scholarly journals Barriers to Evidence-Based Treatment Decision-Making in Acute Myeloid Leukemia: A Quality Improvement Initiative Across Community Oncology Practices

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3016-3016
Author(s):  
Joshua F. Zeidner ◽  
William Blum ◽  
Amir T. Fathi ◽  
Daniel A. Pollyea ◽  
Megan M. Stephan ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Planning ◽  
Shared Decision Making ◽  
Research Funding ◽  
Patient Centered Care ◽  
Molecular Testing ◽  
Shared Decision ◽  
Patient Centered ◽  
Community Oncology ◽  
Centered Care

Abstract Background Availability of molecularly targeted therapies has rapidly changed the treatment landscape for acute myeloid leukemia (AML). With these newer treatment choices, healthcare professionals (HCPs) must consider appropriate uses of molecular testing, treatment selection based on testing results, new sets of adverse events (AEs), and an increased need for patient education and shared decision-making (SDM). In this quality improvement (QI) initiative, we assessed barriers to evidence-based treatment planning for patients with AML in 4 community oncology systems and conducted team-based audit-feedback (AF) sessions within each system to facilitate HCP goal setting to mitigate identified barriers. Methods The QI initiative was conducted between Dec. 7, 2020 and Feb. 10, 2021. Initially, 14 hematology/oncology HCPs completed baseline team-based surveys to assess barriers in 4 community oncology systems (Table 1). To address identified gaps, 43 HCPs in the 4 systems participated in AF sessions. Action plans were developed by the clinical teams based on survey results (Table 1). Additional pre- and post-surveys completed before and after the AF sessions measured changes in participants' confidence and competence. Results On the pre-activity surveys, the most common challenges in AML management were: 1) identifying which treatment options are most appropriate (30%), 2) coordinating with other members of the care team (24%), 3) gaining/maintaining access to new therapies (15%), and 4) integrating molecular testing information into treatment decisions (15%) (Figure 1). After the 4 AF sessions, HCPs prioritized addressing these 4 challenges. In the baseline surveys, HCPs identified additional staff/resources (64%) and additional staff training/education as top resources needed to overcome these challenges. HCPs identified additional challenges in the areas of AE management and patient centered care in the baseline surveys. Identified barriers in patient centered care, specifically, shared decision making (SDM), included not enough time to engage in SDM (57%) and patients' low health literacy (57%). After the 4 AF sessions, HCPs prioritized addressing tailoring treatment decisions to achieve patient goals (42%), coordinating follow-up visits with other care team members (32%), and engaging patients in shared decision-making (21%) as goals for improving patient-centered care. Molecular testing emerged as a key challenge in AML treatment planning over the course of the QI initiative. Pre-activity, only 36% of HCPs expressed high confidence (4/5 Likert scale) in identifying which molecular tests should be ordered to guide treatment planning, and similarly only 36% were highly confident in selecting targeted therapies based on actionable mutations. HCPs also expressed dissatisfaction with ordering and timely receipt of molecular testing results in their systems. In post-activity surveys, over twice as many HCPs selected molecular testing as a challenge they were planning to address within their team (37% compared with 15% pre-activity), suggesting increased awareness of this barrier (Figure 1). Pre- to post-activity, HCPs who self-reported use of targetable mutations as an important factor in planning treatment for patients who are not candidates for induction therapy increased from 27% to 63%. Participation in the QI initiative led to improvements in clinician confidence and competence in molecular testing, treatment selection based on molecular results, AE management, and use of SDM (Figure 2). Conclusions HCPs participating in this QI initiative identified barriers and potential areas for improvement in AML treatment planning, including barriers related to molecular testing, treatment selection and access, AE management, and patient-centered care. Participation in the AF sessions led to measurable improvements in HCP confidence and competence in key areas of AML management which may ultimately improve the quality of AML care in the community. Study Sponsor Statement The study reported in this abstract was funded by an independent educational grant from Genentech. The grantor had no role in the study design, execution, analysis, or reporting. Figure 1 Figure 1. Disclosures Blum: Abbvie: Honoraria; AmerisourceBergen: Honoraria; Forma Therapeutics: Research Funding; Leukemia and Lymphoma Society: Research Funding; Celyad Oncology: Research Funding; Nkarta: Research Funding; Xencor: Research Funding; Syndax: Honoraria. Fathi: Seattle Genetics: Consultancy, Honoraria; Astellas: Consultancy, Honoraria; Daiichi Sankyo: Consultancy, Honoraria; Blueprint: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Celgene/BMS: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria; Agios: Consultancy, Honoraria, Research Funding; Servier: Research Funding; AbbVie: Consultancy, Honoraria, Research Funding; Genentech: Consultancy, Honoraria; Trillium: Consultancy, Honoraria; Kura: Consultancy, Honoraria; Foghorn: Consultancy, Honoraria; Kite: Consultancy, Honoraria; Morphosys: Consultancy, Honoraria; Ipsen: Consultancy, Honoraria. Pollyea: Takeda: Honoraria; Syros: Consultancy, Honoraria; Syndax: Honoraria; Novartis: Consultancy, Honoraria; Kiadis: Honoraria; Aprea: Honoraria; Astellas: Honoraria; Bristol Myers Squibb: Honoraria; Celgene: Honoraria; Foghorn: Honoraria; Genentech: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Jazz: Honoraria; Karyopharm: Consultancy, Honoraria; Amgen: Honoraria; AbbVie: Consultancy, Honoraria, Research Funding; Teva: Research Funding.

scholarly journals Facilitating Team-Based Care Coordination and Collaboration in Myelofibrosis: Findings from a Quality Improvement Study in Three US Community Oncology Systems

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 32-33
Author(s):  
Srdan Verstovsek ◽  
Anne Jacobson ◽  
Jeffrey D Carter ◽  
Tamar Sapir
Keyword(s):  
Decision Making ◽  
Quality Improvement ◽  
Patient Education ◽  
Care Coordination ◽  
Research Funding ◽  
Practice Patterns ◽  
Patient Centered Care ◽  
Patient Centered ◽  
Community Oncology ◽  
Centered Care

Background Care coordination can be especially challenging in the setting of rare malignancies such as myelofibrosis (MF), where hematology/oncology teams have limited experience working together to implement rapidly evolving standards of care. In this quality improvement (QI) initiative, we assessed barriers to patient-centered MF care in 3 community oncology systems and conducted team-based audit-feedback (AF) sessions within each system to facilitate improved care coordination. Methods Between 1/2020 and 3/2020, 31 hematology/oncology healthcare professionals (HCPs) completed surveys designed to characterize self-reported practice patterns, challenges, and barriers to collaborative MF care in 3 community oncology systems (Table 1). Building on findings from the team-based surveys, 39 HCPs from these centers participated in AF sessions to reflect on their own practice patterns and to prioritize areas for improved MF care delivery. Participants developed team-based action plans to overcome identified challenges, including barriers to effective risk stratification, care coordination, and shared decision-making (SDM) for patients with MF. Surveys conducted before and after the small-group AF sessions evaluated changes in participants' beliefs and confidence in delivering collaborative, patient-centered MF care. Results Team-Based Surveys: HCPs identified managing MF-associated anemia and other disease symptoms (42%), providing individualized care despite highly variable clinical presentations (29%), and developing institutional expertise despite low patient numbers (16%) as the most pressing challenges in MF care. For patients who are candidates for JAK inhibitor therapy, HCPs reported most commonly relying on current guidelines (71%) and clinical evidence (61%) to guide treatment selection. HCPs also considered drug safety/tolerability profiles (55%), personal or institutional experience (13%), and out-of-pocket costs for patients (13%); no participants (0%) reported incorporating patient preference into their decision-making. Teams were underutilizing SDM and patient-centered care resources; fewer than 50% reported providing tools to support adherence (48%), visual aids for patient education (47%), financial toxicity counseling (40%), resources for managing MF-related fatigue (36%), or counseling to reduce risk factors for CVD, bleeding, and thrombosis (26%). Small-Group AF Sessions: Across the 3 oncology centers, teams participating in the AF sessions (Table 1) shared a self-reported caseload of 97 patients with MF per month. HCPs reported a meaningful shift in beliefs regarding the importance of collaborative care: following the AF sessions, 100% of HCPs agreed or strongly agreed that collaboration across the extended oncology care team is essential for achieving MF treatment goals, an increase from 71% prior to the AF sessions (Figure 1). Participants also reported increased confidence in their ability to perform each of 6 aspects of evidence-based, collaborative, patient-centered care (Figure 2). In selecting which aspects of patient-centered care to address with their clinical teams, HCPs most commonly prioritized individualizing treatment decision-making based on patient- and disease-related factors (57%), followed by providing adequate patient education about treatment options and potential side effects (24%) and engaging patients in SDM (18%). To achieve these goals, 73% of HCPs committed to sharing their action plans with additional clinical team members; others committed to creating a quality task force to oversee action-plan implementation (15%) and securing buy-in from leadership and stakeholders (9%). Conclusions As a result of participating in this community-based QI initiative, hematology/oncology HCPs demonstrated increased confidence in their ability to deliver patient-centered MF care and improved commitment to team-based collaboration. Remaining practice gaps and challenges can inform future QI programs. Study Sponsor Statement The study reported in this abstract was funded by an independent educational grant from Incyte Corporation. The grantors had no role in the study design, execution, analysis, or reporting. Disclosures Verstovsek: ItalPharma: Research Funding; CTI Biopharma Corp: Research Funding; Promedior: Research Funding; Gilead: Research Funding; NS Pharma: Research Funding; Celgene: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Genentech: Research Funding; Sierra Oncology: Consultancy, Research Funding; PharmaEssentia: Research Funding; AstraZeneca: Research Funding; Incyte Corporation: Consultancy, Research Funding; Blueprint Medicines Corp: Research Funding; Protagonist Therapeutics: Research Funding; Roche: Research Funding.

scholarly journals Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions (Preprint)

2020 ◽  
Author(s):  
Yaara Zisman-Ilani ◽  
Rana Obeidat ◽  
Lauren Fang ◽  
Sarah Hsieh ◽  
Zackary Berger
Keyword(s):  
United States ◽  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Patient Centered Care ◽  
Survey Study ◽  
Shared Decision ◽  
Patient Centered ◽  
Centered Care ◽  
Comparative Survey

BACKGROUND Shared decision making (SDM) is a health communication model that evolved in Europe and North America and largely reflects the values and medical practices dominant in these areas. OBJECTIVE This study aims to understand the beliefs, perceptions, and practices related to SDM and patient-centered care (PCC) of physicians in Israel, Jordan, and the United States. METHODS A hypothesis-generating comparative survey study was administered to physicians from Israel, Jordan, and the United States. RESULTS A total of 36 surveys were collected via snowball sampling (Jordan: n=15; United States: n=12; Israel: n=9). SDM was perceived as a way to inform patients and allow them to participate in their care. Barriers to implementing SDM varied based on place of origin; physicians in the United States mentioned limited time, physicians in Jordan reported that a lack of patient education limits SDM practices, and physicians in Israel reported lack of communication training. Most US physicians defined PCC as a practice for prioritizing patient preferences, whereas both Jordanian and Israeli physicians defined PCC as a holistic approach to care and to prioritizing patient needs. Barriers to implementing PCC, as seen by US physicians, were mostly centered on limited appointment time and insurance coverage. In Jordan and Israel, staff shortage and a lack of resources in the system were seen as major barriers to PCC implementation. CONCLUSIONS The study adds to the limited, yet important, literature on SDM and PCC in areas of the world outside the United States, Canada, Australia, and Western Europe. The study suggests that perceptions of PCC might widely differ among these regions, whereas concepts of SDM might be shared. Future work should clarify these differences.

scholarly journals Patient-Centered Care for Patients with Cardiometabolic Diseases: An Integrative Review

2021 ◽  
Vol 11 (12) ◽  
pp. 1289
Author(s):  
Maria do Céu Marques ◽  
Rute Pires ◽  
Miguel Perdigão ◽  
Luis Sousa ◽  
César Fonseca ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Patient Centered Care ◽  
Therapeutic Management ◽  
Care Planning ◽  
Shared Decision ◽  
Patient Centered ◽  
Quality Health Care ◽  
Cardiometabolic Diseases ◽  
Centered Care

Patient-centered care is essential in high-quality health care, as it leads to beneficial outcomes for patients. The objective of this review is to systematize indicators for the care of patients with cardiometabolic diseases based on patient-centered care, extending from the stages of diagnostic evaluation and care planning to intervention. An integrative literature review was conducted by searching seven scientific databases, and a narrative analysis was performed. A total of 15 articles were included, and indicators related to diagnosis and care planning/intervention were extracted. In the planning of care centered on the person with cardiometabolic diseases, the individuality, dynamics of the processes, flexibility and the participation of all stakeholders should be taken into account. The needs of the person must be addressed through the identification of problems; establishment of individual goals; shared decision making; information and education; systematic feedback; case management; meeting the patient’s preferences and satisfaction with care; engagement of the family; and therapeutic management. The indicators for intervention planning extracted were behavioral interventions, therapeutic management programs, lifestyle promotion, shared decision making, education patient and information, interventions with the use of technology, promotion of self-management, program using technology, therapeutic relationship, therapeutic adherence programs and specialized intervention.

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