Neoplasms

Blood and Lymph Conditions

Immune System Diseases

All Conditions

Rare Diseases

Lymphoma

Lymphoma, Non-Hodgkin

Neoplasms by Histologic Type

Lymphoproliferative Disorders

Lymphatic Diseases

Immunoproliferative Disorders

Lymphosarcoma

* Professionals receive audit \& feedback
* Patients (and clinicians) have access to a website with information tailored to patients with an NHL. This website gives insight into the logistic processes of each diagnostic tool and into the patients' personal care pathway.
* Standardization of diagnostic and evaluative request forms and reports for clinicians.
* Supporting material for standardizing the procedure for multidisciplinary meetings.

Implementation tools

Standard intervention consists of audit\&feedback

Standard intervention

Rosella Hermens, PhD

Nelleke Ottevanger, MD, PhD

The main objective of the proposed study is to assess the effectiveness, feasibility and costs of a tailored strategy (developed in accordance with the barriers found and current practice) to improve care for patients with non-Hodgkin's lymphomas (NHL), compared to a common strategy of 'audit \& feedback'.

In a previous study among 22 Dutch hospitals many gaps in the care for patients with non-Hodgkin's lymphomas (NHL) were found, compared to best evidence as described in guidelines. In a problem analysis study, barriers and facilitators for good quality of NHL-care were assessed and a tailored implementation strategy was developed, based on these findings. The proposed study aims at the effectiveness, feasibility and costs of this tailored strategy to improve quality of care for patients with an NHL in a clustered randomized controlled trial in 19 Dutch hospitals.

Multilevel regression analyses will be performed to evaluate the effectiveness of both strategies. Exposure to and experiences with the strategy elements will be analysed descriptively.

Regarding the costs, the two strategies are compared with a health care perspective. The input of resources will be assessed by collecting volumes of consumed resources and multiplying these by the price of each resource unit; the implementation process and consequently costs will be estimated by an Activity Based Costing (ABC) approach. The output will be determined by the level of adherence to the NHL quality indicators.

PEARL Study: Improvement of Non-Hodgkin's Lymphoma Care

Improvement of Hospital Care for Patients With Non-Hodgkin's Lymphoma

The effect of our interventions will be measured by means of adherence to quality indicators for optimal NHL care. The effects of the audit and feedback strategy (9 hospitals) versus the tailored strategy (9 hospitals) will be evaluated using previously developed quality indicators. These indicators for optimal NHL care were developed on the basis of evidence based guidelines, literature and opinions of clinicians about NHL care in a previous study and were validated.

To study the feasibility of both strategies, a process evaluation has to give insight into the mechanisms and processes responsible for the result (= extent of adherence to the indicator set for optimal NHL care). The actual 'exposure' of the patients and professionals to the implementation elements, together with their experience with these elements may have influenced the final result (success or failure of adherence). Data about 'exposure' to the different interventions will be collected using questionnaires.

Non-adherence to the multidisciplinary NHL guideline may lead to unnecessary medical interventions and more complications, and subsequently to efficiency losses. This economic evaluation compares the two implementation strategies. The perspective of this economic evaluation will be a health care perspective. Both the costs of the implementation strategy and changes in health care consumption will be assessed. The outcome should facilitate local health care decision making on implementation.

Morbidity is an important outcome measure for the effect of the intervention strategy.

Patient Related Outcome Measures as quality of life are important measures to evaluate the outcome of care from a patient perspective.

Radboud University Medical Center

Symptoms and General Pathology

Behaviors and Mental Disorders

Fatigue

Quality of Life

A single-faceted patient-directed (PD) strategy that will embed the change at patient level.

A multi-faceted (MF) strategy that will embed the change at the patient, professional and organizational levels.

The patient-directed strategy will be designed to embed the success of implementation of PCRPs by influencing the patients.

The patient-directed (PD) strategy

The multi-faceted strategy will be designed to embed the success by not only influencing the patients, but also professionals and organizational aspects.

The multi-faceted (MF) strategy

C. IJsbrandy, MD

R.P.M.G. Hermens, PhD

C. IJsbrandy, drs.

The aim of this study is to develop and identify the most effective strategy to implement PCRPs into daily care. We want to assess the added value of a multi-faceted strategy compared with a single-faceted patient-directed strategy.

The aim of this study is to develop and identify the most effective strategy to implement PCRPs into daily care. We want to assess the added value of a multi-faceted strategy compared with a single-faceted patient-directed strategy.

We will conduct a clustered controlled before and after study (CBA) in the Netherlands that compares two strategies to implement PCRPs. The patient-directed (PD) strategy (five hospitals) will focus on change at the patient level. The multi-faceted (MF) strategy (five hospitals) will focus on change at the patient, professional and organizational levels. Eligibility criteria are as follows: (A) patients: adults; preferably (history of) cancer in the gastro-intestinal, reproductive and/or urological system; successful primary treatment; and without recurrence/metastases. (B) Healthcare professionals: involved in cancer care.

A stepwise approach will be followed:

Step 1: Analysis of the current implementation of PCRPs and the examination of barriers and facilitators for implementation, via a qualitative study with patients (four focus groups n = 10-12) and their healthcare workers (four focus groups n = 10-12 and individual interviews n = 30-40) and collecting data on adherence to quality indicators (n = 500 patients, 50 per hospital).

Step 2: Selection and development of interventions to create a PD and MF strategy during expert's roundtable discussions, using the knowledge gained in step 1 and a literature search of the effect of strategies for implementing PCRPs.

Step 3: Test and compare both strategies with a clustered CBA (effectiveness, process evaluation and costs), by data extraction from existing registration systems, questionnaires and interviews. For the effectiveness and cost-effectiveness, n = 500 patients, 50 per hospital. For the process evaluation, n=50 patients, 5 per hospital, and n = 40 healthcare professionals, 4 per hospital.

Implementation of Physical Cancer Rehabilitation Programmes in a European Healthcare System.

An Evaluation of a Patient-directed Strategy Compared With a Multi-faceted Strategy to Implement Physical Cancer Rehabilitation Programmes; a Controlled Before and After Study.

The experiences and exposure of patients and professionals with the PD- and MF strategy will be evaluated by interviews.

incremental costs and incremental cost-effectiveness ratios (ICERs)

A pre- and post measurement of 'the percentage of screened patients with the screening tool recommended by the Dutch guideline 'Cancer Rehabilitation'' will be done. The differences between the pre- and post measurement will be measured.

A pre- and post measurement of 'The percentage of referrals to PCRPs where needed, according to the Dutch guideline 'Cancer Rehabilitation'' will be done. The differences between the pre- and post measurement will be measured.

A pre- and post measurement of 'QoL' will be done. The differences between the pre- and post measurement will be measured.

A pre- and post measurement of 'patientempowerment' will be done. The differences between the pre- and post measurement will be measured.

A pre- and post measurement of ' the Remaining quality indicators of the Dutch guideline 'Cancer Rehabilitation'' will be done. The differences between the pre- and post measurement will be measured.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
PEARL Study: Improvement of Non-Hodgkin's Lymphoma Care	NCT01562509	Non-Hodgkin Lym...	Implementation ... Standard interv...	18 Years -	Radboud University Medical Center
Implementation of Physical Cancer Rehabilitation Programmes in a European Healthcare System.	NCT02205853	Cancer Fatigue	The patient-dir... The multi-facet...	18 Years -	Radboud University Medical Center

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