Knowledge and self-efficacy for caring for breast and colon cancer survivors among safety net primary care providers

8597 Background: Older cancer survivors may experience psychological distress due to their cancer experience and aging health. This study aimed to compare primary care and specialty providers’ inquiries of pain, depression and anxiety to older cancer survivors’ questionnaire responses. Methods: 153 patients seen in oncology clinics at the Veterans Affairs Medical Center (Durham, NC) from November 1999 until April 2000 completed the Hospital Anxiety and Depression Scale and a pain thermometer questionnaire. Blinded chart review examined health provider inquiries of pain, anxiety and depression. Cox proportional hazards survival analyses were performed on subjective pain, anxiety and depression with comorbidities and Karnofsky performance status (KPS) added in controlled models. Results: Patients were on average aged 68, had 5.4 comorbidities, 87.4% KPS, and were 3.1 years from a cancer diagnosis. Health providers missed 17 of 94 patients with significant levels of self-reported pain (sensitivity 0.82). Although 28 (20.6%) and 33 (25.8%) patients screened positively for depression and anxiety respectively, providers asked 7 patients about anxiety (sensitivity 0.15) and 16 patients about depression (sensitivity 0.25). The overall three year mortality was 37.9%. Pain was not associated with mortality. Patients screening for depression [HR 2.03 (95% CI: 1.03, 4.01)] and anxiety [HR 2.02 (95% CI: 1.01, 4.04)] had lower 3 year survival. KPS and comorbidities diminished these effects. Conclusions: In older cancer survivors, anxiety and depression may have an association with mortality. To improve detection, oncology and primary care providers should routinely inquire about mood and aim to intervene with pharmacologic or supportive treatments. No significant financial relationships to disclose.

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Cancer survivorship algorithms as clinical tools for primary care providers.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.100 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 100-100

Author(s):

Guadalupe R. Palos ◽

Katherine Ramsey Gilmore ◽

Paula A. Lewis-Patterson ◽

Maria Alma Rodriguez

Keyword(s):

Primary Care ◽

Cancer Survivors ◽

Cancer Survivorship ◽

Primary Care Providers ◽

Cell Transplant ◽

Care Providers ◽

Coordinated Care ◽

Major Barrier ◽

Site Specific ◽

The Impact

100 Background: Clinical decision tools (CDTs) such as survivorship algorithms may be valuable resources for primary care providers who provide post-treatment care for cancer survivors. Our objective was to assess providers’ perceptions, adoption, and satisfaction with clinical practice algorithms tailored to site-specific cancer survivorship clinics. Methods: Eligible providers were those assigned to one of 9 site-specific survivorship clinics, (breast, colorectal, genitourinary, gynecology, head and neck, lymphoma, melanoma, stem cell transplant, and thyroid). Potential respondents were invited to participate by emails. Voluntary return of the survey indicated a provider’s informed consent. Providers had the choice to participate by clicking on a link embedded in an email. Once the link was activated, the user was taken to a 10-item survey with questions asking about the usability, awareness, and satisfaction with the algorithms specific to their clinic. Descriptive statistics (i.e. frequencies and percentages) were used to summarize the responses. Results: Of 35 providers assigned in the survivorship clinics, 18 responded resulting in a 51% response rate. The majority of respondents (94.4%) were aware of the survivorship algorithms specific to their clinic. Over 75% reported using the algorithms occasionally (16.7%), frequently (33%) and always (33.3%). The major barrier to using the algorithms was a lack of awareness on to access the algorithms. Over half of the providers (55.6%) preferred using the digital versions of the algorithms. 68% strongly agreed the algorithms were practical to use and implement in their clinical setting. The majority of providers’ reported being satisfied (62.5%) or very satisfied (25.0%) with the algorithms tailored to their site specific clinic. Conclusions: Survivorship practice algorithms were perceived as useful clinical resources to deliver coordinated care to cancer survivors with diverse cancer diagnoses. Future work is needed to determine the impact of the algorithms on providers’ practice with cancer survivors.

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The role of annual personal health visits (APHV) on patients' with cancer knowledge and perceptions of the harms of continued smoking.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.152 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 152-152

Author(s):

Delaram Farzanfar ◽

Lin Lu ◽

Jie Su ◽

Devon Alton ◽

Rahul Mohan ◽

...

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Cancer Survivors ◽

Cancer Patients ◽

Primary Care Providers ◽

Smoking History ◽

Care Providers ◽

Risk Of Death ◽

Increase Risk

152 Background: With improvements in cancer detection and therapies, important secondary prevention measures in survivorship include smoking cessation. Primary care providers have an opportunity to discuss these measures with cancer survivors at APHV. We evaluated whether having a recent APHV is associated with cancer patients’ awareness and perceptions of the harms of continued smoking. Methods: Cancer survivors were surveyed from April 2014 to May 2016 with respect to their smoking history, knowledge and perceptions of the harms of continued smoking along with the date of their most recent APHV (term changed from annual health physical examination in 2013). Multivariable logistic regression analyses assessed the association of having an APHV with knowledge and perceptions of the harms of continued smoking. Results: Of 985 cancer patients, 23% smoked at diagnosis; 34% quit > 1 year prior to diagnosis; 55% had tobacco-related cancers; 77% received curative therapy. From a knowledge viewpoint, over 52% reported being unaware that smoking negatively impacts cancer outcomes; despite this, most perceived smoking to negatively influence quality of life (75%), survival (76%), and fatigue (73%). Within the last year, 48% had an APHV, while 84% had an APHV at any time in the past; 18 (2%) reported not having a family doctor. Patients who had an APHV in the last year were more likely to be aware that continued smoking can increase risk of death (adjusted odds ratio (aOR)=1.49, 95% CI [1.13-1.96], P=0.004), and more likely to perceive smoking to negatively impact quality of life (aOR=1.37 [0.94-1.99], P=0.10), survival (aOR=1.60 [0.95-2.71], P=0.08), and fatigue (aOR=1.63 [1.11-2.39], P=0.01). Those ever having an APHV were more likely aware that smoking can increase risk of death (aOR=1.61 [1.07-2.43], P=0.02) and second primaries (aOR=1.53 [1.02-2.33], P=0.04). Conclusions: Having a recent APHV was associated with improved awareness and perceptions of the harms of continued smoking, but it is unclear whether this is related to provider counseling or a healthy bias effect. APHV may be an appropriate time for primary care providers to treat tobacco addiction in their cancer survivors.

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Factors influencing the use of electronic health record systems to provide follow-up care to cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.182 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 182-182

Author(s):

Guadalupe R. Palos ◽

Maria Alma Rodriguez ◽

Paula A. Lewis-Patterson ◽

Rachel Harris ◽

Lewis E. Foxhall

Keyword(s):

Primary Care ◽

Cancer Survivors ◽

Clinical Information ◽

Primary Care Providers ◽

Self Report ◽

Care Providers ◽

Convenience Sample ◽

Major Barrier ◽

Care Plans ◽

Electronic Health

182 Background: One of the expected benefits of electronic health records (EHRs) is their interoperability to remotely access and exchange clinical information across systems and clinicians. Cancer survivors’ treatment summaries (TSs) and care plans (CPs) are documents that can be electronically transferred from oncologists to primary care providers. We conducted a needs assessment to identify factors which influenced EHRs in meeting these expectations in rural and underserved primary care settings. Methods: Clinicians from 2 family practice health care systems, located in central and northeast Texas were surveyed. REDCap, a web-based system, was used to develop, manage, and distribute the survey to a convenience sample of clinical staff from both settings. Survey questions focused on respondents’ demographic and clinical practice characteristics, current experience with TSs and CPs, and type of EHR used. Results: A total of 26 surveys were included in this analysis. Respondents were primarily physicians (73%). Overall 61.5% reported that ≤ 25% of their patients were diagnosed with cancer or currently had cancer. A patient’s self-report was the primary method used by majority of respondents to determine if a patient had a history of cancer. 80.8% indicated they would be interested in learning more about the use and development of TSs and CPs. Barriers reported towards the use of EHRs to deliver TSs and CPs included: EHRs interference with workflow (60%); limited knowledge on how to develop TSs and CPs (48%), inadequate access to IT resources (48%), and inefficient EHR systems (44%). In these settings, EHRs used were: Epic (61.6%), Aria (30.8%), and Medit (7.7%). Respondents’ comments on EHRs weaknesses included: “the two systems…do not completely communicate with each other” or “no place where a cancer treatment summary or survivorship plan is documented”. Conclusions: Primary care providers identified limitations in EHR operability as a major barrier to retrieving health information required for TSs and CPs. Clinicians in rural or underserved regions may benefit from education and retraining in EHR systems.

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Shared care involving cancer specialists and primary care providers - What do cancer survivors want?

Health Expectations ◽

10.1111/hex.12551 ◽

2017 ◽

Vol 20 (5) ◽

pp. 1081-1087 ◽

Cited By ~ 9

Author(s):

Sharon Lawn ◽

Julia Fallon-Ferguson ◽

Bogda Koczwara

Keyword(s):

Primary Care ◽

Cancer Survivors ◽

Primary Care Providers ◽

Shared Care ◽

Care Providers ◽

Cancer Specialists

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Not Perfect, but Better: Primary Care Providers’ Experiences with Electronic Referrals in a Safety Net Health System

Journal of General Internal Medicine ◽

10.1007/s11606-009-0955-3 ◽

2009 ◽

Vol 24 (5) ◽

pp. 614-619 ◽

Cited By ~ 84

Author(s):

Yeuen Kim ◽

Alice Hm Chen ◽

Ellen Keith ◽

Hal F. Yee ◽

Margot B. Kushel

Keyword(s):

Primary Care ◽

Health System ◽

Primary Care Providers ◽

Safety Net ◽

Care Providers ◽

Electronic Referrals

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Using impact asthma echo to influence physician self-efficacy and guideline adherence

10.32469/10355/68955 ◽

2018 ◽

Author(s):

◽

Danny Myers

Keyword(s):

Primary Care ◽

Guideline Adherence ◽

Self Efficacy ◽

Community Of Inquiry ◽

Primary Care Providers ◽

Small Subset ◽

Care Providers ◽

Web Based ◽

Research Questions ◽

Group Engagement

The purpose of this study was to examine the influence on provider self-efficacy and guideline adherence as a result of participation in Impact Asthma ECHO. The researcher addressed the following research questions: How does participation in Impact Asthma ECHO influence primary care provider self-efficacy? How does engagement in the learning activities of Impact Asthma ECHO promote clinical guideline adherence? Participants included 19 Primary Care providers participating in Impact Asthma ECHO via online video-conferencing. The researcher utilized a data-triangulation method, collecting data via self-efficacy surveys, Continuing Medical Education surveys, a Community of Inquiry coding template, and Medicaid Claims Data. While findings of the study were limited by a relatively small subset of participants, the significant contribution of the present research is the utilization of the modified Community of Inquiry coding template for the purposes of evaluating group engagement and learning in a synchronous, web-based videoconferencing educational session.

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