bluuebunny/crossref_metadata_2025 huggingface dataset:
Family caregiver needs assessment in a gynecologic oncology practice: An ASCO quality training program project.
Authors: Donovan Heidi AS , Boisen Michelle M. , Hand Lauren , Lee Young Ji , Lersch Nora , Roberge Mary , Suchonic Barbara , Thomas Teresa , Campbell Grace
Published: October 2019

178

Background: Family caregiver (CG) demands in gynecologic oncology (gynonc) put CGs at risk for anxiety, depression, and inability to care for loved ones. Resources exist to support patients, but systematic support for CGs is lacking. Fifty percent of CGs in our clinic report 9 or more distressing unmet needs. Thus, an ASCO Quality Training Program (QTP) project aimed to assess and intervene on the needs of 75% of gynonc family CGs (identified in a concurrent QTP project). Methods: An interprofessional team reviewed baseline data, defined the problem and project aim, created process maps, and identified root causes of poor CG documentation. With stakeholder buy-in we implemented eight successive PDSA cycles over 6 months to address root causes. Biweekly team meetings were throughout the PDSA cycles. Outcomes were percent of CGs with 1) needs assessed, and 2) intervention received. Results: Root causes of poor CG assessment included 1) no protocol to assess/respond to CG needs; 2) no designated staff to ‘own’ CG assessment; and 3) lack of understanding of the value of CG support among clinicians. PDSA 1 (pre- launch) included: develop CG assessment/intervention protocol; create CG tracking database; pursue EHR capabilities. PDSA cycle 2-3 prioritized information provision about resources (52-73% of CGs) over individualized assessment (20-23% of CGs) due to the large number of CGs identified. Subsequent PDSAs sought to increase assessment effectiveness by focusing assessment/intervention on CGs of newly diagnosed and high risk patients. While there was variability in outcomes across cycles (Table), by PDSA cycle 8, staff had assessed and intervened on 58% and 50% of CGs, respectively. In addition, multiple potential serious CG and patient mental health crises were avoided from team interventions. Conclusions: CG assessment improved from 28% at baseline to >50% post implementation. Further efforts to more fully integrate assessment and tracking into EHR to reduce the burden of CG tracking over time is underway.

[Table: see text]
Living with advanced colorectal cancer: How prepared are informal caregivers to care for their loved ones?
Authors: Kerba Marc , Kassam Shireen , Beaumont Crystal , Biondo Patricia , Earp Madalene , Tang Patricia A. , Simon Jessica , Watanabe Sharon , Sinnarajah Aynharan
Published: October 2019

179

Background: The ‘Living with Colorectal Cancer’ prospective cohort study seeks to characterize the experiences of patients diagnosed with advanced colorectal cancer and their caregivers, in order to inform care improvements. Here we describe informal caregivers’ perceived preparedness for caregiving. Methods: Eligible patients were identified by oncologists in Alberta, Canada’s two tertiary cancer centers. Consenting patients were given the option to invite a caregiver to participate. Caregivers’ preparedness for caregiving was assessed at enrollment and every 3 months thereafter using the Preparedness for Caregiving survey. This survey assesses levels of preparedness using 5-point Likert scales for 8 caregiving domains (e.g. caring for the patient’s physical and emotional needs, finding and setting up services, stress of caregiving, responding to emergencies), and one open-ended question. Results: In one year of recruitment, 55 caregivers in Calgary and Edmonton were enrolled, of which 65% were female, and 80% lived with the patient. Caregiver preparedness decreased over time from months 1 to 7 of follow-up, across all categories. Caregivers were least prepared for the stress of caregiving and caring for the patient’s emotional needs. They were most prepared for taking care of the patient’s physical needs at enrollment. Open-ended comments on specific preparedness needs were numerous and extensive. A range of topics were reported, the top three being: caregiver health (physical, mental, self-care), emotional aspects (preparing children and family, feeling alone) and end of life (hospice, palliative care, transitioning). Conclusions: Our data suggest that in the advanced cancer setting, caregiver perceived preparedness declines, with increasing stress and emotional distress over time. This may be related to patient illness progression. The open-ended qualitative comments on the Preparedness for Caregiving survey were particularly useful in understanding specific caregiver concerns. Caregiver experience, including sense of preparedness, is often under evaluated and this study suggests more attention is needed. Clinical trial information: NCT03572101.
Improving the survivorship care plan process across an academic and community cancer center.
Authors: Stuver Robert , Faig Jennifer , Abrahamian Gerry , Cadorette Matthew M. , Decaneas William M. , Kaplan Irving D. , Kent Michael S. , Van De Wege Christine , Zerillo Jessica A.
Published: October 2019

184

Background: The goal of a survivorship care plan (SCP) is to improve provider coordination and engage patients in their care. Despite requirements from professional societies, implementation of SCPs is challenging. From April to July 2018, 36% of eligible patients received an SCP at our institution. We aimed to identify barriers to SCP completion and implement interventions to increase their delivery for all cancer types at our academic and community cancer sites. Methods: We created a survey to assess physician, nursing and trainee perceptions and identify barriers to SCP completion. The survey was sent to providers within our medical, surgical, and radiation oncology departments. Providers were asked to rate their satisfaction with our current SCP process and identify obstacles and solutions to achieve SCP completion. In response, we held meetings between oncology attendings, trainees, tumor registry staff, and health information management personnel to design an improvement plan. Results: Of 178 providers, 74 (41.6%) responded. Four percent were satisfied with our current process. The most frequently cited barriers were time (62.1%), lack of clarity regarding who completes the SCP (52%), and insufficient personnel (47.3%). The most frequently cited solutions were dedicated personnel (84.9%), disease-specific templates (61.6%), and education regarding SCPs (48.1%). Based on these results, we: (1) Streamlined our SCP process by entering a partially-templated SCP into an eligible patient’s electronic medical record by our tumor registrar; (2) Asked for disease-specific recommendations that can be included in the template; (3) Asked providers to identify additional team members who assist with SCP completion so that SCPs can be appropriately queued; and (4) Designed an online educational module. Conclusions: We identified multiple barriers to SCP completion at our institution. In response, we implemented a multifaceted improvement plan across our academic and community cancer sites. An analysis of its effects are forthcoming.
Use of a question prompt list (QPL) to facilitate communication between patients with metastatic cancer and their oncologists.
Authors: Bah Tonjeh Mary Stella , McKenna Amber , Paul Anu , Marion Jay M. , Gambino Kristina , Tinsley Meagan , Person Elizabeth , Edwards Laci
Published: October 2019

187

Background: Difficult conversations require an immense amount of patience. Yet on average doctors allow patients 11 seconds to speak before interrupting, which makes determining the patient’s agenda and goals of care incredibly difficult. Most patients expect their doctor to initiate prognosis and end of life care conversations. An inexpensive, effective way to increase these conversations is with a Question Prompt List (QPL). Our study examines QPL use with patients who are at least three months into treatment for metastatic cancer and includes a pre and post-visit interview to provide a within-group analysis of the QPL’s effect on their understanding of disease state, prognosis, and goals of treatment. Our patient population includes patients of lower socioeconomic background and a higher percentage of African Americans. Methods: 35 out of 155 eligible patients identified by chart review were enrolled in the study. They were interviewed about their diagnosis and prognosis before their oncologists visit. At the end of the interview, patients were given a QPL and encouraged to read it. Once the oncologists completed the visit, the researcher conducted a final interview about their disease state. Results: Before seeing their oncologist, 26 patients (74%) completely read the QPL. Most patients would recommend more physicians use this tool (77%). Of note, patients thought of new questions or concerns (51%), felt more comfortable asking questions (46%), and reported asking more questions compared to prior visits (34%). A staggering majority (68%) of patients reported never having a prognosis discussion prior to today’s visit. Previously, only 15 patients (43%) understood their treatment was palliative compared to 19 patients (54%) after this visit. Conclusions: The QPL was viewed as beneficial by most patients and increased question asking, prognosis conversations, and accuracy of goals of treatment knowledge. The QPL tool is inexpensive and requires minimal work by office staff to implement. We plan to expand our study and if results remain unchanged, we will look at studies to investigate a shortened QPL given at an initial consultation and used at subsequent visits.
Self-reported patient barriers and the impact of digital health coaching on PRO in cancer.
Authors: Allison Matthew , Burton Stephen , Patel Dhiren , Brassil Kelly Jean
Published: October 2019

189

Background: Barriers during cancer care include lack of social support, financial concerns, and communication with providers. While navigation has been identified as a way to address these concerns in the clinical context, opportunities exist to identify and address patient-reported barriers through digital health coaching to support patients beyond the clinical care setting. Methods: A retrospective analysis evaluated patient-reported barriers during cancer care for 708 individuals over the course of a digital health coaching program. Barriers were assessed in six domains, each represented by 5-10 questions in a company developed survey. The questions were administered prior to coaching on content aligned to the domains, specifically eating healthy, exercise, financial, access to care and medication adherence. Patients ranked both the presence and severity of the barrier. Patient reported outcomes such as exercise (Godin), health eating (Start the Conversation), financial toxicity (Comprehensive Score for Financial Toxicity (COST)) and physiologic and psychosocial outcomes (Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) 10) were measured and aligned to the barrier domains identified by the participants. Results: The eating healthy domain (2.43) received a significantly higher average score compared to other domains: financial (1.86), exercise (1.71), medication adherence (1.68) and access to care (1.65). Over the 12-week coaching program, physical activity increased by 56%, fatigue was reduced by 32%, financial toxicity was reduced by 8%, the healthy eating score improved by 17% and pain was reduced by 13%, as reflected in the PROMIS GH-10, Godin, STC and COST data. Conclusions: Outcomes suggest that healthy eating is a significant barrier identified by cancer patients during their treatment, followed by financial concerns and exercise, each of which demonstrated improvement over the course of digital health coaching. These results suggest digital health coaching provides a benefit to addressing barriers during cancer treatment and may improve patient reported outcomes, particularly as they relate to wellness behaviors such as healthy eating and exercise.
Developing a strategy for delivering educational information to patients with cancer.
Authors: Monteleone Emily Elizabeth , Rachek Meredith , Ibsen Alison , Carrino Cheryl M. , Wortham Edwin , Hook Andre , Steele Scott
Published: October 2019

190

Background: Patients’ preferences and ability to receive information regarding their cancer diagnosis and treatment vary greatly. Large academic medical centers are skilled at diagnosing and treating cancer. The perceived patient experience can be influenced by the delivery of information provided to them by clinical teams, support staff, and online resources. This project identified nuances in how cancer patients absorb and reference information regarding their diagnosis and treatment; specifically, treatment modalities, side effects, and resources available. The objective was to develop a strategy to improve and standardize the delivery and availability of educational information in our large academic medical center. Methods: Development of a team that has influence and understanding in various communication functions throughout the enterprise. Primary focus was on cancer patients. Research was conducted in three phases. Phase one was a patient panel survey electronically administered. Phase two involved observations and interviews of current breast cancer patients. Phase three incorporated the feedback received and design concepts generated from research during phases one and two, and involved six cancer patient focus groups. Results: Panel survey results contained feedback from 777 participants previously diagnosed with or caring for someone with cancer. Observations and interviews encompassed over 40 hours of information gathering from all stages of the breast cancer treatment process, including survivorship. Focus groups involved 7-9 patients (50 total) each of varying ages and diagnoses, with 4 of the 6 groups treated at our cancer center. Conclusions: In getting to know patients, large academic medical centers can tailor their educational information to ensure everyone receives what is needed and wanted in the time and manner best suited for them. Core components of the strategy being developed are 1) formulating ways to personalize the delivery of information, 2) methods to allow patients’ caregivers to participate in educational discussions remotely, 3) enabling on demand access to content previously discussed in person, 4) setting expectations for the intent of appointments ahead of time.
Improving documentation of pain and constipation management within the cancer center of a large urban academic hospital.
Authors: Chineke Iloabueke Gabriel , Curry Marjorie Adams , Dutcher Giselle , Power Steve , Bernal-Mizrachi Leon
Published: October 2019

192

Background: Pain and constipation are common among patients with cancer and remain inadequately controlled in many. Quality Oncology Practice Initiative (QOPI) assessment of pain and constipation at the Georgia Cancer Center for Excellence at Grady Health System identified documentation to be below benchmark levels. A quality improvement initiative to improve pain and constipation management was conducted. Methods: Given the low baseline documentation rates for pain (60%) and constipation (20%), we aimed for a 20-percentage point increase within one year. Based on cause and effect analysis and questionnaires to providers, our multidisciplinary team developed a new provider note template to integrate nurse’s assessment of pain and constipation into the provider’s documentation. A new order panel was developed in the electronic medical record (EPIC) to link appropriate orders with the pain and constipation plan. Results: Integrating the initial nursing assessment into the provider note template increased pain score documentation from 66.7% to 100%, P < 0.01 and pain management plan from 65.3% to 86.4%, P = 0.06. Similarly, constipation assessment documentation improved from 20.4% to 100%, P < 0.01 and a documented constipation plan improved accordingly from 11.2% to 29.1%, P < 0.01. As a result of this intervention, pain control at the 3rd clinic visit improved from 61.5% to 86.8%, P < 0.01. Emergency room visits related to pain and constipation decreased (16.2% to 14.9%, P = 0.19) and hospitalizations marginally increased (1.6% to 3.6%) during the study period. Conclusions: A standardized visit template and mandated assessment of pain and constipation exceeded the goal for improvement in documentation and positively impacted outcomes.
Stability of symptom clusters in patients with gastrointestinal cancers receiving chemotherapy.
Authors: Han Claire J. , Reding Kerryn , Cooper Bruce A. , Paul Steven M. , Conley Yvette , Hammer Marilyn J. , Wright Fay , Cartwright Frances , Levine Jon , Miaskowski Christine
Published: October 2019

193

Background: Patients with gastrointestinal (GI) cancers who undergo chemotherapy (CTX) experience on average of thirteen symptoms. These co-occurring symptoms often cluster together and can influence various patient outcomes including quality of life (QOL). However, little evidence is available on how these symptoms change during a cycle of chemotherapy (CTX). An evaluation of how these symptom cluster together and how these symptom clusters change over time may provide useful information to guide symptom management strategies tailored to multiple symptoms. Objectives: The purpose of this study was to identify and compare symptom clusters using three symptom dimensions (i.e., occurrence, severity, and distress) at different time points during CTX (i.e., prior to CTX [T1], one week after CTX administration [T2], and two weeks after CTX administration [T3]) in patients with GI cancers. Methods: A modified version of the Memorial Symptom Assessment Scale was used to assess the occurrence, severity, and distress of 38 symptoms. Exploratory factor analyses were used to create the symptom clusters. Results: Five distinct symptom clusters were identified across the three symptom dimensions and the three assessments (i.e., psychological, CTX-related, weight change, GI, and epithelial). Psychological, CTX-related and weight change clusters were relatively stable for all three symptom dimensions as well as across time. GI cluster was identified only at T1, while epithelial cluster was identified at T2 and T3 for all three symptom dimensions. Conclusions: The number and types of symptom clusters appear to be relatively stable over time and across the symptom dimensions. Timely management of symptom clusters should be continued over the course of CTX including the recovery phases. Further studies are needed to explore the mechanisms of symptom clusters in patients with GI cancers undergoing CTX.
Performance of the patient reported CAPLET2.0 physical functioning assessment tool.
Authors: McCartney Alexandra , Singer Julia , Aggarwal Reenika , Hueniken Katrina , Commiting Raiza , Shah Shubhangi , Tang Susan , Bapat Priya , Chow Pansy , Dietrich Kristen , Hall Elizabeth , Brown M. Catherine , Xu Wei , Liu Geoffrey
Published: October 2019

194

Background: CAPLET is a published patient reported outcome measure which assesses domains of physical function efficiently in cancer patients through a branching logic algorithm using a patient-reported outcome version of ECOG performance status and EQ5D-3L health utility score (PMID: 29982902; a total of 6 screening questions). We assessed the sensitivity and specificity of this tool after updating it with screening questions from the EQ5D-5L (CAPLET2.0) as opposed to the previously published EQ5D-3L screener (CAPLET). Methods: Eligible cancer patients across all outpatient clinics and disease sites (solid and liquid cancers) at the Princess Margaret Cancer Center completed a questionnaire on touch-screen technology containing the EQ5D-5L, patient-reported outcome (PRO)-ECOG performance scale, the gold standard WHODAS 2.0 (12 items) and HAQ-DI (20 items) physical functioning questionnaires, and a clinico-demographic survey. Results: Of 261 patients, 53% were female, 61% were Caucasian, and 71% had English as a first language. Disease sites included: 12% breast, 10% gastrointestinal, 12% genitourinary, 19% gynecological, 13% head and neck, 13% lung and 13% hematological cancers. The optimal branching logic cut-points were identified when PRO-ECOG, scored as 0-1 and individual EQ5D items scored with the best functioning category allowed specific WHODAS/HAQ-DI questions to be skipped. Against individual WHODAS-HAQ-DI items, CAPLET2.0 had sensitivities ranging from 83-100% (median 93%), and specificities of 50-82% (median 58%). Using CAPLET 2.0, 45% of patients could have skipped all but five questions measuring mental health and cognition which are always asked. Sensitivities, specificities and the proportion of questions that could have been skipped were all similar to the original CAPLET tool. Conclusions: CAPLET2.0, which uses the updated EQ5D-5L and PRO-ECOG as screening questions to assess physical function in cancer patients has comparable performance to the original CAPLET tool. CAPLET2.0 is therefore a viable alternative physical functioning screening tool for both routine and research use.
Correlates of distress for cancer patients: Results from multi-institution use of holistic patient-reported screening tool.
Authors: Weldon Christine B. , Gerhart James I. , Penedo Frank J. , Pasquinelli Mary , Martin Joanna , Khosla Paramjeet , Lillis Teresa , Lo Shelly S. , Feldman Lawrence Eric , Deamant Catherine , Berardi Rosa , Miranda Harry , Newsom Carol , Bowman Anne , Roggenkamp Betty , Trosman Julia Rachel
Published: October 2019

199

Background: The Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action for cancer patients. NCCN and ASCO supportive care and age-related guidelines include patient reported concerns beyond distress. This study compares PHQ4 scores to other patient reported concerns. Methods: The Coleman Supportive Oncology Collaborative aggregated “best of” screening tools to assess patient reported needs and concerns aligned with CoC, NCCN and ASCO guidance. This supportive care screening tool was implemented at 8 sites from July 2015 thru July 2018. Analysis used chi squared test. Results: Most patients, 86% (10,635/12,295), reported one plus concerns and/or above threshold scores on PHQ4, PROMIS Pain, Fatigue or Physical Function. A chi squared comparison of patients with at least mild distress on PHQ4 to patients with no distress resulted in p values < .0001 for every screening category. Conclusions: Patients with a PHQ4 distress score of mild, moderate or severe also reported statistically significant levels of practical, family, physical, nutrition and treatment concerns. These patients also scored threshold levels for PROMIS Pain, Fatigue, and Physical Function. Screening only for distress without screening for other patient concerns may direct patients to services that do not address or focus on the underlying cause of the distress.

[Table: see text]
Effects of rising drug costs on efforts to control overall cost at a large academic cancer center.
Authors: Adelson Kerin B. , Canavan Maureen , Supalla Susanna N. , Sedghi Tannaz , Chaudhry Basit , Sinanis Naralys , Gross Cary Philip
Published: October 2019

2

Background: Value-based payment programs like the Oncology Care Model (OCM) have focused efforts to reduce costly acute care use through improvements in access and coordination rather than targeting the exponential rise in pharmaceutical pricing. We assessed how participation in OCM affected total cost of cancer care at a large academic cancer center. Methods: Using Medicare claims for Yale-Smilow Cancer Hospital, an NCI-designated cancer center with an academic hub and 10 community practices, we identified episodes for chemotherapy initiated during a historical period (pre-OCM, 2012-2015) and performance period (post-OCM, 2016-2017) following OCM criteria to identify total cost of care. We reported frequency of utilization categories, the mean cost per episode, the proportion of total cost attributed to each utilization category and compared pre- and post-participation periods. Results: There were 8,843 episodes during the historical period and 6,679 episodes during the performance period. The mean total cost per episode increased from $28,645 to $32,666, but this was less than the Medicare-defined expected increase (target price). Between the two periods, the percentage of total episodes decreased for emergency department (ED) use from 36% to 33%, inpatient care from 33% to 29%, and post-acute care from 28% to 25% (p < 0.01). Mean costs of drugs per episode increased by 27% between periods, and from 52% to 58% of total cost of care (p < 0.01). While mean cost per episode for ED, inpatient, and post-acute care remained stable, the mean cost per episode for antineoplastics increased 39% from $10,676 to $14,843. Conclusions: After implementing OCM, we beat the Medicare target largely by decreasing acute care use and stabilizing the cost of hospitalizations and ED; however, actual cost increased largely due to pharmaceutical spending. Because drug costs were the largest proportion of overall cost of care, future value-based models must address the rising cost of pharmaceuticals.

[Table: see text]
Perspectives on cancer care delivery from oncology patients who experienced unplanned acute care events.
Authors: Kaufmann Tara L. , Rendle Katharine A. , Aakhus Erin , Bilger Andrea , Gabriel Peter Edward , Nimgaonkar Vivek , Shah Arnav , Trotta Rebecca , Barg Frances , Bekelman Justin E.
Published: October 2019

201

Background: Unplanned acute care is debilitating and burdensome for patients with advanced cancer and their caregivers. There is a pressing need to understand how available evidence-based practices (EBPs) to reduce acute care 1) align with the needs and priorities of patients and 2) are best implemented within large health systems. We are conducting a mixed methods study to assess patient- provider- and system-level factors that shape the decision to seek acute care during active cancer treatment in order to select and adapt EBPs for implementation. Here we present data from patients’ perspectives. Methods: Purposive sampling approach to identify solid tumor cancer patients on active treatment with unplanned acute care events at a large health system from Aug 2018-Jan 2019. We conducted semi-structured interviews to elicit patients’ perspectives on factors that shape their decision to seek acute care and to inform intervention strategies. Results: Forty-nine patients participated in this study. We identify several patient factors that intersect with the decision to seek care: self-management behaviors, guilt, negative ED perception, safety concerns, and trust. Patients attempt self-management prior to contacting their oncology team, which introduces variability in the duration and severity of reported symptoms. Delay is related to patients’ guilt for burdening their oncology team and to provider accessibility. Patients describe a high symptom threshold to seek care that is often coupled with a negative perception of the ED, but do prefer in-person evaluation for new and distressing symptoms for safety. They express a high level of trust in the oncology team and relative distrust of non-oncology providers. Conclusions: Our data suggest a conceptual model for patient factors that drive unplanned acute care. Patients identify three areas for improvement: 1) enhanced peer support and education to manage uncertainty about cancer treatment; 2) accessible portals for patient-clinician communication; and 3) home or clinic-based after-hours oncology symptom management. Interventions to target these needs should address patients’ emotional concerns and be well integrated within the oncology team.
A PROM pilot in GI oncology clinic: Outcomes and lessons in real-world implementation.
Authors: Halbert Brian , Doolin Jim , Tocci Noah Xavier , Zerillo Jessica A.
Published: October 2019

202

Background: Patient reported outcome measures (PROM) can prolong survival, improve quality of life and reduce ED visits. However, implementation of PROM into practice is challenging. We present the results of a PROM pilot in a tertiary GI oncology clinic. Methods: We recruited a convenience sample of 20 patients undergoing infusional chemotherapy. Patients were English speaking and > 18 years old. We developed a PROM instrument targeting pain, nausea, diarrhea, constipation and fever symptoms in a third party secure online application. Symptoms were scored by frequency and severity on a 5-point Likert scale. The survey was distributed weekly to patients via the patient portal from March to April 2019. Survey results were monitored in real-time. Clinical teams were notified for any symptom score of 4 or 5, increase by 2 or more points between weeks, or self-identified concern. We conducted telephone interviews of non-responders halfway through the pilot to assess reasons for non-response. Results: The mean age was 59 years. Most were female (55%) and self-identified as white (75%). Colorectal (45%) and pancreatic (40%) cancer were the most common cancer types. Most (80%) had metastatic disease and FOLFOX (45%) was the most common regimen. Of the 121 weekly surveys sent, we received 40 responses (33%). Individual response rates ranged from 0% to 100% with a median rate of 25%. Of the 40 responses, 24 (60%) resulted in a clinical trigger. Pain was the most common trigger (n = 15; 63%) followed by self-identified concern (n = 9; 38%). Five triggers resulted in change in management; recommendation of an OTC medication was the most common intervention. There were 6 ED visits or hospitalizations among 5 patients. Of 9 non-responding patients, 4 reported not seeing the e-mail and 3 reported illness as the reason for non-response. All reported continued enthusiasm for the project. Conclusions: Despite known benefits, successful implementation of PROM remains challenging. We found difficulties with automated integration into the electronic medical record and patient response rates. These factors must be addressed to allow a successful PROM program. Despite these limitations, significant enthusiasm remains for the future of PROM.
Integrating spiritual care into an ambulatory cancer center.
Authors: Terry Karen , Piccolino Sophia Tsesmelis , Williams Alaysia , Smith Cardinale B.
Published: October 2019

205

Background: Spiritual care is identified as a core component of quality oncologic care. Unmet spiritual needs can lead to worse quality of life, lower satisfaction with care, and greater psychological distress. Despite increasing evidence that cancer outpatients also have unmet spiritual needs, professional spiritual care is often limited in the ambulatory setting. Many cancer centers provide access to professional chaplains only while patients are hospitalized. Where chaplain services are available to outpatients, access is often limited. At Mount Sinai, we embedded a full-time professional chaplain in our ambulatory cancer center. This presentation will describe our methods, results, and conclusions from a year of data on outpatient spiritual care referrals. Methods: We identified three sources of referrals to spiritual care: direct referrals from patients’ primary oncology teams, direct referrals from Supportive Oncology/Palliative Care, and automatic referrals through a question about meaning and purpose on our distress screen. We also included the opportunity for patients to self-refer to spiritual care through our distress screen. We collected data on the number of patients identified through these referral sources, time to initial contact, and the validity of the referral as assessed by our chaplain. Results: These three sources resulted in 454 referrals to spiritual care. We screened 1,410 patients through our distress screen and 16% (226) triggered a referral to spiritual care. Distress screen referrals comprised nearly 50% of all spiritual care referrals. In addition, 32% (144) of our referrals came from the patients’ clinical teams and 10% (46) from the Supportive Oncology team. Our chaplain assessed that 31% (141) had a spiritual need that required regular follow-up and 12% (56) required monitoring. Conclusions: Using multiple referral methods we were able to identify a significant number of ambulatory cancer patients with an identified spiritual need. Future projects will look at specific metrics for patient experience, improving chaplain ability to connect with patients, validating our screening question for spiritual distress, and determining an appropriate patient load for an outpatient chaplain.
High-risk human papilloma virus testing in oropharyngeal squamous cell carcinoma at a university-based cancer center: A quality improvement project.
Authors: Kodali Deepthi , Sanders Melinda , Dowsett Robert James , Spiro Jeffrey , Hegde Upendra P.
Published: October 2019

21

Background: Although traditionally linked to smoking and alcohol, high-risk (HR) human papilloma virus (HPV) associated head and neck cancers are becoming increasingly common in non-smokers. HR HPV causes approx. 70% of all oropharyngeal squamous cell carcinomas (OPSCC) and they have better outcomes when compared with smoking associated OPSCC. An accurate HPV assessment in OPSCC is important due to its relevance in treatment and follow up. This Quality Improvement project was designed to evaluate frequency of HPV testing with p16 immunochemistry (IHC) staining in patients with OPSCC at a University-based cancer center. Methods: All cases diagnosed with OPSCC or those with high suspicion for OPSCC between 2008 and 2017 were obtained from Department of Pathology. Patients with biopsies from sites other than oropharynx as well as those with biopsies performed at outside hospitals were excluded. All pathology reports were reviewed to identifyfrequency of p16 IHC staining. Results: A list of 127 cases was obtained from Pathology. Of these, 26 non-OPSCC and external hospital slides were excluded, making sample size (n) 101. HR HPV testing by p16 IHC staining was performed in 42 of 101 patients (41.5%) and not performed in 59 (58.5%). 38 of 42 patients tested were positive for HR HPV (90.5%). There was an overall upward trend in the frequency of HPV testing over the 10 years. Conclusions: HR HPV testing was done only in 41.5% of eligible patients suggesting a deficiency in testing for this biomarker. Various causes for this lack of testing were identified, most common one being inadequacy of tissue specimen. 90.5% of eligible patients tested were positive for HR-HPV, highlighting the strong association between HPV and OPSCC. Based on importance of testing HR HPV in OPSCC and need for aligning with American Society of Clinical Pathology guidelines, corrective actions were proposed by meeting with pathologists and otolaryngologists.
Oncology urgent care to decrease unnecessary emergency room visits.
Authors: Abbott Maura , Hill Laureen , Kumaraiah Deepa , Russomanno Christina , Ustoyev Yelena , Drimer Katayen Danielle , Kaley Kate , Howard Kristina , Negron Maria , Schwartz Gary K.
Published: October 2019

212

Background: In March 2019, Columbia University Irving Medical Center (CUIMC)/New York Presbyterian (NYP) piloted an oncology urgent care center, Oncology Care Initiation Unit (OCIU). Patients currently on therapy were referred to OCIU Nurse Practitioners (NP) by primary Oncology Teams for acute, non-life threatening complaints for management. We evaluated the impact of the OCIU on preventing unnecessary emergency room (ER) visits, patient wait times, and patient satisfaction. Prior to the OCIU, 52% of oncology patients presenting to the ER were discharged indicating that an ER visit most likely was not needed. Average wait time for evaluation in ERs for non-critical patients is 7 to 9 hours and can be another 7 to 9 hours for intervention. Methods: We opened the 8-week OCIU pilot to Thoracic and Gastrointestinal (GI) Oncology, and Sarcoma patients who had an acute, non-life threatening complaint from, 8AM to 6PM, Monday to Friday. We collected data on all OCIU patient referrals from 3/7/2019 to 5/2/2019, including patient demographics, primary cancer diagnosis, chief complaint, wait times, interventions, disposition and patient satisfaction using a validated 5 question satisfaction survey. Results: During the pilot, we received 51 referrals, 44 (86%) were considered OCIU appropriate and evaluated; 25 (57%) had a GI cancer diagnosis, 14 (32%) Thoracic cancer diagnosis, and 5 (11%) Sarcoma. Primary chief complaints in order of frequency were pain, GI distress, and dyspnea. 44 (100%) had no wait to be evaluated by the OCIU NP. 33 (75%) of OCIU patients were discharged home, 9 (20%) were directly admitted, and 2 (5%) were transferred to the ER. Patients not requiring invasive intervention were discharged home within thirty minutes of their appointment. Patients requiring infusions, radiology services, and/or paracentesis or thoracentesis were discharged within 4 hours of appointment time. 100% patient satisfaction was reported. Conclusions: Implementation of the OCIU has led to decreased ER visits, wait times for evaluation and management, and increased patient satisfaction. These findings support the need for the OCIU, as well as increasing access to the OCIU by extending to additional HICCC patients.
Redefining functional status as a key cancer outcome: Patient-led measure conceptualization and development.
Authors: McNiff Kristen K. , Fuld Nasso Shelley
Published: October 2019

218

Background: Multiple national quality committees have identified PRO-PMs as priority for cancer measure development. Further, measurement of ‘return to functional status’ (RFS) has been prioritized. Finally, stakeholders have called for more patient-centric approaches to measure development. Accordingly, NCCS initiated a project funded by AIR to lead conceptual development and pre-testing specification of PRO-PMs to assess RFS. Methods: RAND Delphi methodology was employed to achieve conceptual consensus and measurement priorities. First, diverse cancer survivors were convened as a Delphi Panel. Themes from panelist brainstorming and related social media outreach, coupled with a detailed literature search, informed the Delphi survey development. Standard RAND Delphi survey methodology was followed, and panelists completed Survey 1. Areas of disagreement and uncertainty were the focus of discussion during a 2-day meeting, followed by Survey 2 completion /scoring. Results: The panel concluded that the term ‘return to functional status’ was inadequate. Structured discussion led to outcome re-naming as redefining functional status following a cancer diagnosis/completion of treatment. The Delphi method revealed priority measurement areas for survivors who have completed cancer treatment, and those receiving long term treatment. Priority areas include: overall quality of life; overall physical health; general mental health; changes in cognitive function; emotional problems; depression; fatigue; pain; changing dietary needs; late effects/side effects of treatment; ability to process loss or grief; maintaining everyday activities; overall independence; sense of control; and resilience. Conclusions: NCCS is a novel organization to lead measure development. NCCS engaged a diverse panel and used an accessible, structured approach to enable cancer survivors themselves to play the leadership role. Next steps for the project include development of pre-testing specifications for the prioritized PRO-PMs. Subsequent efforts will seek measure testing and endorsement. Ultimately, this work will contribute pragmatic methods/learning for future patient-led measure development.
Emergency department (ED) utilization among patients with cancer receiving intravenous (IV) chemotherapy.
Authors: Nipp Ryan David , Azoba Chinenye , Vyas Austin , Kay Paul , Fuh Charn-Xin , Wang Irene , Mai Minh , Soriano Margaret , Mulvey Therese Marie
Published: October 2019

22

Background: ED utilization among patients with cancer is often cited as a potential metric to improve the quality of oncology care. However, efforts to understand emergency department (ED) utilization among patients with cancer receiving IV chemotherapy are lacking. We sought to describe sociodemographic and clinical factors associated with ED utilization and explore predictors of ED arrival time. Methods: We conducted a quality improvement assessment of patients who visited the ED within 30-days of receiving IV chemotherapy at Massachusetts General Hospital from October 2017 to January 2018. We used descriptive statistics to describe the sociodemographic and clinical factors associated with ED visits. We used multivariable regression models to explore predictors of the following outcomes: (1) ED visit occurring during normal clinic hours; and (2) ED visit occurring during the weekend. Results: Of the approximately 2,600 patients receiving IV chemotherapy during the assessment period, we identified 500 ED visits (~19.2%). For these ED visits, median patient age was 65 years (range: 22-93), and 49.6% were female. The majority were white race (84.8%), married (63.6%), diagnosed with metastatic disease (70.4%), and 8+ days since receiving most recent chemotherapy (71.4%). The most common cancer types were gastrointestinal (24.2%), lung (13.2%), and lymphomas (11.0%). The most common reason for ED visits included pain (20.4%), fever/cold symptoms (18.0%), and fatigue (11.0%). Over half (50.4%) of ED visits occurred during normal clinic hours and over one-fourth (28.2%) occurred during the weekend. We found that ED visits were less likely to occur during normal clinic hours for patients with lymphomas (OR = 0.44, P = 0.013) compared with other cancer types. ED visits were less likely to occur during the weekend for patients of older age (OR = 0.98, P = 0.020). Conclusions: We identified a substantial number of ED visits among patients with cancer within 30-days of receiving IV chemotherapy, often occurring during normal clinic hours and most commonly for pain, fever/cold symptoms, and fatigue. These findings highlight issues to address when seeking to reduce ED utilization and enhance cancer care quality.
Evaluation of cancer patients’ perspectives on weight management counseling at a comprehensive cancer center.
Authors: Hansra Damien Mikael , Daniels Cynthia , Alvarez Ricardo H.
Published: October 2019

221

Background: Being overweight (OW) or obese (OB) is a risk factor for a variety of cancers & denotes a worse prognosis for some. Strategies on management of OW & OB patients (pts) are lacking. Data shows majority of physicians are OW & OB & confidence in OB counseling in these individuals is less compared w/ normal weight (NW) counterparts. Here we report results of a survey on cancer pt’s opinions on weight management. Methods: Pts asked to complete a 20-question (Q) survey. Clinical info collected: age, race, cancer type, weight class (underweight, NW, OW, OB, unsure but likely overweight). Survey Qs ask about optimal timing of weight counseling. Also, Qs regarding importance of their oncologists (ONCO) BMI assessed. Other Qs about pt risk factors for obesity, pt willingness, & pt preferred modalities to change dietary & exercise habits also assessed. Stats: 1-way ANOVA & students' T-test used to compare responses. P-value α = 0.05 used. Results: 245 pts completed the survey. Main Qs: Best time for ONCO to address weight with pts is? “Anytime” 45% (111/245), “First visit” 27% (65/245), “After main treatment” 27% (65/245), “Never” 1% (2/245) p < 0.01. Who would you listen to MOST about weight loss advice? “NW ONCO” 41% (101/245), “BMI of my ONCO does not matter” 53% (131/245), “OB or OW” 5% (13/245) p < 0.01. Pts tend to; "eat less healthy when stressed": true 77% (189/245) vs false 23% (56/245) p < 0.01; "eat less healthy when sad or depressed": true 72% (176/245) vs false 28% (69/245) p < 0.01; "exercise less since cancer diagnosis" true 61% (150/245) vs false 39% (95/245) p < 0.01. Pts are willing to change "dietary habits to induce weight loss": yes 94% (231/245) vs no 6% (14/245) p < 0.01; "exercise habits to induce weight loss": yes 96% (234/245) vs no 4% (11/245) p < 0.01. Results of clinical, demographics, other Qs included in presentation. Conclusions: Almost all pts would like to discuss weight loss on the first visit or after main treatment completed. Almost all pts are willing to change dietary & exercise habits. Also, most pts would like to receive counseling by their ONCO regardless of their ONCO’s weight. Furthermore, early interventions into pt's psychological health & exercise habits may benefit pts in weight management.
Understanding patient engagement in breast cancer survivorship care: A national web-based survey.
Authors: Post Kathryn Elizabeth
Published: October 2019

223

Background: Little is known about patient engagement (PE) into survivorship care (SC). Information is needed to further explore PE into SC, what factors may contribute to it and which patients are more likely to engage in SC and thus be better equipped to self-manage during survivorship. Purpose: The purpose of this study was to explore how demographic/personal factors and survivorship variables are related to and may contribute to PE in early stage breast cancer survivors. Methods: A cross-sectional, web-based self-report national survey was conducted using measures assessing personal/demographic factors, survivorship variables: health-related quality of life (HRQOL), fear of cancer recurrence, cancer health literacy and two measures of PE (patient activation (PA) and knowing participation in change (KPC). There was one open-ended question regarding additional survivorship concerns. Participants were recruited using Dr. Susan Love’s Army of Women Research Foundation and Craigslist. Data were analyzed via bivariate associations and backwards linear regression modeling in SPSS. Results: The final sample included 303 participants (301 females and 2 males), Μ age 50.70. The sample was predominantly White, non-Hispanic and equally dispersed across the United States. PE was significantly correlated with 13 predictors. There were 10 predictors resulting in significant ANOVA relationships with PA and KPC. In the KPC and PA regression models, HRQOL significantly predicted PE (p ≤ .001). In the KPC regression model, social support and level of education significantly predicted PE (p ≤ .001) and receipt of a survivorship care plan contributed unique variance to the model (9.1%). The open-ended question response categories included: physical and mental health concerns, financial toxicity, social support, body image concerns, other concerns or none. Conclusions: This study provides evidence that personal/demographic factors and survivorship variables may contribute to PE in breast cancer survivors. Findings may provide insight as to which survivors may be ready to engage in SC and those that may need more resources and support.