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Advance Directives for Patients With Breast Cancer: Applying the Right Info/Right Care/Right Patient/Right Time Oncology Model
BACKGROUND: Advance directives (AD) are an important component of life care planning for patients undergoing treatment for cancer; however, there are few effective interventions to increase AD rates. In this quality improvement project, the authors integrated AD counseling into a novel right info/ri...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Permanente Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10502389/ https://www.ncbi.nlm.nih.gov/pubmed/37255340 http://dx.doi.org/10.7812/TPP/22.177 |
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author | Ossowski, Stephanie Lyon, Liisa Linehan, Elizabeth Gordon, Nancy P Egorova, Olga Mark, Becky Beringer, Kimberly Abbe, Thea Shirazi, Aida Weldon, Christine Trosman, Julia Ravelo, Arliene Liu, Raymond |
author_facet | Ossowski, Stephanie Lyon, Liisa Linehan, Elizabeth Gordon, Nancy P Egorova, Olga Mark, Becky Beringer, Kimberly Abbe, Thea Shirazi, Aida Weldon, Christine Trosman, Julia Ravelo, Arliene Liu, Raymond |
author_sort | Ossowski, Stephanie |
collection | PubMed |
description | BACKGROUND: Advance directives (AD) are an important component of life care planning for patients undergoing treatment for cancer; however, there are few effective interventions to increase AD rates. In this quality improvement project, the authors integrated AD counseling into a novel right info/right care/right patient/right time (4R) sequence of care oncology delivery intervention for breast cancer patients in an integrated health care delivery system. METHODS: The authors studied two groups of patients with newly diagnosed breast cancer who attended a multidisciplinary clinic and underwent definitive surgery at a single facility. The usual care (UC) cohort (N = 139) received care from October 1, 2019 to September 30, 2020. The 4R cohort (N = 141) received care from October 1, 2020 to September 30, 2121 that included discussing AD completion with a health educator prior to surgery. The authors used bivariate analyses to assess whether the AD intervention increased AD completion rates and to identify factors influencing AD completion. RESULTS: The UC and 4R cohorts were similar in age, gender, race/ethnicity, interpreter need, Elixhauser comorbidity index, National Comprehensive Cancer Network distress score ≥ 5, surgery type, stage, histology, grade, and Estrogen receptor/Progesterone receptor/ human epidermal growth factor receptor 2 (ER/PR/HER2) status. AD completion rates prior to surgery were significantly higher for the 4R vs UC cohort (73.8%, 95% confidence interval [CI] [66.5%–81.0%] vs 15.1%, 95% CI [9.2%–21.1%], p < .01) and did not significantly differ by age, race, need for interpreter, or distress scores. CONCLUSION: Incorporation of a health educator discussion into a 4R care sequence plan significantly increased rates of time-sensitive AD completion. |
format | Online Article Text |
id | pubmed-10502389 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | The Permanente Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-105023892023-09-16 Advance Directives for Patients With Breast Cancer: Applying the Right Info/Right Care/Right Patient/Right Time Oncology Model Ossowski, Stephanie Lyon, Liisa Linehan, Elizabeth Gordon, Nancy P Egorova, Olga Mark, Becky Beringer, Kimberly Abbe, Thea Shirazi, Aida Weldon, Christine Trosman, Julia Ravelo, Arliene Liu, Raymond Perm J Original Research BACKGROUND: Advance directives (AD) are an important component of life care planning for patients undergoing treatment for cancer; however, there are few effective interventions to increase AD rates. In this quality improvement project, the authors integrated AD counseling into a novel right info/right care/right patient/right time (4R) sequence of care oncology delivery intervention for breast cancer patients in an integrated health care delivery system. METHODS: The authors studied two groups of patients with newly diagnosed breast cancer who attended a multidisciplinary clinic and underwent definitive surgery at a single facility. The usual care (UC) cohort (N = 139) received care from October 1, 2019 to September 30, 2020. The 4R cohort (N = 141) received care from October 1, 2020 to September 30, 2121 that included discussing AD completion with a health educator prior to surgery. The authors used bivariate analyses to assess whether the AD intervention increased AD completion rates and to identify factors influencing AD completion. RESULTS: The UC and 4R cohorts were similar in age, gender, race/ethnicity, interpreter need, Elixhauser comorbidity index, National Comprehensive Cancer Network distress score ≥ 5, surgery type, stage, histology, grade, and Estrogen receptor/Progesterone receptor/ human epidermal growth factor receptor 2 (ER/PR/HER2) status. AD completion rates prior to surgery were significantly higher for the 4R vs UC cohort (73.8%, 95% confidence interval [CI] [66.5%–81.0%] vs 15.1%, 95% CI [9.2%–21.1%], p < .01) and did not significantly differ by age, race, need for interpreter, or distress scores. CONCLUSION: Incorporation of a health educator discussion into a 4R care sequence plan significantly increased rates of time-sensitive AD completion. The Permanente Press 2023-06-16 /pmc/articles/PMC10502389/ /pubmed/37255340 http://dx.doi.org/10.7812/TPP/22.177 Text en © 2023 The Authors. https://creativecommons.org/licenses/by-nc-nd/4.0/Published by The Permanente Federation LLC under the terms of the CC BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/. |
spellingShingle | Original Research Ossowski, Stephanie Lyon, Liisa Linehan, Elizabeth Gordon, Nancy P Egorova, Olga Mark, Becky Beringer, Kimberly Abbe, Thea Shirazi, Aida Weldon, Christine Trosman, Julia Ravelo, Arliene Liu, Raymond Advance Directives for Patients With Breast Cancer: Applying the Right Info/Right Care/Right Patient/Right Time Oncology Model |
title | Advance Directives for Patients With Breast Cancer: Applying the Right Info/Right Care/Right Patient/Right Time Oncology Model |
title_full | Advance Directives for Patients With Breast Cancer: Applying the Right Info/Right Care/Right Patient/Right Time Oncology Model |
title_fullStr | Advance Directives for Patients With Breast Cancer: Applying the Right Info/Right Care/Right Patient/Right Time Oncology Model |
title_full_unstemmed | Advance Directives for Patients With Breast Cancer: Applying the Right Info/Right Care/Right Patient/Right Time Oncology Model |
title_short | Advance Directives for Patients With Breast Cancer: Applying the Right Info/Right Care/Right Patient/Right Time Oncology Model |
title_sort | advance directives for patients with breast cancer: applying the right info/right care/right patient/right time oncology model |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10502389/ https://www.ncbi.nlm.nih.gov/pubmed/37255340 http://dx.doi.org/10.7812/TPP/22.177 |
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