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Barriers to adequate healthcare in rural areas remain a grand challenge for local healthcare systems. In addition to patients' travel burdens, lack of health insurance, and lower health literacy, rural healthcare systems also experience significant resource shortages, as well as issues with recruitment and retention of healthcare providers, particularly specialists. These factors combined result in complex change management-focused challenges for rural healthcare systems. Change management initiatives are often resource intensive, and in rural health organizations already strapped for resources, it may be particularly risky to embark on change initiatives. One way to address these change management concerns is by leveraging socio-technical simulation models to estimate techno-economic feasibility (e.g., is it technologically feasible, and is it economical?) as well as socio-utility feasibility (e.g., how will the changes be utilized?). We present a framework for how healthcare systems can integrate modeling and simulation techniques from systems engineering into a change management process. Modeling and simulation are particularly useful for investigating the amount of uncertainty about potential outcomes, guiding decision-making that considers different scenarios, and validating theories to determine if they accurately reflect real-life processes. The results of these simulations can be integrated into critical change management recommendations related to developing readiness for change and addressing resistance to change. As part of our integration, we present a case study showcasing how simulation modeling has been used to determine feasibility and potential resistance to change considerations for implementing a mobile radiation oncology unit. Recommendations and implications are discussed.

The sequence of stress, distress and somatization has occupied much of the late twentieth-century psychological research. The anatomy of stress can be viewed from interactional and hybrid theories that suggest that the individual relates with the surroundings by buffering the harmful effects of stressors. These acts or reactions are called coping strategies and are designed as protection from the stressors and adaptation to them. Failure to successfully adapt to stressors results in psychological distress. In some individuals, elevated levels of distress and failed coping are expressed in physical symptoms, rather than through feelings, words, or actions. Such “somatization” defends against the awareness of the psychological distress, as demonstrated in the psychosocial literature. The progression of behavior resulting from somatic distress moves from a private domain into the public arena, involving an elaborate medicalization process, is however less clear in sociological discourse. The invocation of a medical diagnosis to communicate physical discomfort by way of repeated use of health care services poses a major medical, social and economic problem. The goal of this paper is to clarify this connection by investigating the relevant literature in the area of women with breast cancer. This manuscript focuses on the relationship of psychological stress, the stress response of distress, and the preoccupation with one’s body, and proposes a new theoretical construct.

As health care delivery becomes increasingly focused on patient-centered models, interventions such as patient navigation that have the potential to improve care coordination garner interest from health care managers and clinicians. The ability to understand how and to what extent patient navigation is successful in addressing coordination issues, however, is hampered by multiple definitions, vague boundaries, and different contextual implementations of patient navigation. Using a systematic review strategy and classification method, we review both the conceptual and empirical literature regarding navigation in multiple clinical contexts. We then describe and conceptualize variation in how patient navigation has been defined, implemented, and theorized to affect outcomes. This review suggests that patient navigation varies along multiple dimensions and that the variation is related to differing resources, constraints, and goals. We propose a conceptual model to frame further research and suggest that research in this area must carefully account for this variation in order to accurately assess the benefits of patient navigation and provide actionable knowledge for managers.

Recent guidance from the United States Food and Drug Administration discusses patient-reported outcomes as endpoints in clinical trials (FDA, 2006). Using methods consistent with this guidance, we developed symptom indexes for patients with advanced cancer. Input on the most important symptoms was obtained from 533 patients recruited from National Comprehensive Cancer Network (NCCN) member institutions and four non-profit social service organizations. Diagnoses included the following 11 primary cancers: bladder, brain, breast, colorectal, head/neck, hepatobiliary/pancreatic, kidney, lung, lymphoma, ovarian and prostate. Physician experts in each of 11 diseases were also surveyed to differentiate symptoms that were predominantly disease-based from those that were predominantly treatment-induced. Results were evaluated alongside previously published indexes for 9 of these 11 advanced cancers that were created based on expert provider surveys, also at NCCN institutions (Cella et al., 2003). The final results are 11 symptom indexes that reflect the highest priorities of people affected by these 11 advanced cancers and the experienced perspective of the people who provide their medical treatment. Beyond the clinical value of such indexes, they may also contribute significantly to satisfying regulatory requirements for a standardized tool to evaluate drug efficacy with respect to symptomatology.

Purpose – Objective measures of a new treatment's expected ability to improve patients’ health are presumed to be significant factors influencing physicians’ treatment decisions. Physicians’ behavior may also be influenced by their patients’ disease severity and insurance reimbursement policies, firm promotional activities and public media reports. This chapter examines how objective evidence of the incremental effectiveness of novel drugs to treat cancer (“chemotherapies”) impacts the rate at which physicians’ adopt these treatments into practice, holding constant other factors.

Design/methodology – The novelty of the analysis resides in the dataset and estimation strategy employed. Data is derived from a United States population-based chemotherapy order entry system, IntrinsiQ Intellidose. Quality/price endogeneity is overcome by employing sample selection methods and an estimation strategy that exploits quality variation at the molecule-indication level. Pooled diffusion rates across molecule-indication pairs are estimated using nonparametric hazard models.

Findings – Results suggest incremental effectiveness is negatively and nonsignificantly associated with the diffusion of new chemotherapies; faster rates of diffusion are positively and significantly related to low five-year survival probabilities and measures of perceived clinical significance. Results are robust to numerous specification checks, including a measure of alternative therapeutic availability. We discuss the magnitude and potential direction of bias introduced by several threats to internal validity. Evidence of incremental effectiveness does not appear to motivate the rate of specialty physician diffusion of new medical treatment; in all models high risk of disease mortality and perceptions of therapeutic quality are significant drivers of physician use of novel chemotherapies.

Value/originality – Understanding the rate of technological advance across different clinical settings, as well as the product-, provider-, and patient-level determinants of this rate, is an important subject for future research.

This chapter explores the relationships between 12 single mothers with breast cancer and their children, a subtheme of a larger qualitative study.

Qualitative data were collected via interviews. The study used the ecological systems theoretical framework to explain findings.

In speaking with women about how they constructed and altered their social networks post-diagnosis, many talked about their relationships with their children. This chapter explains how these mothers discussed their diagnoses with their children in age-appropriate ways; how they relied on their children during treatment for informational and emotional support; and how relationships with their children changed during treatment and recovery.

Based on findings from this study, family scientists, public health professionals, and oncology care providers may have a better understanding of the specific concerns and experiences related to the children of breast cancer patients without partners.

This study yields new information about the support needs of single breast cancer patients and their children, and offers insight into what researchers and medical teams can do to better support families affected by breast cancer.

Purpose: The issue of whether participation in online peer-support communities has positive or negative impacts on the psychological adjustment of cancer patients warrants further explorations from new perspectives. This research investigates the role of personality traits in moderating the impact of online participation on the psychological adjustment of cancer patients in terms of their general psychological well-being and cancer-specific well-being.

Methodology: Study participants consisted of adults diagnosed with leukemia. Questionnaires were collected from 111 participants in two leukemia-related forums in China, Baidu Leukemia Community and Bloodbbs. Information regarding the personality traits, online participation, and psychological adjustment were collected using an online questionnaire. A linear regression model was used to test the moderation effect of personality traits on the relationship between online participation and psychological adjustment.

Findings: The main effect of participation in online support communities on psychological adjustment was not statistically significant. Importantly, two personality traits (i.e., emotional stability and openness to experience) moderated the relationship between online participation and psychological adjustment to cancer. Leukemia patients with high emotional stability and high openness to experience reported better psychological adjustment as they participated more in the online community. However, this was not the case for patients with low stability and low openness, who reported worse psychological adjustment as their participation in the online support community increased.

Value: This study introduces two personality moderators into the discussion of how participation in online support communities influences the lives of cancer patients. The moderation effects help to explain why there have been contradictions in the findings of previous studies. In addition, this study adds to the current literature on online support communities as little research on this topic has been conducted outside of the US and Europe. Practically, this study not only highlights the need to evaluate the personality traits of patients who are recommended to participate in online communities, but also underlines the necessity of intervention in these communities.

Failure to rescue events, or events involving preventable deaths from complications, are a significant contributor to inpatient mortality. While many interventions have been designed and implemented over several decades, this patient safety issue remains at the forefront of concern for most hospitals. In the first part of this study, the development and implementation of one type of highly studied and widely adopted rescue intervention, algorithm-based patient assessment tools, is examined. The analysis summarizes how a lack of systems-oriented approaches in the design and implementation of these tools has resulted in suboptimal understanding of patient risk of mortality and complications and the early recognition of patient deterioration. The gaps identified impact several critical aspects of excellent patient care, including information-sharing across care settings, support for the development of shared mental models within care teams, and access to timely and accurate patient information.

This chapter describes the use of several system-oriented design and implementation activities to establish design objectives, model clinical processes and workflows, and create an extensible information system model to maximize the benefits of patient state and risk assessment tools in the inpatient setting. A prototype based on the product of the design activities is discussed along with system-level considerations for implementation. This study also demonstrates the effectiveness and impact of applying systems design principles and practices to real-world clinical applications.

Millions of people die of chronic diseases within inpatient settings annually in the United States, despite patient preferences for dying at home. This medicalization of dying has received social and economic critiques for decades. This chapter offers a further analysis to these critiques by examining the ecological impacts of inpatient end-of-life care on the natural environment and occupational and public health.

We compare the ecological health outcomes of medical care in three inpatient units (conventional cancer unit, palliative care ward, and hospice facility) using ethnographic observations, semi-structured interviews, and institutional records on medical supply use, waste generation, and pharmaceutical administration and disposal.

Care provided on all three medical units had significant socioecological impacts. Cumulative impacts were greatest on the conventional unit, followed by palliative care, and lowest on the hospice unit. Variations in impacts mirrored differences in dependence on material interventions, which arose from variations in patient needs, institutional policies, and nursing cultures between the three units.

Social and economic concerns have been major drivers in reforming end-of-life medical care, and our analysis shows that ecological concerns must also be considered. Transitioning terminal patients to less materially intensive modes of care when appropriate could mitigate ecological health impacts while honoring patient preferences.

This chapter describes how the medicalization of dying has converged with institutional policies, practices, and actors to increase the negative consequences of medical care, and recognizes that the far-reaching impacts of clinical decisions make the provision of medical care a socioecological act.