bluuebunny/crossref_metadata_2025_split huggingface dataset:
My choices, my wishes: Advance care planning advocacy in the adult oncology population.
Authors: Mikan Sabrina Q. , Hoverman J. Russell , Patt Debra A. , Turnwald Brian 
Published: February 2017

6 Background: Working through end-of-life care (EOL) issues with our patients is one of the most challenging aspects of cancer care. Although studies of EOL care interventions that are patient-focused and result in high-quality EOL experiences are increasing, most still do not achieve an EOL experience consistent with preferences. We aimed to provide an intervention for standardized advanced care planning (ACP) documentation and education to improve quality of life (QOL) for patients (pts) with terminal cancer (TC). Methods: Pts with TC (for this study defined as stage IV cancer or metastatic disease) were evaluated retrospectively through our EHR IKnowMed (IKM) before and after an ACP documentation and an education intervention. Descriptive statistics were used to identify and measure utilization of ACP introduction and charting as well as completion of advance directive documentation. Within IKM there are discrete fields for EOL data including ACP discussion, ACP facilitation, documentation of ADs. Education on tool documentation occurred in early 2012. Our ACP program was launched in March 2012. This included an ACP office visit conducted by a practitioner with ACP training, standardized education literature on EOL and ACP, launch of a website with EOL and ACP educational material, recording of ACP documents and documentation of hospice utilization and ACP preferences within our EHR. Results: Baseline characteristics and improvements in ACP introduction, charting, and AD documentation that occurred during our documentation and intervention process can be seen in the Table. Conclusions: Implementation of a standardized ACP program improves utilization and documentation of ACP planning, and documentation of ADs. These interventions improve QOL and health literacy for patients with TC. By incorporating these strategies with definable metrics, strategic intervention can be measured and reported. Further study of the relationships between ACP documentation and patient outcomes is necessary for comprehensive oncology care. [Table: see text]
Expanding patient-reported outcomes to oral health complications from systemic cancer therapy.
Authors: Miksad Rebecca A. , Goyal Rohit , Gazelle G. Scott , Swan J. Shannon 
Published: February 2017

60 Background: Cross-disciplinary patient reported outcomes (PROs) assess the full range of side effects from systemic cancer therapy. For oral health complications, however, the validity of oral-health specific and generic health-related quality-of-life (QoL) instruments is unknown for cancer patients. This study evaluates the performance, measurement, and prediction characteristics of the Oral Health Impact Profile (OHIP–14) and EQ–5D in cancer patients with bisphosphonate-associated Osteonecrosis of the Jaw (ONJ). Methods: 34 cancer patients assessed the QoL of their own ONJ with the OHIP–14 and evaluated the QoL of 4 standardized ONJ Health States with the EQ–5D, as previously published. For each instrument, the standard response mean (SRM), effect size (ES), and ability to distinguish minimally important differences (MID) were evaluated for ONJ compared to baseline (longitudinal responsiveness). Instrument MIDs (cross-sectional responsiveness) were also calculated. Performance of a published general dentistry algorithm to predict EQ–5D values from OHIP–14 results was tested. Results: The OHIP–14 and EQ-5D instruments demonstrated moderate to large longitudinal and cross-sectional responsiveness. Pain was one of the most responsive domains for both instruments. Ceiling/floor effects were most prominent for OHIP–14. A general dentistry algorithm did not adequately predict EQ–5D values for cancer patients. Conclusions: This study provides the first empirical evidence for the performance, measurement, and prediction characteristics of oral-health specific and generic QoL instruments for the oral health side effects of systemic cancer treatment. Instrument validity is supported for oral health complications in cancer patients. These results provide benchmarks for PROs at the intersection of oral medicine and surgery, dentistry, and oncology. [Table: see text]
Key concerns and symptoms of patients undergoing second- and third-line treatment for non-small cell lung cancer: Findings from a patient interview study.
Authors: Magasi Susan , Kaiser Karen , Mallick Rajiv , Cella David 
Published: February 2017

63 Background: Understanding key concerns and symptoms of patients undergoing cancer treatment is important for characterizing drug treatment benefit as well as developing appropriate psychosocial support interventions. The purpose of this interview study of patients undergoing second and third line therapy for non-small cell lung cancer (NSCLC) was to characterize their physiological, especially pulmonary, symptoms, functional impacts, emotional distress, health-related quality of life (HRQOL), and coping strategies. Methods: Semi-structured thematic interviews with 20 patients in second and third line treatment for advanced NSCLC. Interviews included open elicitation of NSCLC symptoms, their functional impact, and coping strategies. Results: Mean age was 62 years (range 30-79); 80% of patients had non-squamous histology, and 25% had co-morbid COPD. Patients described a range of core symptom experiences, severity, functional impacts, and coping strategies. Shortness of breath (reported by 16/20, 13/20 rated as very important), cough (reported by 14/20, 10/20 rated as very important), and chest tightness (reported by 15/20, 9/20 rated as very important) emerged as key pulmonary symptoms. Ninety percent (18/20) of patients reported tiredness or fatigue, mostly as “very important.” A quarter (5/20) of the patients reported having no pulmonary symptoms. The symptom importance ratings were influenced by the symptom’s impact on valued roles and responsibilities. Patients reported diverse coping strategies including breaking down activities into manageable tasks, priority setting, using physical assistance, emotional support, and adoption of diet/exercise changes. Conclusions: Findings from this interview study of patients receiving second and third line treatment for advanced NSCLC reveal the importance and relevance of core physiological, especially pulmonary, symptoms in characterizing the benefits of drug therapies. These findings offer insights to the patient education and psychosocial interventions that are likely to enhance patients’ HRQOL.
Development of a quality infrastructure for a 135-site statewide network of community oncologists.
Authors: Lindsey Gay , Hoverman J. Russell 
Published: February 2017

74 Background: The delivery of patient centered, high-value care requires a formal system of continuous quality improvement. In order to bring metrics to the site and physician level the need to revamp our program for 364 physicians was apparent The starting point was 4 physician-led network wide quality committees. Methods: In 2010, the position of Director of Quality Programs was created to assist in the development of a quality infrastructure for a statewide network of community oncologists. Beginning in January 2011 meetings were held with the management team of each site for education on national quality initiatives and the IOM 6 aims for improvement in healthcare. The discussion also included review of quality metrics set forth by ASCO’s QOPI, evidence-based pathway reporting, variance reporting on patient safety and employee safety, and processes to improve patient satisfaction. Each site then identified their team members, physician champion, and frequency of committee meetings. An action plan format was provided with discussion on components of the plan and the reporting structure to the physician-lead quality oversight committees. Results: The network currently has 38 quality committees serving 84 sites of service. Within a year’s time pathways assessable data improved from 84% to 90%, pathways adherence improved from 60% to 68%, and exception documentation rose from 14% to 25%. Variance reporting increased 35% and a network Patient Satisfaction Survey was created and administered with 10 surveys per physician collected and tabulated for baseline data. The survey process was reviewed and refined and will now be administered twice yearly at each site. Documentation of hospice referrals and follow-up processes on deceased patient information are key initiatives at each site. Conclusions: Development of a robust quality infrastructure at the site level can increase adherence to quality measures by identifying common barriers to improvement, sharing of best practices, and supporting the delivery of patient-centered, value-based care.
Securing discharge follow-up appointments in a women’s cancer program.
Authors: Dalby Carole , Campos Susana M. , Doverspike Lisa , Spinks Melissa , Jacobson Joseph O. 
Published: February 2017

81 Background: Ensuring patients have a follow-up appointment scheduled prior to discharge is one of several key interventions shown to reduce hospital readmission rates (Hansen L.O., Young R.S., Hinami K., et al. [2011, October]. Interventions to reduce 30-day rehospitalization: a systematic review. Annals of Internal Medicine, 155[8], 520-528). Lack of follow-up diminishes continuity between the inpatient and outpatient setting, can lead to patient dissatisfaction, as well as delays in proposed therapy. Methods: A three-month review of discharge data highlighted 49% of Women’s Cancer Gynecologic patients at an academic medical center were discharged from the hospital without securing a follow-up appointment. A multidisciplinary team involved in the scheduling process was assembled and determined failure to schedule appointments was attributed to a lack of communication between the inpatient and outpatient services, a complicated scheduling process, as well as ambiguity regarding when patient’s should return. Several rapid PDSA cycles were implemented over a three month period of time. The intervention created a standardized electronic template, including the establishment of standard time frames for follow-up appointments post discharge (7 to 10 days). The template details all required scheduling elements such as services requested, required laboratory studies, and patient preferences. Within the electronic template is the ability to directly email essential staff through a centralized email address embedded within the form. Staff engaged through reviewing of data, identification of the importance of securing a follow-up appointment, and weekly huddles. Results: Post intervention, the rate of compliance of scheduled discharge follow-up appointments rose from 49% to 87%. Staff reported high satisfaction with the new process, highlighting its simplicity and efficiency. Conclusions: Securing a follow-up appointment prior to discharge is feasible as evidence by increased compliance from baseline 49% to 87%. Future endeavors will implement this process across other disease programs in hopes of obtaining similar results.
Implementation of team training in outpatient breast oncology.
Authors: Bunnell Craig A. , Gross Anne , Kalfin Michael , Partridge Ann H. , Lane Sharon , Burstein Harold J. , Fine Barbara , Hilton Nancy , Sullivan Clare , Colicchio Lynn , Hagemeister Erin , Kelly Anne , Szabatura Audrea , Winer Eric P. , Mann Susan , Weingart Saul 
Published: February 2017

83 Background: Team Training (TT) principles, used in high-risk industries to reduce errors and improve communication and task coordination, have been applied in several areas of medicine, but not in outpatient oncology. We piloted a TT program in a large, academic, clinical breast cancer program. Methods: Observations, interviews, and anonymous adverse event reporting systems were used to identify areas of vulnerability for intervention: Communication of changes in same-day chemotherapy orders (“change orders”); Missing treatment orders on days patients were not also scheduled with physician (“unlinked” visits); Follow-up and communication to other team members on important patient issues (e.g., pending test results or changes in patient status); Conflict resolution between providers and staff. Agreements about roles, responsibilities, and behaviors were made to address vulnerabilities. Using a train-the-trainer model, clinical leaders trained all providers and staff in TT principles, behavioral agreements, and the tools to support them. Results: The program was assessed six months after implementation. There was insufficient power to detect a significant difference in communication of change orders because of infrequency of events (< 2% pre- and post-training). However, 100% of providers reported it was easier to communicate change orders and 87% of infusion nurses reported a decrease in non-communicated changes. The incidence of missing orders for unlinked visits decreased from 38%to 2%. Press-Ganey patient satisfaction scores highlighted improvements in perception of care coordination. Providers, infusion nurses, and support staff all reported strongly positive perceptions of improvement in the efficiency (75%, 86%, 90%), quality (82%, 93%, 93%) and safety (92%, 92%, 90%) of patient care. Similarly, all groups reported improved relationships and more respectful behavior among team members (91%, 85%, 93%). Conclusions: Team Training improved communication, task coordination and perceptions of efficiency, quality, safety, and interactions among team members and patients’ perceptions of care coordination. Widespread implementation of TT across the entire Adult Service is ongoing at our institution.
Patient understanding and impression of hematology/oncology fellows.
Authors: Curley Brendan F. , Truong Quoc Van , Curley Anjaly Belur , Culp Mark , Hu Yanqing , Almubarak Mohammed 
Published: February 2017

9 Background: Hematologists/oncologists spend years training in a fellowship program. At academic centers, patients receiving treatment are often seen by fellows. It has not been established what patients understand about fellowship training, therefore our purpose was to explore their understanding and if they are content with fellows taking part in their care. Methods: At West Virginia University/Mary Babb Randolph Cancer Center we drafted a survey. This anonymous and voluntary survey abstracted patient data that included: age, sex, race, level of education, type of cancer diagnosis, amount of time being treated for cancer, experience being cared for by fellows and basic knowledge of a hematology/oncology fellowship. Multiple-choice questions were drafted with 4 to 6 answer choices with no option for unknown. Surveys were collected over a three-week period from July 3, 2012 through July 24, 2012. Patients were surveyed at outpatient appointments, infusion center visits, and laboratory draws. Results: 226 surveys were collected. Statistical analysis was performed and a binomial regression was fit to the data. There is evidence that higher levels of education are more likely to give correct answers (p value 0.035). Patients who stated they had not seen a fellow or were unsure they had seen a fellow were more likely to select incorrect answers (p value 0.001). There is no statistical significance differentiating between cancer types in likelihood of getting answers correct (Table). 1.77% of those surveyed felt they completely understand the role of a fellow in their care, while 84.51% desired further information about fellows. Only 2.21% disliked having a fellow involved in their care. Conclusions: Patients at academic centers being seen by hematology/oncology fellows appear to have a lack of knowledge of a fellow’s role and background but have a desire to be educated. Educational initiatives can be introduced to teaching institutions to help patients better understand the role of a fellow. [Table: see text]
Wait time reduction for patients awaiting chemotherapy infusion using a formal process improvement approach and sequential.
Authors: Norden Andrew David , Buswell Lori A. , Amorati Meg , Arthur Lois , Bernard Antoinette , Constantine Michael , Dalby Carole , Farrar Wendy , Fuller Frances , Kerivan Dawn , Lacourse Kristin , McNulty Brendan D. , Racicot Adonica , Spinks Melissa , Jacobson Joseph O. , Ponte Patricia Reid , Shulman Lawrence N. 
Published: February 2017

92 Background: At a community hospital satellite of an academic cancer center, baseline data indicated that 49% of patients waited longer than 30 minutes from arrival in the treatment chair until treatment was started, resulting in dissatisfaction and decreased chair turnover. Methods: A team was assembled, including physicians, nurses, pharmacists, and administrative staff. The team constructed a detailed process flow map and performed a cause-and-effect analysis. Wait time data were collected using the electronic scheduling system and time sheets. Additionally, nurses used a structured data collection sheet to categorize the reasons for prolonged wait times. A p-type statistical process control chart was constructed to track the proportion of infusion visits per day with wait times longer than 30 minutes. The team brainstormed process improvements and selected ones to implement by employing a priority/pay-off matrix. Results: Baseline data were assessed for 403 visits over a 3 week period. Of 232 visits with wait times longer than 30 minutes, 98 (42%) involved excessive waiting for the physician to see the patient or write orders. One of 4 physicians was responsible for 56 (57%) of these. This physician’s patients were seen exclusively in the infusion room, while the other physicians saw patients in the exam room before sending them to the infusion area. Three PDSA cycles were conducted: (1) All physicians started seeing patients in the exam room before sending them to infusion chairs, (2) Specific treatments were selected that could be routinely administered without the physician seeing the patient, and (3) A reminder system prompted physicians to enter treatment orders within 24 hours of each patient’s visit. After 6 months, 29% of patients waited longer than 30 minutes, down from 49% at baseline. Conclusions: These interventions implemented using PDSA cycles successfully reduced wait times. Measurement and presentation of data were critical in persuading physicians to practice in a more homogeneous fashion.
Using a disease pathway management (DPM) approach to improve the quality of lung cancer care in Ontario.
Authors: Evans William K. , Ung Yee , Sawka Carol Anne , Assouad Nathalie 
Published: February 2017

93 Background: Cancer Care Ontario (CCO) is mandated to oversee quality of cancer care in Ontario and began its Lung Cancer (LC) DPM initiative in 2009. DPM has 4 objectives: align provincial quality improvement (QI) initiatives by disease site; map the patient journey and identify gaps in evidence/quality in clinical practice that impact care or the patient experience; set and manage regional quality indicators across the pathway; and leverage tools to model the impact of policy decisions. Methods: The LC DPM drafted a disease pathway map and established 5 multidisciplinary working groups (WGs) each focussed on a phase of the LC patient journey: prevention, screening, and early diagnosis; diagnosis; treatment; palliative care; the patient experience. WGs held 25 two-hour meetings and developed ideas for 17 QI projects. 8 were selected for discussion at a provincial consensus conference and yielded a Priorities for Action Report. Regional “roadshows” were held in all 14 regions of the province at which region-specific data on incidence, stage at diagnosis, compliance of treatment with guidelines and wait times, amongst other metrics relevant to LC, were shared with the regional care providers. Funding was provided by CCO for regional QI based on the data and identified priorities. Results: Completed diagnostic and treatment pathways are posted on CCO’s website as are educational materials on dyspnea management, including a patient video and a document prepared by patients for patients “Understanding Lung Cancer.” Lung diagnostic assessment units/programs have been initiated in 14 regions. An audit is underway to better understand the barriers to the uniform uptake of evidence-based practices across the province. The percent of LC patients whose symptoms are assessed at least once a month using a standardized symptom assessment instrument (ESAS) has improved. Conclusions: Regional cancer programs are now aware of their performance on a range of LC specific quality metrics. Standardized diagnostic and treatment pathways have been developed and assessment units have been implemented across the province.
Morbidity, mortality, and improvement (MM&I) conference leading to change.
Authors: Moore Andrew Jacob , Coyne Tracy , Cardin Dana Backlund , Gilbert Jill 
Published: February 2017

94 Background: During quarterly MM&I Conferences, a recurrent systems problem identified was the underreporting of chemotherapy infusion reactions. Attendees acknowledged difficulty in obtaining accurate data regarding adverse events and justifications for treatment cessation, which may lead to under dosing of effective therapies. Methods: MM&I conference is an interactive multidisciplinary forum that emphasizes discussion to improve system-based problems. Attendees include faculty, fellows, residents, nursing staff, informatics and pharmacy representatives. Participants used the Ickwaka Fishbone Diagram to identify issues that led to underreporting of reactions. Through discussion of the issues and identification of potential improvement activities, participants recognized that improved nursing documentation could accurately capture data related to adverse drug events. Representatives from the informatics department identified a report that could be generated automatically when infusions are stopped that would require nursing staff to identify the type of reaction and give justification for not completing the infusion. Reports would also include actions taken and patient responses. Results: Implementation of electronic nursing documentation revealed that the prevalence of infusion reactions were much higher than previously identified. During the first 6 months of electronic documentation there were 71 identified reactions compared to 46 reactions documented during the 6 months prior to implementation. Paclitaxel (22%) and Rituximab (39%) were identified as the two most common agents associated with infusion reactions. Twenty (28%) infusion reactions resulted in cessation of that particular chemotherapy. Conclusions: The format of the MM&I Conference engaged members of a multidisciplinary team to promote collaboration for system-based improvements in patient care and safety. Electronic nursing documentation has put a mechanism in place to capture data related to infusion reactions that will allow us to evaluate the effectiveness of future interventions to decrease the prevalence of infusion reactions, as well as the number of therapies that are stopped indefinitely due to these reactions.