bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does the innovative 4R Cancer Care Delivery Model improve patient self-management in safety net and non-safety net centers?
Authors: Trosman Julia Rachel , Gradishar William John , Makower Della F. , Rapkin Bruce D. , Bozier Moreen , Knightly Eileen , Schaeffer Cathleen M. , Hoskins Kent , Gallagher Christopher , Lo Shelly S. , Grace-Louthen Cathy , Throckmorton Alyssa , Vanderwalde Lindi , Krueger Editha A. , Van Horn Jennifer , Ravelo Arliene , Schapira Lidia , Santa-Maria Cesar Augusto , Benson Al Bowen , Weldon Christine B. 
Published: October 2019

172 Background: Under the NCI ASCO Teams Project, we proposed a 4R Model of teamwork and patient self-management (pSM) (Trosman JOP ’16). 4R (Right Info/Care/Patient/Time) enables patient (pt) and care team to manage complex care continuum with an innovative multimodality 4R Care Project Plan. 4R includes a novel “project” feature – a graphical description of care interdependencies. 4R was previously piloted at 3 Chicago centers (Trosman ASCO ‘18). Methods: In this new study, we improved and tested 4R for impact on pSM at 4 safety net and 3 non safety net centers across the US. 4R Plans were provided to stage 0-III breast cancer pts Jan - Nov’18 (4R cohort). We surveyed the 4R cohort and a historical control cohort of pts who received care at same centers pre-4R, Jan - Dec ’17. Results: Survey response rates: 65%, 105/162 (4R cohort); 44%, 190/432 (control). 4R markedly improved 4 of 5 pSM metrics vs control (Table). Additional analyses showed that safety net pts had a significant increase in 4R vs control cohort in “seldom overwhelmed” (84%, 49/58 vs 64%, 67/104 respectively, p = .007), while non safety net pts had nonsignificant increase. Other metrics improved to a similar extent for safety net vs non safety net pts. Within the 4R cohort, 85% found 4R useful in organizing their care and 73% found 4R’s novel “project” feature useful in understanding care interdependencies. Safety net pts reported similar usefulness of 4R in organizing their care as non safety net pts (88%, 51/58 vs 81%, 38/47, NS) and similar usefulness of the “project’ feature in understanding care interdependencies as non safety net pts (74% vs. 72%, NS). Conclusions: 4R significantly improved patient self-management, but further efforts are needed to expand the benefit to as close to a 100% of pts as feasible. Safety net pts benefited from 4R at similar or higher rates than non safety net pts, indicating that 4R may reduce care disparities. An expansion of 4R across the US continues this work. [Table: see text]
A pilot study of a comprehensive financial navigation program in cancer patients and caregivers.
Authors: Steelquist Jordan , Watabayashi Kate , Overstreet Karen , Leahy Tony , Balch Alan James , Bradshaw Erin , Gallagher Kathleen D. , Lobb Rebecca , Lavell Laura , Linden Hannah M. , Ramsey Scott David , Shankaran Veena 
Published: October 2019

174 Background: Few studies have reported on interventions to alleviate financial toxicity (FT) in cancer patients (pts) and informal caregivers (cgs). We developed a financial navigation program in collaboration with Consumer Education and Training Services (CENTS), Patient Advocate Foundation (PAF), and Family Reach Foundation (FRF), to offer financial coaching, insurance navigation, and assistance with unpaid non-medical bills. We conducted a pilot study to assess feasibility of enrolling cgs with pts and to describe the assistance provided. Methods: Pts with any stage solid tumor actively receiving treatment (tx) at the Seattle Cancer Care Alliance were asked to identify a cg who could participate. Pts or pt/cg dyads received an online financial education course and monthly contact for 6 months (mo) with CENTS and PAF. Subjects were referred to FRF for assistance in paying non-medical bills. We describe pt and cg characteristics, and assistance provided by the program. Results: Of 54 pts approached, 30 (median age 59.5, 61% white, 97% stage III/IV disease) were consented. Most pts (53%) had income ≤ $25,000, and all were insured (48% commercial, 28% Medicare, 21% Medicaid). 18 cgs (67% spouse/partner) were consented. At consent, 55% of pts reported debt in the prior 3 mo. Mean score using the COST PRO FT measure (range 0-44, lower score = higher FT) was 17.4 at baseline. After pts’ physical health, out-of-pocket costs were the most stressful aspects of tx for cgs. Cgs with high financial burden from caregiving more often reported taking on new debt, dipping into retirement accounts, or changing their jobs or hours. CENTS coaches assisted with budgeting, updating wills, and employment rights counsel. PAF case managers assisted with financial assistance for drugs, cost of living (e.g. transportation), disability applications, and secured $6,950 in debt relief. FRF dispersed $4,133, primarily for housing expenses. Conclusions: Implementing a financial navigation program that engages both pts and cgs is feasible. This lower income, financially stressed population received $11,000 in financial assistance. Future work will focus on evaluating the impact of this program on financial and psychosocial outcomes in pts and cgs.
Employment outcomes, anxiety, and depression among caregivers of African American cancer survivors.
Authors: Hastert Theresa A. , Ruterbusch Julie J. , Schwartz Kendra L. , Harper Felicity W. K. , Baird Tara , Beebe-Dimmer Jennifer Lynn , Schwartz Ann G. 
Published: October 2019

175 Background: Cancer patients commonly rely on loved ones to act as informal caregivers during and after treatment. Caregivers may need to take time off work or make other employment changes to handle caregiving demands. Employment changes due to caregiving and their impacts on psychological outcomes are not well understood, especially among caregivers of African American cancer survivors. Methods: Results include information from caregivers of participants in the Detroit Research on Cancer Survivors (ROCS) cohort, a population-based study of African American survivors of breast, colorectal, lung, or prostate cancer from Metropolitan Detroit. ROCS participants nominated a friend or family member who acted as a caregiver to participate in the caregiver study. Caregivers provided information on employment and PROMIS depression and anxiety measures. The relationship between work outcomes and anxiety/depression was assessed using logistic regression models controlling for age, sex, income, and the caregiver’s relationship to the survivor. Results: For the first 350 caregivers enrolled, more than half (56%) were employed (42% full time, 14% part time) at the time of the survivor’s diagnosis. 53% of employed caregivers took time off work, including 40% who took unpaid time off to provide care. 16% took one month or more off work, including 12% who took at least one month of unpaid time. Taking at least one month off was associated with 2.3 (95% CI: 1.0, 5.4) times the odds of depressive symptoms but was not associated with anxiety. Extended unpaid time off was not associated with depression or anxiety. 38% of employed caregivers reported that it was somewhat, very or extremely difficult to balance work and caregiving. Difficulty balancing work and caregiving was associated with 3.1 times the odds of depressive symptoms (95% CI: 1.5, 6.2), and 2.2 times the odds of any anxiety (95% CI: 1.1, 4.3) compared with those who reported little or no difficulty. Conclusions: Difficulty balancing work and caregiving is common among caregivers of African American cancer survivors, and is associated with symptoms of depression and anxiety. Supports for caregivers facing employment challenges may improve their psychosocial wellbeing.
A dyadic study of employment outcomes and quality of life in patients with breast cancer and their support persons.
Authors: Veenstra Christine M , Braun Thomas , McLeod Chandler , Wittmann Daniela , Hawley Sarah T. 
Published: October 2019

176 Background: Many women with breast cancer face job loss related to their diagnosis, but little is known about employment outcomes among their partners and other supporters. Moreover, virtually nothing is known about associations between patients’ quality of life and supporters’ employment outcomes. Methods: Breast cancer patients reported to Georgia and LA SEER registries in 2014-15 (N = 2,502, 68% RR) and their key decision support person (DSP) were surveyed separately. 1234 DSPs responded (71% RR). Patients and DSPs were asked about employment impacts of the patient’s breast cancer. Patients’ quality of life (QOL) was measured with the PROMIS scale for global health. Descriptive analyses of employment outcomes (job loss, missed days due to cancer) were generated for patients and DSPs. Associations between patients’ QOL and employment outcomes of patients and their DSPs were assessed using linear mixed model regression analyses stratified by dyad type (partner vs. non-partner DSP). Results: Among DSPs, 43% were partners. 57% were non-partners (daughters, other family, friends). 67% were employed at time of patient’s diagnosis. Among these, 11% were no longer employed at survey completion. 39% missed >30 days work. Non-partner DSPs were as likely as partners to lose their job or miss work because of the patient’s cancer. 65% patients were employed at diagnosis. Compared to patients whose DSP was a partner, patients with non-partner DSP were more likely to lose their job (39% vs. 24%; p<0.01) or miss >30 days work (55% vs. 45%; p<0.01). For patients with partner and non-partner DSPs, having an employed DSP at diagnosis and having an employed DSP who stays employed were associated with improved patient QOL after adjustment for DSP sociodemographic and patient clinical variables. Conclusions: Both non-partner and partner DSPs faced negative employment impacts related to patients’ breast cancer. Job loss and >30 days of missed work were more likely among patients with non-partner DSPs. Having an employed DSP and having an employed DSP who stays employed positively contributed to patients’ QOL.
Integrating family caregiver identification into a gynecologic oncology practice: An ASCO quality training program project.
Authors: Campbell Grace , Boisen Michelle M. , Hand Lauren , Lersch Nora , Suchonic Barbara , Donovan Heidi AS 
Published: October 2019

177 Background: Family caregivers (CGs) in gynecologic (gyn) cancer are essential members of the care team, but no formal systems exist to provide CGs with information and support. A needs assessment of family caregivers (CGs) in our clinic found 50% of CGs report > 9 distressing unmet needs, but chart reviews found only 19% of patients had a documented CG--the first step in mitigating unmet needs. Our ASCO QTP-supported project aim was to identify (ID) and document primary CGs for 85% of patients within 2 clinic visits of a gyn cancer diagnosis. Methods: An Interprofessional team reviewed baseline data, defined the problem and project aim, created process maps, and identified root causes of poor CG documentation. After securing stakeholder buy-in we implemented eight successive PDSA cycles to intervene on root causes. Biweekly team meetings were held to study results, troubleshoot, and plan each PDSA cycle. Primary outcome was the percentage of patients with a CG documented. Results: Root causes of poor CG ID were 1) no protocol for IDing CGs, 2) no designated EHR field for CGs, 3) no designated staff to “own” CG ID, and 4) lack of CG awareness of available support in clinic. Interventions to prepare for project launch (PDSA 1) included protocol development, staff training, spirit activities, and selection of staff ‘champions’. In PDSA 2 CGs were ID’d for 25.3% of all patients in the clinic. By PDSA 4, CG ID dropped to a low of 12.5%. Major changes to PDSA 5 sought to reduce staff burden by narrowing focus to newly diagnosed patients, with an increase in CG ID to 56% of new patients. PDSA cycles 6-8 focused on increasing process efficiency while broadening CG ID to other times of high CG stress (e.g. recurrence; inpatient stays); CG ID rate stabilized at 57-60% over the last 6 weeks. In total, 288 primary CGs were documented. Conclusions: Proportion of CGs ID’d increased initially and then again after PDSA 4 as process efficiency improved. Despite falling short of our benchmark, CG ID more than doubled and we are planning further PDSA cycles to continue this momentum. Our results demonstrate systematic CG ID is feasible in a high volume Gyn Onc clinc and sets the stage for CG assessment and intervention.
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.