bluuebunny/crossref_metadata_2025_split huggingface dataset:
Embodying patient-centered communication: An eHealth prototype and evaluation.
Authors: Haas Niina , Yang DerShung , Lopez Ana Maria 
Published: February 2017

152 Background: An eHealth prototype was developed to embody the principals of Patient-Centered Communication espoused by National Cancer Insitute (NCI). The prototype provides patients with features that support access to their “care” (medical records, symptom reporting and monitoring tools, calendar, treatment schedule), “team” (bio, roles, contact info for care team), “education” (reputable articles, videos, tools), and “community” (local classes, events, support groups, forums). This prototype was evaluated in terms of its usefulness and usability. Methods: The prototype was evaluated through two usability evaluation sessions. 13 cancer patients, 4 caregivers, and 12 cancer health care providers were recruited. During a 30-45 minute session, each subject viewed the prototype and completed a survey about the prototype’s usability and usefulness. The survey included 29 items with Likert scales ranging from 0 (Strongly Disagree) to 4 (Strongly Agree). Descriptive statistics were generated. Results: The results were categorized according to group (patient, caregiver, and provider) and section of prototype (overall, care, team, community, education). The patients rated the prototype higher in terms usefulness and usability across all user groups/sections except for the education section, which was rated highest by providers (Table). Conclusions: The positive feedback on several aspects of the prototype from different user groups indicates that our prototype met our objectives of being useful, easy-to-use, and adding value to the cancer patient’s care journey. Interestingly, there is a difference in the perceived value of the prototype’s different sections among each user group. The patients placed higher value on the “Care” features (medical records, symptom reporting and monitoring tools, and treatment schedule) and “Team” features (bio, roles, contact info for care team) than providers, and caregivers. Whereas providers most valued education content as opposed to patients and caregivers who ranked the team content as most important. [Table: see text]
Quality of life among breast cancer survivors treated with breast-conserving therapy in Hawaii.
Authors: Conde Francisco A. , Wilburn Andrea R. 
Published: February 2017

154 Background: Aim of this study was to compare quality of life (QOL), treatment-related side effects, and needs of recent and long-term breast cancer survivors following breast-conserving therapy. Methods: Surveys were sent to 750 women with Tis, T1 – T4 breast tumors without lymph node involvement who received lumpectomy followed by radiotherapy at a large, tertiary care facility in Hawai‘i from January 2001 to December 2010. To assure adequate representation across years, 75 women were randomly selected from each year. Surveys included demographic items, City of Hope Quality of Life – Breast Cancer Instrument, and Breast Cancer Prevention Trial Symptom Scales. Completed surveys were received from 265 (35.3%) women, and findings were analyzed for long-term survivors (diagnosed from 2001-2003, n=76), mid-range survivors (diagnosed from 2004-2007, n=95), and recent survivors (diagnosed from 2008-2010, n=94). Results: Overall, respondents reported high QOL. Similarly to recent breast cancer survivors, long-term survivors reported slight to moderate side effects, including hot flashes, vaginal problems, musculoskeletal pain, and cognitive dysfunction. After controlling for age, ethnicity, and cancer stage, there was no significant differences in QOL physical, psychological, and social well-being subscale scores across time periods. Long-term survivors were more likely than shorter-term survivors to want information regarding nutrition (p<.01), physical activity (p=.018), and ways to restore strength, mobility, and cognition (p<.01). Conclusions: Breast cancer survivors treated with breast conserving therapy report relatively good QOL between 2 and 12 years post-treatment, although they continued to experience physiological issues (which could be exacerbated by age), and anxieties about their cancer. Healthcare professionals should continually assess for ongoing cancer-related side effects even years after completing treatment. Funding: This research was supported by ‘Imi Hale Native Hawaian Cancer Network (U54 CA153459).
Satisfaction evaluation of medical attention at breast cancer service at National Cancer Institute Mexico.
Authors: Ramirez-Morales Rebeca , Santamaria-Galicia Julieta , Aldama Lucy , Bautista-Leon Alejandra , Aguilar Cristina , Alvarado Miranda Alberto , Calderillo Ruiz German , Arce Salinas Haydee Claudia 
Published: February 2017

156 Background: Breast cancer is the leading cause of attention at the INCan. In 2012, 44,761 medical consults were given therefore 19,584 (44%) of those by breast cancer oncologists. The increasing percentage of patients could be associated with a quality attention deficit, crowded waiting room and a shorter time for consultations affecting patient communication and education. The goal of this study was to evaluate the quality attention given by breast cancer service with the purpose to design different strategies in order to improve quality and cordiality with our patients. Methods: Self-response surveys had been applied to patients with breast cancer at INCan. The variables investigated were demographic characteristics including age, education level, marital status and date of diagnosis. Also variables related with the quality of our medical and paramedical attention, global care support and the waiting time before consultations were asked. Results: 259 patients were interviewed, the median age was 50 years old (17-88), only 18% of them achieved university degree and 28.7% had less than elementary education. One third of our population lived in Mexico City; the rest of them came from different states from the center and south of the country. The waiting time in average was 2 hours (10 min -7 hours). Regarding to attention quality, 28% considered that waiting time should be shorter, 22% answered that doctor-patient relationship needs to improve. In this aspect, the main aspects to improve are: give information in detail including the patient and their relatives; a better explanation about their disease and treatment and also information about diet and physical activity, among others is needed. Finally, 9.3% suggested improvement in nursery service. Conclusions: The results showed that our effort is satisfactory. However our main goal is to improve our medical assistance. It has been proven that patient education and higher satisfaction level improves their adherence and the knowledge related to handle adverse effects of their treatment. Our proposals include psycological-educative strategies easy to understand. Enhance medical services to improve physician-patient relationship. We will keep looking forward about the efficiency of these strategies.
Patients’ and caregivers’ views on the timing and benefits of early palliative care: A qualitative study.
Authors: Hannon Breffni , Swami Nadia , Pope Ashley , Leighl Natasha B. , Krzyzanowska Monika K. , Moore Malcolm J. , Oza Amit M. , Rodin Gary , Zimmermann Camilla 
Published: February 2017

157 Background: Early palliative care referral can improve quality of life and satisfaction with care, and is increasingly encouraged. However, little is known about patients’ and caregivers’ attitudes towards early referral. We conducted qualitative interviews seeking the opinions of advanced cancer patients (who had been randomized to an early palliative care intervention) and their caregivers, to determine whether they perceived a benefit, and if so in which domains. Methods: We recruited participants from medical oncology clinics at a comprehensive cancer centre, following completion of a randomized controlled trial comparing early palliative care referral with standard oncology care. Selective sampling was employed to ensure equivalent numbers of participants based on study arm, age, gender, high vs. low quality of life scores, and high vs. low satisfaction with care. A grounded theory approach was used to explore emerging themes. Results: Twenty-six patients and 14 caregivers completed interviews. Several benefits of early referral were noted. These included: prompt attention to symptom needs; timely, sensitive information about prognosis and end-of-life care options; and destigmatization of palliative care through routine referral. Although some participants did not feel they currently needed palliative care, they did feel comforted that early referral had provided them with a “safety net” that could quickly be put into place if they required future support. Conclusions: Early referral was perceived as useful in several domains, including immediate symptom control, and preparation for the future.
Prognostic information (PI), psychological well-being, and quality of life for advanced cancer patients (ACP) in phase I trials and their spousal caregivers (SC).
Authors: Hlubocky Fay J. , Cella David , Sher Tamara , Ratain Mark J. , Daugherty Christopher 
Published: February 2017

16 Background: The impact of the physician’s (MD) disclosure of PI on the psychological well-being and quality of life (QoL) of clinical trial subjects with terminal disease on phase I trials has not been formally evaluated. Methods: A prospective cohort of ACP enrolling in phase I trials was assessed at baseline (T1) and one month (T2) utilizing various measures including: state-trait anxiety (STAI-S/T), depression (CES-D), quality of life/QoL (FACIT-Pal), and global health (SF-36). Semi-structured interviews of ACPs also evaluated MD-Pt communication re prognosis and worry about ACP death. Results: 100 subjects (50 Phase I ACPs and 50 SC) were separately interviewed at T1 and T2. For the population as a whole: median age 62 (28-78y); 51% male; 100% married; 88% Ca; 68% > HS educ; 56% GI dx; 54% income <$65,000 yr. At T1, 45% of ACPs acknowledged having a discussion re life expectancy with MD; 35% stated the MD gave a prognostic timeframe; and 41% reported worry re death. For SC at T1, 62% recalled a prognosis discussion with the MD; 50% stated MD gave a timeframe; 53% reported PI disclosure was initiated by the MD; 66% reported worry re ACP death. At T2, rates remained consistent for both ACP and SC with the exception of increased reported worry re ACP death at 55% and 70% respectively. At T2, ACP who denied a prognosis was given by the MD had higher STAI-S (35 ± 10 v 29 ± 9, p=0.03) and CES-D scores (16 ± 12 v 7 ± 4, p=0.01); and lower FACT-Pal scores (128 ± 18 v 153 ± 24, p=0.01). SC with acknowledgement of a prognostic timeframe given by the MD had higher STAI-S anxiety (39 ± 16 v 36 ± 16, p=0.04) at T2. Regression analyses revealed that ACP with acknowledgement of a prognostic timeframe given by the MD had poorer FACIT-Pal QoL over time. Also, SC with acknowledgement of a prognostic timeframe at T2 was negatively associated with SF-36 scores. ACP and SC qualitative responses re PI disclosure revealed salient themes: hope for a positive outcome or prolonged survival; stabilization of disease; emotional distress; ambivalence/fear; acceptance. Conclusions: Physician disclosure of a prognostic timeframe is negatively associated with QoL among clinical trial subjects and SC in phase I trials.
Improving oncology quality through the implementation of evidence-based clinical pathways in a payer’s oncology network.
Authors: McCrone Daniel , Gill Dudley , Tran Cecilia , Sturgill Michael 
Published: February 2017

161 Background: Physicians and health plans are collaboratively exploring clinical pathway strategies to improve patient outcomes, reduce treatment variation, and reduce oncology cost. One landmark study found that 33.2% of insured patients did not receive guideline cancer therapy. Additional studies have demonstrated that the use of pathways can lower the cost of care and that oncologist participation is a critical element for success. New Century Health (NCH), in partnership with a leading health plan and one of its Midwestern oncology networks, had two quality goals with the implementation of a chemotherapy prior authorization system: review all chemotherapy regimens for all patients and measure treatment plan adherence to evidence-based clinical pathways. Methods: As one component of a mandatory chemotherapy prior-authorization program, an online prior authorization system was used by oncology practices to submit chemotherapy treatment plans to NCH for approval. The system captured detailed patient clinical information and measured compendium and preferred pathway adherence rates. These data were shared with participating oncology practices on a quarterly basis. For analysis, an average Baseline compendium adherence rate was determined reflecting participating practices for six cancer diagnoses (Breast, Colon, Lung, Lymphoma, Multiple Myeloma, and Prostate). The Baseline rate was compared to the Review period rate. Results: A comparison of the Review and Baseline period metrics indicated a statistically significant increase in the level of compendium-based chemotherapy treatment plans submitted by participating providers. Conclusions: Implementation of an oncology prior authorization system that measures compendia-based adherence rates is associated with increased levels of evidence-based chemotherapy treatment plans by participating providers. [Table: see text]
Comparison of QOPI measure conformance between oncology fellows and attending physicians.
Authors: Zhang Tian , Kamal Arif , Kelley Michael J. 
Published: February 2017

162 Background: Quality improvement measures are uniformly applied to all oncology providers, regardless of their positions. Little is known about differences in conformance to these measures between oncology fellows and attending physicians. In order to tailor improvement interventions to these groups, we investigated conformance across QOPI measures for oncology fellows and attending physicians at the Durham VA Medical Center (DVAMC). Methods: Using data collected from the Spring 2013 QOPI cycle, we abstracted information from patients who had received care at the DVAMC between 2011 and 2013 and separated them based on their provider. To validate the data, we abstracted a subset of patient charts, limited to oral chemotherapy quality measures. Descriptive statistics and the Chi square test were calculated for each measure between the two groups. Results: A total of 97 patients were reviewed at DVAMC. Of these, 21 had a fellow and 47 had an attending as their main provider. Fellows and attendings performed similarly on 119 of 125 QOPI measures (core, end of life, symptom, colorectal, and NSCLC modules). Fellows were less likely to assess pain on the most recent visits when compared to attendings (52% vs. 77%, p=0.046) but more likely to document a management plan if the patient had moderate or severe pain (86% vs 75%, p=0.09). Attendings documented the plan for oral chemotherapy more often (93% vs. 60%, p=0.07). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 80% of the time (p=0.21). Fellows were more likely to document smoking status (95% vs. 64%, p=0.007) and to address smoking cessation (86% vs. 62%, p=0.048). Conclusions: Patient care practices tend to be similar between attendings and fellows overall; some of the significant differences may not remain significant after chart audit. Fellows generally mirror behaviors of attending physicians, and attendings have an important role in modeling best practice behaviors for fellows. Different quality measure standards may not be necessary between fellows and attendings.
Feasibility and utility of influenza vaccination in hematology/oncology clinics.
Authors: Uppal Navjeet , Tobin Swanee , Cape Jennifer , Muller Matthew , Hicks Lisa K. 
Published: February 2017

166 Background: Seasonal influenza vaccination is recommended for cancer patients. However, many cancer clinics do not routinely offer flu shots. Early in January, 2013, Toronto experienced widespread influenza activity. Approximately 25% of hospitalizations on the hematology/oncology ward at St. Michael's Hospital (SMH) during this time were for suspected influenza. A large number of patients were noted to be unvaccinated. In-response, influenza vaccination was organized in parallel with regular hematology/oncology clinics at SMH. Aims: To determine the feasibility and utility of influenza vaccination in a cancer clinic. Methods: All patients seen in the SMH hematology/oncology clinic between January 14 and February 1, 2013, were eligible for influenza vaccination. A brief survey was administered to obtain vaccination history, willingness to receive flu vaccination, and beliefs about flu vaccination. Information regarding diagnosis, treatment, and family physician was obtained from the medical record. Univariate testing was completed with the Chi-squared and Fisher’s exact tests as appropriate. Results: 555 patients were seen during the period of interest; 206 completed the survey (37% response rate). Median age of respondents was 63 years, 42% were male, and 81% had cancer. 107(52%) of respondents had not received seasonal influenza vaccination of whom 41 (38%) accepted vaccination when offered. Among vaccinated patients, most received the flu shot from a family physician (70%). Reasons for not receiving the flu shot were personal preference (24%), belief that it was not necessary (19%), inconvenience (14%), concerns about side effects (8%), believe that it was contraindicated during chemotherapy (7%) and a perception that a medical practitioner advised against it (7%). Patients without a registered family physician were less likely to have received the seasonal flu shot (p=0.03). Patients with a malignant diagnosis and patients receiving IV chemotherapy tended to have lower rates of seasonal flu vaccination (p=0.09 and p=0.12 respectively). Conclusions: Administering influenza vaccination during hematology/oncology clinics is feasible and may address a care gap in this population.
A single center, retrospective analysis evaluating aberrant drug behavior stratification utilizing the opioid risk tool in patients with cancer.
Authors: Ma Joseph D. , Horton John M. , Hwang Michael , Atayee Rabia S. , Roeland Eric 
Published: February 2017

167 Background: Historically, it was believed that cancer patients could not have aberrant drug behaviors. However, clinical experience suggests otherwise. The prevalence of aberrant drug behaviors of cancer patients is unknown as screening is uncommon. Consequently, the UCSD Moores Cancer Center outpatient palliative care clinic initiated screening of aberrant drug behaviors utilizing the opioid risk tool (ORT) on new consultations. The purpose of this retrospective analysis was to identify key risk factors of aberrant behaviors of cancer patients and formulate a routine approach to follow-up and medications quantities. Methods: The treating oncologist referred new consultations to the outpatient palliative care clinic. A cohort of 93 cancer patients was evaluated from July 2012 to February 2013. Patients completed a 10-item, provider-administered, ORT during the consultation visit. Based on the ORT, patients were stratified into high-, moderate-, or low-risk for abarrent drug behavior and follow-up appointments and opioid quantities were adjusted accordingly. Results: Of the 93 patients, 48% were men and 52% women. Most patients had metastatic cancer (n=50; 54%) of gastrointestinal primary (n=27; 29%). Fifty-six (60%) patients were stratified as low-, 15 (16%) moderate-, and 22 (24%) high-risk based on ORT score. The most common risk factors for aberrant behaviors were a history of depression (women=25; men=17) and family history of alcohol abuse (women=22; men=18). There was no difference in the prevalence of depression (p=0.17) or family history of alcohol abuse (p=0.57). The least common risk factor was a personal history of prescription drug abuse (n=1) in women and history of preadolescent sexual abuse in men (n=0). Conclusions: Screening of cancer patients suggests risk factors for aberrant drug behavior exist. Stratifying patients based on a standard, routine tool can help identify cancer patients at risk for aberrant drug behaviors. Moderate and high-risk patients can then be followed closely with limited quantities of opioids until trust is established.
Outpatient documentation of advance care planning (ACP).
Authors: Obel Jennifer Carrie , Brockstein Bruce , Benfield Tiffany , Konchak Chad , Robicsek Ari , Raymond Michael , Tabachow Cory , Kharasch Maureen , Marschke Michael , Hensing Thomas A. 
Published: February 2017

169 Background: To increase and systematize outpatient ACP, our quality improvement team developed enhancements in 2 oncologists’ cohorts of newly diagnosed, incurable cancer patients (pts). At 1st consultation, an ACP form is given to pts; a nurse assesses knowledge about medical POAs and goals of care. Pts return for chemotherapy teaching and ACP education session conducted by a nurse utilizing an ACP workbook describing end-of-life (EOL) scenarios. After reviewing the workbook, the nurse or social worker fills out an Advance Directive Note (ADN). At next visit, the oncologist reviews the plan, cosigns the ADN and inputs code status orders (CSOs). Alternatively, oncologists may choose to create the ADN. Methods: An EOL quality database of 9 metrics was created via the Electronic Health Record to measure quality of EOL care for cancer patients. Before pilot implementation, baseline assessment of ACP documentation in deceased cancer pts was obtained utilizing the EOL database for a 3 month time frame (12/12-2/13) for 2 oncologists (GI and thoracic oncology). These rates are compared to ACP documentation for newly diagnosed incurable cancer patients in the outpatient clinic during the 3 month pilot occurring from 3/13-5/13. Results: During the pilot, 5/13 (38%) new thoracic oncology patients and 13/17 (76%) GI patients had outpatient ADNs. The average days to ADN placement from 1st visit, was 14 and 10 in thoracic and GI, respectively. GI oncology placed 6/13 ADNs on the 1st visit; 12/13 GI pts had ADNs placed less than 10 days from 1st visit. GI oncology also placed 10/17 outpatient CSOs of which 8/10 were less than 10 days from 1st visit. In the same thoracic oncologist’s deceased patients during the baseline period, 2/20 (10%) had outpatient ADNs compared to 7/20 who had inpatient ADNs; 2/20 thoracic patients had outpatient CSOs compared to 15/20 with inpatient CSOs. In two comparable practices which did not participate in the pilot from 3/13-5/13, 0/26 and 1/26 new patients had outpatient ADNs and CSOs, respectively. Conclusions: Outpatient ACP is feasible early in the care of cancer patients through systematic improvement in work flow and motivated providers. Future research will focus on whether ACP soon after a cancer diagnosis affects downstream metrics of quality and cost of care during EOL.