bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing value-based cancer care: A multidisciplinary approach to defining breast cancer outcomes.
Authors: Fayanju Oluwadamilola M. , Mayo Tinisha L. , Spinks Tracy E. , Lee Seohyun , Barcenas Carlos Hernando , Smith Benjamin D. , Giordano Sharon Hermes , Hwang Rosa F. , Ehlers Richard A. , Selber Jesse C. , Walters Ronald Stewart , Tripathy Debu , Hunt Kelly , Buchholz Thomas A. , Feeley Thomas W. , Kuerer Henry Mark 
Published: February 2017

16 Background: Value in healthcare (patient-centered outcomes achieved per dollar spent) unifies performance improvement goals with health outcomes of importance to patients. We describe the process through which value-based measures for breast cancer patients and dynamic capture of these metrics via our new electronic health record (EHR) were developed at our institution. Methods: A review of the breast cancer literature was conducted on treatment options as well as expected outcomes and potential treatment complications. Patient perspective was obtained via focus groups. Multidisciplinary teams met to inform a 3-phase process of (1) concept development, (2) measure specification, and (3) implementation via EHR integration, planned for spring 2016. Results: Outcomes were divided into 3 previously defined tiers (NEJM 2010; 363:2477-2481) that reflect the entire cycle of care (Table).Within these tiers, 22 patient-centered outcomes were defined with inclusion/exclusion criteria, specifications for reporting, and sources for data including the EHR and validated patient-reported outcome questionnaires (e.g., FACT-B+4) administered via our patient portal. Conclusions: A value-based approach to cancer care with transparently reported patient outcomes not only creates opportunity for performance improvement but also enables benchmarking within and across providers, healthcare systems, and even countries. Our value-based framework for breast cancer is the first of its kind in the United States, with a similar model being pursued internationally as well. [Table: see text]
Leveraging web-based interface systems with institutional databases to improve compliance with survivorship care plans.
Authors: Gilmore Katherine Ramsey , Chapman Patricia , Cleveland David , Lewis-Patterson Paula A. , Palos Guadalupe R. , Rodriguez Maria Alma 
Published: February 2017

161 Background: ASCO’s Clinical Oncology Clinical Expert Statement on Cancer Survivorship Planning addressed the importance of using survivorship care plans (SCPs) to improve survivors’ care. Evolving information technology strategies, such as web-based systems, offer real-time reporting tools to track providers’ adherence for completion of SCPs. Our abstract reports on the creation of a web-based system to monitor survivors’ care. Methods: Ongoing audits of SCPs indicated broad variation in compliance rates with SCPs. The institutional benchmark for compliance was set at 90%. Yet, FY 2014 rates ranged from 7-97%, X= 84%. To address low or non-compliance rates, our institution selected a commercially available system as the IT intervention to improve compliance with SCPs. Core metrics identified were arrived appointments, missed appointments, completed SCPs, and transitions to survivorship status. To collect data, we used existing institutional databases with information on medical health, scheduled appointments, and other clinical documentation tools were used to collect data. Descriptive statistics were used to analyze and present data. Results: The current design of the Survivorship Performance Scorecard provided a centralized system for reporting data from 11 survivorship clinics. An exploratory review found 18 Passport templates across the 11 clinics, 188 OrderSets, and 986 scheduling codes were used in planning survivorship clinical services. Procedures for patient transition to survivorship clinics were defined in OrderSets, which were reviewed to identify appropriate fields for inclusion in the report. To ascertain compliance, procedures were developed to link arrived appointments with completed SCPs. Final reports will display all metrics by clinic, provider, and other patient level data. After the system goes live in late 2015, the systems benefits and shortfalls will be analyzed. Conclusions: This evolving tool offers a practice-based method for collecting data elements to monitor compliance with SCPs’ completion standards. Future work will focus on designing an alert system to inform providers when compliance rates are below the 90% compliance benchmark.
Oncologists’ opinions and experiences with electronic release of radiology and pathology results to patients.
Authors: Winget Marcy , Sheikhi Farnoosh , Rosenthal Eben Lloyd , Sharp Christopher , Buyyounouski Mark K. , Asch Steve 
Published: February 2017

162 Background: There is an emerging standard to provide patients rapid electronic access to elements of their medical records,; this practice is controversial among practicing oncologists. Previous studies have primarily reported on patient access to physician notes and lab tests in primary care. In oncology, the emotional import and complexity of the results may be greater, particularly for staging imaging and biopsies. We report the opinions and experiences of oncologists after enabling patient access to radiology and pathology results for four months during which time finalized results were released upon physician action or after seven days. Methods: A brief survey was developed in REDCap and sent via email to all practicing oncologists at Stanford Cancer Center from the Medical Director. Six 5-point Likert scale items measured their experience and attitudes toward this practice. Results: 82/129 (64%) oncologists completed the survey. 51% were medical oncologists, 35% surgeons, and 14% radiation oncologists. 90% were aware of the patient access process and 64% said they had not changed their process of reviewing pathology/radiology results. Most (54%) responded that it is somewhat or very beneficial for patients to receive normal radiology/pathology results prior to discussing with a physician but 87% said it was somewhat or very harmful for patients to receive abnormal or confusing results prior to discussing with a physician. The minimum time oncologists reported as required to review and communicate results was 48 hours (35%) and 96% required less than 14 days. 49% said that release of radiology/pathology reports had had a somewhat or very negative impact on communication with their patients, though an almost equal number, 44%, replied that it had not affected the quality of their communication. Conclusions: Almost half of oncologists report sharing digital radiology and pathology records has had a negative impact on their communication with patients, particularly for abnormal results. Similar patient survey data would complement the physician perspective. Efforts are needed to bring better consensus amongst oncologists and patients on how to best communicate such results in a timely fashion.
Cervical screening reminder calls pilot: Utilizing EMRs to improve cancer screening.
Authors: Dhanji Zabin , Randall Aaron 
Published: February 2017

163 Background: Cancer screening detects pre-cancerous changes, or cancer at an early stage when there is a better chance of treating it successfully. Research shows that that physician encouragement improves the odds of patients getting screened. Furthermore, systematic reviews demonstrate that efforts to encourage screening can be more effective through telephone reminders when compared to other methods of outreach. Electronic Medical Records (EMRs) are a powerful tool for the coordination, recording, monitoring and reporting of patient care in primary care. In Ontario, 80% of primary care providers (PCPs) have adopted EMRs within their practice. CCO developed the Cervical Screening Reminder Calls (CSRC) pilot to support PCPs in increasing their cervical cancer screening rates. The pilot consisted of two components. First, practice staff were trained to utilize their EMRs to identify eligible patients for cervical screening. Once identified, practice staff invited patients via telephone to get screened. Family Health Team’s (ANFHT) pilot implementation will be presented. Methods: Twelve primary care practices were recruited from across Ontario to participate in the four-month pilot. Each practice was assigned a CCO support person to guide them through the implementation. The practice teams completed the self-directed EMR training. They then generated lists of patients eligible for cervical screening based on CCO’s cancer screening guidelines and telephoned patients to book Pap test appointments. Results: Over the course of the pilot, 1593 (57%) of all eligible patients were reached and 71%, or 798, of them scheduled a Pap test. Overall, participating physicians saw an average 2% increase in their total cervical screening participation rates. Conclusions: From a spread and sustainability perspective, the pilot has provided valuable insights to inform future planning at CCO. The lessons learned have implications for the implementation of a broader range of quality improvement initiatives. Next steps will include the development of an implementation model that is ‘lower touch’ thus allowing for spread to a broader number of practices.
Using information technology to power an integrated, community-based oncology palliative care model.
Authors: Gill Dudley , Hertler Andrew Allan , Matthews Lianne , Carr RaeLynn 
Published: February 2017

166 Background: There is a need to improve palliative care program access for patients with cancer. The identification of candidates for palliative care at the point of diagnose can improve care and reduce costs. This pilot program was launched in July 2015 by four stakeholders: Health plan; Regional palliative care provider; Community oncology practice; and Oncology quality management provider. Methods: Objectives are to increase patient satisfaction, reduce unnecessary utilization and costs. Data captured by information technology at the point-of-care are used to: Evaluate Diagnosis, Stage, Treatment Intent, Performance Status, and Line of Therapy criteria to identify patients with recurrent/metastatic disease who would potentially benefit from palliative care; Trigger a palliative care program referral; and Initiate the chemotherapy treatment preauthorization process. Retrospective analysis will evaluate: Patient (Concordance with goals & cultural preferences, Member quality of care at end-of-life, Length of stay on hospice, Death in place of patient’s preference), Hospital (Deaths in acute/facility ICU), and Clinical (Referrals to palliative care and hospice; Use of chemotherapy 2 weeks prior to death). Results: See table below. Conclusions: There is an opportunity to inform physicians and oncology practice mid-level staff about the differences between palliative and hospice care. Community-based supportive care services can prevent avoidable hospital admissions. There have been two instances where having a palliative care nurse visit patients at their homes prevented hospital emergency department admissions. Educating patients about the benefits of palliative care can be challenging. For example, a patient with recurrent/metastatic breast cancer, an ECOG status of 2 and who had received beyond 4th line treatment was not interested in the program. [Table: see text]
Recurrence risk perception and quality of life after treatment of breast cancer.
Authors: Hawley Sarah T. , Janz Nancy K. , Jagsi Reshma , Griffith Kent A. , Friese Christopher Ryan , Kurian Allison W. , Morrow Monica , Wallner Lauren P. , Katz Steven J. 
Published: February 2017

175 Background: Many breast cancer patients overestimate their risk of distant recurrence after treatment. We explored risk perception in a large, diverse population of breast cancer patients with favorable prognosis and assessed associations between overestimation and quality of life (QoL). Methods: As part of the iCanCare Study, we surveyed a weighted random sample of newly diagnosed patients with early-stage breast cancer treated in 2013-14, identified through the population-based SEER registries of Los Angeles & Georgia about 3 months after surgical treatment (N = 2632, RR = 70%). Actual 10-year risk of distant recurrence after treatment was determined for women with DCIS (N = 502), and with low risk invasive (LRI: N = 520, Stg 1A, ER+HER2-, Gr 1-2). Women reported perceptions of their risk numerically between 0 – 100%, with values > 10% for DCIS and > 20% for LRI considered substantial overestimates. We assessed which patient and treatment factors were correlated with overestimation and report the bivariable associations between overestimation and the QoL measures of worry, distress, & PROMIS physical and mental health. Results: One third (36%) of DCIS and 25% of women with LRI breast cancer substantially overestimated their risk of distant recurrence. Overestimation of risk was significantly associated with lower education (p = 0.02), and marginally with lower acculturation (p = 0.08). DCIS patients were more likely to overestimate risk of distant recurrence than LRI patients (OR = 2.0, 95% CI: 1.4-2.7). Women who overestimated risk in both groups reported more worry about recurrence; 49% vs. 16% DCIS, p < 0.001 and 54% vs. 24% LRI, p < 0.001. These women more often had higher distress (0-10 scores, mean of 3.5 vs. 2.5 DCIS p < 0.001, and 3.9 vs. 2.2 for LRI, p < 0.0001) and had poor PROMIS physical (21% vs. 14% DCIS, p < 0.001; 34% vs. 16% LRI, p < 0.001) and mental health (13% vs. 11% DCIS, not significant; 21% vs. 7% LRI, p < 0.001) scores. Conclusions: Marked overestimation of risk after treatment was common, particularly among women with very low risk (DCIS). The strong association between risk overestimates and lower QoL suggests the need to address women’s perception of risk of distant recurrence after treatment of breast cancer. Funding: P01CA163233
Primary care physicians' endorsement of the importance of shared decision making in diverse cancer screening contexts.
Authors: Lafata Jennifer Elston , Brown Richard F. , Pignone Michael P. , Ratliff Scott , Shay Laura Aubree 
Published: February 2017

179 Background: Despite widespread advocacy, shared decision making (SDM) is not routinely used in office-based cancer screening discussions. We describe primary care physicians’ (PCPs) endorsement of the importance of SDM in different cancer screening contexts. Methods: Between 3/15-5/15 we administered a mailed survey to PCPs randomly selected from the American Medical Association’s Master File. Using 5-point Likert scales, we report PCP’s ratings of the importance of SDM for 11 specific screening scenarios graded by the US Preventive Service Task Force (USPSTF), four specific to not screening elderly patients. Multivariable logistic regression, accounting for repeated observations, was used to estimate the association of physicians’ endorsement of SDM as ‘very important’ with (1) USPSTF grade A [highest endorsement] vs. others, and (2) if scenario pertained to not screening among the elderly. The model controlled for physician age, gender, race, specialty, medical school affiliation, practice size, and PCP’s internal/external motivation for SDM. Results: PCPs were on average 52 years of age, 38% female, and 69% white (N = 288). They were most likely to rate SDM as ‘very important’ for colorectal cancer (CRC) screening in adults aged 50-75 (69%), and least likely for CRC screening in adults aged > 85 (34%). Model results indicated PCPs were significantly (p < 0.01) more likely to endorse SDM as ‘very important’ for A-grade services compared to others, particularly D-grade services (OR = 0.63), and less likely to do so when decision was not to screen among elderly (OR = 0.45). PCPs with more internal motivation for SDM were more likely to endorse its importance (OR = 2.29), but no other physician characteristic was associated with SDM endorsement. Conclusions: The more PCPs internally value SDM, the more likely they are to endorse it as very important regardless of screening scenario. Yet, PCPs’ endorsement varied by USPSTF grade, being particularly low when screening was not recommended, especially when the decision pertained to screening not recommended among elderly patients.
Physician decisions related to maintenance therapy for advanced non-small cell lung cancer (NSCLC) in the United States (US).
Authors: Lane Suzanne , Goring Sarah , Mueller Kerstin , Hess Lisa M. , Oton Ana Belen , Muehlenbein Catherine , Zhu Yajun , Aggarwal Himani , Mohamed Mohamed K. , Levy Benjamin Philip , Winfree Katherine B. 
Published: February 2017

182 Background: In 2006, maintenance therapy was added as a treatment guideline for patients with advanced non-squamous (nsq) NSCLC. This study aimed to identify patient- and disease-related factors that impact maintenance therapy decision making. Methods: An online discrete choice survey was administered to physicians currently managing patients with advanced nsq NSCLC in the US. Physicians viewed 12 patient profiles differing in levels of the following attributes: 1st line treatment response (complete, partial, stable, progression), adverse events during 1st line therapy (none, mild, moderate, severe), comorbidities (none, mild renal, severe renal, other), patient motivation/convenience (+/+, +/-, -/+, -/-), patient insurance co-pay rate (0, 5, 10, 20%), and age (45, 58, 68, 80 years). No specific maintenance treatments were stated. For each profile, physicians indicated if they would recommend maintenance therapy. Recommendations were analyzed using a mixed-effects logistic regression model. Odds ratios (ORs) were calculated to estimate the relative odds of a maintenance therapy recommendation for levels of each attribute. Results: The survey was completed by 100 physicians (81% male; mean years of experience: 15.4). The study design was balanced and orthogonal. Maintenance therapy was recommended for 75% of the profiles; 98% of physicians recommended maintenance therapy for at least 1 profile, with 26% recommending it for all profiles. The odds of recommending maintenance therapy were significantly lower when the patient profile included disease progression relative to stable response (OR: 0.17; p<0.01), severe renal impairment relative to no comorbidities (OR: 0.38; p<0.01), or low motivation/convenience relative to high motivation/convenience (OR: 0.25; p<0.01). The odds also decreased with increasing age (OR: 0.97 per year increase in age; p<0.01). Conclusions: Treatment response, age, motivation/convenience, and comorbidities were relevant factors for physicians when recommending maintenance therapy. Physicians report recommending maintenance even in the presence of less desirable patient and disease characteristics indicative of a real world setting.
Patient and clinician perspectives on treatment decision-making for African American men with prostate cancer.
Authors: Bickell Nina A. , Abramson Sarah , Walker Daniel , Sova Lindsey , Lin Jenny J , Fei Kezhen , Franco Rebeca , McAlearney Ann Scheck 
Published: February 2017

186 Background: Prostate cancer is the most common cancer for men in the US, yet the burden of this disease falls disproportionately on African Americans (AAs). The disparity’s etiology is complex. Surgery and radiotherapy offer similar survival but historically have different rates of performance with younger and white men more likely to undergo surgery and AAs more likely to experience underuse. This study aims to examine treatment decision-making (TDM) processes for AA men from patient and physician perspectives. Methods: At 1 academic and 1 municipal urban hospital, pathology records and a tumor registry from 2007-2012 were used to identify 359 AA and 282 white men with locally advanced prostate cancer, a Gleason score of 7-10, and receipt of definitive treatment. 15/17 treating physicians of participating patients were interviewed. Underuse overall was 4%, AA had higher rate of underuse compared to whites (6% vs. 1% respectively, p = 0.0002). 14 patients with longer times between diagnosis and treatment were recruited for 4 focus groups & 2 interviews lasting 60-90 minutes eliciting perspectives on themes related to TDM. Transcripts were coded and analyzed using a grounded theory approach. Results: Preliminary analysis of patient interviews suggests that patients primarily base their treatment decisions on physician recommendations. Patients were often unaware of treatment side effects. However, some patients felt this deficit helped them decide to receive treatment, whereas if they had known about possible impotence and incontinence, they would have refused treatment. Physicians recognized that patient concerns about side effects were a critical TDM factor. Physicians attributed prolonged delays between diagnosis and treatment to waiting times for tests of possible tumor spread and medical comorbidities. Conclusions: Understanding decision making and care processes for AA men with local advanced prostate cancer is critical to reducing the treatment and outcome disparities in this population. This study identifies several patient and physician/system factors that contribute to this process. These data can help inform interventions to improve prostate cancer care for AA men.
A prospective assessment of the quality of multidisciplinary tumor boards in Mexico and its relationship with decision making.
Authors: Trejo rosales Raul Rogelio , Soto Perez De Celis Enrique , Baltazar-Avalos Edgar , Chavarri Guerra Yanin 
Published: February 2017

188 Background: Multidisciplinary Tumor Boards (MDTB) allow the review of cases and have been associated with improved decision making and outcomes. There is limited information regarding the performance of MDTBs in developing countries. The aim of this study was to assess the quality of MDTBs and its relationship with decision making at an academic hospital in Mexico City. Methods: We used a validated tool (MTB-MODe) to prospectively assess the quality of MDTBs at our institution. MTB-MODe assigns a score of 1-5 to various aspects of case presentations at a MDTB, including the quality of the information presented and the performance of team members, which are then averaged to obtain a mean score. The scores of MTDBs which reached a decision were compared against those who failed to do so using Mann-Whitney U-test. Results: 100 cases presented at MDTBs between April and June 2015 were analyzed. Median patient age was 57 years (19 - 87). The most common diagnoses were hepatic (23%), breast (20%) and prostate cancer (15%). 50% of cases (n = 50) were localized. Mean MTB-MODe score was 3.27 (range 1.75-4.75), and a decision was reached in 83% of cases (n = 83). Cases in which a multidisciplinary decision was reached had a better MTB-MODe score than those without a decision (n = 17) (3.4 vs 2.8, p = 0.01). The ability of the MDTB to reach a decision was associated with the quality of case presentation (4.1 vs 3.2, p = 0.01), the presentation of comorbidities (3.5 vs 2.6, p = 0.006), better leadership of the coordinator (3.5 vs 2.5, p = 0.002) and better participation of team members (4.2 vs 2.9, p < 0.001). The patient’s point of view was discussed in only 8% of cases (n = 8), while psychosocial issues were only considered in 10% of cases (n = 10). Conclusions: We found that the quality of case presentations at MDTBs, and the performance of its members, are associated with the ability to reach multidisciplinary decisions. In contrast with reports from developed nations, we found that the patient’s point of view and psychosocial issues were not only largely ignored, but also irrelevant for decision making. The continuous evaluation and improvement of MDTBs is necessary for successful decision making in order to improve patient outcomes.