bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing person-centered care readiness at a cancer system level through a provincial environmental scan in Ontario.
Authors: Moody Lesley , Navarro Jorge , Green Esther , Macdougall Laura , Singh Simron 
Published: February 2017

70 Background: Cancer Care Ontario (CCO) is an Ontario government agency which drives quality and improvement for the Ontario cancer system. Person-Centred Care (PCC) has been an identified goal both from the recent Institute of Medicine (IOM) report and as a corporate strategic priority at CCO. CCO is assessing the degree of PCC practiced in Ontario’s Cancer system to design interventions to improve this aspect of care delivery and design. Currently no established or validated indicators for PCC have been tested and evaluation methodology of PCC is unclear. A baseline of the system’s focus on PCC is required to establish a provincial plan to drive quality improvement. Methods: A series of 14 semi-structured interviews were conducted at Ontario’s regional cancer centers (RCCs) to determine the degree of development of a PCC culture in Ontario’s cancer system. Interviews were conducted with all 14 Regional Cancer Programs (RCPs) including: - 10 Patient and Family Advisors (PFAs); and - 56 RCPs and hospital leaders (Directors, Managers, Physicians, Nursing, Psychosocial Oncology providers). Sixty-six participants (direct interviews/questionnaires) were interviewed; questionnaires were received from 28 organizations (hospitals/RCCs). Results: Although 86% of interviewed organizations reported having a PCC corporate strategy, 41% of hospitals and 73% of RCCs do not have dedicated staff to support the strategy. 53% of organizations work with a Patient and Family Advisory Council (PFAC) and only 43% engage PFAs in decision-making tables with 94% of RCPs expressing a need for guidance on PFA engagement. Key facilitators to promote PCC are: strong and committed leadership and continuous staff engagement/education. Primary barriers include: equity in PFA recruitment, cultural resistance to PCC, and lack of evaluation frameworks. Conclusions: Advancing PCC requires strong provincial direction, training to foster PFA engagement, and measurement and accountability frameworks for cultural change. Clear definitions on accountabilities for PCC roles and expectations for PFAs and staff are also key to supporting PCC regionally.
Demographic trends in clinical trial withdrawal rate within the Bubble Study: Updated analysis.
Authors: Riley Elizabeth Carloss , Dragun Anthony E. , McMasters Kelly , Quillo Amy R. , Scoggins Charles Raben , Wu Xiaoyong , Rai Shesh , Jain Dharamvir 
Published: February 2017

71 Background: There are well described barriers to clinical trial participation among varied racial/ethnic and demographic groups. Little is known about clinical trial drop-out rate among these groups. This is an updated analysis of the demographic and clinical characteristics of patients who originally enrolled in the “Bubble Study” clinical trial but then withdrew at a later date. Bubble Study is a non-blinded, prospective observational cohort study designed to assess the adherence rate of adjuvant endocrine therapy among women with early stage breast cancer. Methods: From Aug 2012 to April of 2014, 88 women were enrolled. Demographic data (age, race. insurance status) and treatment factors (stage, surgery type, therapy duration, co-morbidites) were collected. Comorbidities were defined as none, moderate (1-3) or significant (>3.) Descriptive statistics were produced for the entire cohort and the subjects of cohort. Frequencies were compared using a Chi-square test (Fisher’s exact test when expected cell frequencies are small). Results were declared significant at significance level of 5% and all analyses are performed using SAS (2003, 2005). Results: At the time of analysis, 86 patients enrolled (E), 41 of which withdrew (W.) Blacks represented 21% of the total E. Private insurance represented the majority (60.4% of those E and Medicare, Medicaid and Uninsured followed in that order (24.4%, 14% and 1.2% respectively.) There was no significant difference with regards to race and insurance between the E and W group although there was a trend toward a higher rate of W among Blacks (p=0.21). Stage, surgery type or age did not predict for W. Comorbidites had a marginal effect on W (p=0.02) The most common reasons reported for W were financial and/or insurance reasons (22%) and inconvenience of pharmacy pick up (15%.) Conclusions: Demographic characteristics that traditionally predict for under-representation in clinical trial enrollment did not predict for W from the Bubble Study. Although this sample size is small this data may suggest disparities in clinical trial participation are largely due to enrollement rather than withdrawal. Continued analysis of this trial and others will help confirm these findings. Clinical trial information: NCT01694225.
Hearing the patient’s voice: Utilization of a patient-family advisory group in key cancer care initiatives.
Authors: Franco Theresa , Yager Ann 
Published: February 2017

74 Background: As patient participation and satisfaction move to center stage in defining quality care experience and providing a competitive edge, it has become necessary to develop strategies to secure patient input and engagement in strategic care initiatives. Methods: At the Nebraska Medical Center, a cancer patient advisory group was established to create a better understanding of the patient experience through the lens of the patient/family member. Our goal focuses on the 3 'P's"- people, processes, and places to improve the patient/family cancer experience. Participants were selected through an application/ interview process from a variety of diseases, backgrounds, and ages to represent a broad spectrum. Results: Initially the group provided feedback on educational formats, throughput, and communication methods. Our greatest opportunity to utilize this advisory group emerged in design and development of the Fred and Pamela Buffett Cancer Center. This 570,000 square foot facility includes a research tower as well as multi-disciplinary inpatient and outpatient clinical environments. Knowing this project would be transformational in cancer care delivery, it was critical that patient input be considered in every phase of design and process improvements. The patient advisory group became instrumental for exploring ideas ranging from the initial impression of the lobby, inpatient, infusion, and exam room layouts, to critical amenities, and way finding, signage. Input on equipment, furniture and technology choices was also sought. Their feedback, obtained through multiple venues, has become instrumental in driving change to enhance our care experience. These interactions have resulted in significant design modifications, a greater emphasis on efficiency in care, and the infusion of elements that individualize the cancer care journey. Conclusions: Engaging the patient advisory group has been critical in in advancing both current and future care initiatives. The health care team has benefitted, by creating a greater awareness of the most coveted aspects of a patient/family experience. It is a powerful conduit for hearing the patient’s voice and putting their words into action.
Organizational barriers to receiving quality health care: A qualitative study among lung cancer patients and caregivers.
Authors: Kedia Satish , Ward Kenneth Daniel , Digney Siri Alicia , Jackson Bianca Michelle , Roark Kristina S. , Boyd Stephanie W. , Osarogiagbon Raymond U. 
Published: February 2017

76 Background: For lung cancer patients and caregivers, navigating the healthcare system while coping with the complexities of the illness is challenging. We explored organizational barriers to receiving quality healthcare from the perspectives of these stakeholders. Methods: A qualitative study involving 10 focus groups (5 of patients, 5 of caregivers) was conducted. Discussions were guided by a standardized script, recorded for transcription, and analyzed using Dedoose software. Results: 22 patients (10 Males/12 Females; 15 Caucasians and 7 African Americans) and 24 caregivers (6 Males /18 Females; 17 Caucasians and 7 African Americans) shared their experiences. Content analysis showed 5 recurring themes: (1) Insurance Issues: Delays in diagnosis or treatment were reported due to lack of insurance, lag time in insurance approvals and care processing, uncertainty about coverage, and caps for tests and/or office visits. (2) Appointment Scheduling: Participants reported appointment delays and rescheduling, long wait times, cancellations by providers, and inflexibility to accommodate schedules. (3) Provider Communication: Communication was lacking at times in initial diagnosis disclosure, prognosis and treatment preparation, willingness to answer questions in lay terms, and time dedicated to patients during appointments. (4) Patient Education: Participants had inadequate knowledge about lung cancer, treatment options and duration, prognosis, and relied on providers to educate and direct them to credible resources. Many felt confused, frustrated, anxious, or fatalistic. (5) Healthcare System Support: Participants found support within the healthcare system extremely beneficial, when available, for coping with lung cancer, expediting appointments, seeking information, connecting with physicians, and receiving timely diagnosis and treatments. Conclusions: These findings offer valuable insight into lung cancer patients’ and caregivers’ perspectives on organizational barriers to receiving quality care. By identifying these barriers for lung cancer patients and caregivers, better planning and management of effective cancer services can be developed.
EMR optimized oral chemotherapy monitoring program: Adherence and ADR outcomes.
Authors: Carro George W. , Hensing Thomas A. , Brockstein Bruce , Gavin Shannon Maureen , Harper Abigail , Jee Cheryl , Palafox Anna , Schiavo Kathryn , Hui Wendy , Blankenship Amanda , Hughes Brad , Uhlig William J. , Spath Wayne , Hullett Ashton Marie , Marciniak Madelyn , Filippini Jacqueline , Azhar Yousuf 
Published: February 2017

77 Background: Utilization of oral anticancer agents (OAA) has drastically increased over the past decade, accounting for more than 70% of new oncology agents approved in 2013. There are many challenges associated with OAA, including monitoring of adverse drug reactions (ADR) and adherence. While few studies estimate adherence of OAA, it is known that a multidisciplinary approach with intensive pharmacist counseling may improve outcomes. Currently, the electronic medical record (EMR) at our institution has many limitations on tracking OAA. In 2007, 1,872 OAA prescriptions were written. The 2014 annualized OAA prescriptions will surpass 5,510, demonstrating a growth of 194%. The purpose of this project is to establish an OAA monitoring program to allow consistent documentation, closer monitoring, and timely management of ADR. Methods: American Society of Clinical Oncology’s Quality Oncology Practice Initiative criteria were utilized to develop a unique monitoring tool, specific for OAA, which was employed via EMR. The monitoring tool assesses the current regimen, ADR, labs, adherence, and drug interactions. The initial analysis focused on testing the tools on two of the most commonly prescribed OAA agents within our institution. New start patients were identified through utilization of an OAA pharmacist verification queue. The pharmacist provided education, intensive follow up, and communicated treatment complications to other healthcare team members. Results: Follow-up calls were placed for 24 capecitabine patients and four erlotinib patients. Over half of the patients required an intervention. For capecitabine, there were seven patients with barriers to adherence. There were two patients who were non-adherent and one patient who was lost to follow-up; therefore, overall adherence rate was 91%. For erlotinib, adherence rate was 100% with no barriers to adherence. Symptom management and education were provided to 16 patients with grade 1 toxicities, and four drug interactions were identified. Conclusions: Oral chemotherapy should be treated with the same intensive monitoring as IV chemotherapy. A multidisciplinary pharmacist driven OAA monitoring program may improve adherence and allow more timely management of ADR.
A review of patient self-reported symptom data with a focus on pain.
Authors: Denny Diane , Nutakki Swetha B. , Alston Kayla , Markman Maurie 
Published: February 2017

79 Background: Cancer Treatment Centers of America, Inc (CTCA) is a national network of five hospitals that specialize in the treatment of patients fighting complex or advanced-stage cancer. The Symptom Inventory Tool (SIT) is an assessment tool that captures the patients’ perceived symptom burden. It includes the scientifically validated M. D. Anderson Symptom Inventory core items and is supplemented by CTCA clinician interested ‘custom 8’ (constipation, swelling, mouth soreness, bleeding, sexual interest, family, hope and Quality of Life). Methods: A baseline assessment is administered to new patients. Follow ups are assessed every 21 days or greater. The patients’ answers range from 0 to 10 and a score of 8 or higher was considered a severe symptom. A change of 2 points from baseline to 2nd follow up assessment is considered a clinically significant. Patients who had a severe pain score on a baseline assessment between April 2013 and March 2014 were closely followed. Results: There were 6,836 baseline assessments and 2,961 2nd follow up assessments between April 2013 and March 2014. Fatigue and sleep were the most reported symptoms while bleeding, mouth sores and vomiting were the least reported. Most of the patients had a decrease or stayed unchanged in their symptom scores. The patients who had a significant increase in symptoms at follow up ranged from 6% for bleeding to 28% for fatigue. There were 462 patients who reported severe pain on baseline assessment. Of the 462 patients, 295 patients (63.8%) had improvement in severity by the follow up assessment. After chart review, 447 patients (96.7%) had either improvement by follow up assessment (63.8%) or documented pain intervention (32.9%). Interventions included change to pain medication, addition of a Medtronic pain pump, physical therapy, palliative radiation therapy, cold laser therapy, and integrative therapies such as acupuncture, chiropractic care and massage therapy Conclusions: The SIT was successful in identifying symptom burden and interference with life issues in oncology patients. It has become an integral part of patient care at CTCA in providing exceptional pain and symptom management through the disease process creating visibility and focus.
Quality Oncology Practice Initiative (QOPI) participation as a means to physician engagement, performance improvement, and delivery of safe and high-quality cancer care.
Authors: Chatta Gurkamal S. , Aboulafia David Michael , Brockmeyer Amy , Bumpus Molly , Dimitrova Irina , Goetsch Cathy , Jacobs Andrew , Lin Bruce S. , Malpass Thomas William , Nichols Craig R. , Picozzi Vincent J. , Robinson Nanette , Vishnu Prakash , Rosales Joseph Grant F. 
Published: February 2017

80 Background: High quality and safe medical care has been a consistent goal of the medical community at Virginia Mason Medical Center (VMMC). The Am Soc of Clinical Oncology (ASCO) has set out a list of criteria as part of Its Quality Oncology Practice Initiative (QOPI), which are increasingly being adopted as standards for quality measurement in the Oncology community. Our practice at VMMC participated in the QOPI quality metric survey, with the intent of measuring and enhancing cancer care delivery. Methods: We participated in the web-based QOPI quality metric during the September, 2013 and April, 2014 sessions. Chart abstraction was shared by the providers. Following the Sept session, our performance was analyzed, and targeted areas of improvement were collectively identified by all providers. Following the April session, the clinical note format was changed to incorporate a standard template, addressing areas of underperformance. Results: In the September 2013 session, the primary areas of underperformance were assessment of: a) pain, b) emotional distress, c) performance status (PFS), and d) documentation of staging. Following the April 2014 session, we noted improved performance in all these assessments. Thus, pain reporting rates improved from 40.6 to 61.2%; emotional distress screening from 37.3% to 42.8%; PFS documentation from 42.6 to 53.7%; and staging at initial diagnosis from 74.6% to 80.9%. However our areas of underperformance continued to lag 10 to 30% behind QOPI aggregate reporting rates. With the introduction of a structured note in the electronic medical record (EMR), further improvements are expected the results of which will be reported at the time of the meeting. On the positive side, chemotherapy education and discussion of risk/benefit were consistently areas of superior performance in our practice with our reporting rates being 10 to 40% higher than the QOPI aggregate. Conclusions: QOPI participation is a useful tool for improving and sustaining a high level of practice performance in oncology. Structured notes in the EMR maybe indispensable for maintaining a high level of compliance with performance measures.
Continuity of care: A program for multidisciplinary post-treatment surveillance after definitive treatment for head and neck cancer.
Authors: Beadle Beth Michelle , Burke Laura , Hessel Amy Clark 
Published: February 2017

82 Background: Patients with head and neck cancers (HNC) are treated with a combination of radiation therapy, chemotherapy, and surgery. With the epidemic of HPV-related oropharynx cancers, patients are younger and healthier; they will require routine surveillance and management of long-term toxicity for many years. There is little data on optimal follow-up and significant duplication of efforts with multiple appointments. Our goal was to create a multidisciplinary post-treatment surveillance program for patients with HNC treated with organ preservation to standardize their evaluation, decompress clinics, reduce duplication of testing, and improve patient satisfaction. Methods: A consensus schema to standardize follow-up was created, consistent with the institutional practice and NCCN guidelines. All services agreed to standardized testing with a rotation between the treating physicians for each follow-up. For the first year, testing occurred at 8 weeks and then every 3 months; for the second year, it occurred every 4 months. Deemed the Continuity of Care (COC) program, patients were identified at the time of tumor board, labeled as eligible at treatment initiation, and followed per its rules on completion. Results: A total of 360 new patients were identified that were eligible for follow-up on COC. In total, 237 (65%) of them had been treated at MD Anderson and reached or surpassed their 3 month follow-up visit. Of these, 209 patients (88%) were following the pathway. Overall, compliance with the pathway has been stable, and follow-up clinics have been streamlined for patients and providers. A 28% reduction in appointment duplications within 3 months of the past appointment has been measured. Conclusions: A model program for surveillance after treatment for HNC was designed and implemented. Patients enrolled had standardized testing and streamlined follow-up appointments during the first two years of surveillance, resulting in a significant decrease in appointment duplication. In addition, significant data was collected in this cohort, allowing for future studies of the optimal utilization of imaging, outcomes, and best practices for this growing group of patients.
Early identification of high-risk neutropenia in the ambulatory setting.
Authors: Nallari Anitha S. , Venepalli Neeta K. , Feldman Lawrence Eric , Chowdhery Rozina A. , Golick Janet 
Published: February 2017

87 Background: The University of Illinois Cancer Center (UICC) utilizes nurse (RN) visits for laboratory review and toxicity evaluations for patients (pts) receiving chemotherapy. Upon review of nursing visits, we observed that RN visit documentation for neutropenia was variable without standard language, communication with physicians (MD), or requirement for MD evaluation. We sought to implement an early intervention strategy to prevent morbidity and mortality from high risk neutropenia (HRN). Methods: A multidisciplinary task force of oncology RNs and MDs created actual and ideal process maps, from identification of neutropenia to patient disposition. We developed a Standard Operating Protocol (SOP) involving a HRN checklist (created based on NCCN and ISDA guidelines) and new process for triage of HRN pts. RNs were required to complete the HRN checklist within the electronic health record for all pts with ANC < 1,000. If high risk features were identified, MD evaluation was required within 1 hour of RN call, with SOAP note and attending notification. Results: Over an 8 week period, 17 HRN templates were generated. The process and checklist were adjusted after the first 4 weeks with clinic wide feedback. Within the first 4 weeks, 8 templates were generated (5 MD, 3 RN); no patients met high risk neutropenia criteria and all were discharged home. Within the second 4 weeks, 9 templates were generated (3 MD, 6 RN); 3 HRN pts were identified with two direct admissions and one home discharge with favorable outcomes. Clinic staff reported greater understanding of HRN, increased satisfaction with multidisciplinary interactions, and more comfort with calling MDs for prompt patient evaluation. Conclusions: UICC successfully piloted the creation and implementation of an early identification and intervention strategy for HRN with strong multidisciplinary support. Compared to the prior 6 month period, we found that use of the SOP and checklist resulted in improvement in evaluation of quality and timeliness of HRN pts and prevented morbidity and mortality. Additionally, the checklist provoked critical thinking from end users with more thorough patient evaluations and improved documentation, resulting in aggressive intervention and better outcomes.