Conectar
There is limited evidence on the economic implications of assessing patients’ access to personalised treatments through Comprehensive Genomic Profiling (CGP) and Molecular Tumour Board (MTB), prompting the need to analyse their impact on the cost of the cancer diagnostic journey (from hospital admission to MTB evaluation) and accessibility to personalised therapies.
Retrospective observational cohort.
Patients discussed from April 2020 to September 2021 by the institutional MTB operating at Fondazione IRCCS Istituto Nazionale Tumori of Milan, an Italian centre of excellence in oncology pertaining to the national health system.
676 patients focused on: non-small cell lung cancer (NSCLC), cholangiocarcinoma (CCA), pancreatic carcinoma (PC) and gastro-oesophageal carcinoma (GEC). We defined two different scenarios: (1) patients tested with small Next-Generation Sequencing (NGS) panels (≤60 biomarkers) vs (2) patients tested with comprehensive panels (>60 biomarkers).
We measured (1) patients’ eligibility to personalised therapies based on genomic data obtained using targeted somatic NGS panels, (2) MTB cost and the overall diagnostic journey cost and (3) the cost to find a patient eligible to access personalised treatments.
Tumour profiling with comprehensive NGS panels improved patients’ eligibility to personalised therapies compared with small panels (NSCLC: 39% comprehensive panel vs 37% small panel; CCA: 43% vs 17%; PC: 35% vs 3%; GEC: 40% vs 0%). The overall diagnostic journey cost per patient was between 3.2K and 7.4K (NSCLC: 7.4K comprehensive panel vs 6.4K small panel; CCA: 4.9K vs 3.7K; PC: 5.8K vs 4.5K; GEC: 4.2K vs 3.2K). MTB discussion accounted for only 2–3% of the diagnostic journey cost per patient (around 113/patient). The cost to find patient eligible for personalised treatments varied significantly according to panel size and tumour setting (NSCLC: 5K comprehensive panel vs 2.8K small panel; CCA: 4.4K vs 4.4K; PC: 5.5K vs 27K; GEC: 5.2K vs not measurable since none of the patients analysed with small NGS panels were eligible).
MTB discussion of genomic data obtained with NGS comprehensive panels significantly increases patient eligibility to targeted therapies and optimise the cost to find a patient eligible to personalised treatments, mainly for CCA, PC and GEC patients.
To evaluate the impact of using ‘Situation-Background-Assessment-Recommendation’ method (‘SBAR’) in a palliative care setting.
Effective handover communication is crucial for patient safety. Standardised communication tools, such as the SBAR method, are recommended to reduce errors and improve care coordination, but their use in palliative care is not investigated.
Mixed method study design, adhering to the GRAMMS guideline.
From January to October 2021, a SBAR guide tailored for palliative care was developed using the Delphi method and implemented in a Hospice setting. Data on 150 nurse handovers were collected before and after implementation to assess changes in nursing outcomes, including medication errors, adverse events and the identification of psychological and spiritual needs. Nurses' perceptions on the handover process were gathered through a qualitative survey.
The SBAR guide significantly improved the handovers quality, reducing medication errors and eliminating adverse events postimplementation. The identification of psychological and spiritual needs increased during postimplementation period. Nurses also reported improved clarity, accuracy and completeness of information during handover.
This is the first study to evaluate the impact of SBAR for handover in palliative nursing care. Findings show the added value of using communication tools.
FreshRSS 