Lung cancer is one of the most common and deadly cancers, causing more deaths than colon, breast, and prostate cancers combined, according to the American Cancer Society. Treatment requires an array of specialists. One promising approach is multidisciplinary care, in which all of the specialists involved in a patient’s care work together to develop a coordinated treatment plan. Leading cancer organizations recommend this approach, but questions remain about its effectiveness and how to best implement it.
Results from a PCORI-funded study suggest patients receiving multidisciplinary care—in which pulmonologists, oncologists, radiologists, and surgeons meet to design a care plan with patients and their families—get more-thorough procedures to pinpoint the stage of their cancer than those who see specialists through a sequence of referrals. As a result, the multidisciplinary treatment that patients receive is more appropriate for their stage of cancer. Finally, patients who received multidisciplinary care and their caregivers also were more satisfied with their overall care.
In this PCORI Story, read about how the research team found that with up-front treatment planning among the different specialists, patients get treatment that is more appropriate for their cancer’s severity
People with a serious mental illness (SMI) may have difficulty with daily activities. In this study, the research team compared two programs to help people with SMI manage their symptoms. In the FOCUS program, people used a smartphone app. In the Wellness Recovery Action Plan, or WRAP, program, people went to group sessions at a clinic. They wanted to see if one program was more effective at helping patients get the care they need.
As published in Psychiatric Services, participants assigned to the smartphone program were more likely than those assigned to the clinic-based program to start treatment—90 percent versus 58 percent—and remain fully engaged in eight weeks of care—56 percent versus 40 percent. Participants in both groups improved significantly and did not differ in clinical outcomes. The increased engagement by the telehealth group suggests that the smartphone-based treatment plan may help increase access to care for patients with SMI.
In this study, the research team found that video house calls were an effective way for people with Parkinson’s disease to get care from specialists. Most patients reported being satisfied or very satisfied with care they received during video house calls. After 12 months, there were no differences between patients who received video house calls and those who didn’t in quality of life, quality of care, or amount of caregiver burden.
Compared with patients who had in-person visits at clinics, patients who used video house calls spent less time traveling to doctor visits. Patients who used video house calls also spent more time talking with specialists during visits.
Now, through a Dissemination and Implementation project, the research team is expanding its telehealth services to include visits with doctors and nurses who specialize in conditions that often accompany Parkinson’s disease, such as dementia and depression.
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More than 70 percent of adults with uncomplicated appendicitis were able to safely delay surgery for at least three months by taking a course of intravenous antibiotics, according to early results from The CODA Study published in the New England Journal of Medicine. Researchers issued the results early in response to its relevancy to patients and healthcare providers during the coronavirus pandemic.
The study found that health outcomes associated with antibiotics and appendectomy were similar. The majority of patients on antibiotics also missed less time away from work or school. However, nearly 30 percent who received antibiotics ultimately needed surgery and this group experienced more emergency department and hospital visits than the appendectomy group The study was conducted at 25 sites nationwide and involved a wider range of patients than previous studies, making its results more broadly applicable to typical patients with appendicitis.
An accompanying editorial—noting the timing of the release of the results and the American College of Surgeon’s recent guidance on triage of nonemergency surgical procedures during the pandemic—states that “it will be important to ensure that some people, in particular vulnerable populations, are not offered antibiotic therapy preferentially or without adequate education regarding the longer-term implications.”
View a summary of the early findings from the study. In addition, listen to an episode of “Behind the Knife: The Surgery Podcast,” during which members of the research team discussed the early results of the trial. Listen on Apple Podcasts or Spotify.
A PCORI-funded study in Texas has shown that a decision aid delivered through tobacco quitlines effectively reaches a screening-eligible population and results in informed decisions about lung cancer screening. The researchers devised the patient-centered decision aid to help smokers choose between screening options based on what is most important to them, and then compared its effectiveness versus a traditional brochure that answered common questions about screening.
As the research team reported in JAMA Network Open, compared to the group that received the brochure, patients who used the decision aid were markedly more prepared to make a screening decision. Because the findings suggest that decision aids about lung cancer screening can reach—and significantly help—large numbers of smokers who are eligible for screening through tobacco quitlines, this project has received a PCORI Dissemination and Implementation Award to spread the decision aid to eight state tobacco quitlines.
Adults with severe obesity who had gastric bypass surgery lost more weight, sustained greater weight loss five years afterward, and had a higher remission rate of type 2 diabetes than those who had either sleeve gastrectomy, a newer, simpler procedure, or adjustable gastric banding, this study found. It used PCORnet to analyze data and outcomes of more than 46,000 patients from 41 health systems nationwide, making it the largest study to date to compare these procedures.
People who had bypass maintained an average 26 percent loss of their pre-surgery weight after five years compared to 19 percent with sleeve and just 12 percent with banding. Rates of major problems occurring within 30 days of surgery were small for all three procedures, though highest for bypass. Results appear in the Annals of Internal Medicine, and in two papers in JAMA Surgery. Bypass has been in use longer than the other two procedures. Sleeve has become the most commonly performed approach since its introduction in recent years. Banding is now used in only 10 percent of cases.