The world of cancer care is a strange land to a person newly diagnosed with cancer. Like someone who leaves the familiarity of home and arrives in a foreign place, the person with cancer loses equilibrium and feels lost, experiences an assault on self-identity, and encounters an alien language and culture. It is this person who knocks as a stranger on the door of cancerland. Many philosophic and religious traditions obligate those receiving the stranger to provide a deep hospitality. One model of the practice of deep hospitality is summarized as door, table, space. When applied to the relationship between the cancer care provider and the patient/stranger, this hospitality can humanize the experience for both parties and is education in its elemental sense of drawing out and leading forth—into healing and wisdom.

No description available.

No description available.

The objective of this study was to assess Primary Care Physicians’ attitudes towards adoption of the Diagnostic Assessment Program-Electronic Pathway Solution (DAP-EPS), an electronic tool for improving cancer diagnostic processes. The implementation of DAP-EPS is a provincial activity supported by Cancer Care Ontario in collaboration with the Canadian Cancer Society. We conducted an online survey of Ontario PCPs. To guide our study, we used an integrated theoretical framework combining the Technology Acceptance Model and Diffusion of Innovation. Study results suggested a strong influence of perceived usefulness of the DAP-EPS tool on physicians’ attitudes towards adoption of the tool. The results also found that perceived usefulness was more important than perceived ease-of-use within the PCP context. The study revealed that perceived usefulness is the main predictor of physicians’ attitudes. The findings also suggested that the management and implementation team should emphasize the usefulness of the DAP-EPS to increase adoption among PCPs.

The objective of this study was to assess Primary Care Physicians’ attitudes towards adoption of the Diagnostic Assessment Program-Electronic Pathway Solution (DAP-EPS), an electronic tool for improving cancer diagnostic processes. The implementation of DAP-EPS is a provincial activity supported by Cancer Care Ontario in collaboration with the Canadian Cancer Society. We conducted an online survey of Ontario PCPs. To guide our study, we used an integrated theoretical framework combining the Technology Acceptance Model and Diffusion of Innovation. Study results suggested a strong influence of perceived usefulness of the DAP-EPS tool on physicians’ attitudes towards adoption of the tool. The results also found that perceived usefulness was more important than perceived ease-of-use within the PCP context. The study revealed that perceived usefulness is the main predictor of physicians’ attitudes. The findings also suggested that the management and implementation team should emphasize the usefulness of the DAP-EPS to increase adoption among PCPs.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

This thesis explores the experiences of young people who are survivors of childhood cancer, their parents, health care professionals (HCPs), and case note documentation, of the process of transition from paediatric to adult cancer services. A qualitative, collective case study approach (Stake, 1995), informed by a constructivist-interpretive position, allowed exploration of the multiple realities prioritised in this study. Whilst there is a significant body of literature relating to transition for conditions such as rheumatology and cystic fibrosis, there is little research undertaken into transition in a cancer context, specifically so from an experiences perspective. This study aimed to re-address this issue. The experiences of twelve young people were explored in this study. This resulted in the participation of twelve cases, meaning a total of 35 individual, semi-structured interviews were conducted with young people, parents and HCPs. Young people’s case notes (22 sets) were also reviewed. Data were analysed using matrix-based approaches advocated by Miles and Huberman (1994), at both the within- and between-case level. This generated a multi-dimensional and multiple perspective understanding of the experience of the process of transition. The results of this study clearly identified a central orienting theme: The experience of readiness in the context of transition. Three main themes and six sub-themes were also identified within the data, supporting the explanatory power of the orienting theme. The main themes identified were: The experience of childhood cancer; Planning and preparation: Transition or transfer?; and A process of change. The findings demonstrate that understanding the multi-faceted components of readiness is crucial in understanding people’s experiences of readiness. Readiness should embody people’s illness experiences, the numerous and associated losses intertwined with a move from paediatric to adult care and the simultaneous developmental changes occurring in people’s lives. Only by doing so shall a meaningful understanding of the experience of the process of transition for survivors of childhood cancer, their parents and health care professionals be developed. The thesis concludes by making recommendations for future research and clinical practice.

Background: Psychosocial loneliness is an unpleasant and distressing experience arising from subjective discrepancies between a person’s desired and actual social relationships. An increasingly common problem in UK society, loneliness is linked with serious adverse mental health outcomes and poses a significant risk to physical health, which several experts suggest is as great as smoking and obesity. In recent years leading cancer care organisations have raised awareness of the existence of loneliness and its potential importance in the context of cancer; however little attention has been paid in the literature or in clinical practice to understanding, identifying and alleviating loneliness. AimsThe project reported in this thesis aimed to: 1) clarify the conceptual and theoretical meaning of ‘loneliness’; 2) enhance understanding of loneliness in people living with and beyond cancer; and 3) develop an assessment tool for ‘cancer-related loneliness following treatment completion’. MethodsThe project began with a theoretical concept analysis of ‘loneliness’. This was followed by a systematic scoping review of loneliness and cancer. Gaps in the knowledge base were addressed by means of an exploratory mixed methods study. Phase 1 involved collection of quantitative data concerning loneliness from 107 individuals living with and beyond cancer. Descriptive and inferential statistical analysis of the data was conducted. Phase 2 involved the undertaking of semi-structured interviews with 12 individuals living with and beyond cancer who scored highly for loneliness in phase 1. Thematic Framework Analysis was employed to analyse the interview data. The findings of the qualitative phase, together with the initial conceptual work and the findings of the literature review were employed to develop the Cancer-related Loneliness Assessment Tool. Preliminary cognitive testing of this tool was conducted. FindingsLoneliness results from an interaction between personal and situational factors and is better viewed as an individual process rather than as a clinical condition for which specific diagnostic symptoms and cut-offs exist. The experience of loneliness appears to transcend the boundaries of cancer diagnosis, stage of disease, tumour site and treatment modality. The results of the quantitative phase indicated that participants in the study experienced, on average, ‘moderate’ levels of loneliness. In the study sample age was an independent predictor of cases of loneliness – the odds of individuals aged <30-59 being lonely were 23 times those of individuals aged 70+. Employment status was significantly associated with loneliness scores – non-employed individuals had higher loneliness scores than did employed individuals and retired individuals. The qualitative phase identified a contextual loneliness termed ‘cancer-related loneliness following treatment completion’. Such loneliness is a result of perceived social, emotional, cultural and healthcare-related relationship deficiencies stemming from or exacerbated by cancer-related sources. Loneliness emanating from deficiencies in relationships with healthcare professionals – termed healthcare-related loneliness – has not previously been referred to in the loneliness literature. The Cancer-related Loneliness Assessment Tool operationalised ‘cancer-related loneliness following treatment completion’ and preliminary cognitive testing indicated that the items generate the information intended and that individuals have little trouble completing the assessment tool. ConclusionsCancer-related loneliness following treatment completion should be addressed as part of comprehensive cancer care. Following further development, the Cancer-related Loneliness Assessment Tool could facilitate identification of loneliness in clinical practice. It could also aid with the development/adaptation and evaluation of interventions to address loneliness. Healthcare-related loneliness should be added to the existing tripartite (social, emotional and cultural) typology of loneliness, creating a quadripartite typology that encompasses all types of relationship deficits that can beget loneliness.

Reliance on emergency departments (EDs) by economically disadvantaged people for initial cancer diagnosis in place of primary care and early diagnosis and treatment is 1 obvious plausible explanation for cancer disparities. Claims data from a safety net hospital for the years 2009–2010 were merged with hospital tumor registry data to compare hospitalizations for ED-associated initial cancer diagnoses to non–ED associated initial diagnoses. The proportion of initial cancer diagnoses associated with hospital admissions through the ED was relatively high (32%) for all safety net hospital patients, but disproportionately higher for African Americans and residents of the impoverished urban core. Use of the ED for initial diagnosis was associated with a 75% higher risk of stage 4 versus stage 1 cancer diagnosis, and a 176% higher risk of dying during the 2-year study period. Findings from this study of ED use within a safety net hospital documented profound disparities in cancer care and outcomes with major implications for monitoring disparities, Affordable Care Act impact, and safety net hospital utilization.