BACKGROUND: Since 2011, a tailored, interdisciplinary head and neck rehabilitation (IHNR) program, covered by the basic healthcare insurance, is offered to advanced head and neck cancer (HNC) patients in the Netherlands Cancer Institute (NKI). This program is developed to preserve or restore patients' functioning, and to optimize health-related quality of life (HRQoL). It applies an integrated approach to define patients' individual goals and provide rehabilitation care throughout the cancer care continuum. The aim of the current study is to assess the (cost-) effectiveness of the IHNR approach compared to usual supportive care (USC) consisting of monodisciplinary and multidisciplinary care in advanced HNC patients.METHODS: This multicenter prospective observational study is designed to compare (cost-)effectiveness of the IHNR to USC for advanced HNC patients treated with chemoradiotherapy (CRT) or bioradiotherapy (BRT). The primary outcome is HRQoL represented in the EORTC QLQ-C30 summary score. Functional HRQoL, societal participation, utility values, return to work (RTW), unmet needs (UN), patient satisfaction and clinical outcomes are secondary outcomes, assessed using the EORTC QLQ-H&N35, USER-P, EQ-5D-5 L, and study-specific questionnaires, respectively. Both patient groups (required sample size: 64 per arm) are requested to complete the questionnaires at: diagnosis (baseline; T0), 3 months (T1), 6 months (T2), 9 months (T3) and 12 months (T4) after start of medical treatment. Differences in outcomes between the intervention and control group will be analyzed using mixed effects models, Chi-square test and descriptive statistics. In addition, a cost-effectiveness analysis (CEA) will be performed by means of a Markov decision model. The CEA will be performed using a societal perspective of the Netherlands.DISCUSSION: This prospective multicenter study will provide evidence on the effectiveness and cost-effectiveness of IHNR compared to USC. RTW and societal participation, included as secondary outcomes, have not been studied sufficiently yet in cancer rehabilitation. Interdisciplinary rehabilitation has not yet been implemented as usual care in all centers, which offers the opportunity to perform a controlled clinical study. If demonstrated to be (cost-)effective, national provision of the program can probably be advised.TRIAL REGISTRATION: The study has been retrospectively registered in the Netherlands Trial Registry on April 24th 2018 ( NTR7140 ).
BackgroundSurvivors of critical illness experience long-term functional challenges, which are complex, heterogeneous, and multifactorial in nature. Although the importance of rehabilitation interventions after intensive care unit (ICU) discharge is universally recognized, evidence on feasibility and effectiveness of home-based rehabilitation programs is scarce and ambiguous. This study investigates the feasibility of an interdisciplinary rehabilitation program designed for patients with Post-Intensive Care Syndrome (PICS) who are discharged home.MethodsA mixed method, non-randomized, prospective pilot feasibility study was performed with a 6-month follow-up, comparing the intervention (REACH) with usual care. REACH was provided by trained professionals and included a patient-centered, interdisciplinary approach starting directly after hospital discharge. Primary outcomes were patient safety, satisfaction, adherence, referral need and health care usage. Secondary outcomes, measured at 3 timepoints, were functional exercise capacity, self-perceived health status, health-related quality of life (HRQoL), return to work and psychotrauma. Risk of undernutrition was assessed at baseline.Results43 patients with a median mechanical ventilation duration of 8 (IQR:10) days, were included in the study and 79.1% completed 6-month follow-up. 19 patients received the intervention, 23 received usual care. Groups were similar for gender distribution and ICU length of stay. No adverse events occurred. REACH participants showed higher satisfaction with treatment and reported more allied health professional visits, while the usual care group reported more visits to medical specialists. Qualitative analysis identified positive experiences among REACH-professionals related to providing state-of-the-art interventions and sharing knowledge and expertise within an interprofessional network. Similar recovery was seen between groups on all secondary outcomes, but neither group reached reference values for HRQoL at 6 months. Larger return to work rates were seen in the REACH group. Prevalence of undernutrition at hospital discharge was high in both groups (> 80%), warranting the need for careful tuning of physical therapy and nutritional interventions.ConclusionsThis study shows that providing early, home-based rehabilitation interventions for patients with PICS-related symptoms is feasible and perceived positively by patients and professionals. When provided in an interdisciplinary collaborative network state of the art, person-centered interventions can be tailored to individual needs potentially increasing patient satisfaction, adherence, and efficacy.Registered in the Dutch Trial register: NL7792: https://www.trialregister.nl/trial/7792, registered 7-06-2019.
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Aim of the proposal and urban challenge it addresses* (max 200)The aim of this proposal is to develop an educational program with the provisional name ‘Care and Law’. The aim of this multidisciplinary educational program is to increase the knowledge of future professionals working at the intersection of health, wellbeing and law in the urban environment of Amsterdam.In the Amsterdam metropolitan society, legal and healthcare professionals (including social workers) are increasingly confronted with issues at the intersection of (health)care and justice. Special areas of interest are the problems surrounding people suffering from a mental illness, youngsters that cause nuisances of themselves on the streets and homeless people. The approach to this kind of problems requires a multidisciplinary approach. This means that healthcare, social welfare and legal professionals have to work together, for instance to apply for involuntary care. However, these professionals all have their own perspective and responsibility in these situations which often results in tensions among the professionals and as a result a delayed provision of care (van den Hooff, 2015).External partner(s) (if applicable) Project description abstract (max 750 woorden)We like to develop a new educational program in which students from different faculties work together on real time cases. At this moment, students at the Faculty of Applied Social Sciences and Law and the Faculty of Health are primarily trained in a monodisciplinary manner. They may be better equipped for their future work, if they get interdisciplinary training and courses. They need to learn what is meant by ‘Transcending Responsibility’; which means to be open to the perspective of the others professionals and to create a new shared responsibility (van den Hooff, 2015).In this project, we like to work together with and learn from the expertise of other members of the consortium to enhance the quality of this educational project. The focus of the present project is to develop a new multidisciplinary educational program surrounding legal and care related themes. The idea is to familiarize students with the legal contexts in which they have to operate (for instance themes related to pressure and coercion) as well as the welfare and care context in which the client/patient is situated (the care from neighborhood teams, youth care teams or mental health care teams). In addition, student might jointly develop integrated approaches based on case studies from the professional field.We like to be inspired, informed about and discuss innovative approaches which make interdisciplinary educational programs possible. Maybe it is possible to develop an international educational program with members of the consortium.
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