Using technology to improve symptom management in ICU: a quality improvement study

180 Background: Symptom management is critical to quality cancer care, affecting treatment completion, functioning and quality of life. We describe the use of the Commission on Cancer’s Rapid Quality Reporting System (RQRS) to ascertain cases for PRO collection, identify key PRO quality indicators, and provide actionable symptom management quality improvement (QI) reports to community cancer centers (CCC). Methods: The Patient Reported Outcomes Symptoms & Side Effects Study used RQRS to sample patients (pt) 4-12 months from diagnosis with locoregional breast/colon from 17 National Cancer Institute Community Cancer Centers Program centers. Surveys were mailed with web option. Pts were asked if they talked to a health professional about pain (Talk about) and, separately, if the health professional gave advice about what to do if pain started, got worse, or came back (Advice). Similar questions were asked about fatigue and emotional distress (ED). QI reports were designed with CCC staff feedback and produced for each CCC providing crude and case-mix adjusted CCC-specific rates, and study-wide rates. Direct standardization methods were used to adjust CCC-specific rates for cancer type and education. Results: 2,487 eligible participants responded (RR=61%). This table shows overall study-wide estimates and the range of adjusted CCC-specific estimates for six key indicators. (See Table.) Conclusions: This pilot study shows the registry-based method for PRO collection was successful and has potential for wider dissemination. Study-wide, 20-45% of pts did not report discussing or getting advice about three common symptoms from their healthcare team. CCCs varied significantly on these indicators, suggesting room for improvement. Quality reports were well received by hospital staff, who report sharing them with clinicians, navigators and cancer committees. CCC-specific reports may promote efforts to improve care through professional/patient education and applying standards of care. [Table: see text]

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Subcutaneous Botulinum Toxin Injection for Post-Thoracotomy Pain Syndrome in Palliative Care: A Case Report

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909117716460 ◽

2017 ◽

Vol 35 (3) ◽

pp. 511-513 ◽

Cited By ~ 4

Author(s):

Saima Rashid ◽

Amanda R. Fields ◽

Steven J. Baumrucker

Keyword(s):

Botulinum Toxin ◽

Symptom Management ◽

Pain Control ◽

Clostridium Botulinum ◽

Botulinum Toxin Injection ◽

Botulinum Toxin Type A ◽

Pain Syndrome ◽

Botulinum Toxin Type ◽

Improve Symptom ◽

Traumatic Neuropathy

Post-thoracotomy pain syndrome (PTPS) is a traumatic neuropathy that can affect as many as 50% of patients undergoing thoracotomy. Patients are often refractory to conservative management and may require multiple analgesics for adequate pain control. Botulinum toxin, derived from Clostridium botulinum, has many uses in treating conditions involving spasticity, dystonia, chronic migraine, and a variety of pain disorders including neuropathies. Botulinum toxin type A injections may provide an alternative or adjunct to improve symptom management in patients with PTPS.

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Personalized symptom management: a quality improvement collaborative for implementation of patient reported outcomes (PROs) in ‘real-world’ oncology multisite practices

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-020-00212-x ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Doris Howell ◽

◽

Zeev Rosberger ◽

Carole Mayer ◽

Rosanna Faria ◽

...

Keyword(s):

Quality Improvement ◽

Real World ◽

Symptom Management ◽

Patient Reported Outcomes ◽

Quality Improvement Collaborative ◽

Patient Reported

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Clinical decision support system to optimise symptom management in palliative medicine: focus group study

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-002940 ◽

2021 ◽

pp. bmjspcare-2021-002940

Author(s):

Lotte van der Stap ◽

Albert H de Heij ◽

Agnes van der Heide ◽

Anna KL Reyners ◽

Yvette M van der Linden

Keyword(s):

Palliative Care ◽

Decision Support ◽

Focus Group ◽

Clinical Decision Support ◽

Support System ◽

Symptom Management ◽

Clinical Decision Support System ◽

Clinical Decision ◽

Improve Symptom ◽

Patient Reported

ObjectivesSuboptimal symptom control in patients with life-limiting illnesses is a major issue. A clinical decision support system (CDSS) that combines a patient-reported symptom assessment scale (SAS) and guideline-based individualised recommendations has the potential to improve symptom management. However, lacking end-user acceptance often prevents CDSS use in daily practice.We aimed to evaluate the acceptability and feasibility of a palliative care CDSS according to its targeted end-users.MethodsSix focus groups with different groups of stakeholders were conducted: (1) patient representatives; (2) community nurses; (3) hospital nurses; (4) general practitioners; (5) hospital physicians and (6) palliative care specialists. Audiotapes were transcribed verbatim and thematically analysed.ResultsFifty-one stakeholders (6–12 per focus group) participated. Six themes were discussed: effect, validity, continuity, practical usability, implementation and additional features. All participants expected a CDSS to improve symptom management, for example, by reminding clinicians of blind spots and prompting patient participation. They feared interference with professional autonomy of physicians, doubted the validity of using a patient-reported SAS as CDSS input and thought lacking care continuity would complicate CDSS use. Clinicians needed clear criteria for when to use the CDSS (eg, life-limiting illness, timing in illness trajectory). Participants preferred a patient-coordinated system but were simultaneously concerned patients may be unwilling or unable to fill out an SAS.ConclusionsA palliative care CDSS was considered useful for improving symptom management. To develop a feasible system, barriers for successful implementation must be addressed including concerns about using a patient-reported SAS, lacking care continuity and unclear indications for use.

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Quality of telephone-based cancer symptom management by nurses: a quality improvement project

Supportive Care in Cancer ◽

10.1007/s00520-020-05551-5 ◽

2020 ◽

Vol 29 (2) ◽

pp. 841-849

Author(s):

Dawn Stacey ◽

Claire Ludwig ◽

Lynne Jolicoeur ◽

Meg Carley ◽

Katelyn Balchin ◽

...

Keyword(s):

Quality Improvement ◽

Symptom Management ◽

Quality Improvement Project ◽

Improvement Project ◽

Cancer Symptom Management

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Neoplasm of the spinal cord: Implications for clinical care to improve symptom management and functionality

Clinical Nursing Studies ◽

10.5430/cns.v1n2p14 ◽

2013 ◽

Vol 1 (2) ◽

Author(s):

Vishwa S Raj ◽

Joanna Edeker

Keyword(s):

Spinal Cord ◽

Symptom Management ◽

Clinical Care ◽

Improve Symptom

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An Individualized Representational Intervention to Improve Symptom Management (IRIS) in Older Breast Cancer Survivors: Three Pilot Studies

Oncology Nursing Forum ◽

10.1188/09.onf.e133-e143 ◽

2009 ◽

Vol 36 (3) ◽

pp. E133-E143 ◽

Cited By ~ 24

Author(s):

Susan M. Heidrich ◽

Roger L. Brown ◽

Judith J. Egan ◽

Oscar A. Perez ◽

Cynthia H. Phelan ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Symptom Management ◽

Breast Cancer Survivors ◽

Pilot Studies ◽

Improve Symptom

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Hematopoietic Cell Transplant and Use of Massage for Improved Symptom Management: Results from a Pilot Randomized Control Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2012/450150 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 23

Author(s):

Wolf E. Mehling ◽

E. Anne Lown ◽

Christopher C. Dvorak ◽

Morton J. Cowan ◽

Biljana N. Horn ◽

...

Keyword(s):

Symptom Management ◽

Pilot Trial ◽

Intervention Group ◽

Symptom Burden ◽

Hematopoietic Cell ◽

Cell Transplant ◽

Hematopoietic Cell Transplant ◽

Improve Symptom ◽

Pilot Randomized Control Trial

Background. Pediatric hematopoietic cell transplant (HCT) is a lifesaving treatment that often results in physical and psychological discomfort. An acupressure-massage intervention may improve symptom management in this setting.Methods. This randomized controlled pilot trial compared a combined massage-acupressure intervention to usual care. Children were offered three practitioner-provided sessions per week throughout hospitalization. Parents were trained to provide additional acupressure as needed. Symptoms were assessed using nurses' reports and two questionnaires, the behavioral affective and somatic experiences scale and the Peds quality of life cancer module.Results. We enrolled 23 children, ages 5 to 18. Children receiving the intervention reported fewer days of mucositis (Hedges' g effect sizeES=0.63), lower overall symptom burden (ES=0.26), feeling less tired and run-down (ES=0.86), having fewer moderate/severe symptoms of pain, nausea, and fatigue (ES=0.62), and less pain (ES=0.42). The intervention group showed trends toward increasing contentness/serenity (ES=+0.50) and decreasing depression (ES=−0.45), but not decreased anxiety (ES=+0.42). Differences were not statistically significant.Discussion. Feasibility of studying massage-acupressure was established in children undergoing HCT. Larger studies are needed to test the efficacy of such interventions in reducing HCT-associated symptoms in children.

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Population-Based Standardized Symptom Screening: Cancer Care Ontario's Edmonton Symptom Assessment System and Performance Status Initiatives

Journal of Oncology Practice ◽

10.1200/jop.2014.001390 ◽

2014 ◽

Vol 10 (3) ◽

pp. 212-214 ◽

Cited By ~ 33

Author(s):

José Pereira ◽

Esther Green ◽

Sean Molloy ◽

Deborah Dudgeon ◽

Doris Howell ◽

...

Keyword(s):

Symptom Management ◽

Performance Status ◽

Symptom Assessment ◽

Population Based ◽

Assessment System ◽

Management Tools ◽

Symptom Screening ◽

Improve Symptom ◽

Cancer Symptom Management ◽

And Performance

To improve symptom management, the Ontario Cancer Symptom Management Collaborative uses common assessment and care management tools including Interactive Symptom Assessment and Collection, which allows patients to report their symptoms via kiosks or tablets directly to clinicians in real-time.

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