Investigating the Role of Transportation Barriers in Cancer Patients’ Decision Making Regarding the Treatment Process

Author(s):  
Roya Etminani-Ghasrodashti ◽  
Chen Kan ◽  
Ladan Mozaffarian

Transportation barriers to healthcare access may lead to rescheduled or missed appointments, thereby influencing patients’ treatment outcomes. However, the impact of transportation barriers on stopping cancer treatments remains unknown in the literature. This study aims to investigate the association between cancer patients’ travel behavior and their decisions about stopping or continuing treatments. In this study, an online survey was designed and conducted for cancer patients who received radiotherapy and chemotherapy. Comprehensive questions were asked to reveal personal- and treatment-related factors that affect participants’ decisions, including their travel behavior, travel burden, treatment characteristics, and side effects. With data collected from the survey, machine learning models were further employed to quantitatively assess the factors contributing to patients’ decision making. Results suggest that lack of access to transportation has a significant impact on cancer patients’ decisions with respect to stopping or continuing treatments. Limited access to private vehicles will likely lead to the stopping of radiotherapy. In addition, trip frequency and trip length to caregivers influence the patients’ continuing or quitting chemotherapy. Insights generated in this study have great potential to help policy makers and planners make informed decisions to enhance cancer patients’ access to treatments and improve their health outcomes.

2021 ◽  
Vol 38 (2) ◽  
pp. 158-165
Author(s):  
Ilaria Pergolini ◽  
I. Ekin Demir ◽  
Christian Stöss ◽  
Klaus Emmanuel ◽  
Robert Rosenberg ◽  
...  

Background: This survey aimed to register changes determined by the COVID-19 pandemic on pancreatic surgery in a specific geographic area (Germany, Austria, and Switzerland) to evaluate the impact of the pandemic and obtain interesting cues for the future. Methods: An online survey was designed using Google Forms focusing on the local impact of the pandemic on pancreatic surgery. The survey was conducted at 2 different time points, during and after the lockdown. Results: Twenty-five respondents (25/56) completed the survey. Many aspects of oncological care have been affected with restrictions and delays: staging, tumor board, treatment selection, postoperative course, adjuvant treatments, outpatient care, and follow-up. Overall, 60% of respondents have prioritized pancreatic cancer patients according to stage, age, and comorbidities, and 40% opted not to operate high-risk patients. However, for 96% of participants, the standards of care were guaranteed. Discussion/Conclusions: The first wave of the COVID-19 pandemic had an important impact on pancreatic cancer surgery in central Europe. Guidelines for prompt interventions and prevention of the spread of viral infections in the surgical environment are needed to avoid a deterioration of care in cancer patients in the event of a second wave or a new pandemic. High-volume centers for pancreatic surgery should be preferred and their activity maintained. Virtual conferences have proven to be efficient during this pandemic and should be implemented in the near future.


2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10549-10549
Author(s):  
Jennifer A. Ligibel ◽  
Lori J. Pierce ◽  
Catherine M. Bender ◽  
Tracy E Crane ◽  
Christina Marie Dieli-Conwright ◽  
...  

10549 Background: Obesity and related factors are increasingly associated with increased risk of developing and dying from cancer. The American Society of Clinical Oncology (ASCO) conducted a survey of cancer patients to assess their experience in receiving recommendations and referrals related to weight, diet and exercise as a part of their cancer care. Methods: An online survey was distributed to potential participants between March and June 2020 via ASCO channels and patient advocacy organizations, with an estimated reach of over 25,000 individuals. Eligibility criteria included being 18 years, living in the US, and having been diagnosed with cancer. Logistic regression was used to determine factors associated with recommendation and referral patterns. Results: In total, 2419 individuals responded to the survey. Most respondents were female (75.5%), 61.8% had an early-stage malignancy, 38.2% had advanced disease, and 49.0% were currently receiving treatment. Breast cancer was the most common cancer type (36.0%). Average BMI was 25.8 kg/m2. The majority of respondents consumed £2 servings of fruits and vegetables per day (50.9%) and exercised £2 times per week (50.4%). Exercise was addressed at most or some oncology visits in 57.5% of respondents, diet in 50.7%, and weight in 28.4%. Referrals were less common: 14.9% of respondents were referred to an exercise program, 25.6% to a dietitian and 4.5% to a weight management program. In multiple regression analyses, racial and ethnicity minority respondents were more likely to receive advice about diet (Odds Ratio [OR] 1.92, 95% CI 1.56-2.38) and weight (OR 1.64, 95% CI 1.23-2.17) compared to non-Hispanic whites, individuals diagnosed with cancer in the past 5 yrs (vs > 5 yrs) were more likely to receive advice about exercise (OR 1.48, 95% CI 1.23-1.79), and breast cancer patients were more likely to receive advice about exercise (OR 1.37, 95% CI 1.11-1.68) and weight (OR 1.46, 95% CI 1.03-2.07) than other cancer patients. Overall, 74% of survey respondents had changed their diet or exercise after cancer diagnosis. Respondents reporting that their oncologist spoke to them about increasing exercise or eating healthier foods were more likely to report a change in behavior than those whose oncologists did not (exercise: 79.6% vs 69.0%, P < 0.001; diet 81.1% vs 71.4%, P < 0.001). Respondents whose oncologist had spoken to them about exercise were more likely to exercise > 2 times per week compared to respondents whose oncologists did not address exercise (53.5% vs 44.1%, P < 0.001). Conclusions: In a national survey of oncology patients, slightly more than half of respondents reported attention to diet and exercise during oncology visits. Provider recommendations for diet and exercise were associated with positive changes in these behaviors. Additional attention to diet and exercise as part of oncology visits is needed to help support healthy lifestyle change in cancer patients.


Author(s):  
G. Sanjana ◽  
Vijaya Raghavan

Background: Loneliness can affect anyone at any point in their life. It can be detrimental to the wellbeing and quality of life of individuals and communities. In the ongoing COVID-19 pandemic, loneliness is considered as a public health crisis. Hence, the objectives of the study were to estimate the prevalence of loneliness and family related factors associated with loneliness among general population in south India. Materials and Methods: The study employed a crosssectional online survey design. The data was collected in the first phase of the lockdown in 2020 from adults in Southern India. Socio-demographic profile and family related variables were collected using a semistructured proforma. Loneliness was assessed by UCLA loneliness scale. Results: Of 573 total respondents to the survey, aged between 18-65 years, 43% were male and 57% were female. The overall prevalence of loneliness was 63% (358/573). No significant gender differences were observed in the prevalence of loneliness. Family discord was associated with higher rates of loneliness (p less than 0.01). Other factors associated were younger age and being single. Conclusion: Rates of loneliness during the COVID-19 lockdown were high in Southern India. Findings suggest that interventions should prioritize younger people. Increasing social support and improving interpersonal skills, which in turn would help reduce family discord and may reduce the impact of COVID-19 on loneliness.


2019 ◽  
Vol 8 (5) ◽  
pp. 749
Author(s):  
Toby K. Mayer ◽  
Andreas Koehler ◽  
Jana Eyssel ◽  
Timo O. Nieder

The gender identity of trans individuals influences their treatment preferences, and this in turn seems to affect their individual treatment progress. However, there has been no research which—next to the impact of gender identity on treatment desires—has also investigated the influence of treatment progress using a measure which assumes various possible transition pathways of trans persons.Therefore, an online community survey of trans people was conducted in Germany in 2015. Data were collected via an online survey from a non-clinical sample of n = 415 trans individuals (over half assigned female at birth), aged 16–76 (Mean (M) = 38.12). Almost one fifth of participants embraced non-binary or genderqueer (NBGQ) identities. Participants progressed 60.77% (standard deviation (SD) = 35.21) through treatment at point of data collection, as measured by the individual treatment progress score (ITPS). All participants, especially participants assigned male at birth, differed significantly in desire to participate in decision-making processes based on transition progress; individuals without treatment experience had less desire to decide treatment plans. NBGQ participants assigned male at birth in early stages of transition had significantly more desire for psychotherapy during transition than participants of the same identity in later transition stages. All participants, especially binary participants, significantly differed in desire for aftercare based on transition progress; individuals without treatment experience indicated more desire for aftercare. Results indicate health professionals should expect changing treatment desires in trans individuals at various stages of transition, particularly at treatment start, and based on gender identity.


2019 ◽  
Vol 50 (4) ◽  
pp. 829-840 ◽  
Author(s):  
Gordon Dunlop ◽  
Clare L. Ardern ◽  
Thor Einar Andersen ◽  
Colin Lewin ◽  
Gregory Dupont ◽  
...  

Abstract Purpose Return-to-play (RTP) is an on-going challenge in professional football. Return-to-play related research is increasing. However, it is unknown to what extent the recommendations presented within research are being implemented by professional football teams, and where there are gaps between research and practice. The purposes of this study were (1) to determine if premier-league football teams worldwide follow a RTP continuum, (2) to identify RTP criteria used and (3) to understand how RTP decision-making occurs in applied practice. Methods We sent a structured online survey to practitioners responsible for the RTP programme in 310 professional teams from 34 premier-leagues worldwide. The survey comprised four sections, based on hamstring muscle injury: (1) criteria used throughout RTP phases, (2) the frequency with which progression criteria were achieved, (3) RTP decision-making process and (4) challenges to decision-making. Results One-hundred and thirty-one teams responded with a completed survey (42%). One-hundred and twenty-four teams (95%) used a continuum to guide RTP, assessing a combination of clinical, functional and psychological criteria to inform decisions to progress. One-hundred and five (80%) teams reported using a shared decision-making approach considering the input of multiple stakeholders. Team hierarchy, match- and player-related factors were common challenges perceived to influence decision-making. Conclusions General research recommendations for RTP and the beliefs and practices of practitioners appear to match with, the majority of teams assessing functional, clinical and psychological criteria throughout a RTP continuum to inform decision-making which is also shared among key stakeholders. However, specific criteria, metrics and thresholds used, and the specific involvement, dynamics and interactions of staff during decision-making are not clear.


2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1078-1078
Author(s):  
Christof Vulsteke ◽  
Alena Pfeil ◽  
Barbara Brouwers ◽  
Matthias Schwenkglenks ◽  
Robert Paridaens ◽  
...  

1078 Background: Recently we described the impact of genetic variability on severe toxicity in breast cancer patients receiving (neo-) adjuvant FEC chemotherapy (Annals of Oncology 2013, In Press). We now further assessed the impact of a wide range of patient-related factors on FEC toxicity in routine clinical setting. Methods: Patients with early breast cancer receiving (neo-)adjuvant 6 cycles FEC or sequential 3 cycles of FEC and 3 cycles D were retrospectively evaluated through electronic chart review for febrile neutropenia (primary endpoint; CTC 3.0). Age at diagnosis, body mass index, body surface area, number of cycles received, germline genetic polymorphisms, and baseline biochemical variables (white blood cell count, absolute neutrophil count, platelets, aspartate aminotransferase, alanine aminotransferase, total bilirubin and creatinine) were available for most patients (missing data <10%). All patients had follow up for progression free survival (PFS) and overall survival (OS). Multivariate logistic regression analysis was performed including univariate associates of outcome with a p-value <0.25. Results: We identified 1,031 patients treated between 2000-2010 with 6x FEC (n=488) or 3x FEC followed by 3x D (n=543). 174 (16.9%) patients developed febrile neutropenia during FEC. After logistic regression analysis febrile neutropenia was found to be significantly associated with carriers of the rs45511401 variant T-allele in the MRP1 gene found in 12% of patients (p= 0.03, OR1.99, CI 1.07-3.71) and with increasing serum creatinine values (p=0.05 OR 4.58/CI 0.99-20.98); all other investigated patient-related parameters were not retained by the model. At a mean follow up of 5.2 years, the occurrence of febrile neutropenia was not correlated with PFS and OS. Conclusions: In this study, only the baseline level of serum creatinine and germline genetic polymorphisms in the MRP-1 gene were predictive for the occurrence of febrile neutropenia in patients receiving FEC chemotherapy. The occurrence of febrile neutropenia did not seem to impact on outcome.


2018 ◽  
Vol 32 (3) ◽  
pp. 322-333 ◽  
Author(s):  
Larissa M. Sundermann

PurposeAlthough antecedents and consequences for the sender of word of mouth (WOM) are well evaluated in many research fields, non-profit service research focusing on consequences for WOM receivers is limited. Thus, the purpose of this paper is to provide evidence for the positive effect that WOM has on commitment, trust, satisfaction and identification (relationship-related factors) and on intentional loyalty of blood donors. Furthermore, the role of the social reference group and the incentive ethics are analysed.Design/methodology/approachBlood donors of the German Red Cross Blood Donor Service were invited to take part in an online survey during May/June 2016. A total of 702 (23.74 per cent) blood donors, who first donated in 2015/2016, participated. The data were analysed using partial least squares structural equation modelling.FindingsThe results provide evidence that the mere presence of receiving WOM positively influences commitment, satisfaction and identification as well as intentional loyalty. The negative moderation effect of incentive ethics was partially confirmed.Practical implicationsThis study recommends using WOM approaches to bind donors but first evaluating the exact consequences of provided WOM rewards. WOM is an effective strategy, and non-profit organizations (NPOs) should use this to strengthen their relationship with donors.Originality valueThe paper provides and tests a theoretical framework to evaluate the impact of receiving WOM on relationship-related factors and intentional loyalty. It fills a gap in current discussions about the effectiveness of WOM as a marketing strategy to strengthen donor–NPO relationships.


2020 ◽  
Vol 3 (02) ◽  
pp. 61-67
Author(s):  
G. Sanjana ◽  
Vijaya Raghavan

Background: Loneliness can affect anyone at any point in their life. It can be detrimental to the wellbeing and quality of life of individuals and communities. In the ongoing COVID-19 pandemic, loneliness is considered as a public health crisis. Hence, the objectives of the study were to estimate the prevalence of loneliness and family related factors associated with loneliness among general population in south India. Materials and Methods: The study employed a crosssectional online survey design. The data was collected in the first phase of the lockdown in 2020 from adults in Southern India. Socio-demographic profile and family related variables were collected using a semistructured proforma. Loneliness was assessed by UCLA loneliness scale. Results: Of 573 total respondents to the survey, aged between 18-65 years, 43% were male and 57% were female. The overall prevalence of loneliness was 63% (358/573). No significant gender differences were observed in the prevalence of loneliness. Family discord was associated with higher rates of loneliness (p less than 0.01). Other factors associated were younger age and being single. Conclusion: Rates of loneliness during the COVID-19 lockdown were high in Southern India. Findings suggest that interventions should prioritize younger people. Increasing social support and improving interpersonal skills, which in turn would help reduce family discord and may reduce the impact of COVID-19 on loneliness.


2018 ◽  
Author(s):  
Marie Eggeling ◽  
Martina Bientzle ◽  
Thomas Shiozawa ◽  
Ulrike Cress ◽  
Joachim Kimmerle

BACKGROUND Patients need to be educated about possible treatment choices in order to make informed medical decisions. As most patients are medical laypeople, they find it difficult to understand complex medical information sufficiently to feel confident about a decision. Multimedia interventions such as videos are increasingly used to supplement personal consultations with medical professionals. Former research has shown that such interventions may have a positive effect on understanding, decision making, and emotional reactions. However, it is thus far unclear how different features of videos influence these outcomes. OBJECTIVE We aimed to examine the impact of visualization formats and basic navigational options in medical information videos about cruciate ligament surgery on recipients’ knowledge gain, emotions, attitude, and hypothetical decision-making ability. METHODS In a between-group randomized experiment (Study 1), 151 participants watched 1 of 4 videos (schematic vs realistic visualization; available vs unavailable navigational options). In a separate online survey (Study 2), 110 participants indicated their preference for a video design. All participants were medical laypeople without personal experience with a cruciate ligament rupture and were presented with a fictional decision situation. RESULTS In Study 1, participants who used navigational options (n=36) gained significantly more factual knowledge (P=.005) and procedural knowledge (P<.001) than participants who did not have or use navigational options (n=115). A realistic visualization induced more fear (P=.001) and disgust (P<.001) than a schematic video. Attitude toward the surgery (P=.02) and certainty regarding the decision for or against surgery (P<.001) were significantly more positive after watching the video than before watching the video. Participants who watched a schematic video rated the video significantly higher than that by participants who watched a realistic video (P<.001). There were no significant group differences with regard to hypothetical decision making and attitude toward the intervention. In addition, we did not identify any influence of the visualization format on knowledge acquisition. In Study 2, 58 of 110 participants (52.7%) indicated that they would prefer a schematic visualization, 26 (23.6%) preferred a realistic visualization, 17 (15.5%) wanted either visualization, and 9 (8.2%) did not want to watch a video at all. Of the participants who wanted to watch a video, 91 (90.1%) preferred to have navigational options, 3 (3.0%) preferred not to have navigational options, and 7 (6.9%) did not mind the options. CONCLUSION Our study indicates that the perception of medical information videos is influenced by their design. Schematic videos with navigational options are the most helpful among all videos to avoid negative emotions and support knowledge acquisition when informing patients about an intervention. The visualization format and navigational options are important features that should be considered when designing medical videos for patient education. CLINICALTRIAL Deutsches Register Klinischer Studien DRKS00016003; https://www.drks.de/drks_web/ navigate.do?navigationId= trial.HTML&TRIAL_ID=DRKS00016003 (Archived by WebCite at http://www.webcitation.org/746ASSAhN)


Author(s):  
Despoina G Alamanou ◽  
Konstantinos Giakoumidakis ◽  
Dimosthenis G Theodosiadis ◽  
Nikolaos V Fotos ◽  
Elissavet Patiraki ◽  
...  

Objective: In Greece, the old phenomenon of hiding cancer diagnosis and depriving cancer patients of their right to participate in decisionmaking remains a reality. The aim of this study was to assess the decision-making preferences of Greek cancer patients and their awareness of diagnosis. Methods: It was a cross-sectional study. The sample consisted of 229 adult Greek patients diagnosed with cancer, attending the oncology outpatient department (outpatients) or being hospitalized (inpatients), in one general hospital in Athens. Patients who were aware of cancer diagnosis (n=209) were administered at the Control Preference Scale (CPS), a tool, designed to elicit decision-making preferences. The IBM SPSS program, version 21.0 was used for statistical analysis. Results: One hundred and one patients (52.8%) were males. The mean [±standard deviation (SD)] age was 64.8 (±11.2) years. The vast majority of patients knew they suffered from cancer (n=209, 91.3%). Older patients (p=0.003), those who lived in suburbs of the city (p=0.01), those who had lower educational level (p=0.001), those with lower personal income (p=0.001) and shorter disease duration (p=0.001) stated that were unaware of cancer diagnosis. Seventy five (36.2%) patients chose the shared-decision role in decision-making procedures. Lower age (OR 1.04, 95%, CI: 1.00-1.08, p= 0.05) and higher education level (OR 2, 63, 95%, CI: 1.11-6.29, p=0.03) were significantly associated with the preference of patients to actively participate in decision-making regarding treatment. Conclusions: Although Greek cancer patients are aware of cancer diagnosis and treatment, nowadays, they still seem to hesitate in playing a more active role in the decision-making procedures, which portrays the impact of the dominating paternalistic model of doctor-patient relationship in the Greek medical encounter


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