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Abstract

Objective Cancer is one of the biggest health challenges of our times, affecting all the personal areas of a patient. The interrelationships between these areas and the need for multidisciplinary care require the assessment of psychosocial complexity in cancer patients. The main aim of this study was to reach a consensus on the general definition of psychosocial complexity in cancer and its main elements according to the experts in the field. Method A Delphi study was performed, which first involved a comprehensive review of the literature to create a questionnaire that was validated by two expert panels. The first panel consisted of intra-institutional experts, while the second included extra-institutional experts in the field. The study included three more rounds: (1) validation of the questionnaire by the internal panel, (2) discussion of the results and resolving discrepancies, and (3) validation of the questionnaire by the external panel. Results After the four-round Delphi process, we obtained a consensus definition of psychosocial complexity in cancer patients, as well as of its main factors: medical–physical, social-family, psychological, and spiritual. A 21-indicators list and its 8-indicators brief version were also proposed as indicators of psychosocial complexity. Significance of results We present a definition of psychosocial complexity in cancer patients that has been agreed by experts, also establishing its four factors: medical–physical, social-family, psychological, and spiritual. This has led to the development of a list of indicators (and its brief version) that, after a validation process, could help health professionals to identify patients with high psychosocial complexity to provide them an optimal care.

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... Sumario: 1. Introducción 2. Principios de la Práctica Psicosocial en Oncología 3. Áreas de actuación en la Atención Psicosocial del paciente oncológico y la familia 4. Cribado de malestar emocional y derivación de la persona con enfermedad oncológica y su familia para una atención psicooncológica específica. 4 ...
... La complejidad psicosocial en cáncer se caracteriza por ser multifactorial y multidimensional, es decir, se compone de múltiples elementos biospsicosociales, espirituales y éticos que se interrelacionan en situaciones cambiantes y evolutivas. Hasta fechas muy recientes, nuestro país carecía de guías o Estándares de Atención Psicosocial similares a las de otros países (2,3) , pero fruto de un esfuerzo promovido desde instituciones como el ICO que aúna la experiencia clínica multidisciplinaria acumulada, se ha podido ofrecer una primera propuesta tanto de la definición de la complejidad psicosocial en oncología (4) como del abordaje de la misma (5) . El Hospital Duran y Reynals del Instituto Catalán de Oncología (ICO-DiR) fue pionero en este ámbito, disponiendo de la primera propuesta de Comité Psicosocial multidisciplinario creado en el 2002 y con la elaboración de una guía básica de atención psicosocial en Oncología (6) . ...
... Recientemente y en nuestro país, Casellas-Grau et al., (2020) (4) han presentado la definición de complejidad psicosocial en pacientes con cáncer. Esta definición se construyó en consenso de personas expertas realizado mediante metodología Delphi y ha permitido la elaboración de una lista de indicadores pertenecientes a las cuatro dimensiones de la complejidad psicosocial -médica-física, socioamiliar, psicoemocional y espiritual-. ...
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Introducción: La atención psicosocial de las personas con enfermedad oncológica y la familia debe formar parte de todo modelo integral de atención que pretenda reducir el impacto vital del cáncer. Las intervenciones psicosociales han probado su eficacia en la ayuda a pacientes y familiares para afrontar las situaciones de alta complejidad psicosocial emergentes a consecuencia de un diagnóstico de cáncer. Objetivo: Definir y explicar el modelo de Atención Psicosocial del Comité Psicosocial del Instituto Catalán de Oncología (ICO) utilizando criterios de vulnerabilidad, complejidad y derivación; enmarcado y basado en los valores del ICO (centrados en las necesidades de pacientes con cáncer y sus familias). Método: El modelo que se presenta en este documento consta de cinco pilares: 1) Principios de la Práctica Psicosocial en Oncología; 2) Áreas de actuación en la Atención Psicosocial del paciente con cáncer y la familia; 3) Cribado de malestar emocional y derivación del paciente con cáncer y la familia para una atención psicooncológica específica; 4) Comité Psicosocial: (objetivos; funciones; organización; composición; disciplinas participantes; criterios de derivación y niveles de complejidad; y procedimiento); y 5) Índice de productividad. Resultados: Pacientes y familiares atendidos por el CPS mostraron mejoría estadísticamente significativa en los niveles del malestar emocional, pasando de una media inicial de 8,12/10 (EVA/ ENV) a una media 6,27/10 (EVA/ENV). Asimismo, se constata que las intervenciones derivadas del comité psicosocial redujeron el porcentaje de casos iniciales de alta complejidad, pasando de un 69,3% a un 49,3%. Conclusiones: El abordaje de la complejidad psicosocial mediante un modelo basado en criterios multi e interdisciplinarios consensuados ayuda en la toma de decisiones sobre las acciones a seguir y en la mejora del malestar emocional y complejidad de los pacientes y la familia.
... While Delphi studies can consist of any number of rounds, they commonly involve 3-5 rounds [30]. In fact, most Delphi studies that have been conducted by health science researchers to establish agreed definitions have consisted of 3-5 rounds [32-36, 40-53, [63][64][65][66][67]. Based on this trend, and the format of each round in this study, it is anticipated that there will be 3-5 rounds. ...
... Consensus will be defined a priori as ≥80% agreement for this study. This threshold was chosen as an appropriate cutoff given that most health science researchers that have conducted Delphi studies to establish agreed definitions have defined consensus as either ≥70%, ≥75%, or ≥80% agreement[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][59][60][61][62][63][64][65][66][67], with ≥80% being the most stringent level of agreement. ...
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Introduction: There is currently no agreed definition of social prescribing. This is problematic for research, policy, and practice, as the use of common language is the crux of establishing a common understanding. Both conceptual and operational definitions of social prescribing are needed to address this gap. Therefore, the aim of the study that is outlined in this protocol is to establish internationally accepted conceptual and operational definitions of social prescribing. Methodology: A Delphi study will be conducted to develop internationally accepted conceptual and operational definitions of social prescribing with an international, multidisciplinary panel of experts. It is anticipated that this study will involve approximately 40 participants (range = 20-60 participants) and consist of 3-5 rounds. Consensus will be defined a priori as ≥80% agreement. Discussion: Not only will these definitions serve to unite the social prescribing community, but they will also inform research, policy, and practice. By laying the groundwork for the formation of a robust evidence base, this foundational work will support the advancement of social prescribing and help to unlock the full potential of the social prescribing movement. Conclusion: This important work will be foundational and timely, given the rapid spread of the social prescribing movement around the world.
... [36] For this study, consensus was defined a priori as ≥80% agreement, meaning ≥80% of participants had to rate their agreement as Agree (4) or Strongly Agree (5) on a 5-point Likert scale (Strongly Disagree (1), Disagree (2), Neutral (3), Agree (4), Strongly Agree (5)). This threshold was chosen as an appropriate cutoff given that most health science researchers that have conducted Delphi studies to establish agreed definitions have defined consensus as either ≥70%, ≥75%, or ≥80% agreement, [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][66][67][68][69][70][71][72][73][74] with ≥80% being the most stringent level of agreement. ...
... Recognizing that Delphi studies can consist of any number of rounds, [37] this prediction was not only based on the format of each round in this study, but also on the fact that Delphi studies commonly involve 3-5 rounds, [37] and that most Delphi studies that have been conducted by health science researchers to establish agreed definitions have consisted of 3-5 rounds. [39][40][41][42][43][47][48][49][50][51][52][53][54][55][56][57][58][59][60][70][71][72][73][74] However, we did set a maximum number of rounds in advance -if consensus was not reached on the definitions by a fifth round, then a sixth and final round would take place in the form of a meeting with participants via teleconferencing software to achieve consensus through discussion. ...
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Introduction With the social prescribing movement gaining traction globally, there is a need for an agreed definition of social prescribing. There are two types of definitions — conceptual and operational, meaning agreement on both types of definitions is needed. Objective The aim of this study was to establish internationally accepted conceptual and operational definitions of social prescribing. Design A three-round Delphi study was conducted. Methods Consensus was defined a priori as ≥80% agreement. In Round 1, participants were asked to list key elements that are essential to the conceptual definition of social prescribing and to provide corresponding statements that operationalize each of the key elements. In Round 2, participants were asked to rate their agreement with items from the first round for inclusion in the conceptual and/or operational definitions of social prescribing. Based on the findings from this round, the conceptual and operational definitions of social prescribing were developed, including long and short versions of the conceptual definition. In Round 3, participants were asked to rate their agreement with the conceptual and operational definitions of social prescribing. Participants This study involved an international, multidisciplinary panel of experts. The expert panel (n=48) represented 26 different countries across five continents, numerous expert groups, and a variety of years of experience with social prescribing, with the average being 5 years (range = 1-20 years). Results After three rounds, internationally accepted conceptual and operational definitions of social prescribing were established. The definitions were transformed into the Common Understanding of Social Prescribing (CUSP) conceptual framework. Conclusion This foundational work offers a common thread — a shared sense of what social prescribing is, which may be woven into social prescribing research, policy, and practice to foster common understanding of this concept.
... Emotional distress can be heightened when there is lack of family or social support. The study also underlines the important role that the health-care provider plays in treating these psychosocial complexities (Casellas-Grau et al., 2021). ...
Article
Colorectal cancer (CRC) is a significant cause of morbidity and mortality, with incidence on the rise, particularly in younger adults. Surgery is a key treatment modality and often results in the construction of an ostomy, either temporary or permanent. This integrative review discusses psychosocial implications of ostomies in women with CRC. A literature review was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and PubMed. The search included articles published between January 1, 2012, and December 31, 2022. The search yielded 684 articles, with a total of six included in the final review. Articles were excluded for not being specific to CRC, not being specific to ostomates, lacking data specific to women, and focusing solely on sexual health. The main issues that emerged were the loss of bodily control, impaired social support and acceptance, social limitations, altered body image, and alterations in sense of self. This review found that factors such as time since surgery, age, relationship status, and cultural background may influence the degree of psychosocial impact of ostomies in women with CRC. Given these factors are substantial and multifaceted, future research should be directed at identifying the subset of women with ostomies as a result of CRC with high-risk demographics.
... The Delphi process has been successfully used in various medical fields to establish definitions, with the aim of addressing variations in clinical practice and developing management guidelines. [12][13][14][15][16][17][18][19][20] This study aims to establish consensus among international clinical experts on definitions for the following terms that relate to the diagnosis, treatment, and monitoring of acute porphyrias: acute porphyria, acute porphyria attack, severe acute porphyria attack, active (symptomatic) acute porphyria (including sporadic acute porphyria and recurrent acute porphyria), latent (inactive) acute porphyria, asymptomatic acute porphyria (in remission), symptomatic high excreter, asymptomatic high excreter, prophylactic haemin, and on-demand haemin. We expect that consensus on these terms will greatly facilitate the development of guidelines for diagnosis and treatment of these disorders. ...
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Background: Acute porphyrias are a group of rare inherited disorders causing acute neurovisceral attacks. Many terms used frequently in the literature and in clinical practice are ambiguous, which can lead to confusion in the way patients are managed, studied, and reported in clinical studies. Agreed definitions are a necessary first step in developing management guidelines and will facilitate communication of results of future clinical research. Methods: The Delphi method was used to generate consensus on key terms and definitions in acute porphyria. The process started with a brainstorming phase offered to all members of the European Porphyria Network followed by 2 Delphi rounds among international experts in the field of porphyria (the Acute Porphyria Expert Panel). A consensus of 75% or more was defined as the agreement threshold. Results: 63 respondents from 26 countries participated in the brainstorming phase, leading to the choice of 9 terms and definitions. 34 experts were invited to take part in the Delphi rounds. 7 of the initial 9 terms and definitions which entered the first Delphi round achieved the threshold for agreement. Following a second Delphi round, all 9 definitions achieved agreement. Conclusion: Agreement on the definitions for 9 important terms describing acute porphyrias represents a significant step forward for the porphyria community. It will facilitate more accurate comparison of outcomes among porphyria centres and in clinical trials and provide a strong framework for developing evidence based clinical guidelines.
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Context: Patients with cancer-related pain and concurrent substance use disorder (SUD) present a unique set of challenges for palliative care clinicians. A structured forum for interdisciplinary collaboration is needed to effectively manage this complex population. Objectives: Describe the feasibility and acceptability of a palliative care Complex Pain Board (CPB), an interdisciplinary team meeting to provide concrete care recommendations for patients with cancer-related pain and concurrent SUD and/or psychosocial complexity. Methods: We conducted a retrospective analysis of cases presented at CPB between May 2021 and June 2022 and a cross-sectional analysis of CBP participant surveys. Results: Among 28 cases included for analysis, gastrointestinal cancers (n = 7, 25.9%) and multiple myeloma (n = 5, 18.5%) were the most frequent cancer diagnoses. Primary reasons for referral were SUD (n = 22, 78.6%) and provider/team distress (n = 13, 46.4%). The most frequent recommendations made at CBP were encouraging interdisciplinary collaboration (n = 18, 64.3%), maintaining healthy boundaries (n = 15, 53.6%), and SUD management (n = 13, 46.4%). Of 14 scheduled meetings, most meetings involved the presentation of ≥1 cases (n = 12, 86%). Among 40 CBP participant surveys, most attendees (n = 38, 95%) were likely or highly likely to continue to attend. Conclusion: CPB is a feasible and acceptable intervention that allows for palliative care clinicians to collaborate and receive interdisciplinary team feedback and peer support on the management of patients with cancer-related pain and concurrent SUD and/or psychosocial complexity in the ambulatory care setting. Key Message: A regular, interdisciplinary team meeting (CPB) is a feasible and acceptable intervention to help palliative care clinicians manage challenging cases involving patients with cancer and concurrent SUD and/or psychosocial complexity.
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Objective The aim of this study was to establish internationally accepted conceptual and operational definitions of social prescribing. Design A three-round Delphi study was conducted. Setting This study was conducted virtually using an online survey platform. Participants This study involved an international, multidisciplinary panel of experts. The expert panel (n=48) represented 26 countries across five continents, numerous expert groups and a variety of years of experience with social prescribing, with the average being 5 years (range=1–20 years). Results After three rounds, internationally accepted conceptual and operational definitions of social prescribing were established. The definitions were transformed into the Common Understanding of Social Prescribing (CUSP) conceptual framework. Conclusion This foundational work offers a common thread—a shared sense of what social prescribing is, which may be woven into social prescribing research, policy and practice to foster common understanding of this concept.
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Cancer is a devastating disease causing significant psychological problems among patients and their families. In the past few decades, there have been growing implementation and dissemination of screening methods for the psychological consequences of cancer, including distress, depression, anxiety, post-traumatic stress, and demoralisation. Also, guidelines for the management of psychological distress have been developed and endorsed by a number of scientific cancer associations. This review examines some of the most significant related issues, also focusing on recent advances in psychosocial and psychopharmacological interventions as a part of a mandatory, integrated, and comprehensive approach to cancer care.
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Proposal: Model of early palliative care (PC) integrated in oncology is based on shared care from the diagnosis to the end of life and is mainly focused on patients with greater complexity. However, there is no definition or tools to evaluate PC complexity. The objectives of the study were to identify the factors influencing level determination of complexity, propose predictive models, and build a complexity scale of PC. Patients and method: We performed a prospective, observational, multicenter study in a cohort of advanced cancer patients with an estimated prognosis ≤ 6 months. An ad hoc structured evaluation including socio-demographic and clinical data, symptom burden, functional and cognitive status, psychosocial problems, and existential-ethic dilemmas was recorded systematically. According to this multidimensional evaluation, investigator classified patients as high, medium, or low palliative complexity, associated to need of basic or specialized PC. Logistic regression was used to identify the variables influencing determination of level of PC complexity and explore predictive models. Results: We included 324 patients; 41% were classified as having high PC complexity and 42.9% as medium, both levels being associated with specialized PC. Variables influencing determination of PC complexity were as follows: high symptom burden (OR 3.19 95%CI: 1.72-6.17), difficult pain (OR 2.81 95%CI:1.64-4.9), functional status (OR 0.99 95%CI:0.98-0.9), and social-ethical existential risk factors (OR 3.11 95%CI:1.73-5.77). Logistic analysis of variables allowed construct a complexity model and structured scales (PALCOM 1 and 2) with high predictive value (AUC ROC 76%). Conclusion: This study provides a new model and tools to assess complexity in palliative care, which may be very useful to manage referral to specialized PC services, and agree intensity of their intervention in a model of early-shared care integrated in oncology.
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Resumen Antecedentes y objetivo Evaluar el malestar emocional y el nivel de complejidad de pacientes presentados al Comité de Atención Psicosocial. Materiales y métodos Estudio pre-post con un solo grupo en pacientes con cáncer. De los 144 pacientes, 27 fueron derivados por el comité a especialistas del área psicosocial, y sus niveles de malestar emocional y de complejidad fueron revisados un mes después. Resultados Tras ser atendidos según indicaciones del comité, los pacientes mostraron un descenso significativo de los valores en malestar emocional: la media inicial de 8 puntos en la escala visual analógica de malestar emocional descendía a 5,8 puntos. El descenso se reflejó también en los niveles de complejidad: antes de ser revisados, el 70,4% de los pacientes mostraban un alto nivel de complejidad y el 7,4%, un nivel bajo. Después de ser atendidos, los porcentajes de pacientes con alta complejidad se redujeron al 48,1% en los enfermos con alta complejidad, y aumentaron al 22,3% en los de baja complejidad. Conclusiones El comité ofrece un instrumento para derivar los casos de mayor complejidad que requieren atención preferente y multidisciplinar, permitiendo optimizar recursos, por su eficacia en la resolución de casos complejos.
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This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high‐quality cancer registry data, the basis for planning and implementing evidence‐based cancer control programs, are not available in most low‐ and middle‐income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1‐31. © 2018 American Cancer Society
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Pediatric palliative care is increasingly recognized to be a specialized type of care requiring specific skills and knowledge, yet, as found in several countries, there is little available research evidence on which to base care. The goal of the project was to achieve consensus among palliative care practitioners and researchers regarding the identification of pertinent lines of research. A Delphi technique was used with an interdisciplinary panel (n = 14-16) of researchers and frontline clinicians in pediatric palliative care in Canada. Four priority research questions were identified: What matters most for patients and parents receiving pediatric palliative services? What are the bereavement needs of families in pediatric palliative care? What are the best practice standards in pain and symptom management? What are effective strategies to alleviate suffering at the end of life? These identified priorities will provide guidance and direction for research efforts in Canada, and may prove useful in providing optimal care to patients and families in pediatric palliative care.
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There have been many reports of psychiatric disorder in medical populations, but few have used standard methods on representative patient groups. Even so, there is consistent evidence for considerable psychiatric morbidity in in-patient, out-patient and casualty department populations, much of which is unrecognised by hospital doctors. We require a better classification of psychiatric disorder in the general hospital, improved research measures, and more evidence about the nature and course of the many different types of problem so that we can provide precise advice for their management of routine clinical practice.
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The purpose of this paper is to describe the development and to test the reliability of a new method called INTERMED, for health service needs assessment. The INTERMED integrates the biopsychosocial aspects of disease and the relationship between patient and health care system in a comprehensive scheme and reflects an operationalized conceptual approach to case mix or case complexity. The method is developed to enhance interdisciplinary communication between (para-) medical specialists and to provide a method to describe case complexity for clinical, scientific, and educational purposes. First, a feasibility study (N = 21 patients) was conducted which included double scoring and discussion of the results. This led to a version of the instrument on which two interrater reliability studies were performed. In study 1, the INTERMED was double scored for 14 patients admitted to an internal ward by a psychiatrist and an internist on the basis of a joint interview conducted by both. In study 2, on the basis of medical charts, two clinicians separately double scored the INTERMED in 16 patients referred to the outpatient psychiatric consultation service. Averaged over both studies, in 94.2% of all ratings there was no important difference between the raters (more than 1 point difference). As a research interview, it takes about 20 minutes; as part of the whole process of history taking it takes about 15 minutes. In both studies, improvements were suggested by the results. Analyses of study 1 revealed that on most items there was considerable agreement; some items were improved. Also, the reference point for the prognoses was changed so that it reflected both short- and long-term prognoses. Analyses of study 2 showed that in this setting, less agreement between the raters was obtained due to the fact that the raters were less experienced and the scoring procedure was more susceptible to differences. Some improvements--mainly of the anchor points--were specified which may further enhance interrater reliability. The INTERMED proves to be a reliable method for classifying patients' care needs, especially when used by experienced raters scoring by patient interview. It can be a useful tool in assessing patients' care needs, as well as the level of needed adjustment between general and mental health service delivery. The INTERMED is easily applicable in the clinical setting at low time-costs.
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In a study of breast cancer survivors, the authors used the European Organization for Research and Treatment of Cancer core questionnaire + breast module (EORTC QLQ-C30/+BR23) and the Functional Assessment of Cancer Therapy-Breast (FACT-B)for the assessment of quality of life (QoL). The main focus of this study was to look at the effect of time elapsed since initial treatment on the patients' QoL. Eighty-seven female patients (average age of 53.9 +/- 8.7 years) were included in the study. All women had received curative cancer therapy. The average time elapsed since start of initial treatment was 4.7 +/- 4.3 years. Reduced QoL, especially in the areas of emotional, social, and sexual functioning, was found not only after initial treatment (1-2 years) but also after long posttreatment survival (> 5 years). From these findings, needs for specific psycho-oncological interventions are derived. The findings imply that besides recovering from the acute consequences of cancer therapy, long-term survivors of breast cancer (> 5 years after initial treatment) still may have a special need for psycho-oncological support.
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To outline the key concepts and principles of the Delphi technique. Reference is made to a selection of studies that illustrate a variety of methodological interpretations. Drawing on Heshusius's concept of 'goodness criteria', particular emphasis is given to the question of scientific merit and means of evaluation. Although the technique should be used with caution, it appears to be an established method of harnessing the opinions of an often diverse group of experts on practice-related problems.
Article
The data that were reviewed in this article documented that in health systems, which manage behavioral health disorders independently from general medical disorders, the estimated 10% to 30% of patients with behavioral health service needs can expect (1) poor access or barriers to medical or mental health care; (2) when services are available, most provided will not meet minimum standards for expected outcome change; and (3) as a consequence of (1) and (2), medical and behavioral disorders will be more persistent with increased complications, will be associated with greater disability, and will lead to higher total health care and disability costs than will treatment of patients who do not have behavioral health disorders. This article proposes that these health system deficiencies will persist unless behavioral health services become an integral part of medical care (ie, integrated). By doing so, it creates a win-win situation for virtually all parties involved. Complex patients will receive coordinated general medical and behavioral health care that leads to improved outcomes. Clinicians and the hospitals that support integrated programs will be less encumbered by cross-disciplinary roadblocks as they deliver services that augment patient outcomes. Health plans (insurers) will be able to decrease administrative and claims costs because the complex patients who generate more than 80% of service use will have less complicated claims adjudication and better clinical outcomes. As a result, purchaser premiums, whether government programs, employers, or individuals, will decrease and the impact on national budgets will improve. Ongoing research will be important to assure that application of the best clinical and administrative practices are used to achieve these outcomes.
El desarollo de la atención multidisciplinar en la atención al cáncer. De cuando Europa se presentó en el comité de tumores
  • Borràs
Borràs JM and Prades J (2017) El desarollo de la atención multidisciplinar en la atención al cáncer. De cuando Europa se presentó en el comité de tumores. Encuentros Multidisciplinares 55, 1-6.
Identificación de personas con enfermedades crónicas avanzadas y necesidad de atención paliativa en servicios sanitarios y sociales: Elaboración del instrumento NECPAL CCOMS-ICO©
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Gómez-Batiste X, Martínez-Muñoz M, Blay C, et al. (2013) Identificación de personas con enfermedades crónicas avanzadas y necesidad de atención paliativa en servicios sanitarios y sociales: Elaboración del instrumento NECPAL CCOMS-ICO©. Medicina Clínica 140, 241-245.
Validación y desarrollo de IDC-PAL, instrumento diagnóstico de la complejidad en ciudados paliativos
  • Martin-Rosello
Martin-Rosello ML (2017). Validación y desarrollo de IDC-PAL, instrumento diagnóstico de la complejidad en ciudados paliativos. PhD Thesis, University of Málaga, Spain.
El valor del Instrumento Diagnóstico de la Complejidad en Cuidados Paliativos para identificar la complejidad en pacientes tributarios de cuidados paliativos
  • M R Salvador
  • N Garrido
  • I Perea
Salvador MR, Garrido N, Perea I, et al. (2017) El valor del Instrumento Diagnóstico de la Complejidad en Cuidados Paliativos para identificar la complejidad en pacientes tributarios de cuidados paliativos. Medicina Paliativa 24, 196-203.
Abordaje de la complejidad psicosocial en pacientes con cáncer
  • Gil
The Delphi technique
  • Hsu