11 results on '"Hannon, Breffni"'
Search Results
2. Socioeconomic Status, Palliative Care, and Death at Home Among Patients With Cancer Before and During COVID-19
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Iqbal, Javaid, primary, Moineddin, Rahim, additional, Fowler, Robert A., additional, Krzyzanowska, Monika K., additional, Booth, Christopher M., additional, Downar, James, additional, Lau, Jenny, additional, Le, Lisa W., additional, Rodin, Gary, additional, Seow, Hsien, additional, Tanuseputro, Peter, additional, Earle, Craig C., additional, Quinn, Kieran L., additional, Hannon, Breffni, additional, and Zimmermann, Camilla, additional
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- 2024
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3. Machine Learning to Allocate Palliative Care Consultations During Cancer Treatment
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He, Jiang Chen, primary, Moffat, Gordon Taylor, additional, Podolsky, Sho, additional, Khan, Ferhana, additional, Liu, Ning, additional, Taback, Nathan, additional, Gallinger, Steven, additional, Hannon, Breffni, additional, Krzyzanowska, Monika K., additional, Ghassemi, Marzyeh, additional, Chan, Kelvin K.W., additional, and Grant, Robert C., additional
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- 2024
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4. Implementation of a Social Work-Led Advance Care Planning Clinic for CAR T-Cell Therapy Patients
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Barca, Emily, primary, Hannon, Breffni Louise, additional, Lewin, Warren Harris, additional, Papadakos, Janet, additional, Papadakos, Tina, additional, Klein, Eden, additional, Abreu-Costa, Claudia, additional, Chen, Christine, additional, and Bhella, Sita D., additional
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- 2024
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5. Advanced Cancer in Young Adults (YAs): Living in a Liminal Space.
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Avery, Jonathan, Campbell, Kristin L., Mosher, Pamela, Al-Awamer, Ahmed, Goddard, Karen, Edwards, Annemarie, Burnett, Laura, Hannon, Breffni, Gupta, Abha, and Howard, A. Fuchsia
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TUMOR diagnosis ,DISEASE progression ,COMPUTER software ,SPECIALTY hospitals ,SOCIAL constructionism ,GROUNDED theory ,RESEARCH methodology ,FUNCTIONAL status ,PATIENT decision making ,ACHIEVEMENT ,ACTIVITIES of daily living ,INTERVIEWING ,MENTAL health ,UNCERTAINTY ,PATIENTS' attitudes ,CANCER treatment ,TREATMENT effectiveness ,HOPE ,DIARY (Literary form) ,COMMUNICATION ,FIELD notes (Science) ,RESEARCH funding ,DEATH ,STATISTICAL sampling ,JUDGMENT sampling ,PSYCHOLOGICAL adaptation ,DATA analysis ,DATA analysis software ,ONCOLOGISTS ,CANCER patient medical care ,GOAL (Psychology) ,PROMPTS (Psychology) ,ADULTS - Abstract
Young adults (YAs), defined as individuals between the ages of 18 and 39 years, experience unique challenges when diagnosed with advanced cancer. Using the social constructivist grounded theory approach, we aimed to develop a theoretical understanding of how YAs live day to day with their diagnosis. A sample of 25 YAs (aged 22–39 years) with advanced cancer from across Canada participated in semi-structured interviews. Findings illustrate that the YAs described day-to-day life as an oscillating experience swinging between two opposing disease outcomes: (1) hoping for a cure and (2) facing the possibility of premature death. Oscillating between these potential outcomes was characterized as living in a liminal space wherein participants were unsure how to live from one day to the next. The participants oscillated at various rates, with different factors influencing the rate of oscillation, including inconsistent and poor messaging from their oncologists or treatment team, progression or regression of their cancer, and changes in their physical functioning and mental health. These findings provide a theoretical framework for designing interventions to help YAs adapt to their circumstance. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Telehealth outpatient palliative care in the COVID-19 pandemic: patient experience qualitative study
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Alcalde Castro, Mirza Jacqueline, Zaig, Shenhab, Nissim, Rinat, O’Connor, Brenda, Lau, Jenny, Mak, Ernie, Zimmermann, Camilla, and Hannon, Breffni
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ObjectivesOutpatient in-person early palliative care improves quality of life for patients with advanced cancer. The COVID-19 pandemic forced a rapid shift to telehealth visits; however, little is known about how telehealth in outpatient palliative care settings should be optimised beyond the pandemic. We aimed to explore, from the perspective of patients attending an outpatient palliative care clinic, the most appropriate model of care for in-person versus telehealth visits.MethodsA qualitative study using the grounded theory method. One-on-one, semistructured qualitative interviews were conducted with 26 patients attending an outpatient palliative care clinic at a tertiary cancer centre recruited from two groups: (1) those with >1 in-person appointment prior to 1 March 2020 and >1 telehealth appointment after this date (n=17); and (2) patients who had exclusively telehealth appointments (n=9). Purposive sampling was used to incorporate diverse perspectives.ResultsOverall, participants endorsed a flexible hybrid approach incorporating both in-person and telehealth visits. Specific categories were: (1) in-person outpatient palliative care supported building interpersonal connections and trust; (2) telehealth palliative care facilitated greater efficiency, comfort and independence and (3) patient-preferred circumstances for in-person visits (preferred for initial consultations, visits where a physical examination may be required and advance care planning discussions), versus telehealth visits (preferred during periods of relative heath stability).ConclusionsThe elements of in-person and telehealth outpatient palliative care clinic visits described by patients as integral to their care may be used to develop models of hybrid outpatient palliative care delivery beyond the pandemic alongside reimbursement and regulatory guidelines.
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- 2024
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7. Palliative medicine outpatient clinic ‘no-shows’: retrospective review
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Alcalde Castro, Mirza Jacqueline, Pope, Ashley, Zhang, Yuhua, Al-Awamer, Ahmed, Banerjee, Subrata, Lau, Jenny, Mak, Ernie, O'Connor, Brenda, Saltman, Alexandra, Wentlandt, Kirsten, Zimmermann, Camilla, and Hannon, Breffni
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ObjectivesPatients who do not attend outpatient palliative care clinic appointments (‘no-shows’) may have unmet needs and can impact wait times. We aimed to describe the characteristics and outcomes associated with no-shows.MethodsWe retrospectively reviewed new no-show referrals to the Princess Margaret Cancer Centre Oncology Palliative Care Clinic (OPCC) in Toronto, Canada, between January 2017 and December 2018, compared with a random selection of patients who attended their first appointment, in a 1:2 ratio. We collected patient information, symptoms, performance status (Eastern Cooperative Oncology Group (ECOG) and outcomes. Univariable and multivariable logistic regression analyses were used to identify significant factors.ResultsCompared with those who attended (n=214), no-shows (n=103), on multivariable analysis, were at higher odds than those who attended of being younger (OR 0.98, 95% CI 0.96 to 1.00, p=0.019), living outside Toronto (OR 2.67, 95% CI 1.54 to 4.62, p<0.001) and having ECOG ≥2 (OR 2.98, 95% CI 1.41 to 6.29, p=0.004). No-shows had a shorter median survival compared with those who attended their first appointment (2.3 vs 8.7 months, p<0.001).ConclusionCompared with patients who attended, no-shows lived further from the OPCC, were younger, and had a poorer ECOG. Strategies such as virtual visits should be explored to reduce no-shows and enable attendance at OPCCs.
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- 2024
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8. Public knowledge and attitudes concerning palliative care
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Zimmermann, Camilla, Wong, Joanne L., Swami, Nadia, Pope, Ashley, Cheng, YiQin, Mathews, Jean, Howell, Doris, Sullivan, Richard, Rodin, Gary, Hannon, Breffni, Moineddin, Rahim, and Le, Lisa W.
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ObjectiveWHO recommends early integration of palliative care alongside usual care to improve quality of life, although misunderstanding of palliative care may impede this. We compared the public’s perceived and actual knowledge of palliative care, and examined the relationship of this knowledge to attitudes concerning palliative care.MethodsWe analysed data from a survey of a representative sample of the Canadian public, accessed through a survey panel in May–June 2019. We compared high perceived knowledge (‘know what palliative care is and could explain it’) with actual knowledge of the WHO definition (knew ≥5/8 components, including that palliative care can be provided early in the illness and together with life-prolonging treatments), and examined their associations with attitudes to palliative care.ResultsOf 1518 adult participants residing in Canada, 45% had high perceived knowledge, of whom 46% had high actual knowledge. Participants with high (vs low) perceived knowledge were more likely to associate palliative care with end-of-life care (adjusted OR 2.15 (95% CI 1.66 to 2.79), p<0.0001) and less likely to believe it offered hope (0.62 (95% CI 0.47 to 0.81), p=0.0004). Conversely, participants with high (vs low) actual knowledge were less likely to find palliative care fearful (0.67 (95% CI 0.52 to 0.86), p=0.002) or depressing (0.72 (95% CI 0.56 to 0.93), p=0.01) and more likely to believe it offered hope (1.88 (95% CI 1.46 to 2.43), p<0.0001).ConclusionsStigma regarding palliative care may be perpetuated by those who falsely believe they understand its meaning. Public health education is needed to increase knowledge about palliative care, promote its early integration and counter false assumptions.
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- 2024
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9. Team-based outpatient early palliative care: a complex cancer intervention
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Zimmermann, Camilla, Ryan, Suzanne, Hannon, Breffni, Saltman, Alexandra, Rodin, Gary, Mak, Ernie, Al-Awamer, Ahmed, and Lau, Jenny
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BackgroundAlthough the effectiveness of early palliative care for patients with advanced cancer has been demonstrated in several trials, there has been no detailed published description of an early palliative care intervention.MethodIn this paper, we delineate the iterative conception and systematic evaluation of a complex intervention called team-based outpatient early palliative care (TO-EPC), and describe the components of the intervention. The intervention was developed based on palliative care theory, review of previous palliative care interventions and practice guidelines. We conducted feasibility testing and piloting of TO-EPC in a phase 2 trial, followed by evaluation in a large cluster randomised trial and qualitative research with patients and caregivers. The qualitative research informed the iterative refinement of the intervention.ResultsFour principles and four domains of care constitute a conceptual framework for TO-EPC. The main domains of care are: coping and support, symptom control, decision-making and future planning. The main principles are that care is flexible, attentive, patient-led and family-centred. The most prominent domain for the initial consultation is coping and support; follow-up visits focus on symptom control, decision-making to maximise quality of life and future planning according to patient readiness. Key tasks are described in relation to each domain.ConclusionThe description of our intervention may assist palliative care teams seeking to implement it, researchers wishing to replicate or build on it and oncologists hoping to adapt it for their patients.
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- 2024
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10. Physician and Artificial Intelligence Chatbot Responses to Cancer Questions From Social Media.
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Chen D, Parsa R, Hope A, Hannon B, Mak E, Eng L, Liu FF, Fallah-Rad N, Heesters AM, and Raman S
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- Humans, Physician-Patient Relations, Male, Female, Physicians psychology, Empathy, Artificial Intelligence, Social Media, Neoplasms psychology
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Importance: Artificial intelligence (AI) chatbots pose the opportunity to draft template responses to patient questions. However, the ability of chatbots to generate responses based on domain-specific knowledge of cancer remains to be tested., Objective: To evaluate the competency of AI chatbots (GPT-3.5 [chatbot 1], GPT-4 [chatbot 2], and Claude AI [chatbot 3]) to generate high-quality, empathetic, and readable responses to patient questions about cancer., Design, Setting, and Participants: This equivalence study compared the AI chatbot responses and responses by 6 verified oncologists to 200 patient questions about cancer from a public online forum. Data were collected on May 31, 2023., Exposures: Random sample of 200 patient questions related to cancer from a public online forum (Reddit r/AskDocs) spanning from January 1, 2018, to May 31, 2023, was posed to 3 AI chatbots., Main Outcomes and Measures: The primary outcomes were pilot ratings of the quality, empathy, and readability on a Likert scale from 1 (very poor) to 5 (very good). Two teams of attending oncology specialists evaluated each response based on pilot measures of quality, empathy, and readability in triplicate. The secondary outcome was readability assessed using Flesch-Kincaid Grade Level., Results: Responses to 200 questions generated by chatbot 3, the best-performing AI chatbot, were rated consistently higher in overall measures of quality (mean, 3.56 [95% CI, 3.48-3.63] vs 3.00 [95% CI, 2.91-3.09]; P < .001), empathy (mean, 3.62 [95% CI, 3.53-3.70] vs 2.43 [95% CI, 2.32-2.53]; P < .001), and readability (mean, 3.79 [95% CI, 3.72-3.87] vs 3.07 [95% CI, 3.00-3.15]; P < .001) compared with physician responses. The mean Flesch-Kincaid Grade Level of physician responses (mean, 10.11 [95% CI, 9.21-11.03]) was not significantly different from chatbot 3 responses (mean, 10.31 [95% CI, 9.89-10.72]; P > .99) but was lower than those from chatbot 1 (mean, 12.33 [95% CI, 11.84-12.83]; P < .001) and chatbot 2 (mean, 11.32 [95% CI, 11.05-11.79]; P = .01)., Conclusions and Relevance: The findings of this study suggest that chatbots can generate quality, empathetic, and readable responses to patient questions comparable to physician responses sourced from an online forum. Further research is required to assess the scope, process integration, and patient and physician outcomes of chatbot-facilitated interactions.
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- 2024
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11. Palliative Care as a Component of High-Value and Cost-Saving Care During Hospitalization for Metastatic Cancer.
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Lu S, Rakovitch E, Hannon B, Zimmermann C, Dharmarajan KV, Yan M, De Almeida JR, Yao CMKL, Gillespie EF, Chino F, Yerramilli D, Goonaratne E, Abdel-Rahman F, Othman H, Mheid S, and Tsai CJ
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Purpose: Randomized controlled trials have demonstrated that palliative care (PC) can improve quality of life and survival for outpatients with advanced cancer, but there are limited population-based data on the value of inpatient PC. We assessed PC as a component of high-value care among a nationally representative sample of inpatients with metastatic cancer and identified hospitalization characteristics significantly associated with high costs., Methods: Hospitalizations of patients 18 years and older with a primary diagnosis of metastatic cancer from the National Inpatient Sample from 2010 to 2019 were analyzed. We used multivariable mixed-effects logistic regression to assess medical services, patient demographics, and hospital characteristics associated with higher charges billed to insurance and hospital costs. Generalized linear mixed-effects models were used to determine cost savings associated with provision of PC., Results: Among 397,691 hospitalizations from 2010 to 2019, the median charge per admission increased by 24.9%, from $44,904 in US dollars (USD) to $56,098 USD, whereas the median hospital cost remained stable at $14,300 USD. Receipt of inpatient PC was associated with significantly lower charges (odds ratio [OR], 0.62 [95% CI, 0.61 to 0.64]; P < .001) and costs (OR, 0.59 [95% CI, 0.58 to 0.61]; P < .001). Factors associated with high charges were receipt of invasive medical ventilation ( P < .001) or systemic therapy ( P < .001), Hispanic patients ( P < .001), young age (18-49 years, P < .001), and for-profit hospitals ( P < .001). PC provision was associated with a $1,310 USD (-13.6%, P < .001) reduction in costs per hospitalization compared with no PC, independent of the receipt of invasive care and age., Conclusion: Inpatient PC is associated with reduced hospital costs for patients with metastatic cancer, irrespective of age and receipt of aggressive interventions. Integration of inpatient PC may de-escalate costs incurred through low-value inpatient interventions.
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- 2024
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