑战。他们的观点提出了可行的解决方案,通过尽早确认患者需求、及时提供资源和保持持续的后续行动来克服障碍。此外,它还加深了人们对患者导航员在肿瘤学中发挥的关键作用的理解,他们是筛查与健康相关的社会需求和满足患者个人需求之间的重要纽带。政策摘要:我们的论文试图影响的政策和政策改进包括:癌症护理中的不平等现象和癌症的健康相关社会需求。
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引用次数: 0
Analysis of factors associated with use of real-world data in single technology appraisals of cancer drugs by the National Institute for Health and Care Excellence 国家健康与护理卓越研究所对癌症药物的单一技术评估中使用真实世界数据的相关因素分析。
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-09-26 DOI: 10.1016/j.jcpo.2024.100507
Jiyeon Kang , John Cairns

Objectives

This study investigates factors associated with use of real-world data (RWD) in economic modelling for single technology appraisals (STAs) of cancer drugs by the National Institute for Health and Care Excellence (NICE) to improve systematic understanding of the use of RWD.

Methods

The data were extracted from STAs of cancer drugs, for which NICE issued guidance between January 2011 and December 2022 (n=267). Binary regression was used to test hypotheses concerning the greater or lesser use of RWD. Bonferroni-Holm correction was used to control error rates in multiple hypotheses tests. Several explanatory variables were considered in this analysis, including time (Time), incidence rate of disease (IR), availability of direct treatment comparison (AD), generalisability of trial data (GE), maturity of survival data in trial (MS) and previous technology recommendations by NICE (PR). The primary outcome variable was any use of RWD. Secondary outcome variables were specific uses of RWD in economic models.

Results

AD had a statistical negative association with any use of RWD whereas no associations with non-parametric and parametric use of RWD were found. Time had several statistical associations with use of RWD (validating survival distributions for the intervention, estimating progression-free survival for the intervention, estimating overall survival for comparators and transition probabilities).

Conclusions

RWD were more likely to be used in economic modelling of cancer drugs when randomised controlled trials failed to provide relevant clinical information of the drug for appraisals, particularly in the absence of direct treatment comparisons. These results, based on analysis of data systematically collected from previous appraisals, suggest that uses of RWD were associated with data gaps in the economic modelling. While this result may support some of the claimed advantages of using RWD when evidence is absent, the question, the extent to which use of RWD in indirect treatment comparisons reduces uncertainty is still to be determined.
研究目的本研究调查了美国国家健康与护理优化研究所(NICE)在癌症药物单一技术评估(STAs)的经济建模中使用真实世界数据(RWD)的相关因素,以提高对RWD使用的系统性理解:方法:从2011年1月至2022年12月期间NICE发布指南的抗癌药物STA中提取数据(n=267)。采用二元回归法检验有关RWD使用多寡的假设。Bonferroni-Holm 校正用于控制多重假设检验中的误差率。该分析考虑了多个解释变量,包括时间(Time)、疾病发病率(IR)、是否有直接治疗对比(AD)、试验数据的通用性(GE)、试验中生存数据的成熟度(MS)和 NICE 先前的技术建议(PR)。主要结果变量为是否使用 RWD。次要结果变量为经济模型中RWD的具体用途:结果:AD 与任何 RWD 的使用在统计学上呈负相关,而与非参数和参数 RWD 的使用则无关联。时间与RWD的使用有几种统计学关联(验证干预的生存分布、估计干预的无进展生存期、估计比较者的总生存期和过渡概率):当随机对照试验无法为评估提供药物的相关临床信息时,尤其是在缺乏直接治疗比较的情况下,在癌症药物的经济建模中更有可能使用RWD。这些结果是在对以往评估中系统收集的数据进行分析的基础上得出的,表明随机对照试验的使用与经济建模中的数据缺口有关。虽然这一结果可能支持了在缺乏证据时使用 RWD 的一些优势,但在间接治疗比较中使用 RWD 在多大程度上减少了不确定性这一问题仍有待确定。
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引用次数: 0
Palliative Care in Turkey: Insights from experts through key informant interviews 土耳其的姑息关怀:通过关键信息提供者访谈获得的专家见解
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-09-14 DOI: 10.1016/j.jcpo.2024.100506
Fahad Ahmed , Tezer Kutluk , Sema Yurduşen , Meltem Şengelen , Burça Aydın , Meral Kirazli , Sinem Aydın , Richard Sullivan , Richard Harding

Background

The rising demand for palliative-care (PC) in Turkey, driven by cancer, has prompted increased attention since the national PC policy in 2010. Despite this, the healthcare system predominantly focuses on curative care, lacking PC integration. This is due to combination of administrative obstacles, fragmented coordination, education and training scarcity. Thus urgent strategies are required to address the growing PC gap. This qualitative study explores the perspectives of PC professionals and policymakers, providing valuable insights for national policy and program development.

Material and method

This study employed an exploratory approach using key informant interviews. Interviews were conducted using semi-structured questionnaire. It sought to collect relevant contextual information in order to achieve its aim. Thematic content analysis was employed to examine and interpret the data.

Result

Twenty-one participants, comprising nurses, specialists, and oncologists, were interviewed. The findings are encompassed by eight themes. 1) Integrated Care, highlights the importance of cohesive collaboration among diverse healthcare providers, social care services, and primary care systems to ensure comprehensive and effective care. 2) Meeting social care needs underscores significance of addressing a wide spectrum of patient requirements, including psychosocial support. 3) PC education emphasizes necessity of equipping healthcare professionals with the requisite skills and knowledge through comprehensive training. 4) Legalizing do-notresuscitate orders draws attention to the critical discussion surrounding end-of-life decisions. 5) Empowering communities recognizes bridging knowledge gaps among patients and caregivers. 6) Decision-Making underscores the importance of informed and collaborative decision-making processes. 7) Cultural considerations urge the adoption of culturally sensitive approaches. 8) Ongoing challenges shed light on persistent issues such as provider attitudes, and administrative hurdles.

Conclusion

This study highlights essential factors for establishing an integrated PC program for cancer patients in Turkey. The existing healthcare system in Turkey offers opportunities for advanced PC. Successful implementation demands strategic actions to facilitate meaningful transformation.

背景自 2010 年国家颁布姑息治疗政策以来,土耳其因癌症而日益增长的姑息治疗(PC)需求引起了越来越多的关注。尽管如此,医疗系统仍主要关注治疗护理,缺乏姑息治疗的整合。这是行政障碍、分散协调、教育和培训匮乏等综合因素造成的。因此,需要采取紧急战略来解决 PC 差距日益扩大的问题。本定性研究探讨了 PC 专业人员和政策制定者的观点,为国家政策和计划的制定提供了有价值的见解。访谈使用半结构化问卷进行。研究试图收集相关背景信息,以实现研究目的。结果对 21 名参与者进行了访谈,其中包括护士、专家和肿瘤学家。研究结果包含八个主题。1) 综合护理,强调了不同医疗服务提供者、社会护理服务和初级护理系统之间协调合作的重要性,以确保提供全面有效的护理。2) 满足社会护理需求强调了满足患者广泛需求(包括社会心理支持)的重要性。3) PC 教育强调有必要通过全面培训使医护人员掌握必要的技能和知识。4) 使 "拒绝复苏 "医嘱合法化提请人们关注围绕生命末期决定的重要讨论。5) 增强社区的能力承认弥合患者和护理人员之间的知识差距。6) 决策强调知情和协作决策过程的重要性。7) 文化方面的考虑促使我们采用对文化敏感的方法。8) 持续存在的挑战揭示了长期存在的问题,如提供者的态度和行政障碍。土耳其现有的医疗保健系统为先进的 PC 提供了机遇。要成功实施该计划,就必须采取战略性行动,以促进有意义的转变。
{"title":"Palliative Care in Turkey: Insights from experts through key informant interviews","authors":"Fahad Ahmed ,&nbsp;Tezer Kutluk ,&nbsp;Sema Yurduşen ,&nbsp;Meltem Şengelen ,&nbsp;Burça Aydın ,&nbsp;Meral Kirazli ,&nbsp;Sinem Aydın ,&nbsp;Richard Sullivan ,&nbsp;Richard Harding","doi":"10.1016/j.jcpo.2024.100506","DOIUrl":"10.1016/j.jcpo.2024.100506","url":null,"abstract":"<div><h3>Background</h3><p>The rising demand for palliative-care (PC) in Turkey, driven by cancer, has prompted increased attention since the national PC policy in 2010. Despite this, the healthcare system predominantly focuses on curative care, lacking PC integration. This is due to combination of administrative obstacles, fragmented coordination, education and training scarcity. Thus urgent strategies are required to address the growing PC gap. This qualitative study explores the perspectives of PC professionals and policymakers, providing valuable insights for national policy and program development.</p></div><div><h3>Material and method</h3><p>This study employed an exploratory approach using key informant interviews. Interviews were conducted using semi-structured questionnaire. It sought to collect relevant contextual information in order to achieve its aim. Thematic content analysis was employed to examine and interpret the data.</p></div><div><h3>Result</h3><p>Twenty-one participants, comprising nurses, specialists, and oncologists, were interviewed. The findings are encompassed by eight themes. 1) Integrated Care, highlights the importance of cohesive collaboration among diverse healthcare providers, social care services, and primary care systems to ensure comprehensive and effective care. 2) Meeting social care needs underscores significance of addressing a wide spectrum of patient requirements, including psychosocial support. 3) PC education emphasizes necessity of equipping healthcare professionals with the requisite skills and knowledge through comprehensive training. 4) Legalizing do-notresuscitate orders draws attention to the critical discussion surrounding end-of-life decisions. 5) Empowering communities recognizes bridging knowledge gaps among patients and caregivers. 6) Decision-Making underscores the importance of informed and collaborative decision-making processes. 7) Cultural considerations urge the adoption of culturally sensitive approaches. 8) Ongoing challenges shed light on persistent issues such as provider attitudes, and administrative hurdles.</p></div><div><h3>Conclusion</h3><p>This study highlights essential factors for establishing an integrated PC program for cancer patients in Turkey. The existing healthcare system in Turkey offers opportunities for advanced PC. Successful implementation demands strategic actions to facilitate meaningful transformation.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100506"},"PeriodicalIF":2.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142242630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Is health-related quality of life sufficiently addressed in trials for breast cancer treatments? An assessment based on reimbursement opinions from the French health technology assessment body, 2009–2023 乳腺癌治疗试验是否充分考虑了与健康相关的生活质量?根据法国卫生技术评估机构2009-2023年的报销意见进行评估
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-09-10 DOI: 10.1016/j.jcpo.2024.100504
Maéva Kyheng , Hélène Tonoli , Nicolas Supah , Lionel Riou França , Jacques Massol

Background

Breast cancer treatments can impact the patients’ health-related quality of life (HR-QoL). This criterion is relevant for drug reimbursement decisions. We wanted to assess the usage of HR-QoL in health technology assessments (HTA).

Methods

All HAS (Haute Autorité de Santé, the French HTA body) opinions published between January 1, 2009 and March 31, 2023 for the reimbursement of breast cancer drugs were analysed.

Results

51 distinct appraisals were found during the period, corresponding to 45 product-specific indications, of which 36 (80 %) including clinical studies in which HR-QoL was an endpoint. HAS explicitly rejected HR-QoL data in 25 out of 36 (69 %) indications with such data. Rejections are justified by methodological weaknesses, including lack of adjustment for type I error inflation (n=21 indications), open-label treatment (n=7), lack of a pre-specified clinically relevant HR-QoL threshold (n=6) or missing data (n=6). Regardless of rejection status, HR-QoL results were not mentioned as a determinant of value assessment in 3/36 (8 %) instances (2/25 for rejected data).

Conclusions

HR-QoL data are inconsistently present in HTA assessments of new breast cancer drugs. Their methodological quality often hinders their use in determining the drug’s value.

Policy summary

A rigorous and acceptable comparative experimental framework is expected for HR-QoL assessments. More detail on the precise impact of the absence or presence of HR-QoL data in the determination of the drug’s added value could help understanding how this dimension is influential in the assessments.

背景乳腺癌治疗会影响患者的健康相关生活质量(HR-QoL)。这一标准与药物报销决策息息相关。我们希望评估在卫生技术评估(HTA)中使用 HR-QoL 的情况。方法分析了 2009 年 1 月 1 日至 2023 年 3 月 31 日期间发布的所有 HAS(Haute Autorité de Santé,法国卫生技术评估机构)关于乳腺癌药物报销的意见。结果在此期间发现了 51 份不同的评估意见,对应 45 个特定产品适应症,其中 36 份(80%)包括以 HR-QoL 为终点的临床研究。在有 HR-QoL 数据的 36 个适应症中,有 25 个(69%)的 HAS 明确拒绝接受 HR-QoL 数据。拒绝的理由是方法学上的缺陷,包括缺乏对I型误差膨胀的调整(21个适应症)、开放标签治疗(7个适应症)、缺乏预先指定的临床相关HR-QoL阈值(6个适应症)或数据缺失(6个适应症)。无论否决状态如何,在 3/36 (8 %) 例中(2/25 为否决数据),HR-QoL 结果未被提及作为价值评估的决定因素。这些数据的方法学质量往往妨碍了它们在确定药物价值时的使用。政策摘要:人力资源--生活质量评估应采用严格且可接受的比较实验框架。在确定药物的附加值时,如果能更详细地说明缺乏或存在 HR-QoL 数据的确切影响,将有助于理解这一维度在评估中的影响。
{"title":"Is health-related quality of life sufficiently addressed in trials for breast cancer treatments? An assessment based on reimbursement opinions from the French health technology assessment body, 2009–2023","authors":"Maéva Kyheng ,&nbsp;Hélène Tonoli ,&nbsp;Nicolas Supah ,&nbsp;Lionel Riou França ,&nbsp;Jacques Massol","doi":"10.1016/j.jcpo.2024.100504","DOIUrl":"10.1016/j.jcpo.2024.100504","url":null,"abstract":"<div><h3>Background</h3><p>Breast cancer treatments can impact the patients’ health-related quality of life (HR-QoL). This criterion is relevant for drug reimbursement decisions. We wanted to assess the usage of HR-QoL in health technology assessments (HTA).</p></div><div><h3>Methods</h3><p>All HAS (<em>Haute Autorité de Santé</em>, the French HTA body) opinions published between January 1, 2009 and March 31, 2023 for the reimbursement of breast cancer drugs were analysed.</p></div><div><h3>Results</h3><p>51 distinct appraisals were found during the period, corresponding to 45 product-specific indications, of which 36 (80 %) including clinical studies in which HR-QoL was an endpoint. HAS explicitly rejected HR-QoL data in 25 out of 36 (69 %) indications with such data. Rejections are justified by methodological weaknesses, including lack of adjustment for type I error inflation (n=21 indications), open-label treatment (n=7), lack of a pre-specified clinically relevant HR-QoL threshold (n=6) or missing data (n=6). Regardless of rejection status, HR-QoL results were not mentioned as a determinant of value assessment in 3/36 (8 %) instances (2/25 for rejected data).</p></div><div><h3>Conclusions</h3><p>HR-QoL data are inconsistently present in HTA assessments of new breast cancer drugs. Their methodological quality often hinders their use in determining the drug’s value.</p></div><div><h3>Policy summary</h3><p>A rigorous and acceptable comparative experimental framework is expected for HR-QoL assessments. More detail on the precise impact of the absence or presence of HR-QoL data in the determination of the drug’s added value could help understanding how this dimension is influential in the assessments.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100504"},"PeriodicalIF":2.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142242629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Shaping the future research agenda of Cancer Nursing in Italy: Insights and strategic directions 制定意大利癌症护理未来研究议程:见解和战略方向
IF 2 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-09-08 DOI: 10.1016/j.jcpo.2024.100505
Rosario Caruso , Gianluca Conte , Marco Alfredo Arcidiacono , Serena Caponetti , Gabriele Cremona , Marcella Dabbene , Monica Guberti , Alessio Piredda , Arianna Magon

This report analyzes the evolution of cancer nursing research in Italy, focusing on 207 publications from nursing journals indexed in MEDLINE. Using Latent Dirichlet Allocation, we identified four primary research topics from the included abstracts: Patient-Centered Care, Clinical Nursing Practice, Healthcare Institutions and Systems, and Research and Data Analysis. The temporal trends reveal a shift from foundational studies on healthcare systems in the late 1990s to more recent emphases on patient-centered care and clinical practice. This progression underscores the growing importance of personalized healthcare approaches. Our findings highlight the need for continued investment in innovative nursing interventions and advanced technologies, such as telehealth, to enhance patient outcomes. Research priorities need to investigate how to tailor nursing interventions to individual patient characteristics, such as their cultural background, lifestyle, and personal values, in the area of clinical nursing practice, which is less represented in the literature thus far. The limited publications regarding clinical nursing practice in the Italian context might reflect the need to strengthen cancer nursing as a specialization in Italy to trigger research and practice that address unmet patient needs. The current analysis provides a foundation for future comprehensive studies and strategic development of a research agenda for cancer nursing research in Italy, led by the Italian Association of Cancer Nursing.

本报告分析了意大利癌症护理研究的发展历程,重点关注 MEDLINE 索引的护理期刊中的 207 篇论文。通过使用潜在德里希勒分配法(Latent Dirichlet Allocation),我们从收录的摘要中确定了四个主要研究课题:以患者为中心的护理、临床护理实践、医疗机构和系统以及研究和数据分析。从时间趋势上看,从 20 世纪 90 年代末有关医疗保健系统的基础研究到最近强调以患者为中心的护理和临床实践的转变。这一变化凸显了个性化医疗保健方法的重要性与日俱增。我们的研究结果突出表明,有必要继续投资于创新护理干预措施和远程医疗等先进技术,以提高患者的治疗效果。在临床护理实践领域,需要优先研究如何根据患者的文化背景、生活方式和个人价值观等个体特征调整护理干预措施,迄今为止,这方面的文献较少。有关意大利临床护理实践的出版物有限,这可能反映出意大利需要加强癌症护理这一专业,以引发研究和实践,解决患者未得到满足的需求。在意大利癌症护理协会的领导下,目前的分析为未来的综合研究和意大利癌症护理研究议程的战略发展奠定了基础。
{"title":"Shaping the future research agenda of Cancer Nursing in Italy: Insights and strategic directions","authors":"Rosario Caruso ,&nbsp;Gianluca Conte ,&nbsp;Marco Alfredo Arcidiacono ,&nbsp;Serena Caponetti ,&nbsp;Gabriele Cremona ,&nbsp;Marcella Dabbene ,&nbsp;Monica Guberti ,&nbsp;Alessio Piredda ,&nbsp;Arianna Magon","doi":"10.1016/j.jcpo.2024.100505","DOIUrl":"10.1016/j.jcpo.2024.100505","url":null,"abstract":"<div><p>This report analyzes the evolution of cancer nursing research in Italy, focusing on 207 publications from nursing journals indexed in MEDLINE. Using Latent Dirichlet Allocation, we identified four primary research topics from the included abstracts: Patient-Centered Care, Clinical Nursing Practice, Healthcare Institutions and Systems, and Research and Data Analysis. The temporal trends reveal a shift from foundational studies on healthcare systems in the late 1990s to more recent emphases on patient-centered care and clinical practice. This progression underscores the growing importance of personalized healthcare approaches. Our findings highlight the need for continued investment in innovative nursing interventions and advanced technologies, such as telehealth, to enhance patient outcomes. Research priorities need to investigate how to tailor nursing interventions to individual patient characteristics, such as their cultural background, lifestyle, and personal values, in the area of clinical nursing practice, which is less represented in the literature thus far. The limited publications regarding clinical nursing practice in the Italian context might reflect the need to strengthen cancer nursing as a specialization in Italy to trigger research and practice that address unmet patient needs. The current analysis provides a foundation for future comprehensive studies and strategic development of a research agenda for cancer nursing research in Italy, led by the Italian Association of Cancer Nursing.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100505"},"PeriodicalIF":2.0,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Cancer Policy
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