Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology–ASCO Guideline

Journal of Clinical Oncology, Год журнала: 2023, Номер 41(28), С. 4562 - 4591

Опубликована: Авг. 15, 2023

To provide evidence-based recommendations to health care providers on integrative approaches managing anxiety and depression symptoms in adults living with cancer.The Society for Integrative Oncology ASCO convened an expert panel of oncology, medical radiation surgical palliative social sciences, mind-body medicine, nursing, methodology, patient advocacy representatives. The literature search included systematic reviews, meta-analyses, randomized controlled trials published from 1990 through 2023. Outcomes interest or as measured by validated psychometric tools, adverse events. Expert members used this evidence informal consensus the Guidelines into Decision Support methodology develop guideline recommendations.The identified 110 relevant studies (30 reviews 80 trials) inform base guideline.Recommendations were made mindfulness-based interventions (MBIs), yoga, relaxation, music therapy, reflexology, aromatherapy (using inhalation) treating during active treatment; MBIs, acupuncture, tai chi and/or qigong, reflexology after cancer treatment. For symptoms, recommended treatment, qigong post-treatment.Issues patient-health provider communication, disparities, comorbid conditions, cost implications, implementation, training credentialing, quality assurance natural products are discussed. While several such MBIs yoga appear effective, limitations including assessment risk bias, nonstandardization therapies, lack diversity study samples, control conditions well future research directions discussed.Additional information is available at www.asco.org/survivorship-guidelines.

Язык: Английский

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The care planning umbrella: The evolution of advance care planning

Journal of the American Geriatrics Society, Год журнала: 2023, Номер 71(7), С. 2350 - 2356

Опубликована: Фев. 25, 2023

Advance care planning (ACP) was initially narrowly defined as documentation of life-sustaining treatment (LST). One initial goal to curb unwanted LSTs and costs.1 Yet, a focus solely on legal LST preferences has resulted in mixed data goal-concordant healthcare utilization.2-4 Fortunately, the conceptualization ACP continues evolve, is now widely recognized process preparing patients (people) surrogate decision-makers for communication medical decision-making.5, 6 This involves complex array patient, surrogate, clinician behaviors, health systems workflows, interventions, communities, policy. rooted what quality life means people.4, 5, 7 However, antiquated narrow definitions one-time checkbox or code status persist, resulting heterogeneous research, clinical, policy initiatives.2, 4 To address this heterogeneity, modified Delphi panel 2017 "a that supports adults at any age stage understanding sharing their personal values, goals, regarding future care."7 As field evolved, definition focused "future decisions" proven be too it does not include preparation surrogates decision-making over course public perceptions ACP.8-10 The use non-standardized potentially inappropriate outcomes research also makes difficult evaluate ACP's effectiveness.4, 11 Goal-concordant been considered "gold standard," but there lack validated standardized measures.12-15 Because patient may change, reliance retrospective chart review assess concordance inaccurate,13, 14 growing consensus should one key research.6 Additionally, unlikely affect some such life, which impacted by other factors symptom burden, available support, so forth, utilization, patient-centered affected access, systemic injustice, issues.12, 16 Furthermore, unique needs historically marginalized populations are well represented prior identification. Rates much lower (<20%) among racially ethnically minoritized those with limited literacy.17-19 Disparities persist lesbian, gay, bisexual, transgender, queer, intersexual, asexual, homeless, incarcerated populations.20, 21 Reasons access healthcare, experiential discrimination, well-founded mistrust,22, 23 culturally diverse views autonomy decision-making,24, 25 making preferable many begin discussions communities. Diverse interdisciplinary clinicians community-based experts, have included efforts define outcomes. We propose new framework reflects updated conceptualizes part continuum planning. overarching construct under "Care Planning Umbrella" focuses decision-making,5 brings meaning purpose fundamental cornerstone. Underneath broader umbrella multiple steps, people, clinical community decisions—some in-the-moment advance. Care shaped person's (or surrogate's) life; these constructs dynamic evolve time.28 It an individual's readiness, control decision-making, illness understanding, prognostic awareness, acceptable/unacceptable tradeoffs.5 All influenced family caregiver social norms, accessible resources, current Umbrella spans people move between healthy/chronic illness, serious end life. They face different types decisions (e.g., diabetes medication regimen chronically ill, chemotherapy seriously hospice life), receive settings community, outpatient, acute care, long-term hospice).5, 29 must tailored course, they facing, based person time. For example, although designation integration into appropriate every stage, appropriateness integrating awareness tradeoffs will vary (Figure 1).30, 31 At all stages, treatment, chemotherapy, end-of-life procedures) advance setting preferences). Over lines advanced fluid.3, 30, even early strong enduring about experiences beliefs. Those individuals given opportunity discuss document while educating them change time revisited. onus our disentangle complexity (i.e., planning) caregivers desire studies show decreases distress.4 Based recent consensus, more clinically meaningful from perspective burden distress; feeling heard understood; satisfaction communication, decision-making.4, In addition, implementation science human engineering can used help achieve its next step evolutionary process. Implementation offers tools understand processes, including determining strategies meet families.32 System-level strategic approaches consider organizational preferred examination individual components interventions clinicians).2, 4, 33-35 recently Consolidated Framework Research (CFIR) well-established implementing evidence-based real-world settings.36, 37 CFIR provides guide systematically identifying determine whether programs succeed fail. recognizes barriers arise level identify overcome barriers. consists five, interrelated domains (see Table 1 Supplemental figure [Appendix S1]): Outer Setting cultural/social racism, policies laws, information exchanges, metrics, reimbursement, etc.); Inner system readiness policies, incentives, EMR infrastructure); Individuals disease trajectory; cultural backgrounds; racism mistrust Capacity, Opportunity, Motivation (COM-B)38); Innovation design caregivers: educational modalities; documentation; navigators; events, medical-legal partnerships, etc. staff: training protocols; conversation guides; electronic record (EMR) templates, Process39, 40 degree collaboration across leadership, multidisciplinary teams, settings; champions; buy-in; populations; messaging marketing, improvement, etc.). design: How assembled presented Structural characteristics Relational Connections/Communication Culture recipient patients, caregivers, clinicians): Capability, (COM-B) Model Behavior Change Human methods applied how engage processes improve play role improving planning.41 Process mapping visualize relevant workflows tasks parties clinicians, surrogates, members, faith leaders, attorneys, etc.) using multiple, iterative steps. Integrating model ensure complete involved. likely require maps fully reflect parties, settings, patients' necessary care. requires broad range partners extends beyond where live others shown, outreach patient-or community-facing needed, addition goals conversations.42 Future need representatives nurses, workers, chaplains, navigators) experts faith-based attorneys). evolved past several decades still evolving. get we reconceptualize holistic, ongoing includes both stage. suggest systems-level approach evidenced-based inclusion communities develop support settings. Concept figures: Susan E. Hickman, Rebecca L. Sudore; Preparation manuscript: Hillary D. Lum, Anne M Walling, April Savoy, Sudore. Thank you graphic artist Kaylee Stewart helping us communicate ideas visually. work unfunded. Dr. Sudore funded National Institute Aging, Institutes Health (K24AG054415). Savoy supported Career Development Award (K01AG076971). authors declare no conflict interest. unfunded content responsibility authors. Appendix S1. Application consolidated Please note: publisher responsible functionality supporting supplied Any queries (other than missing content) directed corresponding author article.

Язык: Английский

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Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

Journal of Medical Internet Research, Год журнала: 2023, Номер 25, С. e48000 - e48000

Опубликована: Июль 25, 2023

Background Digital therapeutics are patient-facing digital health interventions that can significantly alter the care landscape. Despite being used to successfully treat a range of conditions, their uptake in systems remains limited. Understanding full spectrum factors is essential identify ways which policy makers and providers facilitate adoption effective within system, as well steps developers take assist deployment products. Objective In this review, we aimed map most frequently discussed determine integration into practical use by patients professionals. Methods A scoping review was conducted MEDLINE, Web Science, Cochrane Database Systematic Reviews, Google Scholar. Relevant data were extracted synthesized using thematic analysis. Results We identified 35,541 academic 221 gray literature reports, with 244 (0.69%) included covering 35 countries. Overall, 85 impact pooled 5 categories: patient characteristics, properties therapeutics, characteristics professionals, outcomes. The need for regulatory framework stated factor at level. Demographic formed iterated patient-related factor, whereas literacy considered important Among interoperability across broader system emphasized. Finally, ability expand access outcome measure. Conclusions developed offers multistakeholder approach recognizing pathway provides an analytical tool assess system’s readiness therapeutics.

Язык: Английский

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Barriers and enablers for the implementation of trauma-informed care in healthcare settings: a systematic review

Implementation Science Communications, Год журнала: 2023, Номер 4(1)

Опубликована: Май 5, 2023

Healthcare services can be re-traumatising for trauma survivors where they trigger memories of past distressing events and exert limits to a survivor's sense autonomy, choice, control. The benefits receiving trauma-informed healthcare are well established; however, factors that promote or impede the implementation care not yet characterised understood. aim this review was systematically identify synthesise evidence regarding reduce TIC in settings.This systematic followed Preferred Reporting Items Systematic Reviews Meta-analyses (PRISMA) 2.0 guidelines. Scopus, MEDLINE, Proquest, PsycINFO grey literature were searched original research evaluations published between January 2000 April 2021 reporting barriers and/or facilitating setting. Two reviewers independently assessed quality each included study using Mixed Methods Appraisal Tool (MMAT) Checklist.Twenty-seven studies included, 22 which USA. Implementation occurred range health settings, predominantly mental services. facilitators implementing categorised as follows: intervention characteristics (perceived relevance setting target population), influences external organisation (e.g. interagency collaboration actions other agencies) within leadership engagement, financial staffing resources policy procedure changes flexibility protocols). Other related processes flexible accessible training, service user feedback collection initiative outcomes) finally individuals system such resistance change.This identifies key should targeted implementation. Continued will helpful characterising what looks like when it is delivered well, providing validated frameworks organisational uptake benefit survivors.The protocol registered on PROSPERO database (CRD42021242891).

Язык: Английский

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Rethinking children’s physical activity interventions at school: A new context-specific approach

Frontiers in Public Health, Год журнала: 2023, Номер 11

Опубликована: Апрель 13, 2023

Physical activity is important for children’s health. However, evidence suggests that many children and adults do not meet international physical recommendations. Current school-based interventions have had limited effect on alternative approaches are needed. Context, which includes school setting, ethos, staff, sociodemographic factors, a key largely ignored contributing factor to intervention effectiveness, impacting in several interacting ways. Conceptualization programs focus tightly-constructed content ignores the context program will be delivered, thereby limiting effectiveness. We propose move away from uniform maximize internal validity toward flexible approach enables schools tailor their specific context. Evaluation designs of context-specific should explicitly consider This challenging cluster randomized controlled trial designs. Thus, such as natural experiment stepped-wedge warrant further consideration. Primary outcome A collective average minutes moderate-to-vigorous intensity may always most appropriate choice. wider range outcomes improve health long-term. In this paper, we argue greater consideration design analysis help overcome existing limitations effective thus progress field. While evaluation untested, hope stimulate debate issues future development implementation.

Язык: Английский

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Lung-function trajectories: relevance and implementation in clinical practice

The Lancet, Год журнала: 2024, Номер 403(10435), С. 1494 - 1503

Опубликована: Март 12, 2024

Язык: Английский

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Actioning the Learning Health System: An applied framework for integrating research into health systems

SSM - Health Systems, Год журнала: 2024, Номер 2, С. 100010 - 100010

Опубликована: Март 24, 2024

Health systems across the world experience pervasive gaps in speed with which high quality evidence is generated, implemented and refined. A Learning System (LHS) approach that blends research health care operations to eliminate or reduce delays. This paper builds on existing LHS frameworks deepen our practical understanding of research-health interface provide actionable insights how realize a practice. We present an action framework describes are linked enacted comprehensive advance population equity. seeking implement can use this identify capabilities necessary enact learning elements, including key questions methods, ensure systematic achieving equity-centered quadruple aim metrics.

Язык: Английский

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Acceptability, Feasibility and Appropriateness of Care of Patients with Depression at Health and Wellness Centre in a District of India

Deleted Journal, Год журнала: 2024, Номер 1(1), С. 41 - 46

Опубликована: Янв. 1, 2024

Abstract Objective: To study implementation of mental health services delivery with depression as tracer condition through Health and Wellness Centres (HWCs) under Ayushman Bharat programme in India. Materials Methods: Mixed methods approach. The outcomes acceptability, appropriateness feasibility were measured analysed. Results: found a low level medium acceptability for using HWCs platform the management patients depression. Increased availability trained human resources, improved infrastructure drug availability, integration other programmes coordination higher centres referral follow-up are suggested key interventions to enhance care. Conclusion: There is need innovative model care that places an emphasis on implement strategies maximise HWCs.

Язык: Английский

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Intervention Optimization: A Paradigm Shift and Its Potential Implications for Clinical Psychology

Annual Review of Clinical Psychology, Год журнала: 2024, Номер 20(1), С. 21 - 47

Опубликована: Фев. 5, 2024

To build a coherent knowledge base about what psychological intervention strategies work, develop interventions that have positive societal impact, and maintain increase this impact over time, it is necessary to replace the classical treatment package research paradigm. The multiphase optimization strategy (MOST) an alternative paradigm integrates ideas from behavioral science, engineering, implementation economics, decision science. MOST enables of strategically balance effectiveness, affordability, scalability, efficiency. In review we provide overview MOST, discuss several experimental designs can be used in optimization, consider how investigator use results select components for inclusion optimized intervention, application list future issues rapidly evolving field. We highlight feasibility adopting new as well its potential hasten progress

Язык: Английский

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Barriers and Facilitators of User Engagement With Digital Mental Health Interventions for People With Psychosis or Bipolar Disorder: Systematic Review and Best-Fit Framework Synthesis

JMIR Mental Health, Год журнала: 2025, Номер 12, С. e65246 - e65246

Опубликована: Янв. 20, 2025

Background Digital mental health interventions (DMHIs) to monitor and improve the of people with psychosis or bipolar disorder show promise; however, user engagement is variable, integrated clinical use low. Objective This prospectively registered systematic review examined barriers facilitators clinician patient DMHIs, inform implementation within real-world settings. Methods A search 7 databases identified empirical studies reporting qualitative quantitative data about factors affecting staff DMHIs aiming physical disorder. The Consolidated Framework for Implementation Research was used synthesize on facilitators, following a best-fit framework synthesis approach. Results included 175 papers (150 studies; 11,446 participants) describing randomized controlled trials; surveys; interviews; usability, cohort, case studies. Samples schizophrenia spectrum (98/150, 65.3% studies), (62/150, 41.3% clinicians (26/150, 17.3% studies). Key were strong recognition DMHIs’ relative advantages, clear link between intervention focus specific needs, simple, low-effort digital interface, human-supported delivery, device provision where needed. Although thought patients would lose, damage, sell devices, reviewed found only 11% loss. Barriers complexity, perceived risks, motivation, discomfort self-reflection, poverty, symptoms psychosis, poor compatibility existing workflows, fears that replace traditional face-to-face care, infrastructure limitations, limited financial support delivery. Conclusions Identified highlight key considerations DMHI development implementation. As broader implications, sustainable business models are needed ensure evidence-based maintained deployed. Trial Registration PROSPERO CRD42021282871; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282871

Язык: Английский

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