Info.Rx Cases: NCI

Monday, June 23, 2008

Ureteral cancer: case

Scenario

One of the GPs asks me for patient level information on the topic of ureteral cancer. One of his patients has been recently diagnosed and would like to have some information about it. Also he would like his patient to have some information about treatment options.

Resolution

There is a lot of information on urethral cancer but not a lot on ureteral cancer,* so I try a few places before finding a good overview on the BC Cancer Agency website.

BC Cancer agency > Patient/public info> Types of cancer > ureteral.

MedlinePlus has an entry in the encyclopedia: Cancer - renal pelvis or ureter.

Neither one goes into whole lot of detail about treatment options.

For that I find the National Cancer Institute's (NCI) PDQ®** on the subject through Onkolink. This can also be found on the NCI website of course, but Onkolink presents the information from the PDQ® in a way that is easier to navigate and read.

To get to the PDQ® though Oncolink: Oncolink > Types of Cancer > Urinary Tract Cancers > Urethral Cancer > NCI Resources.***

To get to it on NCI's website: NCI > A-Z list of cancers > S-Z > Ureter and Renal Pelvis, Transitional Cell Cancer

Last but certainly not least I Google ureteral cancer treatment options and find a great overview of ureteral cancer on the Fox Chase Cancer Center website which also discusses treatments at the various stages of the disease and the information is based on the NCI PDQ® as well.

* Click here for a definition of the two terms.

** What is PDQ ®?

*** To be perfectly honest this is the path as it appears on the Onkolink website. If you try to follow it it doesn't work. Urinary tract cancers does not appear on the list of cancers! But if you do a site search for ureter it will be the first hit on the list.

Monday, April 7, 2008

Prostate cancer treatment options and decision aids: case

I have gotten several requests for information on the topic of prostate cancer, both from patients and from health professionals, so I thought I would share what I found.

Before I do so, I thought it might be helpful to explain what a decision aid (or guide) is, in case anybody reading this has never seen one or is not sure what one is.

I had a hell of a time finding a definition. I checked MedlinePlus' medical dictionary and encyclopedia, and neither had one. Cambridge Dictionaries Online didn't list the term, and neither did the Merriam-Webster online medical dictionary. This time even Google failed me. (I am searching online since I am at the clinic and so don't have access to print resources, much as the average patient or family member wouldn't.) I am finally able to find one definition though. According to the US Department of Health and Human Services,

Decision aids are mechanisms or interventions that have been developed to improve communication between health professionals and patients, and to help involve patients in making decisions regarding their health care. Decision aids can include brochures, videotapes or interactive computer programs. Recent reviews have suggested that decision aids may be effective in supporting general health care decisions.

But what does that mean in plain English? You could say that any information that helps you make a decision could be considered a decision aid, but there two types of tools that are usually referred to using the term decision aid or decision guide.

One kind works like a sort of "choose your own adventure." At each step in the process you are given your options and depending on which you pick, or which is recommended based on test results, other choices are then offered and so on, branching out like a little tree. This makes it possible to see what might happen if you chose one treatment over another.

The other kind brings up important questions and help you make a list of pros and cons, much the same way you might do if you were making any other decision.

Scenario

Information on prostate cancer treatment options and decision aids.

Resolution

Here are a few resources that I found useful:

Treatment options:

National Cancer Institute: What you need to know about prostate cancer.

National Cancer Institute: Prostate cancer treatment

Family Doctor: Prostate cancer treatment options

Canadian Cancer Society: What is prostate cancer?

Decision aids:

Mayo Clinic: Prostate cancer guide

American Cancer Society: Detailed guide- prostate cancer

National Comprehensive Cancer Network treatment guidelines for patients: prostate cancer (for very advanced readers)

These are for screening but might still be of interest:

Centres for Disease Control and Prevention: Prostate cancer screening decision guide

Lab Tests Online: Prostate cancer tests

About Info.Rx

Update:

In the fall of 2008 a Clinical Medical Librarianship component was added to the service. The librarian now acts as a resident supervisor in the teaching rooms at the clinic one half-day per week, providing support for clinical decision-making in addition to continued support for patient education.

The service is based on an innovative InformationRx model first implemented in the UK (see: Early experience of the
contribution of an information specialist within a primary
healthcare team: a partnership venture between
library and healthcare services, doi: 10.1177/0961000604048915].

This model sees the information professional acting as a member of the health care team by providing informational/instructional support for patients/families and health professionals at point of care. Support for the service is provided by the main hospital library and is vital for ensuring long term sustainability.

The information professional is available 7 hrs per week to consult with patients/families that are in need of health information.

Health staff are encouraged to write InformationRx for patients which can then be filled by the information professional. Consultations with patients are treated as clinical encounters and are documented in the charts. The service has a clinic in the Centre's appointment scheduling software.

Patients and family members are welcome to drop in, or to submit questions by phone or email at their convenience. They can schedule appointments by contacting the information professional directly or by calling their team coordinator.

The library provides support by welcoming questions from patients and their families when the coordinator is not available. Herzl patients and families are able to borrow books from the Patient and Family Resource Centre's (PFRC) print collection, and a family medicine section has been created on the PFRC website which provides links to reliable and up-to-date consumer health resources.

About this blog

The Patient health Information Service at Herzl (H-PHIS) opened its doors in early July of this year (2007) and is in the early developmental stages. The challenges faced by myself (the service's coordinator), the staff, and the health care team at the HFPC are many and varied, as is to be expected when implementing a new and innovative service.

Perhaps the most unique aspect of the InfoRx model is the presence and participation of the information professional/librarian at point of care. This new and multidisciplinary approach presents a distinctive challenge. Health and support staff are not always clear on what knowledge and skills a librarian brings to the team. Conversely, I must be able to recognize and adapt to the needs and character of the community and of the setting itself.

This blog was created in response to some very astute and constructive criticism. After presenting to the residents at their weekly rounds, I was approached by one of the partners at the clinic who suggested that rather than introducing myself and the service and then explaining how to use it, it would have been more effective to present some cases illustrating what the service has to offer to the residents and to their patients. I see this as a perfect example of the kind of disconnect that can happen when two very different professions come together. In essence I had presented the way I would have to my own professional colleagues, but this was not the most appropriate approach given my audience.

After giving it some thought it occurred to me that it could be useful, both for myself and the rest of the team, for me to present a weekly case here, and talk about some of the challenges we are faced with and how these might best be resolved. Hopefully this will introduce some transparency to the InfoRx process.

This is meant to serve as a record of, and forum for discussion about, our challenges and successes. It is hopefully also an opportunity for other information professionals to be inspired by one example of what can be accomplished outside of the library setting.

Monday, June 23, 2008

Ureteral cancer: case

Monday, April 7, 2008

Prostate cancer treatment options and decision aids: case

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