Impact of COVID-19 on the Organization of Cancer Care in Belgium: Lessons Learned for the (Post-)Pandemic Future
Abstract
:1. Introduction
2. Materials and Methods
2.1. Aim
2.2. Design
2.3. Population and Setting
2.4. Data Collection
2.5. Data Analysis
3. Results
3.1. First Wave: Significant Reorganization of Oncological Care
3.1.1. Minimal Changes in Medical Treatment
3.1.2. On-Site Consultations Were Exceptional
3.1.3. Telephone Consultations Became the New Standard
3.1.4. Strict but Diverse Safety Measures across Hospitals
3.1.5. Limited Access to Psychosocial Care
3.1.6. Major Differences in Primary Care Involvement
3.2. Inter-Wave Period: Back to Regular Care
3.3. Second Wave: No Entanglements despite Increasing Infection Rate
3.4. Post-Pandemic Future: Minimum Intentions to Retain Changes
4. Discussion
4.1. A Need for Guidance
4.2. Where Is Patient-Centered Care?
4.3. A Change Process with Remarkable Speed
4.4. A Plea Not to Return to Normal
4.5. Lessons Learned for a (Post-)Pandemic Future
- Healthcare teams should be sufficiently supported by guidelines and recommendations. A roadmap for future pandemics or similar situations should be prepared and made available as soon as possible when a crisis arises. A roadmap can provide structure to HCPs in a chaotic situation, can guarantee more uniform decisions across institutions, and prevent low-quality care. The roadmap should not only focus on treatment guidelines but should include all aspects of the care spectrum.
- In the education and training of HCPs, sufficient attention should be paid to care provision during a pandemic or similar crisis. In this way, HCPs can be better prepared to handle such crisis situations efficiently, without compromising the quality of care. They must learn to set priorities during a crisis, without losing sight of the patient. Additionally, training can make HCPs more resilient in such difficult and demanding circumstances.
- Care provision should always and everywhere be patient-centered even in crisis situations. Patients and relatives find it difficult to cope with changes in planned care, whether due to a crisis situation or not. Therefore, HCPs should always consider the impact of change on the patient’s well-being. Not only the risk of infection should be taken into account when making decisions, but also the patient’s concerns, needs, and preferences.
- Access to psychosocial care must be guaranteed at all times, especially during a crisis situation as elevated distress and anxiety levels are common among patients.
- Telehealth can be useful for a certain subgroup of patients. Telehealth can be used instead of regular follow-up in the hospital for patients with stable disease, or it can be used in addition to regular consultations for patients in need of closer monitoring.
- Better communication and collaboration with primary care is not a utopia. As proven during the COVID-19 pandemic, the involvement of primary care professionals (home care nurse and GP) is feasible, e.g., for intermediate follow-up/blood sampling.
- Treatment protocols can be adapted to reduce hospital visits and therefore healthcare costs.
4.6. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- World Health Organization. COVID-19 Significantly Impacts Health Services for Noncommunicable Diseases; World Health Organization: Geneva, Switzerland, 2020. [Google Scholar]
- Moujaess, E.; Kourie, H.R.; Ghosn, M. Cancer patients and research during COVID-19 pandemic: A systematic review of current evidence. Crit. Rev. Oncol. Hematol. 2020, 150, 102972. [Google Scholar] [CrossRef] [PubMed]
- Liang, W.; Guan, W.; Chen, R.; Wang, W.; Li, J.; Xu, K.; Li, C.; Ai, Q.; Lu, W.; Liang, H.; et al. Cancer patients in SARS-CoV-2 infection: A nationwide analysis in China. Lancet Oncol. 2020, 21, 335–337. [Google Scholar] [CrossRef]
- Lee, K.A.; Ma, W.; Sikavi, D.R.; Drew, D.A.; Nguyen, L.H.; Bowyer, R.C.E.; Cardoso, M.J.; Fall, T.; Freidin, M.B.; Gomez, M.; et al. Cancer and Risk of COVID-19 Through a General Community Survey. Oncologist 2021, 26, e182–e185. [Google Scholar] [CrossRef] [PubMed]
- ElGohary, G.M.; Hashmi, S.; Styczynski, J.; Kharfan-Dabaja, M.A.; Alblooshi, R.M.; de la Cámara, R.; Mohmed, S.; Alshaibani, A.; Cesaro, S.; Abd El-Aziz, N.; et al. The risk and prognosis of COVID-19 infection in cancer patients: A systematic review and meta-analysis. Hematol. Oncol. Stem Cell Ther. 2020. [Google Scholar] [CrossRef]
- Robilotti, E.V.; Babady, N.E.; Mead, P.A.; Rolling, T.; Perez-Johnston, R.; Bernardes, M.; Bogler, Y.; Caldararo, M.; Figueroa, C.J.; Glickman, M.S.; et al. Determinants of COVID-19 disease severity in patients with cancer. Nat. Med. 2020, 26, 1218–1223. [Google Scholar] [CrossRef]
- Silversmit, G.; Verdoodt, F.; Van Damme, N.; De Schutter, H.; Van Eycken, L. Excess Mortality in a Nationwide Cohort of Cancer Patients during the Initial Phase of the COVID-19 Pandemic in Belgium. Cancer Epidemiol. Biomark. Prev. 2021, 30, 1615–1619. [Google Scholar] [CrossRef]
- Spicer, J.; Chamberlain, C.; Papa, S. Provision of cancer care during the COVID-19 pandemic. Nat. Rev. Clin. Oncol. 2020, 17, 329–331. [Google Scholar] [CrossRef]
- The Lancet Oncology. COVID-19: Global consequences for oncology. Lancet Oncol. 2020, 21, 467. [Google Scholar] [CrossRef]
- Brooks, S.K.; Webster, R.K.; Smith, L.E.; Woodland, L.; Wessely, S.; Greenberg, N.; Rubin, G.J. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020, 395, 912–920. [Google Scholar] [CrossRef]
- Kenis, I.; Theys, S.; Daem, M.; Decoene, E.; Demolder, V.; Duprez, V.; Pape, E.; Quaghebeur, M.; Verhaeghe, S.; Foulon, V.; et al. Experiences of patients with cancer and their relatives confronted with COVID-19 related delay or change in care: A qualitative study. J. Adv. Nurs. 2022. [Google Scholar] [CrossRef]
- Tartarone, A.; Lerose, R. COVID-19 and cancer care: What do international guidelines say? Med. Oncol. 2020, 37, 80. [Google Scholar] [CrossRef] [PubMed]
- Elo, S.; Kyngäs, H. The qualitative content analysis process. J. Adv. Nurs. 2008, 62, 107–115. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. COVID-19 Weekly Epidemiological Bulletin (24 June 2022); World Health Organization: Geneva, Switzerland, 2022. [Google Scholar]
- Belkacemi, Y.; Grellier, N.; Ghith, S.; Debbi, K.; Coraggio, G.; Bounedjar, A.; Samlali, R.; Tsoutsou, P.G.; Ozsahin, M.; Chauvet, M.P.; et al. A review of the international early recommendations for departments organization and cancer management priorities during the global COVID-19 pandemic: Applicability in low- and middle-income countries. Eur. J. Cancer 2020, 135, 130–146. [Google Scholar] [CrossRef] [PubMed]
- Belgian Society of Medical Oncology. COVID-19 and Cancer; Belgian Society of Medical Oncology: Gent, Belgium, 2020. [Google Scholar]
- Belgian Hematology Society. COVID-19 Guidelines; Belgian Hematology Society: Brussel, Belgium, 2020. [Google Scholar]
- Momenimovahed, Z.; Salehiniya, H.; Hadavandsiri, F.; Allahqoli, L.; Günther, V.; Alkatout, I. Psychological Distress among Cancer Patients during COVID-19 Pandemic in the World: A Systematic Review. Front. Psychol. 2021, 12, 682154. [Google Scholar] [CrossRef]
- Chassin, M.R. Improving the quality of health care: What’s taking so long? Health Aff. 2013, 32, 1761–1765. [Google Scholar] [CrossRef]
- Longenecker, C.O.; Longenecker, P.D. Why hospital improvement efforts fail: A view from the front line. J. Health Manag. 2014, 59, 147–157. [Google Scholar] [CrossRef]
- Appelbaum, S.H.; Wohl, L. Transformation or change: Some prescriptions for health care organizations. Manag. Serv. Qual. Int. J. 2000, 10, 279–298. [Google Scholar] [CrossRef]
- Nilsen, P.; Seing, I.; Ericsson, C.; Birken, S.A.; Schildmeijer, K. Characteristics of successful changes in health care organizations: An interview study with physicians, registered nurses and assistant nurses. BMC Health Serv. Res. 2020, 20, 147. [Google Scholar] [CrossRef]
- Allen, B. Effective design, implementation and management of change in healthcare. Nurs. Stand. 2016, 31, 58–71. [Google Scholar] [CrossRef]
- Milella, F.; Minelli, E.A.; Strozzi, F.; Croce, D. Change and Innovation in Healthcare: Findings from Literature. Clin. Outcomes Res. 2021, 13, 395–408. [Google Scholar] [CrossRef]
- Erlingsdottir, G.; Ersson, A.; Borell, J.; Rydenfält, C. Driving for successful change processes in healthcare by putting staff at the wheel. J. Health Organ. Manag. 2018, 32, 69–84. [Google Scholar] [CrossRef] [PubMed]
- van Rossum, L.; Aij, K.H.; Simons, F.E.; van der Eng, N.; Ten Have, W.D. Lean healthcare from a change management perspective. J. Health Organ. Manag. 2016, 30, 475–493. [Google Scholar] [CrossRef] [PubMed]
- van den Bulck, A.O.E.; de Korte, M.H.; Metzelthin, S.F.; Elissen, A.M.J.; Everink, I.H.J.; Ruwaard, D.; Mikkers, M.C. In the Eye of the Storm: A Quantitative and Qualitative Account of the Impact of the COVID-19 Pandemic on Dutch Home Healthcare. Int. J. Environ. Res. Public Health 2022, 19, 2252. [Google Scholar] [CrossRef]
- Rücker, F.; Hårdstedt, M.; Rücker, S.C.M.; Aspelin, E.; Smirnoff, A.; Lindblom, A.; Gustavsson, C. From chaos to control—Experiences of healthcare workers during the early phase of the COVID-19 pandemic: A focus group study. BMC Health Serv. Res. 2021, 21, 1219. [Google Scholar] [CrossRef] [PubMed]
- Ardura, M.; Hartley, D.; Dandoy, C.; Lehmann, L.; Jaglowski, S.; Auletta, J.J. Addressing the Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Hematopoietic Cell Transplantation: Learning Networks as a Means for Sharing Best Practices. Biol. Blood Marrow Transplant. 2020, 26, e147–e160. [Google Scholar] [CrossRef]
- Carpenter, D.; Hassell, S.; Mardon, R.; Fair, S.; Johnson, M.; Siegel, S.; Nix, M. Using Learning Communities to Support Adoption of Health Care Innovations. J. Comm. J. Qual. Patient Saf. 2018, 44, 566–573. [Google Scholar] [CrossRef]
- Jeffs, L.; McShane, J.; Flintoft, V.; White, P.; Indar, A.; Maione, M.; Lopez, A.J.; Bookey-Bassett, S.; Scavuzzo, L. Contextualizing learning to improve care using collaborative communities of practices. BMC Health Serv. Res. 2016, 16, 464. [Google Scholar] [CrossRef] [Green Version]
Characteristics | ||
---|---|---|
First round | Second round | |
Type of HCP | ||
Nurse (oncology nurse, ONN, APN) | 7 | 8 |
Head nurse | 1 | 1 |
Oncologist | 4 | 1 |
Age | ||
≤35 years | 3 | 1 |
36–45 years | 2 | 3 |
46–55 years | 7 | 6 |
Gender | ||
Female | 11 | 10 |
Male | 1 | 0 |
Years of experience in oncology | ||
≤5 years | 2 | 0 |
6–15 years | 4 | 3 |
16–25 years | 4 | 4 |
26–35 years | 2 | 3 |
Type of hospital of employment | ||
General | 9 | 7 |
University | 3 | 3 |
Type of oncology department | ||
Medical oncology | 9 | 7 |
Hematology | 1 | 1 |
Digestive oncology | 1 | 1 |
Respiratory oncology | 1 | 1 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Kenis, I.; Theys, S.; Hermie, E.; Foulon, V.; Van Hecke, A. Impact of COVID-19 on the Organization of Cancer Care in Belgium: Lessons Learned for the (Post-)Pandemic Future. Int. J. Environ. Res. Public Health 2022, 19, 12456. https://doi.org/10.3390/ijerph191912456
Kenis I, Theys S, Hermie E, Foulon V, Van Hecke A. Impact of COVID-19 on the Organization of Cancer Care in Belgium: Lessons Learned for the (Post-)Pandemic Future. International Journal of Environmental Research and Public Health. 2022; 19(19):12456. https://doi.org/10.3390/ijerph191912456
Chicago/Turabian StyleKenis, Ilyse, Sofie Theys, Ella Hermie, Veerle Foulon, and Ann Van Hecke. 2022. "Impact of COVID-19 on the Organization of Cancer Care in Belgium: Lessons Learned for the (Post-)Pandemic Future" International Journal of Environmental Research and Public Health 19, no. 19: 12456. https://doi.org/10.3390/ijerph191912456