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  • 1
    Online Resource
    Online Resource
    Using implementation science to examine impact of a social responsibility agenda on addressing cancer health disparities in Ceará, Brazil.
    American Society of Clinical Oncology (ASCO) ; 2020
    In:  Journal of Clinical Oncology Vol. 38, No. 15_suppl ( 2020-05-20), p. e19071-e19071
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 38, No. 15_suppl ( 2020-05-20), p. e19071-e19071
    Abstract: e19071 Background: Programs to address disparities in cancer care outcomes in resource-limited settings require attention to social determinants of health (SDoH) to achieve successful clinical care implementation. The Instituto de Câncer do Ceará, the largest cancer center in northeastern Brazil, has implemented a Social Responsibility Agenda (SRA) to guide equitable cancer care delivery. This goal of this study was to develop a framework for an implementation science (IS) study evaluating the longitudinal impact of the SRA on cancer outcomes. Methods: We outlined a mixed-methods and participatory study incorporating a process model, the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework. A list of constructs and links to measurement tools associated with IS models were identified to guide the study phases. Results: We established a logic model to guide in evaluating the health and economic impact of the SRA. We identified 〉 30 constructs and measures across domains of IS models. The table shows a driver diagram to inform the framework. Conclusions: Understanding determinants, key drivers and change concepts are important initial steps in an ongoing evaluation of the impact of evidence based SDoH interventions to address cancer disparities. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2020.38.15_suppl.e19071
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2020
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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    Online Resource
  • 2
    Online Resource
    Online Resource
    Shared-decision making in prostate cancer with clinical decision-support.
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 15_suppl ( 2019-05-20), p. e16576-e16576
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 15_suppl ( 2019-05-20), p. e16576-e16576
    Abstract: e16576 Background: Shared decision-making is the process of deliberately interacting with patients who wish to make informed value-based choices, when there are no indicated best treatment options. Given the wide variation in prostate cancer treatment options, clinical decision-support systems (CDSS) may effectively support treatment decisions for patients with challenging risk-benefit profiles. However, limited data are available regarding CDSS in shared decision making. This study aimed to assess the alignment of CDSS therapeutic options with treatment received through a shared decision process. Methods: We identified patients with prostate cancer (Gleason Groups 1-5) who were engaged in shared treatment decision making, (from August–September 2018) at the Instituto do Câncer do Ceará, Brazil. IBM Watson for Oncology (WfO), a CDSS was used for the study. Treatment decisions were compared with WfO options (active surveillance, clinical trial, chemotherapy [CT], hormone therapy [HT] , radiation [RT], brachytherapy [brachy] , surgery and systemic therapy with GnRH suppression) and categorized as concordant (equivalent), partially concordant (a partial match), or discordant. Results: Concordance between WfO and shared treatment decisions was observed in 54% (26/48) of patients, partial concordance in 15% (7/48) and discordance in 31% (15/48). Most frequent treatments were RT+HT combination therapy (25%) and prostatectomy (21%). 8/15 (53%) discordant cases were due to patient preference for treatment over active surveillance. Patient preference for treatment over active surveillance was the most common reason (53%) for discordance. Conclusions: Variation in prostate cancer treatment exists. CDSS therapy options may be useful in quantifying and modifying unwarranted variations in prostate cancer treatment. Future studies are important for understanding reasons for variations. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2019.37.15_suppl.e16576
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 3
    Online Resource
    Online Resource
    An evaluation of artificial intelligence-based clinical decision supports use in Brazil.
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 15_suppl ( 2019-05-20), p. e18081-e18081
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 15_suppl ( 2019-05-20), p. e18081-e18081
    Abstract: e18081 Background: The Instituto do Câncer do Ceará (ICC), a 160-bed oncology hospital located in Brazil, serves approximately 23,000 patients monthly. In December of 2017, ICC implemented Watson for Oncology (WFO), an artificial intelligence (AI)-based clinical decision-support (CDS) tool to help enhance personalized cancer care. As of December 2018, 903 cases involving mainly breast, prostate and gastric cancers were entered in WFO. The purpose of this study was to investigate how implementation of WFO and use by oncologists affects clinical decision-making and workflow. Methods: 7 oncologists who employed WfO during and after the patients’ first visit were recruited to complete a survey regarding usability, decision-making and workflow. The group consisted of 1 urologist, 3 gastric surgeons, 1 gynecologist, 1 breast surgeon, 1 head-neck surgeon. Survey questions integrated the CDS Five Rights framework. Results: Most oncologists agreed that WFO is easy to understand and provides complete, relevant and actionable information at an appropriate time (Table). Opinions on the impact on treatment decisions varied. 71.4% expressed positive statements (agree or strongly agree) pertaining to the use of WFO. Conclusions: In this study, oncologists felt WFO met 5 Rights expectations for CDS; 57% felt that WFO exceed expectations. Further research is needed to understand how variation in experience affects decision impact. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2019.37.15_suppl.e18081
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 4
    Online Resource
    Online Resource
    A retrospective evaluation of treatment decision making for thyroid cancer using clinical decision support in Brazil.
    American Society of Clinical Oncology (ASCO) ; 2020
    In:  Journal of Clinical Oncology Vol. 38, No. 15_suppl ( 2020-05-20), p. e19193-e19193
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 38, No. 15_suppl ( 2020-05-20), p. e19193-e19193
    Abstract: e19193 Background: Artificial intelligence-driven clinical decision-support systems such as Watson for Oncology (WfO) may aid cancer care in economically challenged health systems. Evidence of the applicability of such tools in resource-constrained settings is limited. The study objective was to evaluate treatment agreement between physician-prescribed therapy and WfO recommended treatment options in thyroid cancer in Brazil. An in-depth evaluation of discordant cases by a blinded expert panel of medical oncologists and cancer surgeons was performed to identify preferred therapies and predictors of discordance. Methods: Thyroid cancer patients treated at the Instituto do Câncer do Ceará, Brazil from July 2018 to June 2019, but not processed in WfO, were selected for entry into WfO in January 2020. Blinded to treatment-plan source (i.e., WfO or historical), the expert panel reviewed all WfO therapeutic options and historical physician-prescribed treatment plans for discordant cases and selected their preferred treatment options. Clinical and demographic characteristics were analyzed using logistic regression. Results: Thyroid cancer patients (n = 83) evaluated for concordance between WfO therapeutic options and historical treatments were mostly female (91%) and between the ages of 18 - 78 years (mean 47.7). Concordance between historical physician-prescribed treatment decisions and WfO was 73.5% (61/83). Demographics and clinical characteristics associated with discordance are shown in Table. For all discordant cases (n = 22), preferred treatment decisions, as determined by the expert panel, were in agreement with WfO. Conclusions: High concordance between WfO recommended treatment options and historical treatment decisions for thyroid cancer was observed at Instituto do Câncer do Ceará. For discordant cases, a blinded expert panel agreed with WfO recommended treatment options in all cases, demonstrating there may be a role for decision support in aiding individual oncologists to make best-practice and evidence-informed treatment decisions. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2020.38.15_suppl.e19193
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2020
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
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