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Quality of Care and Long-Term Outcomes of Active Surveillance : = Gaining Insights from Population-level Perspectives.

Record Type:	Language materials, manuscript : Monograph/item
Title/Author:	Quality of Care and Long-Term Outcomes of Active Surveillance :/
Reminder of title:	Gaining Insights from Population-level Perspectives.
Author:	Timilshina, Narhari.
Description:	1 online resource (299 pages)
Notes:	Source: Dissertations Abstracts International, Volume: 84-09, Section: B.
Contained By:	Dissertations Abstracts International84-09B.
Subject:	Health sciences. -
Online resource:	click for full text (PQDT)
ISBN:	9798377618539

Quality of Care and Long-Term Outcomes of Active Surveillance : = Gaining Insights from Population-level Perspectives.
Timilshina, Narhari.

Quality of Care and Long-Term Outcomes of Active Surveillance :Gaining Insights from Population-level Perspectives. - 1 online resource (299 pages)

Source: Dissertations Abstracts International, Volume: 84-09, Section: B.

Thesis (Ph.D.)--University of Toronto (Canada), 2023.

Includes bibliographical references

Active surveillance (AS) for low-risk prostate cancer (PC) is evolving as an internationally recognized standard of care and is recognized by major urological associations as a preferred treatment option. AS is increasingly used worldwide, yet research on variations of quality of care during AS is lacking, and compliance with AS guidelines is largely unknown at the population level.The aims of this research were to develop quality indicators (QIs) for AS, evaluate the quality of care for patients on AS using those QIs, and estimate long-term oncological outcomes after initial AS. A first study aimed to develop national consensus-based system-level QIs for evaluation of AS care among patients with low-risk PC. A second study aimed to critically apply QIs to examine/understand quality of care during AS at the population level. A third study aimed to evaluate long-term oncological outcomes at the population level in patients who received initial AS.This thesis establishes a foundation on which to measure and monitor the quality of care for AS patients at the population level. We developed 20 comprehensive structure-process-outcome-based QIs for measuring quality of AS care. Further, by applying these AS QIs to a large Canadian population database, we identified current gaps in the quality of AS care. The findings suggest that process of care QIs measured at PC diagnosis and during eligibility assessment for AS were improving in recent years; however, considerable variation appeared with many process indicators during the AS follow-up phase. Finally, our third study is one of the first to measure long-term oncological outcomes of AS using population-level data compared with initial treatment. Among men diagnosed with low-risk PC and managed with AS, the results suggest excellent 10- and 15-year metastasis-free survival, overall survival, and PC-specific mortality, similar to published observational studies from academic centres. However, at a population level, AS was associated with slightly worse long-term metastasis-free survival, overall survival and PC-specific mortality compared with initial treatment. These results should help clinicians and policy makers understand the impact of AS on long-term outcomes after widespread adoption.

Electronic reproduction.
Ann Arbor, Mich. :
ProQuest,
2024

Mode of access: World Wide Web

ISBN: 9798377618539Subjects--Topical Terms:

1179212
Health sciences.
Subjects--Index Terms:

Active surveillanceIndex Terms--Genre/Form:

554714
Electronic books.

Quality of Care and Long-Term Outcomes of Active Surveillance : = Gaining Insights from Population-level Perspectives.
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