Petra Liljestrand

Untreated Peristomal Skin Complications Among Long-Term Colorectal Cancer Survivors With Ostomies

This ethnography of family caregiving explored why peristomal skin complications are common and undertreated among colorectal cancer survivors with intestinal ostomies. Data were collected through in-depth interviews with 31 cancer survivors and their family caregivers, fieldwork, structured assessments, and medical records review, and analyzed with qualitative theme and matrix analyses. Survivors who received help changing the skin barrier around their stoma had fewer obstacles to detection and treatment of peristomal skin complications. Half of the survivors received unpaid help with ostomy care, and all such help came from spouses. Married couples who collaborated in ostomy care reported that having assistance in placing the ostomy appliance helped with preventing leaks, detecting skin changes, and modifying ostomy care routines. In addition, survivors who struggled to manage ostomy care independently reported more obstacles to alleviating and seeking treatment for skin problems. Oncology nurses can improve treatment of peristomal skin problems by asking patients and caregivers about ostomy care and skin problems, examining the peristomal area, and facilitating routine checkups with a wound, ostomy, and continence nurse.

Effect of Neonatal Jaundice and Phototherapy on the Frequency of First-Year Outpatient Visits

OBJECTIVE: The objective of this study was to determine whether either hyperbilirubinemia or inpatient phototherapy is associated with increased subsequent outpatient visit rates, a possible effect of the “vulnerable child syndrome.” METHODS: We compared 3 groups of otherwise well term and late-preterm infants who were born between 1995 and 2004 in Northern California Kaiser hospitals: group 1 never had a documented total serum bilirubin (TSB) level ≥12 mg/dL (n = 128 417); group 2 had a TSB level ≥17 and <23 mg/dL as outpatients between 48 hours and 7 days of age and did not receive inpatient phototherapy (n = 6777); and group 3 met criteria for group 2 but did receive inpatient phototherapy (n = 1765). We compared outpatient visit rates from 15 to 364 days of age adjusting for other predictors of visit rates by using Poisson and linear regression. RESULTS: The mean total number of visits between 15 and 364 days was 9.83. Compared with group 1, adjusted total first-year visit rates were slightly increased in group 2 (adjusted incidence rate ratio: 1.04 [95% confidence interval: 1.02–1.05]) and group 3 (incidence rate ratio: 1.07 [95% confidence interval: 1.05–1.10]). The increases in visit rates were greatest for visits from 15 to 59 days of age, for specialty visits, and for unspecified diagnoses. These rates correspond to adjusted increases in total first-year visits (compared with group 1) of 0.36 visits in group 2 and 0.73 visits in group 3. CONCLUSIONS: Neonatal jaundice and inpatient phototherapy are associated with only small increases in first-year outpatient visit rates, consistent with mild or infrequent contribution to the vulnerable child syndrome in this population.

Use of the motor performance checklist to study motor outcomes in 5-year-olds

Aim:  To report findings about the Motor Performance Checklist (MPC) for 5‐year‐olds, a simple 12‐item instrument for assessing gross and fine motor skills, in a research study of neurodevelopmental outcomes after neonatal events.

Oncologists' attitudes toward KRAS testing: a multisite study.

Recent discoveries promise increasingly to help oncologists individually tailor anticancer therapy to their patients’ molecular tumor characteristics. One such promising molecular diagnostic is Kirsten ras (KRAS) tumor mutation testing for metastatic colorectal cancer (mCRC) patients. In the current study, we examined how and why physicians adopt KRAS testing and how they subsequently utilize the information when discussing treatment strategies with patients. We conducted 34 semi‐structured in‐person or telephone interviews with oncologists from seven different health plans. Each interview was audiotaped, transcribed, and coded using qualitative research methods. Information and salient themes relating to the research questions were summarized for each interview. All of the oncologists in this study reported using the KRAS test at the time of the interview. Most appeared to have adopted the test rapidly, within 6 months of the publication of National Clinical Guidelines. Oncologists chose to administer the test at various time points, although the majority ordered the test at the time their patient was diagnosed with mCRC. While oncologists expressed a range of opinions about the KRAS test, there was a general consensus that the test was useful and provided benefits to mCRC patients. The rapid adoption and enthusiasm for KRAS suggests that these types of tests may be filling an important informational need for oncologists when making treatment decisions. Future research should focus on the informational needs of patients around this test and whether patients feel informed or confident with their physicians’ use of these tests to determine treatment access.

CC4-05: Patient Views of KRAS Testing for Treatment of Metastatic Colorectal Cancer.

Background/Aims ASCO provisional clinical guidelines (2009) recommend that patients with metastatic colon cancer (mCRC) be tested for mutations in the Kristen ras (KRAS) oncogene, and that those with a mutated KRAS gene (KRAS+) not be offered anti-epidermal growth factor receptor (EGFR) therapy as they are unlikely to benefit from the therapy. For patients without the mutation (KRAS-), anti-EGFR therapy may extend life but it is often associated with severe side-effects. The objectives of this study were to explore mCRC patients’ understanding of KRAS testing vis-à-vis their treatment decision making, including their preferences for aggressive chemotherapy or palliative care. Methods We conducted 21 semi-structured, in-person or telephone, interviews with mCRC patients (40–70 min duration). We developed a codebook through a reflexive, iterative process, and used the AtlasTi software for coding and data analysis. Results We identified 115 patients with mCRC who had a KRAS test conducted 6/1/10-4/11/11. Of these, we selected a diverse sample with respect to KRAS status, clinical factors, and demographics. Participants were 63 years old on average, mostly white (57%), and KRAS+ (52%). KRAS+ patients more often recalled having had the test than did KRAS- patients (50% vs. 11%). Most participants felt the test was potentially useful in directing their treatment, because it is “scientific,” although several would question its accuracy if anti-EGFR drugs were contraindicated. A few KRAS+ patients were disappointed in the results. Patients frequently described their physician as “the expert,” and used the internet mainly to validate current treatment. They underscored the importance of their physician’s “fighting” for them. Most patients desired aggressive treatment and had not considered declining chemotherapy. Discussion Most respondents did not recall having the KRAS test, and most appeared to view the test as inconsequential to their treatment considerations. Confidence in their physician’s optimism and recommendations were of greater consequence. Imaging scans, conducted repeatedly to measure progression of illness, seemed to carry more salience in their treatment experience than did the KRAS test.

C-A3-01: Current Use of KRAS Testing in Clinical Practice

Background/Aims Provisional clinical guidelines, published by the American Society of Clinical Oncology in 2009, recommend that patients with metastatic colon cancer (mCRC) be tested for mutations in the Kirsten ras (KRAS) oncogene, and that patients found to have the non mutated KRAS gene be offered anti-epidermal growth factor receptor (EGFR) antibody therapy. Such therapy has been shown to extend life; yet it is also expensive and frequently associated with severe side-effects. Currently, little is known about how clinicians are using KRAS testing in clinical practice. This study compares the adoption of policies for and usage of KRAS testing and anti-EGFR therapy in clinical practice among seven integrated health delivery systems. The purposes were to examine 1) physicians’ attitudes toward and experiences with KRAS testing and the communication process with their patients, 2) patients’ experiences with KRAS testing and anti-EGFR therapy and associated quality-of-life issues, and 3) the adoption of policies for KRAS testing and anti-EGFR therapy at the different health plans. Methods Data collection includes 1) semi-structured interviews with 33 oncologists at the participating HMORN sites, one leader at each site, and 20 mCRC patients in KPNC, and 2) collection of policy documents from each site. Coding is conducted through an iterative process by three social scientists. Results To date, twenty-eight 15–30 minute physician interviews have been conducted; coding and data analysis has begun. For this meeting, we will focus on the range of practices among the physicians, specifically addressing following questions: To what extent have oncologists adopted the KRAS test? At what point in the clinical process do they test for KRAS? What concerns regarding the KRAS test do they articulate? To what extent do costs (of the test, of treatment) feature into their treatment decisions? How do oncologists incorporate patients into the treatment decision making process? To what extent are these physicians adhering to guidelines for KRAS testing vs. considering the specifics of each case in their treatment plan? Conclusions We expect that the results will shed light on how recommendations for KRAS testing are translated into clinical practice.