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This study aims to assess the feasibility of a shared-care model for low-risk differentiated thyroid cancer (DTC) patients, primary care practitioners (PCPs) and the tertiary care center utilizing a digital health-based thyroid cancer assessment reminder system (TCARS) in Medable with an expedited referral to specialists for rapid assessment in case of a concern of recurrence.
Low risk differentiated thyroid cancer (DTC) is being increasingly diagnosed and although its overall survival is excellent, lifelong follow-up is needed due to the risk of ongoing health challenges and the cancer recurring. While it is not feasible to follow this growing number of patients in specialist centers due to limited resources, recent studies have suggested that simply discharging them to their PCP is not ideal because many PCPs do not feel confident in managing various aspects of DTC. More importantly, a large number of patients in Nova Scotia do not have regular access to PCPs and are thus followed by walk-in clinics or nurse practitioners.The optimal approach would therefore be, to establish a shared care follow-up model including participation from patients, primary care practitioners (PCPs) and specialists.
In this study, the feasibility of a shared care follow-up strategy involving patients, PCPs and specialists that uses an automated reminder system will be tested. This strategy will be compared to standard specialist only follow-up. The study population comprises 60 low risk adult DTC patients who will be randomly allocated to either Shared-care or Control group on a 1:1 basis (30 patients each).
The main objectives of this study is to:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Shared-care Group | The Shared-care Group will comprise of patients who are receiving long term follow-up care for their condition by their PCP. |
| |
| Control Group | The Control Group will be made of patients who are receiving long term follow-up care for their condition of low-risk DTC at the Halifax Interdisciplinary Thyroid Oncology Clinic (ITOC). |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Shared-care model | Behavioral | A Shared care follow-up strategy involving patients, PCPs and specialists that uses an automated reminder system (TCARS). |
|
| Measure | Description | Time Frame |
|---|---|---|
| Feasibility outcomes | These outcomes will assess the feasibility of the pilot study. These include:
| after up to 24 months (after the 2nd Follow-up) |
| DTC shared-care outcomes | These outcomes will be measured to compare shared-care vs control DTC patients during the study duration and prospectively entered into a computerized DTC outcome registry of all study patients to follow their progress. This will be separate from TCARS, which will contain no clinical information.This information will be entered by the study coordinator. These include:
| after up to 24 months (after the 2nd Follow-up) |
| Measure | Description | Time Frame |
|---|---|---|
| Patient satisfaction outcomes | Patient satisfaction will be assessed in both groups using the Patient Satisfaction Questionnaire Short form (PSQ -18). The PSQ-18 is a Likert scale questionnaire, consisting of 18 items tapping each of the seven dimensions of satisfaction with medical care. These are 1) general satisfaction, 2) technical quality, 3) interpersonal manner, 4) communication, 5) financial aspects, 6) time spent with doctor, and 7) accessibility and convenience. |
| Measure | Description | Time Frame |
|---|---|---|
| DCT (Medable) specific outcomes | Feedback on the use of the Medable (DCT) system will be assessed using qualitative data gathered through patient and PCP surveys. Some responses will be on a 5-point Likert-type scale from strongly disagree to strongly agree or very unlikely to likely. Other questions will be in a multiple choice format. An open dialogue box will appear at the end of the survey for respondents to enter additional comments. |
Inclusion Criteria:
Adult (>18 years old) consenting patients being followed at the Halifax Interdisciplinary Thyroid Oncology Clinic (ITOC) meeting the following criteria:
Exclusion Criteria:
Patient does not have a consented PCP.
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Control group = 30 patients, where 15 patients are from the Nova Scotia central zone, and 15 patients are from the Nova Scotia non-central zone.
Shared-care group = 30 patients, where 15 patients are from the Nova Scotia central zone, and patients are from the Nova Scotia non-central zone .
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Syed A. Imran, Dr. | Contact | 902-473-2952 | Ali.Imran@nshealth.ca | |
| Glenda Mccarthy | Contact | 902-473-7803 | glenda.mccarthy@nshealth.ca |
| Name | Affiliation | Role |
|---|---|---|
| Syed A. Imran, Dr. | Nova Scotia Health | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Nova Scotia Health | Recruiting | Halifax | Nova Scotia | B2Y 1A7 | Canada |
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| ID | Term |
|---|---|
| D013964 | Thyroid Neoplasms |
| ID | Term |
|---|---|
| D004701 | Endocrine Gland Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D006258 | Head and Neck Neoplasms |
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| after up to 5 months (after 1st follow-up) and after up to 24 months (after 2nd follow-up) |
| Patient and provider acceptability and experience outcomes | Patient and provider satisfaction, acceptability and experience will be assessed through qualitative data gathered by provider (Specialist and PCP) interviews (n=8) and patient focus groups (n=12-16; 2 groups of 6-8 participants each). | after up to 24 months (after 2nd Follow-up) |
| PCP confidence in DTC management outcomes | PCP involvement and confidence in DTC management outcomes will be based on previously published surveys. The survey is based on the National Cancer Institute Survey of Physician Attitudes Regarding the Care of Cancer Survivors which was modified for thyroid cancer. In addition to the standard survey items, PCPs will be asked to report how confident they are in discussing key aspects of follow-up care with thyroid cancer survivors including:
| after up to 5 months (after 1st follow-up) and after up to 24 months (after 2nd follow-up) |
| after up to 5 months (after 1st follow-up) and after up to 24 months (after 2nd follow-up) |
| D004700 |
| Endocrine System Diseases |
| D013959 | Thyroid Diseases |