bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of audio-visual tool on patient comfort level at a comprehensive cancer center infusion suite: Preliminary results.
Authors: Cheeti Apoorva , Hashemi-Sadraei Neda , Okino Candy , Cox Andrea , Kittson Ronald , Tawfik Bernard , Dayao Zoneddy R. , Crozier Nick
Published: October 2023

348

Background: Patients receiving chemotherapy often experience anxiety which may result in dissatisfaction with care and decreased adherence to treatment, subsequently leading to unfavorable outcomes. Patient education is shown to ameliorate the anxiety and improve patient comfort. However, retention of information by patients may be sub-optimal in this setting and utilization of multiple information sources may enhance patient recall. We hypothesized that a short “welcome video” on what to expect at an infusion visit, in addition to nursing- patient education would improve patient comfort level. Methods: We conducted a single center prospective pre-post study at the University of New Mexico Comprehensive Cancer Center (UNMCCC) to evaluate the impact of an educational audio-visual tool on the comfort level of patients. An introductory welcome video was developed and made available on: (i) the UNMCCC website (ii) on iPads All patients receiving infusions are asked to complete a survey prior to their infusion. In the phase 1 patients completed surveys prior to the “welcome video” being released. In the phase 2, the video has been introduced. We plan to compare the comfort level of the two populations before and after the video release. Study was reviewed and approved by University of New Mexico Health Sciences IRB. Results: In the first phase, 43 patients completed the survey. Overall, patients felt to have a good understanding of what to expect on their infusion day (average score - 8.9/10), felt somewhat nervous (average score: 3/10), and were interested to learn more about treatment side effects (average score: 5/10), on the 10-point Likert scale (1- strongly disagree, 10- strongly agree (table 1). In the phase 2, preliminary data collection on 40 surveyed patients showed that only 15% (6/40) watched the welcome video. Strategies planned to enhance access including a text message link to the video at patient registration are being implemented as we continue to collect phase 2 survey results. Conclusions: At our center, patients already demonstrate a strong sense of comprehension regarding what to anticipate on their infusion day, primarily through nursing-patient education. Our goal is to further enhance their understanding by improving the delivery of our welcome video and refining the survey questions to yield more informative insights.[Table: see text]
Interdisciplinary implementation of a synoptic reporting template for melanoma nodal surveillance ultrasound.
Authors: Montgomery Kelsey B. , Duncan Zoey , Holder Ashley M. , Burgan Constantine , Galgano Samuel J. , Broman Kristy Kummerow
Published: October 2023

35

Background: As nodal surveillance is increasingly used for sentinel lymph node positive (SLN+) melanoma following the Second Multicenter Selective Lymphadenectomy Trial (MSLT-II), availability of high-quality nodal surveillance ultrasonography (U/S) has become a critical need. Based on MSLT-II, U/S criteria concerning for nodal recurrence should be evaluated to determine indication for lymph node (LN) biopsy. We previously demonstrated low utilization of MSLT-II criteria for reporting nodal U/S at our tertiary cancer center, diminishing the clinical utility of these reports. Working in an interdisciplinary team of surgeons and radiologists, we aimed to implement and evaluate a synoptic reporting template for melanoma nodal ultrasound at our institution. Methods: Patients undergoing melanoma nodal surveillance at a tertiary cancer center from July 2017 to June 2023 who received at least one nodal U/S were identified retrospectively. Reporting language from each U/S was analyzed for number of MSLT-II criteria reported and presence of clinically actionable recommendations for the referring surgical team (e.g. normal LN appearance or abnormal LN with recommendation for biopsy or observation). The synoptic report was designed collaboratively by a group of radiologists and surgical oncologists to include MSLT-II U/S criteria and thresholds for biopsy versus continued surveillance, with the institutional U/S dictation template revised accordingly. Dissemination to clinical teams was conducted and utilization was monitored in the course of clinical care. Following implementation of the synoptic template in January 2023, post-implementation adherence and outcomes were reviewed. Descriptive statistics and bivariate analysis were performed. Results: 337 nodal U/S studies were performed on 94 SLN+ melanoma patients, with a median of 2.5 U/S per patient (range 1 to 12). Forty-two U/S (12.5%) were performed in the post-implementation period and eligible for synoptic reporting; of these, 32 (76.0%) were reported with the synoptic template. The mean number of MSLT-II criteria reported was greater post-implementation (Pre 0.5 ± 0.8 vs Post 2.5 ± 1.0, p<0.001). Abnormal findings were reported in 73 U/S (21.7%), with a significant increase in the proportion of clinically actionable recommendations for abnormal findings reported in the Post versus Pre group (93.0% vs 64.0%, p=0.037). Conclusions: Following the implementation of a collaboratively designed synoptic reporting template for melanoma nodal U/S, reports were much more likely to have MSLT-II criteria reported in addition to an actionable recommendation. There was notable improvement when ultrasounds had abnormal findings, when the application of these reporting criteria is most crucial. Further iterative improvement to increase adherence to the synoptic report and dissemination to other cancer centers is ongoing.
Cancer care in the context of COVID-19.
Authors: Cohn Eliza Brumer , Nelson Judy , Kreizenbeck Karma L. , Kestner Shannon , Hempstead Bridgette , Slim Jennifer Nadine , Ramsey Scott David
Published: October 2023

359

Background: The COVID pandemic increased mental health challenges for cancer patients, overburdened oncology providers, and exacerbated health disparities. Using focus groups, this study aimed to understand the impact of COVID on people with cancer from underserved communities in WA state. Methods: In 4 focus groups (English and Spanish) people diagnosed with cancer from March 2020 or later in WA state were asked about their treatment, mental health, COVID testing and vaccine experiences, finances, and bias and racism during the pandemic. Focus groups included individuals with a cancer diagnosis in specific communities: Black and African American (n=8), English-Speaking Hispanic/Latinx (n=5), Spanish-Speaking Hispanic/Latinx (n=5), and Rural (n=4). Transcripts were analyzed using conventional content analysis in Dedoose 9.0. Initial coding used notes from preliminary data review. Codes were combined, deleted, and added during subsequent coding. Data was exported and themes were developed. Results: Several themes emerged from the discussions. See table. Conclusions: Cancer patients in WA State reported increased difficulties with navigating hospital policies, mental health, racism during treatment and at work, and economic stress during COVID. Some identified emotional support from family and community as mitigating factors. Feedback from the groups confirmed the need to prioritize mental health and social needs of people with cancer. Future research is needed on interventions to address such needs among individuals with cancer.[Table: see text]
Barriers to engagement of patients in medication reconciliation.
Authors: Hack Saidah , Powis Melanie Lynn , Ali Anum , Dara Celina , Macedo Alyssa , Kukreti Vishal , Krzyzanowska Monika K.
Published: October 2023

362

Background: Medication reconciliation (MedRec) is a process where a detailed medication list is compiled and reviewed with an appropriate health care professional for completeness and drug-drug interactions, then communicated across all of the patient’s healthcare teams. While effective MedRec can minimize the risk of adverse events, uptake in outpatient oncology can be poor. Engagement of patients and caregivers in collection of medication lists through patient portals has been suggested as a potential change idea to improve uptake. To understand barriers and facilitators of patient engagement in the MedRec process through an electronic patient portal we undertook semi structured interviews in a comprehensive cancer center in Ontario, Canada. Methods: Patients in outpatient oncology clinics and chemo-daycare waiting areas were approached to participate in interviews; as we wished to understand barriers both users and non-users of the medication list feature of the patient portal were eligible to participate. Participant recruitment continued until saturation of data was reached. Interviews were carried out virtually following a semi-structured guide between 08/2022 and 12/2022. Interviews were recorded and transcribed verbatim; thematic coding was completed in NVIVO by two members of the study team. Results: A total of 10 patients participated in interviews; participants ranged in age between 30 to 89 years, and all completed post-secondary education. Patients’ emphasized issues with provider/care team communication expressing it was unclear why they were asked to enter medications and did not know if anyone was reviewing the medications entered. Additionally, patients had a fear of inputting erroneous medications resulting in their overall avoidance to use the portal. Portal features such as the use of generic vs trade name medications created lack of clarity for patients when entering medications into the system. Presently, the language is limited to English which may reduce the number of users. Accessibility issues such as font size and overall layout, especially on mobile devices were noteworthy during interviews. Patients recommended the addition of the following features: refill information including requests, medication reminder features via text/email and linkable medication information. Conclusions: Our findings indicate that although patients are using the portal to upload their medication lists, there are technical and systemic improvements that can be made to increase patient usage. In addition to updates to the patient portal to create added value to patients, and improve comprehension and accessibility, patient education is needed to raise awareness of the importance of MedRec and their role in the process and improve buy in.
Leveraging electronic patient-reported outcomes collected at six cancer centers to identify symptom clusters across the first four weeks of chemotherapy.
Authors: Pozzar Rachel A. , Tramontano Angela , Cronin Christine , Hassett Michael J. , Schrag Deborah , Osarogiagbon Raymond U. , Hazard-Jenkins Hannah W. , Bian Jessica J , Wong Sandra L. , Dizon Don S. , Wright Alexi A.
Published: October 2023

366

Background: Symptom clusters are groups of two or more related concurrent symptoms. Interventions that target symptom clusters may be more efficient than those which address individual symptoms, yet few studies have identified symptom clusters using patient-reported outcomes collected in routine practice. The purpose of this study was to identify symptom clusters de novo using data reported in eSyM, an electronic health record-integrated cancer symptom management program deployed across six large and diverse health systems. Methods: Adults starting chemotherapy to treat thoracic, gastrointestinal, and gynecologic cancers used eSyM to report symptoms twice weekly for up to six months. We analyzed patient-reported symptom data from cycle 1, day 2 (T0), one week (T1), and two (T2), three (T3), and four (T4) weeks later. Patients reported attributes (i.e., frequency, severity, and interference) of 12 symptoms using items derived from the PRO-CTCAE. We calculated a composite grade (0, 1, 2, or 3) for each symptom and conducted an exploratory factor analysis using polychoric correlations and unweighted least squares estimation to identify symptom clusters at each time point. We considered rotated factor loadings ≥|0.30| meaningful and assessed the Eigenvalues, structure, and clinical relevance of two- through four-factor (i.e., cluster) models. Finally, we labeled each cluster according to its predominant symptoms using labels adopted from prior studies of symptom clusters in patients undergoing chemotherapy. Results: Our analytic sample at each time point included 730 (T0), 1605 (T1), 1571 (T2), 1617 (T3), and 1456 (T4) symptom reports. Of the two-, three-, and four-factor models, the two-factor model had the least cross-loading and was the most clinically relevant across time points. The two-factor model accounted for 100% of the total variance in symptoms. In this model, a gastrointestinal symptom cluster was comprised of vomiting, nausea, decreased appetite, trouble drinking, and diarrhea at all time points, while a psychoneurological symptom cluster was comprised of fatigue, pain, anxiety, shortness of breath, and constipation at all time points. Rash was present in the psychoneurological cluster at T0 but was not present in any cluster at T1-T4. Conclusions: Patients experience gastrointestinal and psychoneurological symptom clusters in the first four weeks of chemotherapy. Our findings suggest it is feasible to use routinely collected data to identify symptom clusters using composite PRO-CTCAE grades. Future research will investigate the prevalence of symptom clusters, clinical and demographic characteristics of patients at high risk for severe symptoms, and how to better manage symptom clusters.
Gaps in care planning and delivery for patients with liver cancer: Baseline assessment for implementation of 4R Oncology model.
Authors: Therapondos George , Trosman Julia R. , Du Lingling , Mizrahi Jonathan , Sandow Tyler , Cohen Ari , Gimenez Juan , Palmer Carol , Medina Amanda , O'Brien Michelle , Tan Amie , Weldon Christine B.
Published: October 2023

381

Background: Liver cancer is a complex disease, requiring detailed care planning, patient engagement and delivery of comprehensive care, including supportive and health maintenance care. The 4R Oncology Model for patient facing care planning, patient self-management and team based delivery of complex care has the potential to address these needs. 4R (Right Info/Care/Patient/Time) significantly improves patient self-management and optimizes delivery of supportive and health maintenance care in breast and lung cancer (Trosman JCOOP 2021; Liu JCOOP 2022). The impact of 4R in liver cancer has not been examined. Ochsner Health’s multi-disciplinary live cancer team is implementing and evaluating 4R. Here we describe the baseline assessment of provider practices and patient experience of care planning and delivery of supportive and health maintenance care. Methods: Surveys of providers and patients on current care planning and delivery in liver cancer were conducted Oct 2022 – Jan 2023. We used 3 metrics of care planning and 3 metrics of care delivery (Table). Results: Survey response rates: providers 55% (33/60), patients 45% (27/60). Providers included physicians, advance practitioners, nurses and navigators from Hepatology, Transplant, Interventional Radiology and Medical Oncology. Patients were 56% female, 63% white, 37% black, 56% < 30k income. In care planning, patient experience was reported at a similar rate as provider practices for informed on goal of care, but significantly higher than providers for informed on next steps in care and receiving a detailed care plan (Table). In care delivery, patient experience and provider referral practices for social and supportive care were similarly low. Rates of patients’ receiving primary care and substance abuse assistance were significantly higher than respective rates of provider referrals. Among providers, 73% give patients a verbal care plan and 27% a hand written plan. The current process to create care plans is satisfactory to 54% of providers. Conclusions: We found substantial gaps in care planning and referrals to supportive and health maintenance care. Higher rates of patients reporting receipt of care planning and services suggest that many patients may resort to their own devices in these aspects of care. Ochsner Health aims to address these gaps by implementing the 4R Oncology model in liver cancer and will share results when available.[Table: see text]
Using blood wisely in oncology patients: An institutional experience implementing Choosing Wisely Canada restrictive transfusion practices.
Authors: Alghawas Mae , Gerrie Alina S. , Tesch Megan E
Published: October 2023

382

Background: Using Blood Wisely is a national Choosing Wisely Canada (CWC) initiative that challenges hospitals to benchmark themselves on evidence-informed restrictive transfusion strategies, with the aim to decrease inappropriate red blood cell (RBC) transfusions in Canada. We previously assessed transfusion practices among oncology patients at BC Cancer Vancouver during a 12-month period. Here we present the results of a second audit, after implementation of quality improvement (QI) interventions. Methods: BC Cancer Vancouver RBC transfusion records were obtained for the periods of October 2019-September 2020 and April 2021-March 2022. The percentage of transfusions that were single-unit or for hemoglobin (Hg) ≤80 g/L were measured to assess adherence to CWC targets of ≥65% and ≥80%, respectively, for these metrics. QI interventions were implemented after the first audit, including staff education (grand rounds presentation, sitewide email bulletin) and direct engagement of ordering physicians by nursing staff. Uni- and multivariate analyses were used to test associations between patient characteristics and transfusion outcomes. Results: Single-unit transfusions increased from 41% in inpatients (49/120) and 12% in outpatients (69/586) in the first audit, to 86% (126/146) in inpatients ( P<0.001) and 34% (170/495) in outpatients ( P<0.001) in the second audit. Transfusions for Hg ≤80 g/L increased from 79% (95/120) in inpatients and 66% (384/586) in outpatients, to 93% (136/146) in inpatients ( P=0.001) and 78% (384/495) in outpatients ( P<0.001). Patient factors associated with restrictive transfusion practices included inpatient status and having a hematological malignancy. Conclusions: In the face of fluctuating RBC shortages, interventions aimed at high-use populations like oncology patients are crucial to reducing transfusion overuse. Through education and prescriber engagement, we successfully reduced the rate of inappropriate RBC transfusions at our institution and achieved the status of a designated Using Blood Wisely Hospital.[Table: see text]
Cardiac safety of pegylated liposomal doxorubicin after conventional doxorubicin exposure in patients with sarcoma and breast cancer.
Authors: Alhaja Maher , Chen Sherry , Chin Alan , Schulte Brian , Legasto Carlo S
Published: October 2023

388

Background: Lifetime cumulative doses of conventional doxorubicin (>450 mg/m2) are associated with dose-dependent cardiotoxicity. In soft tissue sarcoma (STS) and breast cancer, conventional doxorubicin is often utilized in earlier lines of therapy, whereas pegylated liposomal doxorubicin (PLD) is typically reserved for recurrent and metastatic disease. PLD is associated with less cardiotoxicity than conventional doxorubicin and high doses of PLD can be administered without increased risk of cardiotoxicity in patients without prior exposure to conventional doxorubicin. Limited data exists evaluating cardiotoxicity associated with PLD treatment after conventional doxorubicin, especially when doxorubicin lifetime doses approach the established cumulative total lifetime dose of 450-550 mg/m2. This study aims to evaluate the cardiac safety of PLD use in patients who had prior exposure to conventional doxorubicin. Methods: This was a single-center, observational, retrospective cohort study conducted in patients ≥18 years with STS or breast cancer, who were exposed to conventional doxorubicin from an earlier line of treatment prior to PLD between January 2010 – May 2022. Patients participating in clinical trials were excluded. The primary outcome of the study was cardiac safety. Cardiac toxicity was defined as ≥ 10% decrease in left ventricle ejection fraction (LVEF) or new diagnosis of heart failure within 6 months after PLD cessation. Results: 494 patients were screened and 50 patients met inclusion criteria, 8 STS and 42 breast cancer patients. Median lifetime cumulative conventional doxorubicin dose in patients with STS was 450 mg/m2 with a max dose of 825 mg/m2, and 240 mg/m2 with a max dose of 300 mg/m2 in breast cancer patients. Median lifetime cumulative PLD dose was 105 mg/m2 (range: 35-150 mg/m2) in the STS group and 105 mg/m2 (range: 35-510 mg/m2) in the breast cancer group. A decrease of ≥ 10% in LVEF was not observed in the STS group. 22 breast cancer patients had available LVEF data on PLD; 3 of these patients experienced ≥ 10% in LVEF drop and one of three patients was diagnosed heart failure. The average cumulative dose of PLD administered in patients with > 10% decrease in LVEF was 177 mg/m2 and had an average of 3.5 cycles. Most of STS patients initiated PLD treatment within 2 years after conventional doxorubicin while most breast patients initiated PLD treatment at least 10 years following conventional doxorubicin exposure. Conclusions: PLD administration in patients with prior exposure to conventional doxorubicin appears to be safe with limited cardiotoxicity in patients with STS and breast cancer. Future research is needed to determine if and how often routine cardiac monitoring is needed for patients on PLD without existing cardiac risk.
Impact of self-directed exercise intervention in a minority rich, hematopoietic stem cell transplant (HSCT) inpatient population at high risk for sarcopenia and falls.
Authors: Brody Rachel , Sakalian Susan , LoBasso Raffaele , Wright Karen , Lombardo Amanda , Khatun Fariha , Gritsman Kira , Verma Amit , Goldfinger Mendel , Packer Stuart H. , Levin Sheryl , Sica Alejandro R.
Published: October 2023

390

Background: Extended hospitalizations in the adult HSCT population increase patients’ risk for deconditioning and sarcopenia. Sarcopenia negatively impacts overall survival in adult HSCT patients (Armenian et al, 2019) and is strongly associated with falls among older adults (Yeung et al, 2019; Marques A & Queirós C., 2018; Wheatley et al, 2021). Methods: In a safety net, minority rich, academic medical center in suburban NYC, stationary pedals were placed inside patient rooms in a 31-bedded inpatient HSCT unit starting Q4 2020. Intentional, inpatient room placement prevented additional risk of infectious exposures to COVID-19 in late 2020-2021, allowed for safe access to pedals from a seated position in chairs inside patient rooms, and provided insight into self-directed exercise participation. Attending MDs, PAs and RNs encourage HSCT patients to utilize stationary pedals up to 3 times daily, while usage remains self-directed. Direct observation of patient pedal usage and patient-verbalized interest in participation reflects positive acceptance and consistent usage since implementation. Results: 2019-2023 Midas Event Reporting data was reviewed by the author. Total numbers of Weak/Impaired Gait patient falls decreased in the post-implementation period: 19 falls at baseline versus 13 falls in 2021, 11 falls in 2022, and 3 falls in Q1 2023. Pre-intervention 2019 data indicates 63.3% of falls are among Weak/Impaired Gait patients. (2020 falls data is not included due to unit closures during the COVID-19 pandemic). Post-intervention 2021-2023 data reveals a mean of 51.2% of falls are in Weak/Impaired Gait patients, indicating a 12.1% decline in falls in the post-intervention period of 2.25 years. Conclusions: Sarcopenia and inpatient falls impact patient outcomes (i.e., injuries, extended hospitalizations, and survival) and are financially burdensome. Each inpatient fall, whether injurious or not, costs hospitals approximately 35,000 (Dykes et al, 2023). Reductions in numbers of inpatient falls at this institution are potentially associated with the following hospital cost savings: 210K in 2021, 280K in 2022 and a projected 245K in 2023. Reduction in sarcopenia during extended hospitalizations, when reviewed alongside the financial impact of inpatient falls, supports the ongoing implementation of self-directed exercises in this population. Next steps include self-directed use of resistance bands, chair-based and bed-based stretches, and utilizing self-tracking devices to record exercise duration. (Full references available upon request).
Post COVID19 vaccination burnout?: Providers’ perspectives on patients with lung cancer.
Authors: Kim Casey , Tatake Ishan , Paolillo Rebecca , Rangachari Deepa , Zerillo Jessica Ann ,   InSIGHT Core, Center for Healthcare Delivery Science, BIDMC
Published: October 2023

401

Background: Patients with solid cancers undergoing chemotherapy or immunotherapy face increased risk of infections due to their immunosuppression and are recommended to undergo routine vaccination. However, despite increased attention to vaccination with the COVID19 pandemic, vaccination rates remain suboptimal among patients with cancer. Methods: Retrospective chart review was used to determine baseline rates of COVID19, Influenza, and Pneumococcal vaccination among a cohort of newly diagnosed patients with lung cancer at multi-site academic cancer center from 2018-2022 (n = 624). An anonymous survey was distributed to all Hematology-Oncology providers (n = 101) at the same institution with questions on current practice on accessing vaccination records and barriers to vaccinating patients starting chemotherapy and/or immunotherapy. Results: The baseline documented COVID-19 vaccination rate was 29.6%, while the baseline documented influenza and pneumococcal vaccination rates were 27.2% and 1.42%, respectively. Survey response was 32.7% (n = 33). Respondents were 60.0% Female (n = 15), 52.0% 30 - 39 years old (n = 13), 56.0% Attending Physicians (n = 14), 28.0% Fellow Physicians (n = 7), and 16.0% Nurse Practitioners (n = 4). 54.5% and 57.6% of respondents always recommended or discussed COVID19 and influenza vaccination, respectively, with their patients on chemotherapy or immunotherapy regardless of cancer type. 12.1% of respondents always recommended pneumococcal vaccination with their patients. The most common moderate barriers to COVID19 and influenza vaccination were “not having enough time” (COVID19, n = 12, 40.0%), (Influenza, n = 7, 26.9%), and “forgetting to bring up vaccines during the visit” (COVID19, n = 12, 40.0%), (Influenza, n = 9, 34.9%). “Not knowing when to administer the vaccine” was a moderate barrier to pneumococcal vaccination in 53.8% of respondents (n = 14). The most common preferred method for obtaining vaccination record information was through patient interview (n = 14, 63.6%). Similar trends were noted when limited to providers who cared for patients with lung cancer. Conclusions: Patients with lung cancer at this academic medical center were found to have low documented rates for COVID19, influenza, and pneumococcal vaccination. Common barriers in vaccination included lack of time and forgetting to bring up vaccination, but lack of knowledge of vaccination timing was only a significant barrier for pneumococcal vaccination. Improvement initiatives to address these identified factors are forthcoming.
Improved oral anticancer medication (OAM) adherence/toxicity assessment documentation.
Authors: Holle Lisa , Moran Andrea , Savage Margaret , Keng Michael Kenneth
Published: October 2023

409

Background: Based on national OAM guidelines and to improve patient safety, most OAM programs monitor toxicity/adherence within 10-14 days following OAM initiation. At our institution, only 50% of toxicity/adherence documentation tasks were completed by day 10 of cycle 1 after initiating OAM. We aimed to increase toxicity/adherence documentation tasks to at least 75% by day 10 of cycle 1 following a newly prescribed OAM in collaboration with Hematology/Oncology Pharmacy Association/American Society of Clinical Oncology 2022 quality training program (QTP). Methods: We engaged a multidisciplinary team to gather/interpret data, create process map, and identify barriers. Outcome measure was documentation of toxicity/adherence by day 10 of cycle 1. Included all cancer patients initiating OAM treatment plan. Excluded those on intravenous/oral regimens and gynecology/oncology patients. Process measure was percentage of 9 crucial tasks identified as necessary to appropriately document toxicity/adherence. Balance measures included provider visits, emergency department visits, telephone/electronic medical record OAM-related messages, and nursing satisfaction. A cause-and-effect diagram, pareto chart and prioritization matrix were used to narrow focus of improvement changes. Two plan-do-study-act (PDSA) cycles were conducted from January 2023-June 2023. All data were analyzed using Statistical Process Control Charts with 3-sigma control limits. Results: Original high-impact, easy-to-implement intervention (re-training staff) delayed due to institutional-directed intervention (education documentation retraining due to The Joint Commission survey). Education documentation retraining did not significantly improve toxicity/adherence task completion rate (50% to 53%) by improved provider and emergency department visits (16.7% and 12.5% to 0%) (see Table 1). Nursing turnover, lack of formal OAM process training and institutional buy-in for OAM program/training likely contributed to results. Re-training supported with institutional buy-in completed. PDSA cycle 2 data collection is ongoing; preliminary results show no change in task completion rate. Conclusions: Education documentation and retraining alone is insufficient to improve OAM toxicity/adherence documentation rates. Other interventions are needed to attain our goal.[Table: see text]
Clinician burnout (CBO) research trends from 2013-2022: Results from the State of Cancer Care in America (SOCCA) ASCO Annual Meeting abstract analysis.
Authors: Gregory Abby , Kirkwood Margaret Kelsey , Levit Laura A. , Schenkel Caroline , Kaltenbaugh Melinda , Garrett-Mayer Elizabeth
Published: October 2023

41

Background: Interest in CBO and wellness has increased due to concern about the impact of workforce wellness on the quality of care. Oncology CBO accelerated during the COVID-19 pandemic and affected the entire health care system and workforce. We analyzed whether increased interest in CBO is reflected in research on the oncology workforce by reviewing abstracts submitted to the ASCO Annual Meeting between 2013-2022. Methods: We reviewed abstracts from the 2013-2022 ASCO Annual Meetings available from the ASCO Data Library. We limited our analysis to abstracts accepted to the Care Delivery and Regulatory Policy, Health Services Research, and the Professional Development & Education Advances tracks. Abstract titles and body text were searched for keywords related to CBO, and a manual review was conducted to ensure match validity. A Poisson regression was used to estimate the annual rate of change. Results: Of the 48,761 abstracts submitted to the ASCO Annual Meeting between 2013-2022, 4,843 abstracts were submitted to the tracks of interest. The keyword search and subsequent manual review identified 53 abstracts related to CBO (1.1% of relevant track submissions, and 0.1% of all abstract submissions). 4 (8%) abstracts flagged for CBO terms were submitted in the first 5 years of the time-period (2013-2017), while 49 (92%) abstracts were submitted in the last 5 years of the time-period (2018-2022). From 2013-2022 there was a 34.1% annual increase (95% confidence interval: 18.1%, 54.1%) in CBO related abstracts submitted to the tracks of interest. Of those submitted between 2021-2022, 30% (n=8) were related to the impact of COVID-19 on CBO. Between 2013-2022, 53% of all abstracts and 72% of health service track abstracts submitted to the ASCO Annual Meeting were submitted by US-based authors. Of the 53 CBO abstracts identified between 2013-2022, 72% (n=38) were written by US-based authors. Conclusions: CBO-related research submitted to the ASCO Annual Meeting increased between 2013-2022 with a predominant share originating from US-based researchers. This reflects the growing concern in the U.S. health care system around workforce wellness and the potential negative impact of CBO on the quality of patient care. Importantly, the factors contributing to CBO existed prior to the COVID-19 pandemic, including institutional and system-level burdens. The COVID-19 pandemic likely accelerated this existing trend as demonstrated by the increase in abstract submissions on CBO in recent years. [Table: see text]
Creation of an adherence assessment workflow through a quality improvement initiative.
Authors: Lee Erica Hyejin , Capezza Cassondra , Silvia Sarah , Giannone Gabriella , Legare Robert Duffy , Srivastava Piyush , Brown Britny R.
Published: October 2023

414

Background: Immunomodulatory therapies (IMIDs) have been shown to significantly improve overall survival and progression-free survival in patients with multiple myeloma. However, real-world adherence to IMIDs is not well documented. This quality improvement project aims to establish a process for adherence assessment documentation among patients taking IMIDs. Methods: A collaborative team was formed including pharmacists, a nurse, and an oncologist. Patients newly initiating IMID therapy (first 6 months of treatment) at Westerly and Waterford infusion sites were included for analysis. The baseline data period was a one-time lookback from the time of data availability through December 2022. Participating institutions completed a Qualtrics survey to quantify the magnitude of contributing factors for lack of adherence assessment, which were identified by a fishbone and process map. A Priority/Pay-off matrix elucidated the lowest effort and highest yield interventions. Plan-Do-Study-Act (PDSA) cycle methodology was used for post-intervention assessment, where Cycle 1 studied the impact of pharmacy team outreach using an Epic reminder list and SmartPhrase. Adherence rates to IMIDs were captured each month as a secondary outcome. This work was supported by a HOPA membership education initiative, which funded ASCO Quality Training Program participation. Results: The first PDSA cycle resulted in an adherence assessment rate of 80.5%. The inability to reach a patient via phone was the predominant reason for missing adherence assessment. Patients were classified as adherent in 81% (26/32) of encounters. Of encounters with nonadherence, 50% (3/6) had a delay in receiving their IMID. Conclusions: Our first PDSA intervention period resulted in a significant improvement in adherence assessment documentation, from 4.2% to 80.5% (Table 1). The inclusion of learners such as pharmacy students appears to improve adherence assessment feasibility. Limitations include a small study population (n=12) at two infusion centers in a single region (southern CT/RI). The next planned PDSA cycle is an Epic reminder list dedicated solely to IMID adherence assessment patients, enabling the pharmacy team to confirm all have scheduled follow-up.[Table: see text]
Assessing preventable emergency department visits and hospitalizations following implementation of a high-touch program at an academic cancer center.
Authors: Mistry Hetal , Wernert Taylor , Has Phinnara , Begnoche Megan H. , Fenton Mary Anne
Published: October 2023

415

Background: Patients with cancer undergoing treatment are high utilizers of emergency department (ED) services and are at increased risk of hospitalization. A “high-touch” (HT) model of identifying and increasing communication with cancer patients at elevated risk of ED visits was implemented. The goal was to assess whether patients in the HT cohort had a reduced rate of unplanned ED visits and hospitalizations when compared to patients prior to implementation of the model. Methods: In this retrospective study (1/1/2018-4/1/2021), 51 patients on primarily palliative-intent treatment for their cancer were prospectively included in the HT group based on providers’ assessment of their risk of ED visits and malignancy-related complications. This group was compared to a similar cohort (n= 71) pre-implementation of the HT model. Data on baseline characteristics, malignancy type, reason for unplanned ED visits, and patient interaction with the oncology clinic immediately prior to ED visits were obtained, along with end-of-life outcomes including palliative measures. Each ED visit was also categorized as a potentially preventable or non-preventable visit, based on established criteria from Centers for Medicare and Medicaid Services (CMS). Results: While implementation of a HT program did not significantly decrease utilization, the percent of ED visits (p < 0.001) and hospitalizations (p = 0.002) for CMS-preventable reasons was notably higher in the HT cohort. Patients in the HT cohort also reached out to clinic providers significantly more frequently before visiting the ED (p < 0.001). Over half of patients in the HT cohort were seen by a palliative care physician in the inpatient setting within the last 6 months of life. Patients in both groups had similar high rates of dying at home or inpatient hospice versus dying in a hospital setting. Conclusions: Incorporation of a HT model of care in an oncology clinic may promote closer patient interaction with oncology providers prior to emergency department visits, but may come at the cost of increased medical utilization for otherwise CMS-preventable hospitalizations.[Table: see text]
Implementation of advance care planning quality initiative in community cancer center.
Authors: Weber Dana , Traul Abigail
Published: October 2023

422

Background: Advance Care Planning (ACP) is an integral part of the journey of a cancer patient. Our goal was to increase awareness, normalize conversations, and improve documentation of Advance Care Planning needs in Oncology Patients. Methods: 2021 Q4: Identified MIPS 047 Advance Care Planning and PIMSH1 Advance Care Planning in Stage 4 disease as an opportunity to improve ACP. Forms updated to include ACP information on New Patient Paperwork, including a Consent to Communicate, which included detailed information on Surrogate Decision Maker designation. Q1: Letter to the patient was added to New Patient Packet with information on Advance Directive (AD) and POLST for all patients. Standardized the use of Oregon Health Authority AD and User Guide, available in multiple languages. Q2: Educated Front Desk staff to include screening for Surrogate Decision Maker. Educated MA team on screening for ACP needs, appropriate documentation in EHR and State POLST Registry, and on appropriate follow up for patients requesting ACP counseling Q3: The US Oncology Network provided a Difficult Conversations Workshop and ACP training with Support Services Team, including Patient Navigation Team and Social Workers. Social Workers provided ACP visits. Q4: Standardized Nurse Navigator visits to include ACP needs and resources at C1D1 education or when referred. 2023: Changes to workflow are on-going and fine tuning occurs with review of metrics and a Continuous Quality Process Improvement plan. Results: See table. Conclusions: MIPS 047 has risen from 42.8% in 2021 to 94.4% 2023 YTD, which includes patients 65 and older that have been screened for ACP needs, have designated a Surrogate Decision Maker, or have a copy of an AD or POLST on file in the EHR. This has increased from 21.8% to 77.6%. Early and often conversations around ACP has markedly increased ACP information and education for a large majority of our patients. This team-based approach has impacted increase in metrics and understanding.[Table: see text]
Lean Six Sigma implementation in medical school.
Authors: Alin James , Gangasani Nikhil , Wood Madison , Kim Joyce , Schafer Pascha
Published: October 2023

426

Background: While medical schools teach advanced medical, surgical, and radiation interventions in oncology, we often don’t teach students how to identify deficits in existing modalities and methodically implement change. Medical students are underexposed to concepts of QI, and many medical educators feel that tools like Lean Six Sigma are too advanced or esoteric for student involvement. A gap exists to create a QI curriculum that invites medical student engagement, while also allowing them to develop self-efficacy to begin a lifelong career of continue process improvement in medicine. Methods: We previously demonstrated that a Value-based Care competition, can serve as a medical school QI curriculum with high levels of student engagement in both local and national competitions. Teams of students collaborate with key stakeholders at their hospital to implement QI projects through the Lean Six Sigma process improvement methodology. This competition is currently completing its third year, and recruiting for the 4th cycle. We performed a multi-year review of student engagement, the degree to which students progressed down the steps of Lean Six Sigma, and the outcomes of QI projects developed through these competitions. Results: For the 2022-23 competition cycle, six medical schools across the country (MCG, UCSD, Florida State University (FSU), Baylor, Penn State, and even internationally at the University of Queensland ran local competitions, representing a 50% growth over the previous cycle (four schools total in 2021-22). Of these schools, four of them are now participating in the National Competition to implement their projects using Lean Six Sigma; representing a 33% growth compared to last year (three schools total in 2021-22). In terms of implementation tools, students have successfully achieved IRB approvals, development of implementations timetables, defining and measuring controls and outcomes, and recruiting patients. Conclusions: Despite being busy with many other components of their medical education, and despite the entirely voluntary nature of the competition, there continues to be a strong appetite amongst medical students to participate in quality improvement. Students have demonstrated their willingness and ability to learn and implement QI projects using Lean Six Sigma. We have also employed a ‘see one, do one, teach one’ model of peer mentorship to create a sustainable multi-year, multi-school, and now multi-national curriculum that continues to grow.
Evaluating feasibility and acceptability of an innovative personalized hybrid longitudinal communication skills training program.
Authors: Kania Brooke Elizabeth , Kapoor Sharan , Kamath Bhoomika , Habib Muhammad Hamza Hamza , Saraiya Biren
Published: October 2023

428

Background: Effective patient-physician communication plays a vital role in providing care. Improved patient satisfaction and reduced burnout are among the many benefits of effective communication. Medical training in this area through didactic lectures, group discussions, and role play with feedback can facilitate better acquisition and honing of communication skills. We aimed to create a longitudinal training program assisting residents in developing communication skills. Methods: Internal Medicine (IM) residents participated in a 6-month project as part of their training. Residents completed a baseline questionnaire to assess confidence in communication skills, followed by a curriculum comprised of 3 x 1-hour sessions every 5 weeks where expert lecturers guided didactics on pertinent topics (e.g., delivering bad news, discussing goals of care (GOC), and completing a Practitioner Orders for Life-Sustaining Treatment (POLST)). Participants completed post-session surveys after each training, and a comprehensive post-training self-assessment. Comfort level was assessed on a 1-5 scale (1 least comfortable, 5 most comfortable) throughout the surveys. Results: Pre-intervention, most residents utilized “Ask, Tell, Ask (ATA)” (46.67%) and “Setting, Perception, Invitation, Knowledge, Emotion, Summarize (SPIKES)” (40%) frameworks to facilitate conversations with patients. Post-intervention, a greater number of residents utilized SPIKES (52.08%) compared to ATA (37.5%). 1st (PGY1) and 2nd (PGY2) year residents reported completing +25.71% and +60% more POLST forms post-intervention. In the inpatient (IP) setting, resident comfort levels in initiating GOC increased by +15.8% (for PGY1s) and +6.7% in total (all classes). Comfort levels in breaking bad news to patients in the IP setting increased by +9.09% (+24.14% for PGY1s specifically). PGY2s had the most substantial increase in comfort level in completing POLST forms (+21.08% IP, +31.52% outpatient (OP)), with an overall improvement in comfort from all classes of +12.32% (IP) and 12.53% (OP) post-intervention. Conclusions: This curriculum represents a helpful tool to improve physician-patient communication among IM residents. PGY1s demonstrated the most substantial improvement in confidence following the program, which may indicate the importance of prioritizing training for first year residents. Qualitative feedback from residents included distributing sessions throughout the year (beginning, middle, end), holding sessions in the intensive care unit (ICU) for applicability to patients in real-time, and continued instruction of practical skills. These findings may allow for future curriculum planning to help bolster trainee confidence and skills when facilitating meaningful conversations with their patients.
Enhancing policy communication: Establishing a formal channel for disseminating policy updates to improve staff access and engagement.
Authors: Man Yun , Xu Fuwang , Scullion Bridget
Published: October 2023

43

Background: Institutional policies serve as a fundamental framework that enables staff to fulfill their roles and responsibilities. A comprehensive analysis of 5 months of policy access log data extracted from Ellucid, our policy management system, showed that the average views per updated pharmacy policy ranged from 0 to 3 within the 7-day period following the updates. These findings reveal a notable lack of visibility and limited user engagement with policy updates within the pharmacy department, which consists of approximately 300 staff members. To bridge this gap and enhance policy communication, we aim to keep pharmacy staff well-informed and provide easy access to the most up-to-date policies at Dana-Farber Cancer Institute. Methods: The study employed the Plan-Do-Study-Act (PDSA) cycle methodology to guide the quality improvement process. An assessment of preintervention data from the policy access log was conducted to identify the problem. Subsequently, a survey was designed and administered to evaluate staff’s ability to navigate the policy management system, their awareness of policy updates, and their preferred communication channels for receiving updates. Descriptive statistics were utilized to summarize the survey responses, providing valuable diagnostic data. Additionally, a Statistical Process Control (SPC) chart was employed to monitor the process change over time, ensuring ongoing improvement. Results: The survey was distributed to select pharmacy staff in various areas, with a response rate of 30% (13/42). The majority of participants (80%) indicated that email is their preferred communication method for receiving policy updates on a quarterly basis. In the first cycle of the PDSA, an email communication channel was established using the Staffbase program to disseminate policy updates and was piloted within the pharmacy department. The email communication included a summary of all pharmacy policy updates from the past three months, with key changes highlighted. Each policy was attached with a hyperlink directing staff to the full policy on Ellucid, facilitating convenient access. Staff were also provided with education on navigating the communication email. These interventions resulted in a two-fold increase in the policy access rate compared to the baseline. Conclusions: The implementation of a formal communication channel for policy updates, along with improved accessibility to relevant content, successfully enhanced pharmacy staff access to policies. Ongoing monitoring of the policy access log will be maintained to ensure the sustainability of these improvements in the future.