Barriers and facilitators to the implementation of routine ototoxicity screening for head and neck cancer patients.
Bibliographic record
Abstract
127 Background: Ototoxicity after cisplatin +/- radiation occurs in 22-58% of patients with head and neck cancers. Routine post-treatment hearing tests are useful in the early detection of hearing loss, allowing for possible early intervention. This study aimed to identify current hearing screening practices for follow-up, barriers to screening, and recommendations for its implementation. Methods: Stakeholders (physicians, nurses, coordinators, audiologists) identified barriers and facilitators to the implementation of a routine hearing screening follow-up program at Princess Margaret Cancer Centre. Themes were identified using an inductive approach and mapped to the Knowledge to Action (KTA) framework, which guides the implementation of new clinical practices. Results: The problem: While all patients received baseline hearing tests, follow-up testing was inconsistently performed in asymptomatic patients. Patients may also lack awareness of subclinical hearing loss. A formalized follow-up hearing test program was identified as the best approach by stakeholders. Barriers: Individual-level barriers included limited knowledge about intervals for hearing testing and lack of time during clinic visits. Institutional-level factors included personnel, financial resources and logistical supports. Patient travel distances and times were barriers, as well as scheduling tests on the same day as other clinic visits. Societal stigma of hearing loss was a possible barrier. Facilitators: These included greater staff and patient education, and designating a local clinic champion. Instructions for follow-up after identifying hearing loss was deemed essential. Adapting to the local context: Automated flagging post-treatment and auto-referrals to the Hearing Clinic through the electronic medical record system could facilitate increased rates of participation. Mail/phone reminders could be useful adjuncts. Conclusions: Participants supported a formal post-treatment hearing test program for patients with head and neck cancers treated with cisplatin +/- radiation. Individual and institutional barriers were identified, but could be mitigated by appropriate facilitators.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.041 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".