bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of advance care planning quality initiative in community cancer center.
Authors: Weber Dana , Traul Abigail 
Published: October 2023

422 Background: Advance Care Planning (ACP) is an integral part of the journey of a cancer patient. Our goal was to increase awareness, normalize conversations, and improve documentation of Advance Care Planning needs in Oncology Patients. Methods: 2021 Q4: Identified MIPS 047 Advance Care Planning and PIMSH1 Advance Care Planning in Stage 4 disease as an opportunity to improve ACP. Forms updated to include ACP information on New Patient Paperwork, including a Consent to Communicate, which included detailed information on Surrogate Decision Maker designation. Q1: Letter to the patient was added to New Patient Packet with information on Advance Directive (AD) and POLST for all patients. Standardized the use of Oregon Health Authority AD and User Guide, available in multiple languages. Q2: Educated Front Desk staff to include screening for Surrogate Decision Maker. Educated MA team on screening for ACP needs, appropriate documentation in EHR and State POLST Registry, and on appropriate follow up for patients requesting ACP counseling Q3: The US Oncology Network provided a Difficult Conversations Workshop and ACP training with Support Services Team, including Patient Navigation Team and Social Workers. Social Workers provided ACP visits. Q4: Standardized Nurse Navigator visits to include ACP needs and resources at C1D1 education or when referred. 2023: Changes to workflow are on-going and fine tuning occurs with review of metrics and a Continuous Quality Process Improvement plan. Results: See table. Conclusions: MIPS 047 has risen from 42.8% in 2021 to 94.4% 2023 YTD, which includes patients 65 and older that have been screened for ACP needs, have designated a Surrogate Decision Maker, or have a copy of an AD or POLST on file in the EHR. This has increased from 21.8% to 77.6%. Early and often conversations around ACP has markedly increased ACP information and education for a large majority of our patients. This team-based approach has impacted increase in metrics and understanding.[Table: see text]
Lean Six Sigma implementation in medical school.
Authors: Alin James , Gangasani Nikhil , Wood Madison , Kim Joyce , Schafer Pascha 
Published: October 2023

426 Background: While medical schools teach advanced medical, surgical, and radiation interventions in oncology, we often don’t teach students how to identify deficits in existing modalities and methodically implement change. Medical students are underexposed to concepts of QI, and many medical educators feel that tools like Lean Six Sigma are too advanced or esoteric for student involvement. A gap exists to create a QI curriculum that invites medical student engagement, while also allowing them to develop self-efficacy to begin a lifelong career of continue process improvement in medicine. Methods: We previously demonstrated that a Value-based Care competition, can serve as a medical school QI curriculum with high levels of student engagement in both local and national competitions. Teams of students collaborate with key stakeholders at their hospital to implement QI projects through the Lean Six Sigma process improvement methodology. This competition is currently completing its third year, and recruiting for the 4th cycle. We performed a multi-year review of student engagement, the degree to which students progressed down the steps of Lean Six Sigma, and the outcomes of QI projects developed through these competitions. Results: For the 2022-23 competition cycle, six medical schools across the country (MCG, UCSD, Florida State University (FSU), Baylor, Penn State, and even internationally at the University of Queensland ran local competitions, representing a 50% growth over the previous cycle (four schools total in 2021-22). Of these schools, four of them are now participating in the National Competition to implement their projects using Lean Six Sigma; representing a 33% growth compared to last year (three schools total in 2021-22). In terms of implementation tools, students have successfully achieved IRB approvals, development of implementations timetables, defining and measuring controls and outcomes, and recruiting patients. Conclusions: Despite being busy with many other components of their medical education, and despite the entirely voluntary nature of the competition, there continues to be a strong appetite amongst medical students to participate in quality improvement. Students have demonstrated their willingness and ability to learn and implement QI projects using Lean Six Sigma. We have also employed a ‘see one, do one, teach one’ model of peer mentorship to create a sustainable multi-year, multi-school, and now multi-national curriculum that continues to grow.
Evaluating feasibility and acceptability of an innovative personalized hybrid longitudinal communication skills training program.
Authors: Kania Brooke Elizabeth , Kapoor Sharan , Kamath Bhoomika , Habib Muhammad Hamza Hamza , Saraiya Biren 
Published: October 2023

428 Background: Effective patient-physician communication plays a vital role in providing care. Improved patient satisfaction and reduced burnout are among the many benefits of effective communication. Medical training in this area through didactic lectures, group discussions, and role play with feedback can facilitate better acquisition and honing of communication skills. We aimed to create a longitudinal training program assisting residents in developing communication skills. Methods: Internal Medicine (IM) residents participated in a 6-month project as part of their training. Residents completed a baseline questionnaire to assess confidence in communication skills, followed by a curriculum comprised of 3 x 1-hour sessions every 5 weeks where expert lecturers guided didactics on pertinent topics (e.g., delivering bad news, discussing goals of care (GOC), and completing a Practitioner Orders for Life-Sustaining Treatment (POLST)). Participants completed post-session surveys after each training, and a comprehensive post-training self-assessment. Comfort level was assessed on a 1-5 scale (1 least comfortable, 5 most comfortable) throughout the surveys. Results: Pre-intervention, most residents utilized “Ask, Tell, Ask (ATA)” (46.67%) and “Setting, Perception, Invitation, Knowledge, Emotion, Summarize (SPIKES)” (40%) frameworks to facilitate conversations with patients. Post-intervention, a greater number of residents utilized SPIKES (52.08%) compared to ATA (37.5%). 1st (PGY1) and 2nd (PGY2) year residents reported completing +25.71% and +60% more POLST forms post-intervention. In the inpatient (IP) setting, resident comfort levels in initiating GOC increased by +15.8% (for PGY1s) and +6.7% in total (all classes). Comfort levels in breaking bad news to patients in the IP setting increased by +9.09% (+24.14% for PGY1s specifically). PGY2s had the most substantial increase in comfort level in completing POLST forms (+21.08% IP, +31.52% outpatient (OP)), with an overall improvement in comfort from all classes of +12.32% (IP) and 12.53% (OP) post-intervention. Conclusions: This curriculum represents a helpful tool to improve physician-patient communication among IM residents. PGY1s demonstrated the most substantial improvement in confidence following the program, which may indicate the importance of prioritizing training for first year residents. Qualitative feedback from residents included distributing sessions throughout the year (beginning, middle, end), holding sessions in the intensive care unit (ICU) for applicability to patients in real-time, and continued instruction of practical skills. These findings may allow for future curriculum planning to help bolster trainee confidence and skills when facilitating meaningful conversations with their patients.
Enhancing policy communication: Establishing a formal channel for disseminating policy updates to improve staff access and engagement.
Authors: Man Yun , Xu Fuwang , Scullion Bridget 
Published: October 2023

43 Background: Institutional policies serve as a fundamental framework that enables staff to fulfill their roles and responsibilities. A comprehensive analysis of 5 months of policy access log data extracted from Ellucid, our policy management system, showed that the average views per updated pharmacy policy ranged from 0 to 3 within the 7-day period following the updates. These findings reveal a notable lack of visibility and limited user engagement with policy updates within the pharmacy department, which consists of approximately 300 staff members. To bridge this gap and enhance policy communication, we aim to keep pharmacy staff well-informed and provide easy access to the most up-to-date policies at Dana-Farber Cancer Institute. Methods: The study employed the Plan-Do-Study-Act (PDSA) cycle methodology to guide the quality improvement process. An assessment of preintervention data from the policy access log was conducted to identify the problem. Subsequently, a survey was designed and administered to evaluate staff’s ability to navigate the policy management system, their awareness of policy updates, and their preferred communication channels for receiving updates. Descriptive statistics were utilized to summarize the survey responses, providing valuable diagnostic data. Additionally, a Statistical Process Control (SPC) chart was employed to monitor the process change over time, ensuring ongoing improvement. Results: The survey was distributed to select pharmacy staff in various areas, with a response rate of 30% (13/42). The majority of participants (80%) indicated that email is their preferred communication method for receiving policy updates on a quarterly basis. In the first cycle of the PDSA, an email communication channel was established using the Staffbase program to disseminate policy updates and was piloted within the pharmacy department. The email communication included a summary of all pharmacy policy updates from the past three months, with key changes highlighted. Each policy was attached with a hyperlink directing staff to the full policy on Ellucid, facilitating convenient access. Staff were also provided with education on navigating the communication email. These interventions resulted in a two-fold increase in the policy access rate compared to the baseline. Conclusions: The implementation of a formal communication channel for policy updates, along with improved accessibility to relevant content, successfully enhanced pharmacy staff access to policies. Ongoing monitoring of the policy access log will be maintained to ensure the sustainability of these improvements in the future.
Quality of colorectal and anal cancer care delivered during the COVID pandemic.
Authors: Powis Melanie Lynn , Sutradhar Rinku , Hack Saidah , Alibhai Shabbir M.H. , Singh Simron , Baiad Abed , Li Huaqi , Mohmand Zuhal , Krzyzanowska Monika K. 
Published: October 2023

432 Background: Reports suggest that there have been significant impacts to the provision of cancer care with delays, interruptions and cancellations across all treatment modalities as a result of the COVID pandemic which have implications for the quality of care. We evaluated the impact of the early phase of the pandemic relative to the same period in the year prior using a panel of measures spanning the six domains of quality; 8 measures focused on pandemic-specific care modifications, and 16 established measures. Methods: The cohort consisted of all new patient consultations between 02/19 to 12/19 (comparator) or 02/20 to 12/20 (COVID) at Princess Margaret Cancer Centre (PM) in Toronto, Canada, who were >18 years of age and newly diagnosed with colon, rectal or anal cancer. Chart abstraction data was linked to Census and the Ontario Marginalization Index datasets to derive additional population-weighted sociodemographic variables. A summary quality score across established measures was computed and a benchmark was set using the pared mean approach representing the top 10% of performers. Associations between achieving the quality benchmark and patient characteristics were evaluated using a multivariable logistic regression model. Results: Relative to the year prior, there was a 12.2% reduction new patient consultations (294 vs 335). Significant findings for individual indicators are summarized below. Relative to English-first language patients, those whose first language was not English were 7.4 times less likely to achieve the benchmark (OR 0.13; 95% CI 0.01-0.61). Compared to those with stage I disease, patients with stage IV disease at diagnosis were 6.5 times less likely to achieve the benchmark (OR: 0.15; 95% CI 0.02-0.78). Conclusions: While overall quality of care was poorer during the early phase of the pandemic, there was a reduction in the proportion of patients treated with systemic therapy within 30 days of death. This likely reflects efforts to prioritize fitter patients with curative disease for treatment and reduce avoidable healthcare utilization. Future work should focus on understanding the downstream impacts of these differences in care quality on clinical outcomes and optimizing preparedness for future disasters.[Table: see text]
Quality improvement project to improve smoking cessation among an oncology cohort at a large US multistate cancer center.
Authors: Jose Thulasee , Ohde Joshua , Warner David O. 
Published: October 2023

435 Background: Assessing tobacco use and providing cessation support is recommended by the American Society for Clinical Oncology (ASCO). As part of the National Cancer Institute Cancer Center Cessation Initiative, we established an electronic health record based "opt-out" approach to refer patients to tobacco treatment specialists. However, the role of oncologists in contributing to the “opt-out” approach to patients has not been explored. We tested the hypothesis that a multi-component educational program for oncologists would increase the proportion of patients who completed tobacco treatment appointments. Methods: As a quality improvement initiative, oncology providers at the Rochester Mayo Clinic Cancer Center were educated using a multimodal academic detailing approach with group and individual educational sessions. Its effectiveness was tested using a modified step-wedge implementation design. The primary outcomes were patient behaviors that could plausibly be changed by conversations with their provider: the rate at which cancer patients identified as current tobacco users scheduled an appointment in the Nicotine Dependence Center, and the rate at which patients scheduled for a NDC appointment completed their appointment. Comparisons were made before, during, and after the education period (from July through Dec 2019) and with a separate group of providers who did not complete education (results examined over a similar time period). Results: Education intervention did not improve outcomes among providers who received education; indeed, the rate of appointment scheduling decreased, although this may reflect other concurrent changes in the tobacco treatment referral process (Table 1). Outcomes were similar between oncology providers who did and did not receive multicomponent education intervention. Conclusions: Smoking cessation efforts can be successfully integrated into routine cancer care. The implementation of the “opt-out” referral system resulted in approximately 1 in 5 patients being seen for tobacco use, but a multicomponent education intervention designed to equip oncologists to encourage patients to complete appointments was not effective. Novel approaches are needed to increase the uptake of tobacco treatment among patients.[Table: see text]
Evaluating the acceptability, usability, and feasibility of a clinic-based genetic testing risk assessment intervention in Black women with breast cancer.
Authors: Housten Ashley J. , Eggers Michelle , Siječić Amela , Linnenbringer Erin , Baumann Ana , Johnson Judy , Stevenson Nedra , Neal Camille , Ademuyiwa Foluso Olabisi 
Published: October 2023

436 Background: Black women diagnosed with breast cancer utilize genetic counseling and testing services less often than White women despite these services having the potential to personalize medical management of breast cancer and identify family members for cascade testing. Lower rates of provider recommendations may be a driver of these disparities, as uptake does not appear to differ by race. The objective of this study was to evaluate the acceptability, usability, and feasibility of a clinic-based genetic risk assessment to facilitate provider recommendations for genetic testing in Black women diagnosed with breast cancer. Methods: A clinic-embedded, race-concordant, trained navigator administered a 15-minute screening tool based on National Comprehensive Cancer Network genetic testing criteria to English-speaking, Black women ≥18 and newly diagnosed with breast cancer. A copy of the results were given to the treating surgeon to facilitate consideration of genetic testing for the patient. However, the decision to recommend genetic testing was left to discretion of the surgeon. After enrollment completion, we conducted semi-structured interviews with a subsample of patients and surgeons who participated in the intervention to elicit their perspectives and experiences. We also used medical record data to determine if surgeons recommended genetic testing to participating patients, and if so, whether they completed it. Results: Between January 2022 and April 2023, 37 patients with a median age of 56.9 years (IQR 15.0-37.5) consented to participate. Surgeons recommended genetic testing to 25/37 patients and 5/37 additional patients were referred outside of this intervention (81.1% total). 12/37 patients (including those who were and were not recommended genetic testing) and 4/4 surgeons completed follow-up interviews. For clinician usability and acceptability, surgeons reported little to no negative impact on their clinic flow. While some found the intervention to be a helpful reminder, others shared it made no discernible impact on their practice, as they reported already incorporating a similar system into their clinic flow. For patient usability and acceptability, some patients found questions on the screening tool difficult to answer and expressed feeling overwhelmed at the time it was administered but the navigator was comforting, reassuring, and informative. Patients, surgeons, and the navigator recommended administering the screening tool prior to the initial appointment with the surgeon and ensuring follow up with patients regarding results. Conclusions: Participating patients and surgeons found this intervention to be feasible and acceptable. Usability challenges warrant further exploration into the logistics of the intervention, including timing, delivery, and medium.
Quantifying emissions and enhancing inclusivity: Insights from ASCO attendance data.
Authors: Lichter Katie , Sabbagh Ali , Demeulenaere Sasha , Drew Taylor , Conway Alexandra , Nogueira Leticia M , Kirkwood Margaret Kelsey , Kamboj Jasmine , Hampshire Karly , Gundling Katherine , Teherani Arianne , Thottathil Sapna , Mohamad Osama 
Published: October 2023

442 Background: In-person conference attendance contributes significantly to a professional’s annual greenhouse gas (GHG) emissions. However, estimating conference emissions has often relied on assumptions about attendee numbers and travel, especially for investigations of medical conferences. This project aims to address these limitations by utilizing actual attendance data from the American Society of Clinical Oncology’s (ASCO) Annual Meetings. The objectives of this project are to establish a quantitative baseline of conference-associated emissions for different formats (in-person, virtual, and hybrid) and simulate changes to conference parameters with evaluation of associated emissions to provide recommendations for sustainable changes. Methods: Data was provided by ASCO including the number of attendees, zip codes of origin, and attendance method (in-person versus virtual) for their 2019-2022 Annual Meetings. Using a variety of conservative assumptions, emissions were calculated with consideration of the following factors: travel versus virtual attendance, conference space utilization, hotel stays, and electricity. The results were stratified by country, attendance method, and year, and differences in emissions were assessed with t-tests. Simulations were conducted to evaluate the impact of different conference sizes, locations, and formats on emissions. Results: The highest estimated GHG emissions were associated with the in-person 2019 conference, totaling 37,251 metric tons of carbon dioxide equivalents. While international attendees accounted for the largest proportion of emissions (>50%) in all years, optimizing conference locations models only reduced emissions by 3%. However, simulations of hub-and-spoke models showed the potential for larger decreases of up to 86%, and various hybrid models offered similar emission savings. Furthermore, hybrid conferences in 2020 and 2021 demonstrated increased attendee diversity with a higher percentage of international attendees compared to the in-person 2019 conference (44% international attendance in 2019 versus 53% in 2020 and 54% in 2021). Conclusions: This study not only quantifies the emissions impact of alternative conference formats but also highlights the importance of diversity, equity, and inclusion (DEI) considerations in reducing emissions. While travel remains a significant contributor to conference emissions, conference models focusing solely on location optimization were not as effective as hybrid models in reducing emissions. Hybrid models may present an opportunity to effectively mitigate GHG emissions while maintaining networking opportunities and cultivating inclusivity for attendees from diverse backgrounds.