bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intervention to optimize guideline-recommended interdependent care delivery in breast and lung cancers with the 4R Oncology model.
Authors: Liu Raymond , Trosman Julia R. , Linehan Elizabeth Shurell , Gordon Nancy P. , Hennings Marti , James Henie , Abbe Thea , Katzel Jed Abraham , Ng Chun Fai , Tomita Megumi , Velotta Jeffrey B. , Sakoda Lori C. , Beringer Kimberly , Ravelo Arliene , Zhu Zheng , Rapkin Bruce , Weldon Christine B. 
Published: October 2023

34 Background: Team-based care improves quality, reduces fragmentation and lowers clinician burnout related to ad hoc care coordination. A key teamwork principle is managing timing and sequence of interdependent care (Vogel JOP 2016). The 4R Oncology model featured by the NCI ASCO Teams initiative fosters effective teamwork by facilitating systematic timing / sequence of interdependent care.1 4R is Right Info / Care / Patient / Time. Using a 4R intervention, a large health system created a high-functioning care team and conducted optimizations of guideline-based interdependent care in breast and lung cancers Oct 2020 - Dec 2021.2 We present results of these optimizations. Methods: We compared data from electronic health record on timing and sequence of care between historical control cohorts of patients who received care pre-4R (breast n=274, lung n=173) to the post-optimization 4R cohorts (breast n=211, lung n=140). Patient and tumor characteristics between control and 4R cohorts in both cancers were similar. Results: Timing and sequence of care for 6 of the 7 breast cancer metrics and all 7 lung cancer metrics was significantly improved between the control and 4R cohorts (Table). Despite significant increase, the rate of timely care for some metrics remained low, such as referrals based on distress screening in breast cancer and palliative care consult in lung cancer. Conclusions: The 4R Oncology model is effective in applying teamwork principles and improving timing and sequence of guideline-based care. Opportunities for further care optimizations exist to expand the 4R benefit to a higher number of patients. A learning system established in our institution will inform iterative optimizations. 1. Trosman JOP 2016. 2. Liu JCOOP 2022. [Table: see text]
Patient engagement with a portal-based symptom management program across six health systems.
Authors: Hassett Michael J. , Cronin Christine , Tramontano Angela , Wong Sandra L. , Uno Hajime , Bian Jessica J , Dizon Don S. , Hazard-Jenkins Hannah W. , Schrag Deborah , Osarogiagbon Raymond U. 
Published: October 2023

351 Background: Collecting patient-reported outcomes (PROs) improves quality of life and self-efficacy, reduces acute care needs, and extends survival for cancer patients. Prior studies evaluating the efficacy of PROs have often relied on unrepresentative populations seen at well-resourced health systems and treated in controlled settings. As a result, widespread PRO implementation has not been achieved. We sought to study the reach of an electronic PRO-based, EHR-integrated symptom management system (eSyM) that was deployed in routine clinical practice across six diverse health systems. Methods: All patients receiving medical oncology (MO) or surgical (SURG) care for a confirmed or suspected gastrointestinal, gynecologic, or thoracic malignancy were invited to use eSyM – a patient portal-based tool that asks patients to respond to symptom questionnaires, provides symptom management resources, and fosters patient-clinician communication. Study outcomes included any portal use, sending a message via the portal, and completing an eSyM symptom questionnaire via the portal. Spearman coefficients were used to assess the correlation between portal message use and eSyM questionnaire completion. Multivariable logistic regression models were used to identify factors associated with completing at least one eSyM questionnaire. Results: From September 2019 to March 2023, 9589 MO and 13,297 SURG patients had access to eSyM. Patient characteristics and usage rates were analyzed [Table]. Among portal users, most patients accessed it via the web app only, with 39.2% of MO and 42.6% of SURG patients accessing it via both the web and mobile apps. Correlations between message use and questionnaire use were moderate (0.48 for MO, 0.43 for SURG). Notably, 17.9% of MO and 21.7% of SURG patients sent a portal message but did not submit an eSyM questionnaire. Factors associated with lower odds of eSyM questionnaire completion for both the MO and SURG cohorts included: older age, male sex, Black race, Medicaid insurance, and being single, widowed, or disabled. Conclusions: In a diverse patient population from six community-based cancer centers, over 80% used the portal for any reason, over 58% sent a message, and over 46% submitted at least one eSyM questionnaire. Strategies that improve patient engagement and ameliorate disparities with ePRO-based programs are needed. Some eSyM non-responders never used the portal, whereas others used the portal for different reasons, suggesting that technical and non-technical barriers to ePRO programs exist.[Table: see text]
“A double-edged sword”: Influence of the 21st Century Cures Act on the childhood cancer care experience.
Authors: Lindsay Meghan , Clappier Mona , De Oliveira Sophia , Gleeson Dara , Feifer Deborah , O'bryan Sarra Kchouk , Kessler Amber , Mali Nidhi , Snaman Jennifer Malia , Kaye Erica , Ananth Prasanna Janaki 
Published: October 2023

360 Background: The 21st Century Cures Act allows patients to immediately access their electronic health record (EHR) via an online portal. For pediatric patients with cancer and their families, this federal mandate has profound implications. We sought to explore perspectives of key stakeholders on how the Cures Act influences the childhood cancer care experience, receipt of results, and communication with the oncology team. Methods: In a multi-center qualitative study at three National Cancer Institute-designated comprehensive cancer centers, we conducted semi-structured interviews with adolescent and young adult patients with cancer (n=26), parents of children with cancer (n=32), and interdisciplinary clinicians in pediatric oncology (n=23). Interviews were audio-recorded, transcribed verbatim, coded, and thematically analyzed. Results: Across 81 participants, 73% self-identified as women, 69% as White race, and 17% as Hispanic/Latinx ethnicity. Most patients and parents perceived the EHR portal to be a convenient, centralized record-keeping tool that enables them to prepare for appointments, track treatment progress, and assume greater agency in their cancer care. Many patients and parents preferred the immediacy of the portal to bypass wait times and facilitate real-time decision-making. Access to notes and results on the portal was widely perceived to enhance communication and appeared to engender greater trust in the oncology team. Simultaneously, patients and parents acknowledged that instant access to results laden with medical jargon can heighten confusion, worry, and anger, particularly upon receipt of concerning results (i.e., pathology or radiology results revealing a new diagnosis of cancer or relapse) before meeting with a clinician. Clinicians generally favored the EHR portal and reported adapting their practices to provide greater anticipatory guidance, occasionally altering language in clinical notes to avoid upsetting patients or families. However, several clinicians expressed concern about situations in which high-stakes results are instantly available to patients and the responsible clinician has not yet had an opportunity to interpret and discuss. Clinicians spoke of shifting expectations regarding prompt communication of results. Many clinicians would prefer a system in which a time delay is built into the release of particularly sensitive results. Overall, clinicians reported that the EHR portal may increase administrative burden and interfere with clinical workflow. Conclusions: While key stakeholders recognize that the Cures Act offers important patient-centered innovations, many participants identified challenges that impede on optimal implementation. This study underscores the need to establish best practices for integrating use of the EHR portal into routine childhood cancer care.
Association of patient experience with overall satisfaction with care in a radiation oncology center.
Authors: Todd Sarah , Tidwell Rebecca , Zaebst Denise , Ning Matthew S. , Parikh Anuj , Woodward Wendy A. , Hoffman Karen E. 
Published: October 2023

363 Background: To better understand what aspects of positive patient experience are associated with patients’ overall satisfaction with Radiation Oncology care, we analyzed patient responses to the Press Ganey Outpatient Oncology Radiation Therapy Survey. Methods: Survey responses completed by 3,533 patients treated at the MD Anderson Radiation Oncology Department from December 2018 to June 2021 were compiled. Responses to individual questions about patient experience were categorized as good/very good vs. very poor/poor/fair. Spearman’s rank correlations among key patient characteristics and all survey questions were calculated. Multivariate logistic regression was performed with selected uncorrelated patient characteristics and questions with strong association with either overall satisfaction or likelihood of recommending services to others. All analyses were performed in SAS 9.4 [SAS Institute Inc., Cary, NC]. Results: Median age was 66 years and 50% were female. On multivariate analysis (MVA) predicting good/very good overall rating of care, the following were positively associated with satisfaction: degree to which care was well coordinated among doctors/other caregivers (adjusted odds ratio [aOR] 4.65 [95%CI 2.66-8.13], p<0.001); staff courtesy during radiation therapy (aOR 4.49 [2.29-8.77], p<0.001); and staff concern for privacy (aOR 3.31 [1.48-7.84], p=0.004). Region of residency had mixed association (USA, Non-Texas (TX) vs. TX (aOR 2.97 [0.58, 15.23]) and Non-USA vs. TX (aOR 0.10 [0.01, 0.91], p=0.04). Ease of reaching the office staff on the telephone, cleanliness of the facility, ease of finding way around facility, privacy of changing rooms, ease of registration, waiting time in the radiation therapy area and patient age were not associated with overall rating of care on MVA (all p>0.05). On MVA predicting good/very good likelihood of recommending services to others, degree to which care was well coordinated among doctors/other caregivers (aOR 4.98 [3.20-7.74], p<0.001), staff courtesy during radiation therapy (aOR 3.07 [1.72-5.48], p<0.001), and ease of reaching on phone (aOR 1.88 [1.12-3.17], p=0.004) were positively associated. Cleanliness of the facility, ease of finding way around facility, privacy of changing rooms, ease of registration, waiting time in the radiation therapy area and patient age and region of residency were not associated with likelihood of recommending services to others on MVA (p >0.05). Conclusions: Degree to which care was well coordinated and staff courtesy during radiation therapy were most highly associated with overall satisfaction with care and likelihood to recommend services to others in a Radiation Oncology Center. This suggests efforts to improve staff courtesy and care coordination will enhance patient’s overall satisfaction with radiation oncology care.
Patient and nursing staff perspectives on automated scalp cooling (ASC) for chemotherapy-induced alopecia in breast cancer.
Authors: Ueberroth Benjamin Edward , Kosiorek Heidi E. , Nafissi Nellie , Ertz-Archambault Natalie , Haddad Tufia C. , Northfelt Donald W. 
Published: October 2023

365 Background: Automated scalp cooling (ASC) is utilized in breast cancer patients to reduce chemotherapy-induced alopecia. Nursing staff and patient perspectives on ASC are limited regarding impact on care delivery and outcomes. Methods: A survey-based study of patient and chemotherapy nurse perspectives of ASC was conducted at three multi-regional Mayo Clinic sites. One-time surveys were sent to breast cancer patients and nurses for self-reporting of the ASC experience. Patients were identified via ICD-10 codes for breast cancer with subsequent chart review to confirm relevant chemotherapy regimen and ASC use. Chemotherapy nurses were identified by their respective chemotherapy unit nurse managers. Patient survey responses were compared between groups that did or did not use ASC by use of Pearson chi-square test for frequency data and the Kruskal-Wallis rank sum test for continuous measures. P values <0.05 were considered statistically significant. Results: Surveys were sent to 181 nurses with 61 (33.7%) completing them. Nurses reported ASC administration to 10-50 patients (n=43, 63.9%) or ≥50 patients (n=18, 29.5%). Most felt they had little or no technical support available (67.2%), witnessed scheduling difficulties (52.5%), were distressed by workload intensity (52.5%), and did not receive adequate training (67.2%). Most felt that ASC demanded greater nursing time compared to other duties (57.4%). Most would not recommend ASC to a friend or family member (88.6%). Surveys were sent to chemotherapy patients with 93 of 465 (20.0%) ASC patients and 56 of 341 (16.4%) without ASC (control) completing them. Controls were significantly more likely to experience hair loss, shave their head, and wear a wig (all p<0.001). There was no significant difference between groups for the EORTC QLQC30, EORTC BR23, and Body Image Scale results or frequency of headaches. Patients who used ASC for less than half of their chemotherapy sessions reported significantly more cold discomfort ( p=0.040) and dizziness ( p=0.003). Time investment (33.3%) and side effects (31.2%) were the most frequent burdens cited. Conclusions: Most nurses indicated that ASC increased nursing workload compared with other duties, and they lacked adequate training and technical support. Increasing formal nurse education and access to technical support documents and live technical support may be options for improving nursing satisfaction with ASC. Patient responses suggest qualitative effectiveness of ASC in reducing hair loss. While those with ASC were less likely to shave or use a wig, this did not translate to significant differences in quality of life or psychosocial body image compared to controls. Cold discomfort and dizziness were the most frequent side effects among those with lower utilization of ASC.
Implementation of malnutrition screening tool initiative in community cancer center for cycle 1 day 1, change in regimen, and new metastatic disease patients from Sept.–March 2022.
Authors: Weber Dana , Traul Abigail 
Published: October 2023

367 Background: Identification of patients at risk for malnutrition is imperative to provide early nutrition intervention. Patients undergoing cancer therapy are at risk for developing a variety of side effects that impact their intake, absorption, and nutritional status while undergoing antineoplastic therapy. Methods: 2021 Q4 Pilot: Implemented Malnutrition Screening Tool (MST) to identify patients at risk of malnutrition for C1D1 patients only during the Nurse Navigator visit. If the MST score is <2, but a patient requests Dietitian Counseling, a patient would be referred to the RD. If score is clinically significant, > or = 2, Nurse Navigator referred to the RD, including rationale and additional detail (i.e., amount of weight loss, poor appetite, etc.). RD reviewed all referrals related to the MST and completes further assessment and intervention if appropriate. 2022 Q4: Screening utilizing the MST was standardized during Nurse Navigator visits for all C1D1 patients, patients with new metastatic disease, patients with change in regimen and new oral therapy patients. Results: See table. Conclusions: Of the patients screened with the NCCN Distress Thermometer, 67% of those patients were identified to be screened for Malnutrition. Of the patients who were screened with the MST, ~ 26% of the patients were identified to be at risk for malnutrition. Early identification of malnutrition in treatment will result in early intervention and assessment by the dietitian to prevent poor outcomes.[Table: see text]
Evaluation of symptom severity, tolerability, and physical function in the I-SPY2 trial.
Authors: Basu Amrita B , Umashankar Saumya , Musthafa Mina , Jones Tamia , Blevins Kaylee , Brown Thelma , Heditsian Diane , Parker Beverly , Brain Susie , Simmons Carol , Hieken Tina J. , Ruddy Kathryn Jean , Mainor Candace Bavette , Tevis Sarah Emily Amend , Blaes Anne Hudson , Rugo Hope S. , Dunn Imogene , Melisko Michelle E. , Esserman Laura , Hershman Dawn L. 
Published: October 2023

369 Background: Patient-reported outcomes (PROs) are a valuable component to understand treatment tolerability and toxicity. We have implemented an electronic system for monitoring PROs and quality of life (QOL) for patients enrolled in the I-SPY2 trial, a phase II trial evaluating the effect of novel neoadjuvant therapies for breast cancer. We associated patient demographic factors with symptoms, decline in physical function (PF), and tolerability to treatment. Methods: Study population for this analysis includes 259 enrolled patients receiving combinations of experimental immunotherapy and chemotherapy. Patients completed PRO-CTCAE/PROMIS/FACT surveys reflecting symptom severity, symptom frequency, tolerability of drug, and physical function at baseline through follow up (12 months). CTCAE 5.0 was collected weekly at these timepoints to assess adverse events (AE). Odds ratio and regularized multi-variate regression was used to evaluate early symptoms predictive of a clinically significant decline in PF from baseline to post-treatment follow-up. Results: Of 259 patients, 160 (58%) were White, 13 (5%) were Asian, 26 (10%) were African American (AA), and 25 (9.3%) were Hispanic. 25% of all patients had a clinically significant decline in PF between baseline and pre-surgery/follow-up. Symptom predictors of decline included high frequency of diarrhea and severity of joint pain. African American (AA) patients had higher severity of joint pain than White patients (OR = 14.9, P < 0.05). Within the first 12 weeks of treatment, AA patients and non-white (NW) patients were more likely to report severe vomiting than White patients (OR =13.22 and 12.72, P< 0.05 and P< 0.03 respectively). Overall, patients that reported lower tolerance to therapy had higher grade of AE. While patients with low-grade adverse events were less bothered by their side effects at follow-up, higher grade adverse events such as hypothyroidism impacted distress levels by more than double. Conclusions: Among I-SPY2 participants, when higher grade of symptoms is persistent through follow up, it impacts physical function and tolerability even after end of therapy. Our study can allow physicians to be more diligent in active and post treatment monitoring. Clinical trial information: NCT01042379 .
To err is human: A healthcare organization blueprint towards safety and reliability.
Authors: Gonzalez Carmen E. , Luk Wing-Si , Rivera Jose A , Newman Alana 
Published: October 2023

392 Background: In 2019, a comprehensive cancer center was audited by a regulatory agency that identified opportunities to improve the safe delivery of healthcare. Even though the organization has been engaged in multiple continuous improvement initiatives, we found that to run a complex enterprise efficiently, we needed to break silos, learn from the frontline, and educate and train leaders in a psychologically safe environment. The overarching goal is to improve our culture of safety by developing a safety-focused workforce, improving robust processes around high-harm events, increasing transparency/feedback regarding safety events, and advancing the institution towards a High Reliability Organization (HRO)1 with zero preventable patient harm. Methods: Key interventions implemented: 1. Revamped our Root Cause Analysis; 2. Developed a Quality Assurance Performance Improvement (QAPI)2 council with leadership from the enterprise and representatives of the Patient Family Advisory Program, patients of the organization; 3. Implemented a Tiered Readiness Briefing (TRB) 7 days a week; 4. Selection of Serious Safety Event Rate (SSER)3 as the organization's measurement of patient safety and made it transparent; 5. Implementation of a mandatory training program in HRO skills and tools necessary to change behaviour. Training of leadership first goal was to get their buy-in so that the rest of the workforce would comply with the training; 6. Created Priority Focus Areas (PFA) initiatives supported by QAPI, the board, and leadership- providing resources to improve widespread, problem-prone, high-risk issues. Also, a system of accountability. Results: From June 2020 to April 2023- 59% reduction on SSER and sustained rate <0.9; 96% of leaders and 86% of medical faculty trained in HRO; 100% of “Start the Clock” issues identified in TRB are acted on within 24 hrs.; PFA success: the creation of the Blood Shortage Safety Decision Matrix- resulted in no surgery cancellation due to blood shortage. Conclusions: Rigorously implementing HRO principles in a comprehensive and complex cancer center resulted in improved process outcomes and patient safety outcomes that significantly reduced serious safety events. References: 1. Veazie S, Peterson K, Bourne D. Evidence Brief: Implementation of High Reliability Organization Principles. Washington (DC): Department of Veterans Affairs (US); 2019 May. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542883/ ; 2. Center for Medicare and Medicaid (2021, December 1). QAPI Description and Background. CMS.gov. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/qapidefinition ; 3. Donnelly LF, Uhlhorn E, Bargmann-Losche J, Platchek TS. Serious Experience Events: Applying Patient Safety Concepts to Improve Patient Experience. J Patient Exp. 2022 May 23; 9:23743735221102670. doi: 10.1177/23743735221102670. PMID: 35647270; PMCID: PMC9134394.