Browsing by Author "Reynolds, Kathleen"

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    Documenting patients’ and providers’ preferences when proposing a randomized controlled trial: a qualitative exploration
    (2022-03-06) Oberoi, Devesh; Kwok, Cynthia; Li, Yong; Railton, Cindy; Horsman, Susan; Reynolds, Kathleen; Joy, Anil A.; King, Karen M.; Lupichuk, Sasha M.; Speca, Michael; Culos-Reed, Nicole; Carlson, Linda E.; Giese-Davis, Janine
    Abstract Background With advances in cancer diagnosis and treatment, women with early-stage breast cancer (ESBC) are living longer, increasing the number of patients receiving post-treatment follow-up care. Best-practice survivorship models recommend transitioning ESBC patients from oncology-provider (OP) care to community-based care. While developing materials for a future randomized controlled trial (RCT) to test the feasibility of a nurse-led Telephone Survivorship Clinic (TSC) for a smooth transition of ESBC survivors to follow-up care, we explored patients’ and OPs’ reactions to several of our proposed methods. Methods We used a qualitative study design with thematic analysis and a two-pronged approach. We interviewed OPs, seeking feedback on ways to recruit their ESBC patients for the trial, and ESBC patients, seeking input on a questionnaire package assessing outcomes and processes in the trial. Results OPs identified facilitators and barriers and offered suggestions for study design and recruitment process improvement. Facilitators included the novelty and utility of the study and simplicity of methods; barriers included lack of coordination between treating and discharging clinicians, time constraints, language barriers, motivation, and using a paper-based referral letter. OPs suggested using a combination of electronic and paper referral letters and supporting clinicians to help with recruitment. Patient advisors reported satisfaction with the content and length of the assessment package. However, they questioned the relevance of some questions (childhood trauma) while adding questions about trust in physicians and proximity to primary-care providers. Conclusions OPs and patient advisors rated our methods for the proposed trial highly for their simplicity and relevance then suggested changes. These findings document processes that could be effective for cancer-patient recruitment in survivorship clinical trials.
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    Healthcare Utilization Among Young Adult Survivors of Childhood Cancer in Canada: The Role of Patient-Level Factors
    (2024-09-20) Drummond, Rachelle Marie; Schulte, Fiona; Campbell, Tavis; Reynolds, Kathleen; Ronksley, Paul
    Background: Survivors of childhood cancer (SCC) face substantive risks for developing late effects (LE) from their cancer treatments due to disruptions in crucial periods of physical and social development while undergoing cancer treatment (Tonorezos et al., 2022; Baker & Syrjala, 2018). The inappropriate use of healthcare services, whether underutilization or overutilization, may jeopardize the effective risk-based prevention and management of LE among SCC. In addition, inappropriate healthcare utilization (HCU) may contribute to unsustainability and inefficiency in the healthcare system, creating challenges for supporting the growing population of survivors in Canada. Despite existing knowledge that young adult (YA) SCC are at a heightened high risk for the development of LE and life-long complications from their treatments, limited research exists that describes HCU among this population. The two aims of this study were to 1) identify and explore the associations of survivor’s demographics (i.e., sex, gender, age, race, geographic location, SES), knowledge of cancer history and risks, and psychological factors (i.e., anxiety, depression) and perceived vulnerability with healthcare utilization; and 2) examine the relationships among demographic, clinical, and psychological patient-level factors with HCU among YA SCC. Methods: Canadian YA SCC (n=123; 31% male; mean age=28.19yrs, mean time post treatment= 16.56yrs) diagnosed <18 years of age; and >5 years from diagnosis and/or >2 years from treatment completed the Self-Report Survey of Cancer Knowledge (Kunin-Batson et al., 2016), and the Self-Report Survey of Core Health Beliefs (Tercyak et al., 2004), to assess knowledge of cancer history and risks and perceived vulnerability, respectively. Survivors completed the Patient-Reported Outcomes Measurement Information System (PROMIS) SF v1.0 Anxiety 8a and the PROMIS SF v1.0 Depression 8a to assess levels of anxiety and depression respectively. To assess HCU, survivors reported the number of times that they saw a doctor within the last 2 years, in relation to their cancer diagnosis. A bivariate logistic regression model examined associations between YA SCC’s demographics, knowledge of cancer history, and psychological factors with HCU. Results: Survivors reported a wide range of HCU rates over the past 2 years (median= 3-4 visits). The number of reported visits ranged from 0-20+ visits. Despite 45.5% of reported health problems being attributed to mental health, psychiatrists and psychologists/counselors were the third and fourth least utilized types of providers, respectively. A logistic regression model was conducted to assess the associations between HCU and patient-related factors. The model was significant X2(8) =23.68, p=0.003, and accounted for 29.3% of variance in healthcare utilization among YA SCC (NagelKerke R2= 0.293). Anxiety was the only independent variable that contributed significantly to the model (p<0.001), and higher anxiety scores were associated with increased odds of HCU. Conclusion: Anxiety levels were a significant predictor of HCU rates within this population, whereby higher anxiety scores were associated with higher HCU rates. Based on the findings of this study, behavioral interventions could be beneficial in reducing anxiety among YA SCC and promoting appropriate risk based HCU that support the long-term well-being of survivors, and the sustainability of the healthcare system.
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    The Cancer Journey Among Survivors of Pediatric Acute Lymphoblastic Leukemia
    (2023-04-28) Cho, Sara Kaitlyn; Schulte, Fiona; Reynolds, Kathleen; Fay-McClymont, Taryn
    Pediatric acute lymphoblastic leukemia (ALL) is the most common form of pediatric cancer. Treatment for ALL has advanced recently, contributing to the impressive increase in cancer survival. Early treatments used cranial radiation therapy (CRT) which has been linked to debilitating late effects. Modern treatments (e.g., chemotherapies) have moved away from CRT, maximizing central nervous system (CNS) drug exposure while attempting to minimize drug toxicity. However, we do not understand modern therapies effects on several psychosocial late effects, including social adjustment. First, a systematic review was conducted to examine current literature on social adjustment in survivors of pediatric ALL. Four databases were searched and 43 articles were included in the final review. Findings from the articles indicated survivors of pediatric ALL experienced social adjustment difficulties when compared to control groups. However, treatment and non-treatment related factors require further elucidation. Secondly, a qualitative exploration of survivors and their caregivers’ memories was conducted. Nineteen dyads insights were captured through semi-structured, one-on-one interviews. Reflexive thematic analysis following principles of qualitative description generated two themes contingent on role (survivor or caregiver): difficulties remembering the cancer experience and managing their child’s cancer experience, and two unified themes: the role of others in getting through the cancer experience, and the lasting impact of the cancer diagnosis and experience. Findings indicate the need for whole family interventions. Additionally, caregivers, with the help of healthcare providers, should strive for open and developmentally appropriate communication with their children around cancer care and survivorship. Evidence from this thesis will help guide future research, highlighting the need for theoretically grounded research, and patient-identified priorities to advance the field of psychosocial research among this population.