bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing burnout among oncologists in Ontario, Canada.
Authors: Singh Simron , Farrelly Ashley C , Chan Catherine , Nazeri-Rad Narges , Nicholls Brett , Bauman Glenn , Bellicoso Daniela , Eisen Andrea , Falkson Conrad B , Fox Colleen , Holloway Claire MB , Kennedy Erin , McLeod Robin , Rothenberger David A. , Trudeau Maureen E. , Shanafelt Tait D. 
Published: October 2020

41 Background: Provider experience and physician burnout has been recognized as a critical issue in medicine. Ontario, Canada has a single payer cancer system run by Ontario Health (Cancer Care Ontario) with a mandate covering system level planning and delivery of cancer services, funding, and quality improvement. As part of a larger provincial initiative to address clinician burnout, we examined the prevalence and drivers of burnout in practicing physician oncologists in Ontario. Methods: In November-December 2019, surgical, medical, hematological, and radiation oncologists in Ontario were invited to complete an anonymous online survey to assess burnout and its drivers. Burnout prevalence was assessed through the Maslach Burnout Inventory – Human Services Survey for Medical Personnel (MBI-HSS MP). Data on demographic, workplace, engagement, and practice profiles were collected. Logistic regression modeling was conducted to assess key variables associated with “high” burnout using a common definition of high scores on the MBI subscales of emotional exhaustion (EE) (> 27) and/or depersonalization (DP) (>10). Results: Response rate to the survey was 44% (n=418) with 72% reporting high levels of burnout. Mean scores for EE (30.7, SD 12.1) and DP (9.9, SD 6.7) were consistent with high burnout. Participants endorsed known drivers of burnout including: 1) a poor culture of wellness at work (e.g., not comfortable talking to leadership (72%), 2) inefficiencies of practice (e.g. feeling insufficient documentation time (67%)) and 3) personal resilience (e.g. not feeling they are contributing professionally in ways they value (21%)). Age (<45yrs) (OR: 2.15), poor/marginal control over workload (OR: 4.42), feeling used/unappreciated (OR: 2.63), working atmosphere that feels hectic/chaotic (OR: 2.68), and insufficient time for documentation requirements (OR: 2.52) significantly impacted the odds of high burnout in the regression model (p<0.05). Conclusions: The high rate of burnout among oncology physicians in a single payer public cancer system in Ontario is concerning for the wellbeing of providers, patients and system sustainability. Drivers important for maintaining a culture of wellness and efficiency of practice will require local, regional and provincial health policy to improve. Next steps will include raising awareness with provincial initiatives/policy to address key burnout drivers, and examining the impact of working under pandemic conditions (Covid-19) on oncologist burnout.
The effect of COVID-19 on revenue cycle staff.
Authors: Poole Stacey L , Blakely Johnetta , Crouse Cheryl , Colangelo Pam , Dickson Natalie R. 
Published: October 2020

42 Background: The COVID-19 pandemic caused a public health emergency declaration in March 2020. A safer at home order was issued by the Tennessee governor on March 12 urging non-essential employees to stay at home. The decision was made to offer telecommuting to employees at Tennessee Oncology (TO) who could effectively work from home. 90% of the revenue cycle staff (RCS) began working remotely within a week of the decision. Methods: TO had been conducting a telecommuting pilot involving 20 RCS. This pilot was expanded within a week to accommodate 130 RCS including billing, credentialing, collections, financial counseling, analysts, authorization and benefit specialists. Employees signed telecommuting agreements and provided equipment based on IT recommendations. IT installed software which allowed secure connection through a Citrix gateway. Surveys were later conducted to measure work-from-home satisfaction. Less than 10 RCS remained onsite to perform essential duties. Results: Compared to the prior year there was an 80% reduction in turnover and an 82% reduction in unscheduled absences for telecommuting employees vs in-office employees. 92% reported an improved work/life balance. Productivity metrics by team are displayed below: Key financial metrics including payer turnaround, days in AR and patient payments improved over prior months. Payer turnaround dropped by 3 days and days in AR decreased by 3.9 compared to February. Patient payments were up 14% compared to the prior year. Conclusions: COVID-19 has been a challenging time in healthcare but it has taught us some valuable lessons. Telecommuting could be the wave of the future showing positive financial return in the form of employee retention, reduction of non-productive time (including unplanned absences) and increased employee satisfaction. Data shows these factors lead to higher producing team members who yield superior results. [Table: see text]
Emotional impact of COVID-19 preparations on metro and regional cancer workforces in Queensland Australia: "We are all in this together".
Authors: Roberts Natasha Anne , Chan Bryan , Ahern Elizabeth Stephanie , Gasper Harry Michael , Kennedy Glen , Hughes Brett Gordon Maxwell , Wyld David , Eastgate Melissa A. , Lwin Zarnie 
Published: October 2020

44 Background: Australia has achieved a “flattening of the curve” with a sustained COVID-19 roadmap to recovery in place. We explored the emotional impact of COVID-19 on our cancer workforce, during the preparation phase of the pandemic. Methods: We developed and pilot-tested an online survey to capture the emotional impact on cancer care staff during the COVID-19 health system response. Two large cancer centres were identified for study sample, one metropolitan and one regional, in Queensland, Australia. All cancer care staff with patient-facing roles were invited via all-staff email to participate on a weekly basis, uniquely also including ancillary and administrative workers. The final survey questionnaire included qualitative domains with open text responses for reflections on difficult decisions and subsequent emotional impacts. At the same time, a prospective diary of organizational developments was independently maintained by two investigators in order to contextualize changing survey responses over time. Qualitative data analyses by four investigators included independent, multiple cross-coding, memos, dataset review and member-checking to ensure methodological rigour. Data were synthesised into key themes utilising the Framework Method (Gale, 2013). Results: 117 metropolitan and 59 regional staff were surveyed over a 6-week period. Participants were medical, nursing, allied health, administrative and ancillary staff, working across inpatient and outpatient oncology services. Four key themes were emergent across the trajectory of the COVID preparation phase; ‘Strategies for protection’ (self-isolation, using PPE, protecting patients, families and each other), ‘Navigating rules and keeping up’ (compliance, exceptions, conflict and complex decision fatigue), ‘Tempered optimism’ (this is grief, strategies for coping, pride in one’s place), and ‘Framing the new normal’ (using new technology, second wave, uncertainty). At different time points, one theme dominated more than others. Conclusions: Despite rapid adaptations to system changes, staff responses highlight that it was their sense of connectedness that had the greatest influence on their reflections during the COVID-19 pandemic, but also underpinned the humanistic aspects of their responses. Staff perceptions of feeling supported and prepared, permeated through the duration of the survey. Results from the recovery phase are awaited.
Oncology treatments during COVID-19 pandemic in Israel: ONCOR study.
Authors: Wolf Ido , Hirsh-Yechezkel Galit , Chetrit Angela , Ben-Avraham Sivan 
Published: October 2020

50 Background: The SARS-CoV-2 pandemic outbreak declared by the World Health Organization in March 2020 challenged health systems in affected countries and raised concerns for its potential direct and indirect impact on cancer patients. Cancer patients are at high risk for COVID-19 infections and complications due to factors related to their underlying condition and treatments. We aimed to evaluate the impact of COVID-19 on clinical activity of the oncology departments in Israel, and to assess the implementation of measures aimed at containment of COVID-19 diffusion, while allowing continuation of quality cancer care. Methods: A national survey among 18 of 19 oncology departments in Israel was conducted on April 2020 focusing on the institute's preparedness for treatment of their cancer patients during the COVID-19 pandemic. Results: Prevention measures against COVID-19 spread were taken prior to patients' arrival and at arrival or while staying at the departments. most participants reported employing a quick triage of patients and caregivers, prior to their entrance to the oncology units. Most departments limited the entrance of caregivers; one third not allowing entrance of any caregivers and more than half allowing entrance of only one caregiver. Some differences between large and small/medium sized medical centers were observed, with less strict measures taken by the smaller hospitals. Most departments implemented steps aimed at reducing unnecessary visits to the clinic. These included a shift to telephone interactions or telemedicine (78%) and switching to oral therapies, rather than intravenous ones, when possible. This approach was taken mostly by the medium/small hospitals compared to large hospitals (60% vs. 92%, p = 0.1). Conclusions: Oncology departments in Israel were able to prepare and adapt their services to guidelines and requirements related to the COVID-19 pandemic with little harm to their treatment capacity. However, some differences between large and small hospitals were noted. These findings call for either better allocation of resources in case of an epidemic.
Oncologist- versus hospitalist-led service: Differences in hospital utilization for solid tumor patients.
Authors: Wu Lesley , Aslanova Minira , Theroux Haley Hines , Huang Hsin-hui , Smith Cardinale B. 
Published: October 2020

53 Background: Hospitalists have been practicing alongside oncologists to provide high quality care for hospitalized cancer patients. We examined the differences in hospital utilization and outcomes among solid tumor patients admitted to oncologist-led teams (OT) versus hospitalist-led teams (HT). Methods: We performed a retrospective cohort study of patients with solid tumors admitted to the OT or HT at Mount Sinai Hospital from July to December 2019. We excluded patients less than 18 years of age, primary hematologic malignancies, or admission to intensive care or surgical units. We used the Activity Measure for Post Acute Care (AMPAC) and Charlson Comorbidity Index as a measure of functional ability and illness severity, respectively. We performed bivariate and multivariate analyses comparing differences in length of stay, ICU transfers, palliative care consults, healthcare proxy (HCP) decision, new DNR decision, readmission within 30 days and inpatient mortality by type of admitting service (OT vs HT). Results: A total of 544 patients were identified; 61% (334) admitted to HT. There were significant differences according to race and cancer type (p= 0.001 for both). HT patients had more functional impairment (p<0.0001) and poorer prognosis (p=0.0002). In bivariate analysis, HT had significantly more ICU transfers (OT, 2% vs HT, 8%; p=0.008), new DNR decisions (OT, 7% vs HT, 16%; p=0.002), and inpatient mortality (OT, 4% vs HT, 9%; p=0.02) while OT had significantly more palliative care consults (OT, 45% vs HT, 20%; p<0.0001). Multivariate analysis (Table) demonstrates HT had significantly more new DNR decisions (odds ratio [OR]: 0.46, 95% confidence interval [CI]: 0.23-0.93) and OT had significantly more palliative care consults (OR: 4.01, 95% CI: 2.51-6.43). Conclusions: At our academic hospital, inpatient cancer care led by hospitalists is comparable to that of oncologists despite HT caring for more severely ill oncology patients. From a value perspective, hospitalists facilitating care for hospitalized cancer patients will allow oncologists to maximize ambulatory time and focus on active cancer treatment. [Table: see text]
Process of the integration of patient advisors in oncology: Patient advisors' views.
Authors: Pomey Marie-Pascale , Vachon Marie-France , Charpentier Danielle , Côté Marie-Andrée , Desforges Mado , Bouchard Karine , Vialaron Cécile , Iliescu-Nelea Monica , Normandin Louise 
Published: October 2020

54 Background: Since 2017, in Quebec (Canada), a research project is focusing on the feasibility, the processes, and the contribution of integrating patients who have already had cancer experiences (named patient advisors (PA)) in the oncology clinical team. In fact, the trained PA meet patients in health care settings in addition to the other health professionals in order to improve health care and partnership between professionals and patients. This presentation communicates the PA’s perception of their contribution and the factors influencing implementation of these programs in 4 establishments. Methods: Between April and May 2020, semi-structured virtual interviews lasting about 60 minutes were conducted on 12 patient advisors involved since 2017 in the elaboration of these support programs. The interviews were recorded and transcribed completely. The data analysis was done with content analysis using the QDA Miner 5.0 software, applying the qualitative analysis quality standards. Results: First of all, the 12 PAs have reported that the accompaniment of 67 patients have allowed them to share their experiential knowledge not only related to living with the illness but also about healthcare organization and the anticipation of treatments. They also highlighted their capacity to share situations that can be improved by healthcare professionals (example: wait times for exams; patients’ difficulty in understanding their illness, etc). However, they also highlighted 4 factors which limit the implementation: 1) organizational (the unclear and changing nature of the breast cancer consultation schedule, difficulty of access to consultation rooms and unsuitable schedules for the PA’s reality.; 2) leadership (lack of clinicians promoting the intervention; managers’ low involvement; lack of clarity of roles); 3) human (work overload and employee turnover); 4) PA’s status (lack of compensation and of recognition). Also, to optimize their integration, the PA’s suggest to work on a lasting bond of trust with the professionals, the creation of a status recognized by health establishments, the recognition of their role by the clinical team, to give them access to physical spaces, and an openness of the teams to their complementary knowledge. Conclusions: These first results suggest the importance during the implementation of such programs of working proactively with the PAs and the professionals on organization, leadership, resources, and status factors to allow the people dealing with cancer to benefit from experiential knowledge of other patients within their clinical team.
Support by peers in the clinical team in oncology: Perception of the contribution of patient advisors to improve the patient experience.
Authors: Pomey Marie-Pascale , Fortin Israël , Côté Marie-Andrée , Desforges Mado , Bouchard Karine , Vialaron Cécile , Iliescu-Nelea Monica , Normandin Louise 
Published: October 2020

57 Background: Since 2018, three establishments in Quebec have introduced patient advisors (PA) in their healthcare team in order to improve cancer patients’ experience. These PA, who have had a cancer experience, meet patients undergoing radiotherapy treatments or in oncogenetics for breast cancer on the healthcare site. They conduct consultations to complete the offer of services by bringing emotional, informational, and educational support. Methods: A longitudinal study of multiple cases was completed from January to June 2020. After each accompaniment, the PA filled out a logbook to document the main themes covered and the accompanied patient fill out a survey to evaluate their experience one week after the intervention. A qualitative analysis of the logbook content and descriptive statistics were conducted. The REDCAP platform was used for monitoring the process of data collection and to administer the surveys online. Results: In total, 67 patients were accompanied by 4 PA. 71 logbooks were completed by the PA. The logbooks show that 70.3% of accompaniments took place right before radiotherapy and 63.6% following the results of the genetic test in oncogenetics. 50% of meetings took place in person in the establishment (in a space dedicated to the PA or not) and 45.8% were by phone. The meetings lasted approximately 37 minutes (min: 15 minutes and max: 90 minutes). The majority only met once (93.1 %). The most common themes discussed are: the role of the PA (94.1%), returning to day life (57.6%) and dealing with stress and anxiety (52.2%). 96% of PA felt that they did not encounter any difficulties during the accompaniment. For the accompanied women, the partnership was most beneficial for their experience with the illness (sharing experiences of side-effects, on the impact of the illness on every day life, with their social circle). 79% of patients found that the accompaniment met their needs. 90% of patients estimate that these meetings are complimentary to the healthcare professionals’ interventions. Finally, 89.5% of accompanied patients think that it would be very important to develop these types of meetings on a larger scale. Concerning the adaptation of spaces for the meetings, 26.3% are very satisfied and 26.3% are rather satisfied (probably an area for improvement). Conclusions: Overall, the partnerships seem to answer the needs of the accompanied patients and the PA can share their experience inside the clinical team.
Fostering interspeciality learning in cancer survivorship care: Learning suite results.
Authors: Chaput Genevieve , Williams Tristan , Sussman Jonathan 
Published: October 2020

59 Background: As survivorship provision declines within cancer centres, primary care providers are increasingly entrusted in the follow-up care of cancer survivors. Empowering specialists and primary care providers about survivorship through educational interventions is essential. Interspecialty education is poorly integrated into residency training, which may impede collaboration between different providers in practice. Interspecialty partnership can positively impact patient and resource- use outcomes. The aim of this study was to assess if a cancer survivorship learning suite (LS) impacts attitudes of family medicine, radiation oncology and medical oncology trainees towards interspecialty collaboration in Montreal, Canada. Methods: A survivorship (LS) developed by a Manitoba-based team under the sponsorship of a Canadian Partnership Against Cancer grant held by Cancer Care Ontario was delivered to 49 McGill University family medicine, radiation oncology, and medical oncology trainees. The LS comprised in-person delivery of a 3-hour case-based workshop, presented by a radiation oncologist and a family physician, both experienced in the field of survivorship. An adapted version of the Readiness for Interprofessional Learning Scale (RIPLS) was completed by participants before and after workshop delivery. Statistical analyses included Wilcoxon Signed-rank test comparisons. Results: Response rate was 63.2%, and included family medicine (65%), radiation oncology (26%), and medical oncology (10%) trainees, respectively. Following the workshop, participants were significantly more likely to agree that interspecialty learning in residency “would help physicians become better team workers”, (Z = 2.7, p < 0.008, n = 31), and “improves relationships between physicians of different specialties in independent practice afterwards”, (Z = 2.6, p < 0.009, n = 31). Participants were also significantly more likely to agree that “shared interspecialty learning < would > increase < their > ability to understand clinical problems”, (Z = 2.8, p < 0.005, n = 31). Conclusions: While much literature has focused on interprofessional collaboration at different levels of education and practice, few studies have assessed interspecialty collaboration of physicians of different specialties. This survivorship LS demonstrated favorable changes in attitudes towards interspecialty learning.
Practice patterns in bone modifying agent utilization: An analysis in patients with metastatic cancer and bone involvement at an NCI-designated center.
Authors: Manohar Poorni , Bastys Kyle , Tratt Micah , Gralow Julie , Eaton Keith D. 
Published: October 2020

62 Background: Bone modifying agents (BMA) can reduce skeletal related events for patients with metastatic cancer and bone involvement. ASCO supports use of Zoledronic acid (ZA) and Denosumab (DB), with specific endorsement of both an every 3 to 4-week (Q1 month) and every 12-week (Q3 month) schedule for ZA in metastatic breast cancer. Trends in BMA utilization may identify areas to improve value in cancer care. Methods: We retrospectively reviewed utilization of BMAs at Seattle Cancer Care Alliance/University of Washington from fiscal year 2015-2019. We identified 1,286 patients who underwent 12,594 administrations. Data was categorized by BMA (ZA acid vs DB) and disease group. A 45-day cutoff defined interval of treatment (Q1 vs Q3). Whole-sale acquisition cost (WAC) and administration costs were estimated from CMS allowed charges. We calculated total costs spent during time period and projected potential savings for switching from Q1 to Q3 ZA administration. Results: A total of 904 patients received ZA (7201 administrations) and 473 patients received DB (5,393 administrations). The breast, myeloma, prostate, and kidney groups accounted for 81% of administrations. In breast, 427 patients received ZA (1,761 administrations) and 411 patients received DB (2,708 administrations). Among all patients, DM and ZA administrations remained constant over time, however, in breast, there was a trend towards less DB and more ZA administrations. The administration frequency (Q1 vs Q3) for both drugs stayed constant in the total cohort. Among ZA administrations in breast, there was a reversal in the trend for Q1 vs Q3, with Q1 being most common in 2015, and Q3 the most common in 2019 (crossover in 2018 fiscal year). In breast, 30 patients transitioned from Q1 to Q3, with majority occurring before 2017 ASCO update. Total costs on BMA utilization was estimated as $11,672,189,80, 90% attributable to DB. The projected savings for switching from Q1 to Q3 ZA administration was $1,223,961.08. Conclusions: BMA prescribing patterns from 2015-2019 show no change in ZA and DB utilization, though a trend towards increased ZA and decreased DB use in breast cancer was observed. There was a transition in practice patterns to adopt the Q3 ZA administration over time, however, the uptake of this has been incomplete. It is hoped that raising awareness of these practice patterns will lead to adoption of guideline-based decision making and promote value-based cancer care.