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  • Quality Improvement in Itself Changes Your Thinking: Lessons From Disseminating Quality Improvement Methods Through a Multisite International Collaborative Palliative Care Project in India. JCO global oncology Satija, A., Lorenz, K. A., Spruijt, O., Ganesh, A., Singh, N., Connell, N. B., Gamboa, R. C., Fereydooni, S., Chandrashekaran, S., Hennings, T., Giannitrapani, K. F., Bhatnagar, S. 2022; 8: e2200147


    PURPOSE: Seven major palliative care (PC) centers in India were mentored through the Palliative Care-Promoting Assessment and Improvement of the Cancer Experience (PC-PAICE) by US and Australian academic institutions to implement a quality improvement (QI) project to improve the accessibility and quality of PC at their respective centers. The objective was to evaluate the experiences of teams in implementing QI methods across diverse geographical settings in India.METHODS: A quota sampling approach was used to elicit perspectives of local stakeholders at each site. The Consolidated Framework for Implementation Research informed development of a semistructured interview guide. Analysis leveraged deductive and inductive approaches.RESULTS: We interviewed 44 participants (eight organizational leaders, 12 clinical leaders, and 24 team members) at seven sites and identified five themes. (1) Implementing QI methods enabled QI teams to think analytically to solve a complex problem and to identify resources. (2) Developing a problem statement by identifying specific gaps in patient care fostered team collaboration toward a common goal. (3) Making use of QI tools (eg, A3 process) systematically provided a new, straightforward QI toolkit and improved QI teams' conceptual understanding. (4) Enhancing stakeholder engagement allowed shared understanding of QI team members' roles and processes and shaped interventions tailored to the local context. (5) Designing less subjective processes for patient care such as assessment scales to identify patient's symptomatic needs positively changed work practices and culture.CONCLUSION: Engaging and empowering multiple stakeholders to use QI methods facilitated the expansion and improvement of PC and cancer services in India. PC-PAICE demonstrated an efficient, effective way to apply QI methods in an international context. The impact of PC-PAICE is being magnified by developing a cadre of Indian QI leaders.

    View details for DOI 10.1200/GO.22.00147

    View details for PubMedID 36252162

  • Considerations for Fostering Palliative Care Awareness in Developing Contexts: Strategies from Locally Initiated Projects in India. Journal of pain and symptom management Singh, N., Giannitrapani, K. F., Satija, A., Ganesh, A., Gamboa, R., Fereydooni, S., Hennings, T., Chandrashekaran, S., Spruijt, O., Bhatnagar, S., Lorenz, K. A. 2022


    Lack of palliative care (PC) awareness is a barrier to its utilization in developing contexts.To identify and understand strategies that changed awareness of the concepts and value of palliative care in a multi-site quality improvement project in India.The Palliative Care - Promoting Assessment and Improvement of the Cancer Experience (PC-PAICE) evaluation team conducted 44 semi-structured interviews with clinician and organization stakeholders at seven geographically dispersed sites. We used inductive and deductive approaches in this secondary analysis to identify emerging themes.We identified the following strategies to improve awareness of concepts and value of palliative care. Strategy 1: Educate medical trainees, staff, and the community about palliative care and its concepts. Sub-strategies: Participate in community events. Integrate PC concepts into early medical education. Standardize training for practitioners. Strategy 2: Design and disseminate India-specific research to reinforce awareness of the value of palliative care. Sub-strategies: Publish and use India-specific palliative care research. Strategy 3: Facilitate communication between providers and departments to improve awareness of palliative care services and its concepts. Sub-strategies: Create referral frameworks and network with providers referring to palliative care to change awareness of available services and palliative care concepts.To increase palliative care utilization, program development can include community and provider-focused efforts on awareness of the concepts and value of palliative care. These three strategies held salience across sites representing diverse Indian geographic and cultural settings; as such, they may be applicable to other contexts.

    View details for DOI 10.1016/j.jpainsymman.2022.06.011

    View details for PubMedID 35764200

  • "Shoot from the Hip": What Patients with Cancer Want from Communication About Serious Illness During COVID-19 Singh, N., Giannitrapani, K., Gamboa, R., Walling, A., Lindvall, C., Lorenz, K. ELSEVIER SCIENCE INC. 2022: 919-920
  • Empowering families to take on a palliative caregiver role for patients with cancer in India: Persistent challenges and promising strategies. PloS one Fereydooni, S., Lorenz, K. A., Ganesh, A., Satija, A., Spruijt, O., Bhatnagar, S., Gamboa, R. C., Singh, N., Giannitrapani, K. F. 2022; 17 (9): e0274770


    BACKGROUND: The population of patients with cancer requiring palliative care (PC) is on the rise in India. Family caregivers will be essential members of the care team in the provision of PC.OBJECTIVE: We aimed to characterize provider perspectives of the challenges that Indian families face in taking on a palliative caregiving role.METHOD: Data for this analysis came from an evaluation of the PC-PAICE project, a series of quality improvement interventions for PC in India. We conducted 44 in-depth semi-structured interviews with organizational leaders and clinical team members at seven geographically and structurally diverse settings. Through thematic content analysis, themes relating to the caregivers' role were identified using a combination of deductive and inductive approaches.RESULT: Contextual challenges to taking up the PC caregiving role included family members' limited knowledge about PC and cancer, the necessity of training for caregiving responsibilities, and cultural preferences for pursuing curative treatments over palliative ones. Some logistical challenges include financial, time, and mental health limitations that family caregivers may encounter when navigating the expectations of taking on the caregiving role. Strategies to facilitate family buy-in for PC provision include adopting a family care model, connecting them to services provided by Non-Governmental Organizations, leveraging volunteers and social workers to foster PC awareness and training, and responding specifically to family's requests.CONCLUSION: Understanding and addressing the various challenges that families face in adopting the caregiver role are essential steps in the provision and expansion of PC in India. Locally initiated quality improvement projects can be a way to address these challenges based on the context.

    View details for DOI 10.1371/journal.pone.0274770

    View details for PubMedID 36112593

  • Empowering Families to Take on a Primary Caregiver Role for Patients with Cancer in India: Promising Strategies, Persistent Challenges, and Tradeoffs Fereydooni, S., Lorenz, K., Gamboa, R., Ganesh, A., Bhatnagar, S., Satija, A., Singh, N., Chandrashekaran, S., Giannitrapani, K. ELSEVIER SCIENCE INC. 2021: 684
  • Considerations for Fostering Awareness of Palliative Care in Developing Contexts: Lessons from the PC-PAICE Evaluation in India Singh, N., Giannitrapani, K., Bhatnagar, S., Satija, A., Ganesh, A., Gamboa, R., Fereydooni, S., Chandrashekaran, S., Spruijt, O., Lorenz, K. ELSEVIER SCIENCE INC. 2021: 683–84