bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disparities between provider assessment and documentation of care needs in the care of adolescent and young adult patients with sarcoma.
Authors: McKay Grace Eileen , Parkes Amanda Marie 
Published: October 2020

218 Background: Given the occurrence of cancer during a complex developmental time, adolescent and young adult (AYA) patients have unique psychosocial needs, necessitating supportive care guidelines including National Comprehensive Cancer Network (NCCN) AYA guidelines. We sought to assess compliance with NCCN AYA guidelines and compare to oncology provider identified AYA care needs. Methods: Retrospective chart review was performed on AYA patients (15-39 years) with sarcoma seen at least once in 2019 at the University of Wisconsin (UW), identifying documentation of discussions deemed critical per NCCN AYA guidelines. As per ASCO’s Quality Oncology Practice Initiative certification, we considered a threshold of 75% or higher to be compliant. Compliance was compared with an electronic survey of UW oncology providers regarding AYA patient needs, with items determined to have adequate resources if noted sufficient by >75% of providers. Results: We identified 43 AYA patients with sarcoma. As seen in table, <75% of patients had documentation regarding contraception, fertility, finances, genetics, social work referral and clinical trials indicating non-compliance. Surveys, completed by 38 oncology providers, showed significant discordance between provider’s perception of adequate access to resources and compliance on chart review. Conclusions: Disparities between oncology provider assessment of AYA care needs and lack of documentation of critical components of AYA patient care demonstrates the need for novel tools to evaluate AYA care needs beyond provider assessments. Care needs identified in our study will serve as the basis of an ongoing quality improvement project to better support AYA patients at UW. [Table: see text]
Defining and measuring quality cancer survivorship care: An environmental scan.
Authors: Ly Lena , Lisy Karolina , Clode Melanie , Kelly Helana , Jefford Michael 
Published: October 2020

219 Background: It is recognised that current models of survivorship care are suboptimal and unsustainable. The landmark Institute of Medicine (IOM) report ‘From Cancer Patient to Cancer Survivor: Lost in Transition’ suggested four essential components of survivorship care: prevention of recurrent and new cancers; surveillance for recurrent or second cancers; intervention for consequences of cancer and its treatment, and coordinated care between health providers. The report also recommended “quality of survivorship care measures should be developed... and quality assurance programs implemented to monitor and improve the care that all survivors receive.” Nekhlyudov et al (JNCI 2019) built on the IOM’s recommendations to develop a quality of cancer survivorship care framework. We undertook an environmental scan to understand how quality survivorship care is conceptualised internationally, and what metrics are available. Methods: This scan comprised limited literature review, review of organisations’ websites, and expert consultation to source documents that described and measured quality survivorship care. Documents were assessed against the domains proposed by Nekhlyudov et al. Metrics were categorised as policy, process or outcome measures. Results: The search yielded 40 documents from six countries. There was agreement that quality survivorship care is founded on the IOM elements, expanded by Nekhlyudov et al. The review also noted risk stratification/personalised pathways of care and patient self-management as other elements of quality care. Many countries have proposed or implemented quality measures, with greater emphasis on processes over outcome assessments. Only the USA was found to have implemented policy measures. In the process domain, frequently reported metrics included completion of needs assessments and survivorship care plans, and adherence to recommended follow up guidelines. Regarding outcome measures, patient-reported outcomes and experiences were commonly proposed, however there was a lack of specific elements, or recommended instruments. Conclusions: There is broad agreement on what constitutes quality survivorship care internationally. Future work should consider policy or structural elements that support optimal care. Findings from this scan will inform a modified reactive Delphi study to establish consensus-based criteria for high quality survivorship care. Additional work should consider how to define and implement metrics of quality care, and how to use metrics to improve survivors’ outcomes.
Oral chemotherapy education: Hitting the mark?
Authors: Berry Jonathan L , Doolin Jim W , Diltz Garrett , Dechen Tenzin , Forbath Natalia , Zerillo Jessica A. , Shea Meghan 
Published: October 2020

221 Background: ASCO’s Quality Oncology Practice Initiative (QOPI) includes process measures on oral chemotherapy education. Whether achievement of these measures has an impact on clinical outcomes and if an intervention to improve these measures can improve outcomes is not yet known. Methods: A retrospective analysis was conducted of patients initiated on oral chemotherapy in an academic medical center site and a community oncology practice between January 2016 and October 2019. The primary aim was to compare the time to emergency department (ED) within 90 days from initiation of oral chemotherapy of patients who met the QOPI process measure through an intervention of pharmacist-driven education with a comparison group of patients who had not received formal education. A secondary aim was to assess for a difference in oral chemotherapy medication persistence. Data were also analyzed by demographics, concurrent parenteral therapy, intent of therapy, and disease group. Results: 285 patients in the education group and 284 patients in the non-education group were analyzed. The education group had a higher proportion of patients with gastrointestinal and gynecologic cancers, and a lower proportion of patients with hematologic malignancies, compared to the non-education group. The education group also had a higher proportion of patients treated at the community practice compared to the non-education group. There was no statistical difference in median time-to-ED, with 49 days (IQR 37-74) in the education group and 59 days (IQR 41-60) in the non-education group (p=0.15). Conclusions: In patients receiving oral chemotherapy, pharmacist-driven education with improvement in QOPI process measures did not result in an improvement in time to ED. One factor contributing to this result may be that only 20% of patients required ED-level care within 90 days of starting oral We continue to collect data regarding medication persistence, which may be a more sensitive outcome measure. At this point, further work is needed to determine if achievement or modification of the QOPI oral chemotherapy process measures results in a clinically significant change in outcome. [Table: see text]
Barriers and facilitators to implementation of serial point-of-care hearing tests using a novel iPad-based audiometry in platinum chemotherapy-treated cancer patients (pts).
Authors: Soberano Spencer , Khan Khaleeq , Hueniken Katrina , Diekoloreoluwa Famoriyo Elyon , Soriano Joelle , Gill Sarfraz , Zhan Luna Jia , Shepherd Frances A. , Sacher Adrian G. , Bradbury Penelope Ann , Leighl Natasha B. , Bedard Philippe L. , Hansen Aaron Richard , Spreafico Anna , Xu Wei , Brown Catherine , Liu Geoffrey 
Published: October 2020

223 Background: Platinum-based chemotherapy agents cause significant hearing loss in 40-80% of treated cancer pts. Lack of follow-up serial testing has created gaps in knowledge regarding hearing loss onset, progression, and possible recovery between treatment cycles. This study aims to determine barriers and facilitators to implementation of a tablet-based point-of-care hearing test, as a serial screening tool to address these knowledge gaps. Methods: From Jul 2019 to Mar 2020, 53 pts receiving high dose platinum agents were recruited from three clinics (Thoracic, head and neck, and testicular cancer) at a comprehensive cancer centre, to undergo serial audiometry testing. Baseline hearing tests, mid cycles (3,6, and 9 weeks), and post treatment tests (3,6,9,12, 19 and 24 months) were completed during the pts’ clinic appointments. Clinical research coordinators (CRCs) collected feedback from physicians, nurses, and pts to identify barriers and facilitators of implementing serial point-of-care hearing tests in these clinics. An inductive and iterative approach was used to identify themes. Implementation was tailored and mapped to the CIHR Knowledge to Action Framework (KTA). Results: Barriers: Logistical barriers included: locating quiet and accessible rooms to administer the test; pts being distracted or interrupted while completing the test; presence of family members adding to noise levels; concerns over the serial testing during treatment; length of each test; and clinic staff burden. Facilitators: User-friendly self-administered tests; increasing healthcare staff education and pt management. Adapting to the local context: Logistical barriers were resolved by CRCs designating quiet spaces for the study to occur, and meeting pts upon arrival to utilize their wait time. A ‘hearing test in progress’ sign put on exam room doors prevented interruptions. CRCs utilized the test’s ‘assisted mode’ feature to keep pts attentive and/or accelerate the process. Low noise level was emphasized to obtain accurate test results. Pt engagement in their test results facilitated retention in the study. Test length may be shortened in the future by omitting low frequency testing. Conclusions: Participants and stakeholders expressed support for in-clinic hearing tests and identified personal and systemic barriers to implementation. These findings suggest that implementation should focus on addressing concerns related to accessible rooms, pt time investment and overall clinic flow.
4R Care Delivery Program results: Impact of implementation metrics on patient self-management and 4R usefulness.
Authors: Trosman Julia Rachel , Weldon Christine B. , Makower Della F. , Rapkin Bruce D. , Perez Claudia Beth , Kulkarni Swati , Schaeffer Cathleen M. , Hoskins Kent , Gallagher Christopher , Lo Shelly S. , Grace-Louthen Cathy , Throckmorton Alyssa , Krueger Editha A. , Van Horn Jennifer , Reaves Brieyona Chardee , Ravelo Arliene , Yu Elaine , Schapira Lidia , Benson Al Bowen , Gradishar William John 
Published: October 2020

225 Background: We previously proposed a 4R care delivery model that facilitates teamwork and patient self-management (pSM) in cancer care (NCI ASCO Teams Project, Trosman JOP 2016). 4R (Right Info / Care / Patient / Time) enables patient and care team to manage complex care with an innovative 4R Care Sequence. We tested 4R at 10 US sites in a stepwise mode 2016-2019. Methods: Step 1 included 1 academic and 2 nonacademic sites; step 2 included 3 academic and 4 nonacademic sites. Patients with stage 0-III breast cancer received 4R Sequences (4R Cohort). We surveyed 4R and historical control cohorts of patients treated at the same sites pre-4R. We assessed the impact of implementation metrics on usefulness of 4R to the 4R cohort and on improvement of pSM in 4R cohort vs historical control cohort. Results: Survey response rates: 63%, 422/670 (4R cohort); 47%, 466/992 (control cohort). Three of the five implementation metrics significantly impacted patient usefulness of 4R (Table). Patients at step 2 sites; sites with a systematic care process; and sites with small practices reported significantly higher 4R usefulness than patients in the comparison subgroup within respective metrics. 4R usefulness was not affected by practice setting or availability of patient navigators. pSM was significantly improved between control and 4R cohorts along all implementation metrics (p < .001), but the magnitude of incremental improvement between comparison subgroups varied across metrics (Table), with the largest increment associated with the program step metric. Conclusions: 4R is useful to patients across settings, with or without patient navigators. Stepwise design is effective in increasing 4R impact overtime. Future 4R Program will investigate an expanded array of implementation metrics and their influence on 4R outcomes. [Table: see text]
Reducing futile acute care services (ACS) for terminally ill cancer patients (Dignity Project).
Authors: Salama Hind , Al Mutairi Nashmia , Damlaj Moussab , Alolayan Ashwaq Aman Mohammed , Binahmed Ahmed , Salama Hagir , Tlayjeh Haytham , Lawrence Myer , Shehata Hussam , Al Shami Mona , Alkaiyat Mohammad , Jazieh Abdul-Rahman 
Published: October 2020

23 Background: Patients with terminal diseases frequently undergo procedures and interventions that are futile and maybe detrimental to the patients’ quality of life. We conducted a quality improvement project aimed to reduce futile acute care services (ACS) for cancer patients treated with a palliative intent. Methods: A multidisciplinary team retrospectively reviewed the records of terminally ill cancer patients who died during in the hospital at our institution, King Abdulaziz Medical City, Riyadh, Saudi Arabia. We included all patients expired between November 2017 to May 2018. The review aimed to assess the magnitude of improper utilization of acute care services (ACS) such as: critical care response team (CCRT), cardio-pulmonary resuscitations (CPR) and admission to intensive care unit (ICU). A root cause analysis and process mapping were conducted to identify reasons for over utilization of these services. Timely documentation of goals of care was identified as a main reason for this problem. Then interventions were implemented to improve the practice. Post intervention data was captured and compared to the baseline data. Results: After delivery of staff education sessions and implementation of mandatory documentation of goals of care in the electronic healthcare record system, the timely documentation of goal of care for patients with palliative intent had significantly increased from 59% of cases in the baseline to 86% for the post intervention phase. As a result, admission to ICU decreased from 32% of cases in the pre intervention phase to 14% in the post intervention phase reducing monthly cost of admission to the ICU by 40% and estimated to be on average of $48,000 USD monthly ($576,000 USD annually). Conclusions: Our interventions resulted in improved documentation of the goal of care leading to decrease in the utilization of acute care services (ACS) including reduction of intensive care unit (ICU) admissions and cost. This outcome is even more relevant nowadays during COVID-19 pandemic and the pressure on critical care resources. Improvement is sustained by integrating the changes in the work process and electronic medical records.
Real-world practice patterns in follicular lymphoma (FL) care at community oncology centers.
Authors: Barr Paul M. , Patel Taral , Dela Cruz Servillano E. , Hussein Maen A. , Castine Michael J. , Farris Breanne Y , Crawford Rebecca R , Carter Jeffrey D. , Sapir Tamar 
Published: October 2020

231 Background: Though FL generally has good outcomes, patients with high risk FL have poorer outcomes; proper risk stratification for early intervention has been shown to improve overall benefit in some patients. In a quality improvement (QI) initiative conducted in 4 community oncology systems, we assessed practice patterns involving prognostication and the integration of patient-disease-and treatment-related factors to improve decision-making for patients with FL. Methods: Between 10/17/2019 and 3/4/2020, we surveyed hematology/oncology health care professionals (HCP; N=59) to assess challenges, barriers, and self-reported performance of quality FL care. Electronic medical records (EMR) of 100 patients were audited for demographics, disease characteristics, risk stratification, treatment, and patient-centered metrics. To address suboptimal guideline-aligned care, teams participated in audit-feedback sessions to develop action plans for resolving identified gaps. Results: The EMR audit demonstrated low levels of documentation of staging, grade, and criteria required by risk stratification models (Table). Despite 92% of HCP indicating the use of risk stratification or prognostic models to determine treatment choice, only 23% of charts indicated use of a model for risk stratification. 55% of HCP indicated testing for t(14;18), though no patients had documented evidence of t(14;18) testing results. Survey findings indicated low confidence integrating patient-related factors to determine appropriate risk group (24%). Treatment choice was aligned with guidelines. In surveys, providers reported uncertainty about when to initiate treatment (13%), which treatments are most appropriate for each patient (23%), and engaging patients in shared decision-making (28%) as top barriers to care. During audit-feedback sessions, teams created action plans to improve documentation for variables of risk stratification, patient symptoms, molecular results, and shared decision-making. Further, teams identified the need for improved resources and personnel. Conclusions: These findings reveal important challenges to providing individualized FL care in community settings, such as documentation of clinically important metrics, care coordination, and engaging patients in shared decision-making. These gaps may inform future QI and implementation science initiatives. [Table: see text]
Patterns of care in ALK+ or ROS1+ non-small cell lung cancer (NSCLC) in community systems.
Authors: Levy Benjamin Philip , Farris Breanne Y , Crawford Rebecca R , Carter Jeffrey D. , Sapir Tamar 
Published: October 2020

232 Background: For patients who have ALK or ROS1+ NSCLC, targeted therapies have greatly improved treatment options, though challenges personalizing care have hindered effective integration. In a quality improvement (QI) program conducted in 2 community oncology systems, practices involving the use of targeted therapies for NSCLC were assessed. Methods: Between 01-04/2020, retrospective EMR audits of 100 patients with ALK or ROS1+ NSCLC were analyzed for demographics, molecular testing, disease characteristics, treatment history, and shared decision-making (SDM). Surveys were administered to evaluate healthcare professionals’ (HCP; N = 47) challenges and barriers. HCP teams participated in audit-feedback sessions and developed action plans for resolving identified gaps. Results: 64% of HCPs indicated high confidence in utilizing molecular tests to inform treatment and properly sequencing targeted therapies; however, the EMR audit demonstrated challenges efficiently integrating guideline-aligned testing into practice. The mean time from diagnosis to molecular testing results was 22 days and documentation of testing for genetic aberrations other than ALK/ROS1 during work-up were low (Table). Delays in receiving molecular testing results may have presented challenges aligning treatment practices to guidelines as some patients were not receiving frontline targeted therapies (31% ALK+, 24% ROS1+). Additionally, EMR audits suggested sub-optimal use of distress screening (37%), tobacco counseling (38%), quality of life screening (60%), and engagement/documentation of various aspects of SDM (Table) for patient-centered care. Importantly, given the role internalized stigma can play in lung cancer, only 59% of those surveyed indicated that they routinely use tools to identify patients affected by stigma. During audit-feedback sessions, teams identified increased documentation, improved molecular testing/collaboration with pathology team, and provision of patient-centered care, including reduction of smoking-associated stigma as action items. Conclusions: These findings reveal important performance gaps in providing targeted and patient-centered treatment for NSCLC in community settings. These findings may be relevant for future QI programs. [Table: see text]
Quality indicators of colorectal cancer care in a public healthcare institution in Uruguay: Results from a retrospective population-based study.
Authors: Fontes Santiago , Cuello Mauricio , Marín-Jiménez Ana , Sánchez Juan Carlos , Berry Megan , Reyes Graciela , Requena Nicolás , Krygier Gabriel David 
Published: October 2020

234 Background: There is an urgent need to assess quality of cancer care in Latin America, especially amongst the most prevalent tumors, such as colorectal cancer. The main aim of this study was to assess adherence to previously validated quality indicators (QIs) for colorectal cancer in the context of a public healthcare provider in Uruguay. Methods: Data regarding all colorectal cancers registered between January 1, 2008 and December 31, 2019 at the National Cancer Institute of Montevideo was collected through retrospective analysis of medical records. We used 12 QIs (4 diagnostic, 7 treatment,1 surveillance) validated in previous publications. Each QI was analyzed as a proportion (%) and compared to target values with 95% confidence interval. Results: A total of 808 colorectal cancers were identified; only 10.1% were diagnosed by screening, 87% were diagnosed after reporting symptoms and 29.5% underwent emergency surgery. A complete preoperative colonoscopy was performed in 47% of patients, 64% had a CT-TAP scan and 63% of locally advanced rectal cancers had staging MRI prior to definitive treatment. Surgical resection with tumor free margins was obtained in 97% of cases, and for 68% at least 12 lymph nodes were examined. Neoadjuvant radiotherapy plus chemotherapy as first therapeutic strategy was implemented in 79% of rectal cancers. High risk stage II and III colon cancer received adjuvant chemotherapy within 16 weeks of surgery in 72,9% of cases. Postoperative follow up with CEA was registered in 97% of our series. Most patients ≤ 75 years of age with metastatic unresectable colorectal cancer at diagnosis underwent first-line chemotherapy or bio-chemotherapy. A low level of adherence was identified in micro-satellite and RAS status testing, 16 and 22 patients respectively. Conclusions: This study is a pioneer study in Latin America. The standardization of QI definition to achieve interregional comparative goals remains an unmet need.Our data indicates there is much to improve in early diagnosis, preoperative staging, neoadjuvant therapy and molecular testing. QI indicators in surgery and adjuvant chemotherapy prescription are similar to those reported in international studies.