Category Ranking
98%
Total Visits
921
Avg Visit Duration
2 minutes
Citations
20
Article Abstract
Purpose: More than half of patients with head and neck squamous cell carcinoma (HNSCC) experience a delay initiating guideline-adherent postoperative radiation therapy (PORT), contributing to excess mortality and racial disparities in survival. However, interventions to improve the delivery of timely, equitable PORT among patients with HNSCC are lacking. This study (1) describes the development of NDURE (Navigation for Disparities and Untimely Radiation thErapy), a navigation-based multilevel intervention (MLI) to improve guideline-adherent PORT and (2) evaluates its feasibility, acceptability, and preliminary efficacy.
Methods: NDURE was developed using the six steps of intervention mapping (IM). Subsequently, NDURE was evaluated by enrolling consecutive patients with locally advanced HNSCC undergoing surgery and PORT (n = 15) into a single-arm clinical trial with a mixed-methods approach to process evaluation.
Results: NDURE is a navigation-based MLI targeting barriers to timely, guideline-adherent PORT at the patient, healthcare team, and organizational levels. NDURE is delivered via three in-person navigation sessions anchored to case identification and surgical care transitions. Intervention components include the following: (1) patient education, (2) travel support, (3) a standardized process for initiating the discussion of expectations for PORT, (4) PORT care plans, (5) referral tracking and follow-up, and (6) organizational restructuring. NDURE was feasible, as judged by accrual (88% of eligible patients [100% Blacks] enrolled) and dropout (n = 0). One hundred percent of patients reported moderate or strong agreement that NDURE helped solve challenges starting PORT; 86% were highly likely to recommend NDURE. The rate of timely, guideline-adherent PORT was 86% overall and 100% for Black patients.
Conclusion: NDURE is a navigation-based MLI that is feasible, is acceptable, and has the potential to improve the timely, equitable, guideline-adherent PORT.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8791819 | PMC |
| http://dx.doi.org/10.1200/OP.20.00943 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Education of healthcare professionals to improve guideline adherence in atrial fibrillation: the STEEER-AF cluster-randomized clinical trial.
Nat Med
August 2025
Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
Guideline-adherent care is associated with better patient outcomes, but whether this can be achieved by professional education is unclear. Here we conducted a cluster-randomized controlled trial across 70 centers in six countries to understand if a program for the education of healthcare professionals could improve patient-level adherence to clinical practice guidelines on atrial fibrillation (AF). Each center recruited patients with AF seen in routine practice (total N = 1,732), after which the centers were randomized, accounting for baseline guideline adherence to class I and III recommendations from the European Society of Cardiology on stroke prevention and rhythm control.
View Article and Find Full Text PDFSurvival Associations of Timely Postoperative Radiotherapy Among Head and Neck Cancer High-Risk Subgroups.
Laryngoscope
August 2025
Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Objective: Effective implementation of timely postoperative radiation therapy (PORT) as a quality metric for head and neck squamous cell carcinoma (HNSCC) care may reduce survival disparities in subgroups with the highest risk of mortality-advanced stage and Black race. We sought to determine if the association between timely PORT and survival varies among clinical and demographic high-risk subgroups.
Methods: In this retrospective cohort study using the National Cancer Database 2004-2020, patients with HPV-negative HNSCC treated with surgery and PORT were identified.
Improving the evaluation of non-accidental trauma across multiple specialties at a single institution.
BMJ Open Qual
January 2025
Inova Fairfax Medical Campus, Falls Church, Virginia, USA.
Background: Based on the presenting injury, patients undergoing abuse evaluation may be managed by different specialties. Our local child abuse specialist expressed concern over the variability in evaluation of patients presenting with injuries concerning for non-accidental trauma (NAT). The aim of this quality improvement project was to increase the percentage of patients for whom there is a concern for NAT who receive a guideline-adherent evaluation from 7.
View Article and Find Full Text PDFFactors Associated with Head and Neck Cancer Postoperative Radiotherapy Delays: A Systematic Review and Meta-analysis.
Otolaryngol Head Neck Surg
November 2024
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Objective: Initiating postoperative radiotherapy (PORT) within 6 weeks of surgery for head and neck squamous cell carcinoma (HNSCC) is included in the National Comprehensive Cancer Network Clincal Practice Guidelines and is a Commission on Cancer quality metric. Factors associated with delays in starting PORT have not been systematically described nor synthesized.
Data Sources: PubMed, Scopus, and CINAHL.
Neighborhood-Level Disadvantage and Delayed Adjuvant Therapy in Head and Neck Cancer.
JAMA Otolaryngol Head Neck Surg
June 2024
Department of Population and Public Health Sciences and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles.
Importance: For patients with head and neck squamous cell carcinoma (HNSCC), initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery is recommended by the National Comprehensive Cancer Network Guidelines and the Commission on Cancer. Although individual-level measures of socioeconomic status are associated with receipt of timely, guideline-adherent PORT, the role of neighborhood-level disadvantage has not been examined.
Objective: To characterize the association of neighborhood-level disadvantage with delays in receiving PORT.