Feasibility of an embedded palliative care clinic model for patients with an advanced thoracic malignancy.

PURPOSE: Early palliative care (PC) with standard oncology care has demonstrated improved patient outcomes, but multiple care delivery models are utilized. This study prospectively evaluated the feasibility of an embedded PC clinic model and collected patient-reported outcomes (PROs) and caregiver needs. METHODS: In this observational study of embedded outpatient PC for patients with advanced thoracic malignancies treated at The Ohio State University Thoracic Oncology clinic, patients received same-day coordinated oncology and palliative care visits at one clinic location. PC encounters included comprehensive symptom assessment and management, advanced care planning, and goals of care discussion. Multiple study assessments were utilized. We describe the feasibility of evaluating PROs and caregiver needs in an embedded PC model. RESULTS: Forty patients and 28 caregivers were enrolled. PROs were collected at baseline and follow-up visits. Over a 12-month follow-up, 36 patients discontinued study participation due to hospice enrollment, death, study withdrawal, or COVID restrictions. At baseline, 32 patients (80%) rated distress as moderate-severe with clinically significant depression (44%) and anxiety (36%). Survey completion rates significantly decreased over time: 3 months (24 eligible, 66% completed), 6 months (17 eligible; 41% completed), 9 months (9 eligible; 44% completed), and 12 months (4 eligible; 50% completed). CONCLUSION: We found that an embedded PC clinic was feasible, although there were challenges encountered in longitudinal collection of PROs due to high study attrition. Ongoing assessment and expansion of this embedded PC model will continue to identify strengths and challenges to improve patient and caregiver outcomes.

Costs and effects of a 'healthy living' approach to community development in two deprived communities: findings from a mixed methods study.

BACKGROUND: Inequalities in health have proved resistant to 'top down' approaches. It is increasingly recognised that health promotion initiatives are unlikely to succeed without strong local involvement at all stages of the process and many programmes now use grass roots approaches. A healthy living approach to community development (HLA) was developed as an innovative response to local concerns about a lack of appropriate services in two deprived communities in Pembrokeshire, West Wales. We sought to assess feasibility, costs, benefits and working relationships of this HLA. METHODS: The HLA intervention operated through existing community forums and focused on the whole community and its relationship with statutory and voluntary sectors. Local people were trained as community researchers and gathered views about local needs though resident interviews. Forums used interview results to write action plans, disseminated to commissioning organisations. The process was supported throughout through the project.The evaluation used a multi-method before and after study design including process and outcome formative and summative evaluation; data gathered through documentary evidence, diaries and reflective accounts, semi-structured interviews, focus groups and costing proformas. Main outcome measures were processes and timelines of implementation of HLA; self reported impact on communities and participants; community-agency processes of liaison; costs. RESULTS: Communities were able to produce and disseminate action plans based on locally-identified needs. The process was slower than anticipated: few community changes had occurred but expectations were high. Community participants gained skills and confidence. Cross-sector partnership working developed. The process had credibility within service provider organisations but mechanisms for refocusing commissioning were patchy. Intervention costs averaged £58,304 per community per annum. CONCLUSIONS: The intervention was feasible and inexpensive, with indications of potential impact at individual, community and policy planning levels. However, it is a long term process which requires sustained investment and must be embedded in planning and service delivery processes.

Inter- and intra-observer reliability of calculating cumulative lumbar spine loads.

The aim of this study was to quantify the precision of manual video digitization of three typical industrial tasks, as evaluated by the comparison of four cumulative kinetic parameters at the L4/L5 intervertebral joint: compression, joint shear, reaction shear and moment. Ten observers were recruited (five male and five female), with an undergraduate background in human anatomy. On each of three test days, each observer digitized five repeats of each of three typical industrial lifting tasks of 5 to 6 s in duration. A rigid link segment model that incorporated a single muscle equivalent model was used to calculate the cumulative loading based on the digitized coordinates. Inter-observer reliability was assessed using a mixed model ANOVA, and no significant differences were found to result from observer, gender, day or trial. Intraclass correlation coefficients (ICC) were calculated within each task to quantify intra-observer reliability. Overall, the ICCs were excellent (>0.75), with the exception of moderate values for reaction shear for Tasks 2 and 3. Compression and moment demonstrated the highest reliability of the four parameters studied, which is beneficial from an ergonomic standpoint, as compression is the most commonly used parameter for job assessments. This study demonstrated manual video digitization to be a reliable tool for the quantification of cumulative spinal loading, both within a given observer, and across days, trials and observers.