bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of coaching-based lay patient navigation on patient satisfaction and overcoming barriers to care.
Authors: Wiatrek Dawn , Erb Nicole , Roberts Shelby 
Published: November 2019

36 Background: The American Cancer Society is enhancing its lay patient navigator program to include tailored coaching in addition to resource navigation. The goal is to increase the patient’s engagement in overcoming barriers to care. In a pilot of this new model, 6 navigators in 6 different program sites completed a training in coaching, active listening and action planning with patients. Methods: A total of 1,210 patients were navigated through the pilot program over 2 phases. This abstract focuses on phase 2 consisting of 792 patients navigated by 3 navigators at 3 different safety-net hospitals. The navigators met with patients over a 1-year period and engaged in coaching sessions to set action plans to overcome barriers to care. In the first session, navigators developed an action plan with the patient and administered a patient satisfaction survey. Over time, the navigators continued meeting with the patient and documenting progress on the action plan. Navigators administered a second patient satisfaction survey prior to or during the patient's last session. Results: 792 patients had a first coaching session with the navigator and set a combined 2,430 actions to overcome 1,356 barriers. 87% of patients agreed to take the first patient satisfaction survey with 95% reporting that they created a plan with the navigator. Patients reported an average confidence level of 8.6/10 that the plan they set with the navigator would work. Patients also reported a high level of satisfaction with the meeting with an average score of 4.4 on a 5-point scale. 408 patients completed the full coaching program during the project period and 77% of those patients with a final coaching session completed the satisfaction survey. 88% of patients reported completing at least some steps in their action plan and 89% reported solving at least one problem with the navigator that came up during their cancer care. Overall satisfaction with the navigator remained constant at 4.4/5. Conclusions: Patients responded positively to coaching-based lay patient navigation and were able to create action plans with the navigator, achieve those actions, and ultimately overcome non-medical barriers to cancer care.
Randomized trial of a hospice video decision aid for patients with advanced cancer and their caregivers.
Authors: El-Jawahri Areej , Vanbenschoten Olivia , Bhatt Sunil Mahesh , Fenech Alyssa L. , Markovitz Netana , Traeger Lara , Greer Joseph , Volandes Angelo E. , Temel Jennifer S. 
Published: November 2019

42 Background: Although hospice provides high-quality end-of-life care for patients with advanced cancer, the service remains underutilized in part due to lack of adequate information provided to patients and families about hospice care. Methods: We conducted a single-site randomized clinical trial of a hospice video decision aid versus a verbal description in 150 hospitalized patients with advanced cancer and their caregivers. Patients without an available caregiver were eligible to participate. Intervention participants (75 patients; 18 caregivers) received a verbal description about hospice plus a six-minute video depicting hospice care. Control participants (75 patients; 26 caregivers) received only the verbal description. The primary endpoint was patient preference for hospice care immediately after the intervention, adjusting for baseline preferences. Secondary outcomes included patient and caregiver knowledge and perceptions of hospice, and hospice utilization. Results: Between 2/2017 and 1/2019, we enrolled 55.7% (150/269) of potentially eligible patients and 44 caregivers. Post-intervention, patients assigned to the video group were more likely to prefer hospice care (86.7% vs. 82.7%, OR = 2.85, P = 0.08), but this was not statistically significant. Patients in the video group reported greater knowledge about hospice (B = 0.50, P = 0.024) and were less likely to endorse that hospice care is only about death (6.7% vs. 21.6%, OR = 0.28, P = 0.035). Among patients who died (n = 116), those assigned to the intervention were more likely to utilize hospice (85.2% vs. 63.6%, P = 0.01) and had a longer hospice length-of-stay (LOS) (median 12 vs. 3 days, P < 0.001). Post-intervention, caregivers assigned to the video were more likely to prefer hospice care for their loved ones (94.4% vs. 65.4%, P = 0.031), reported greater knowledge about hospice (B = 1.94, P < 0.001), and were less likely to endorse that hospice care is only about death (0.0% vs. 23.1%, P = 0.066). Conclusions: Patients with advanced cancer and their caregivers who viewed a hospice video decision aid were more informed about hospice, reported more favorable perceptions of hospice, and were more likely to utilize hospice and have a longer hospice LOS. Clinical trial information: NCT03040102.
Implementation and dissemination of a shared mental model of palliative oncology.
Authors: D'Ambruoso Sarah F. , Glaspy John A. , Wenger Neil , Pietras Christopher , Ahmed Kauser , Hurvitz Sara A. , Drakaki Alexandra , Goldman Jonathan Wade , Anand Sidharth , Simon Wendy , Kung Jennie , Coscarelli Anne , Rosen Lee S. , Peddi Parvin F. , Wong Deborah J.L. , Phung Peter , Karlin Daniel , Walling Anne M. 
Published: November 2019

58 Background: American Society of Clinical Oncology guidelines support early integration of palliative care (PC) into standard oncology practice; however, little is known as to whether improved outcomes can be achieved by modifying health care delivery and training oncology providers. Methods: We report our five year experience of embedding a nurse practitioner (NP) in an oncology clinic (March 2014-March 2019) to develop a shared mental model (SMM) of early, concurrent advance care planning (ACP) and PC as well as the collaborative effort to further disseminate this SMM throughout the Division of Hematology-Oncology using communication training, quality measurement, audit and feedback, leadership support, and monthly collaborative meetings. We developed PC quality metrics (process measures and end of life utilization measures) using a validated advanced cancer denominator. We used these measures to evaluate the impact of the PC-NP program (2014-2019) and provide individualized metric packets to each oncologist in the context of an annual half-day interactive communication training sessions (1-hr didactic, 3-hr small group role-play) each spring and monthly implementation team meetings from 2017-2019. Results: Compared to patients with advanced cancer not seen by the PC-NP program, patients who are enrolled in the program have higher rates of goals of care note documentation (80% vs. 17%, p < 0.01), higher rates of Physician Orders for Life Sustaining Treatment (POLST) completion (19% vs. 5%, p < 0.01), higher referral rates to the psychosocial oncology program (51% vs. 25%, p < 0.01), and higher referral rates to hospice (60% vs. 33%, p < 0.01). Among decedents, there was less hospital use (12 vs. 18 days) and ICU use (1.5 vs. 2.6 days) in the last 6 months of life. Since spring 2017, 19/21 NP’s, 64/68 physicians, and 17/20 fellows have participated in communication training. Among all patients with advanced cancer, goals of care note documentation has improved from 3% in March 2014 to 21% in March 2019. Conclusions: Embedding a trained PC-NP in oncology clinics to deliver upstream PC to patients on active treatment can lead to opportunities for development and dissemination of a SMM that translates into better primary and specialist PC.
Narrative medicine: A useful approach for difficult conversations.
Authors: Hinyard Leslie J. , Wallace Cara L. , Trees April , Ohs Jennifer E. 
Published: November 2019

6 Background: Narrative medicine (NM) is acknowledged as an effective approach for valuing patient and provider experiences. The NM approach requires developing narrative competence to “recognize, absorb, interpret, and honor” the stories of self and other (Charon, 2010). Given the difficulties providers face engaging in end-of-life (EOL) and advance care planning (ACP) conversations, this study reports the results of a NM workshop to 1) develop skills in attending and responding to the stories of others as part of ACP conversations and 2) reflect on their own stories of loss in relation to their professional practice. Methods: 80 health care professionals participated in a workshop on NM principles for end-of-life care and completed both pre- and post-workshop surveys. Workshop activities included a close reading on a professional’s story of personal loss and a reflective writing exercise sharing one’s own personal story of loss. Small groups debriefed after each exercise. 2 participants were current students and were dropped from analysis, for a final analytic sample of 78. Participants completed surveys at baseline and at the conclusion of the workshop. Surveys included questions on participant demographics, confidence for EOL conversations, and the ACP Self Efficacy scale. Descriptive statistics were calculated for sample demographics and post-workshop evaluation questions. A paired sample t-test was used to compare ACP Self Efficacy scores pre- and post-workshop. Confidence for EOL conversations was compared pre- and post-workshop using Kendall’s tau-b. Results: The mean age of the sample was 46.6 years (SD 13.1), 94% were female, and 82% were White. Social workers represented 84.6% of the sample. 53% of the sample reported having some type of advance care directive for themselves. Self-efficacy for engaging in ACP conversations increased from pre- to post-workshop (p < 0.0001) and there was a statistically significant improvement in confidence discussing death and dying from pre- to post-workshop (p = 0.004). Conclusions: NM competencies improve self-efficacy and confidence for engaging in ACP and EOL conversations. Providers find the NM approach to be a useful framework for engaging in difficult conversations about end-of-life.
Eflapegrastim, a novel, long-acting GCSF for reducing chemotherapy-induced neutropenia: Integrated results from two phase III trials in breast cancer patients.
Authors: Schwartzberg Lee S. , Bhat Gajanan , Bharadwaj Jayaram S. , Hlalah Osama , Restrepo Alvaro , Mehmi Inderjit , Chawla Shanta , Cobb Patrick Wayne 
Published: November 2019

61 Background: Eflapegrastim (E) is a novel, long-acting GCSF comprised of recombinant human GCSF covalently linked to human IgG4 Fc fragment via a PEG linker (MW, 72 kDa). E showed increased potency vs pegfilgrastim (P) in preclinical and Phase I and II trials. Two identically designed Phase III pivotal trials (NCT02643420, NCT02953340) were conducted globally with a fixed dose of 13.2 mg E containing 3.6 mg GCSF to evaluate E vs P (6 mg) in pts receiving chemotherapy for early-stage breast cancer. Methods: Each open-label trial randomized pts 1:1 to a single subcutaneous dose of E 13.2 mg/0.6 mL or P 6 mg/0.6 mL on Day 2 of each of four 21-day cycles following Day 1 adj/neoadj docetaxel 75 mg/m2 + cyclophosphamide 600mg/m2 (TC) . The primary endpoint was to demonstrate E non-inferiority (NI) to P as measured by mean duration of severe neutropenia (DSN) in Cycle 1. Results: A total 643 intent-to-treat pts (314 E/329 P) with median age 60 yrs (24–88) were enrolled. Cycle 1 mean (SD) DSN was 0.24 (0.581) vs 0.36 (0.789) days for E and P, confirming NI (p<.0001) and suggesting statistical superiority (p<.029). DSN NI was also shown across cycles 2–4. Among subgroups, including elderly (≥65 yrs) and overweight (>75kg) pts, DSN was reduced for E vs P. In Cycle 1, E showed an absolute risk reduction for severe neutropenia of 6.5% vs P (27.1% relative risk reduction, p<.043). Neutropenic complications (hospitalization and/or anti-infective use) were 2.9% and 4.0% for E and P (p=ns) in Cycle 1. Incidence of FN was low for both E and P, 1.6% vs 1.8% in Cycle 1 and 3.2% vs 3.0% overall. ANC profiles showed sustained increased levels for E vs P in the recovery phase across all cycles. Safety profiles including events of special interest, irrespective of grade, were mostly similar for E and P. The most common ≥ Grade 3 adverse events were hematologic due to chemotherapy. Conclusions: These integrated pivotal trial results confirm a similar safety profile and non-inferiority in reducing neutropenic risk for E at a lower GCSF dose vs P. The data also suggests the potential for increased potency of E to deliver improved clinical benefit, a possibility that warrants further clinical trials. Clinical trial information: NCT02643420 and NCT02953340.
Building a real-time clinical dashboard to identify and target supportive care interventions in patients with cancer: The Lung Cancer Report Card (LCRC).
Authors: Adonizio Christian S. , Wojtowicz Mark , Manikowski Jesse , Siegrist Cory , Hardenstine Jonathan , Belletti Daniel , Oberle Anne Marie ,   On behalf of the Thoracic Oncology Care Gaps addressed with Clinical Analytics (TOGAA) working group
Published: November 2019

66 Background: Many studies aiming to improve supportive care of patients with cancer have been single or bundled large population intervention(s). Potential use of unified clinical data architectures has not been realized in oncology, despite large patient-specific data sources generated during routine clinical care (electronic health records). Such systems can systematically apply clinical algorithms and data analytics to identify care gaps in individual patients with specific needs. Methods: Utilizing a design-think paradigm, we developed the LCRC, a near real-time interactive dashboard identifying actionable care gaps in all patients with lung cancer currently followed at Geisinger. Using an iterative process, data analysts served an expanded role in clinical delivery of targeted supportive oncology care, including recommending measures of risk for admission. Results: The table shows aggregate data as of 6/30/2019. Using the LCRC, we were able to identify 174 open care gaps in a population of 1199 active patients. We were also able to identify ‘high-risk’ clinical features in individual patients and the entire patient population. This was completed with analytics alone, without the need for lengthy chart review. Conclusions: By utilizing a population health view, the health system can more accurately estimate resources needed to better address patient needs. The LCRC can be used to directly determine the choice of supportive care interventions for specific patients with lung cancer. [Table: see text]
Who is at risk for palliative care misconceptions and how do we address them? A mixed-methods study of metastatic lung cancer patients.
Authors: McLouth Laurie , Gabbard Jennifer , Levine Beverly J , Nightingale Chandylen L , Furgurson Kate , Lycan Thomas , Petty William J. , Weaver Kathryn E. 
Published: November 2019

67 Background: A major misperception of palliative care (PC) is that it is only for people who are about to die. We recently identified this misperception as a barrier to PC in metastatic non-small cell lung cancer (mNSCLC) patients, patients who should all receive early PC per guidelines. The goal of this study was to assess patient characteristics associated with misperceptions about PC and to elicit patient perspectives on how to address them. Methods: We conducted a mixed-methods study of mNSCLC patients on immunotherapy or chemo-immunotherapy. A survey assessed sociodemographics, health literacy, and PC misperceptions. Semi-structured interviews queried perceptions of PC, experiences discussing PC with providers, and reactions to our institutional definition of PC. Qualitative data from interviews were analyzed using directed content analysis approach. Results: Sixty patients (Mean age = 63, 40% male; 18% African American, 45% inadequate health literacy) completed the survey. Twelve of the survey participants (Mean age = 65, 50% male, 25% African American, 67% inadequate health literacy; 50% with caregivers participating) also completed a semi-structured interview. Quantitative survey results showed equating PC with death and/or hospice did not differ based on gender, health literacy, rural vs. urban residence, or time since diagnosis (p’s > .05). Qualitative results showed patients and caregivers consistently associated PC with death (e.g., “the next step to the graveyard”) and hospice. Though some patients noted differences between our institution’s definition of PC and their perceptions (e.g., “delivered at any stage”), the definition did not increase interest and sometimes reinforced misperceptions (e.g., “See, that's a death spiral”). To address misconceptions, patients and caregivers suggested distinguishing PC from end of life and hospice, presenting it positively, and discussing it early into treatment. Conclusions: Lung cancer patients may associate PC with death even if they have adequate health literacy. Commonly used definitions of PC may not quell patient fears. PC needs to be presented as a positive service to patients early into treatment.
Current landscape of combined oncology/palliative care training in the United States.
Authors: Sedhom Ramy , Gupta Arjun , Smith Thomas J. , Kamal Arif 
Published: November 2019

68 Background: Recent calls by ASCO and others recommend early integration of oncology and palliative care. The rapid growth of new cancer therapies (e.g. immunotherapy) and their associated side effects and prognostic uncertainty suggest the need for oncologists to have palliative care sub-specialization. Despite the logical integration of oncology and palliative care training, the current landscape of ACGME training programs for these fields is unknown. Methods: We explored the ERAS Fellowship Website (https://www.aamc.org/services/eras/) on June 15, 2019, and collected information on Medical oncology, Medical Oncology/Hematology, and Hospice and Palliative Medicine (HPM) Programs. We identified institutions/ health systems that offered both Medical Oncology and HPM programs. We also identified institutions/ health systems that offered other Fellowships combined with Medical Oncology. We validated information by verifying each training program's website. Results: 152 unique programs offered Medical Oncology fellowship (144 combined with hematology) and 131 unique programs offered HPM fellowship. 7 Medical Oncology programs had tracks that allowed combination with geriatrics or infectious disease. 73 unique institutions/ health systems offered both Medical Oncology and HPM training separately, but no programs offered a combined Medical Oncology/ HPM track. Conclusions: Despite the call to better integrate palliative care in oncology care, we did not find any published descriptions of tracks combining Medical Oncology and HPM training. Successful examples of integrating Medical Oncology with other disciplines such as geriatrics exist. Trainees may still forge their own pathway and do sequential fellowships in Medical Oncology and HPM, but investment by key stakeholders is essential to pilot novel educational programs to address workforce issues in this field. It remains unknown how many programs accommodate combined or sequential training for interested applicants, or how they are funded.
Breast cancer patients in a female sexual medicine and women’s health program: A cross-sectional retrospective study.
Authors: Carter Jeanne , Saban Sally , Arkema Ashley , Goldfrank Deborah J. , Goldfarb Shari Beth 
Published: November 2019

8 Background: Cancer treatment impacts sexual health and QOL with symptoms of vulvovaginal dryness, dyspareunia, and sexual dysfunction. There are limited data on specific sexual changes in patients with varying treatments. We examined patient-reported and exam outcomes of breast cancer patients’ initial consults at Female Sexual Medicine & Women’s Health Program (FSMWHP) at Memorial Sloan Kettering Cancer Center. Methods: We obtained a limited waiver to evaluate medical records and Female Sexual Medicine Clinic Assessment Forms (FSMCAFs) of initial consults at FSMWHP from 6/29/12–12/23/16. The FSMCAF is composed of a pelvic exam checklist, sexual function measures (Female Sexual Function Index-FSFI; Sexual Activity Questionnaire-SAQ), vulvovaginal health measures (Vaginal Assessment Scale—VAS; Vulvar Assessment Scale—VuAS), and questions about concerns. Descriptive statistics were calculated using SPSS. Results: 446 women were categorized by menopausal status and endocrine therapy. Subcohorts were: postmenopausal with aromatase inhibitors (AIs) alone (30%), tamoxifen followed by AI (22%), tamoxifen alone (16%) or no therapy (16%), and pre/peri-menopausal with tamoxifen alone (9%) or no therapy (5%). In postmenopausal women, initial consults avg. 3.3 yrs post-treatment (pre/peri avg. 1.8 yrs). Endocrine use avg. 3 yrs. across groups. 99% of postmenopausal women scored < 26.6 on FSFI, indicating sexual dysfunction (tamoxifen alone avg: 13.7; tamoxifen followed by AI avg: 10.4). Vulvovaginal dryness and severe dyspareunia were highest in postmenopausal women with endocrine exposure (AI alone: 83% and 36%; tamoxifen alone: 66% and 32%). Related exam outcomes (pH > 6.5, petechiae, vulvovaginal atrophy, minimal/no moisture) were also highest in postmenopausal women (AI alone: 30%, 13%, 78%, 89%; tamoxifen alone: 19%, 5%, 65%, 70% respectively). Conclusions: Sexual health concerns are common in breast cancer patients. Endocrine exposure and menopause can negatively impact tissue quality. Women exposed to AIs appear to have the poorest self-reported and clinical outcomes. Proactive sexual health interventions, including early counseling, are warranted in these patients.
Developing a population health tool to identify patients with serious mental illness at cancer diagnosis.
Authors: Pappano Catherine , Fung Vicki , Barry Maura , Zucconi Tanya , Chen Jing , Irwin Kelly 
Published: November 2019

82 Background: Individuals with serious mental illness (SMI) experience increased cancer mortality and are less likely to receive timely cancer care. Despite increasing recognition that psychosocial care is essential for quality cancer care, mental illness remains underrecognized and undertreated. Involving psychiatry early may prevent cancer care disruptions. We developed an EHR-based algorithm to identify patients with SMI and cancer who may benefit from targeted interventions. Methods: We utilized structured codes from a widely-used, commercial EHR to identify patients with preexisting SMI and new breast, lung, head/neck, and gastrointestinal cancers seen in the Massachusetts General Cancer Center. We developed and refined an algorithm using ICD-10 diagnostic codes, medical history, appointment types, and consultations from across the health system. The algorithm updates every 24 hours to facilitate rapid intervention. We embedded a classification system to prioritize high-risk subgroups and key time points. We validated psychiatric diagnoses, cancer types, and appointments by randomly selecting 20 charts within each category and conducting a manual chart review. Results: Over 60 days from May to July 2019, the center saw 7674 patients in breast, thoracic, head/neck, and gastrointestinal oncology including 1674 patients (22%) with documented SMI. We identified 69 people (0.9%) with psychotic disorders, 111 (1.4%) with bipolar disorder, and 1,494 (19.5%) with major depression. Among patients with major depression, we prioritized recurrent major depression (N = 199), inpatient psychiatry consultation (N = 84), alcohol use disorders (N = 77), and opioid use disorders (N = 25). SMI was well-represented across cancers including 24% (916/3,815) of patients seen in breast, 25% (291/1,164) of thoracic, 24% (180/738) of head/neck, and 15% (287/1,956) of gastrointestinal oncology. Conclusions: We developed an EHR-based tool that identified a substantial population with SMI and cancer, prioritizing subgroups at high risk of cancer care disruptions. Leveraging data in the EHR is a feasible and promising strategy to detect a vulnerable population in need of targeted psychosocial interventions. Clinical trial information: NCT03360695.