Integrating a touchscreen-based brief geriatric assessment in older adults with multiple myeloma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21703-e21703 ◽  
Author(s):  
Nitya Nathwani ◽  
Supriya Gupta Mohile ◽  
Brea Lipe ◽  
Karen Carig ◽  
Laura DiGiovanni ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Multiple Myeloma ◽  
Geriatric Assessment ◽  
Daily Living ◽  
Dose Intensity ◽  
Treatment Decision ◽  
Activity Of Daily Living ◽  
Treatment Decision Making ◽  
Frailty Score

e21703 Background: Multiple myeloma (MM) is a disease of older adults (OAs) with > 60% of diagnoses and nearly 75% of deaths occurring in patients > 65 years old (YO). Geriatric Assessment (GA) is associated with toxicity and survival in OAs with MM, but not routinely used in practice. This project pilot tests a tablet-based modified Geriatric Assessment (mGA) that presents compiled GA results, including (the Palumbo) frailty score, to clinicians at a treatment decision-making visit in a single screen dashboard. Methods: In this multisite ongoing study, 210 patients with MM ≥65 YO facing a decision point for care will complete a mGA that includes the Charlson Comorbidity Index (CCI), Katz Activity of Daily Living (ADL) Score, and Lawton Instrumental Activity of Daily Living (IADL) Score prior to meeting with a physician. mGA results, including composite frailty score, are provided to physicians at the start of a visit. Results: Thirty-six patients have been enrolled to date; enrollment continues. Participants are 69% (n = 25) white, 64% (n = 23) male, and mean age of 72 YO (range 65-87). Most (74%, n = 20) currently receive ≥1 therapy and have few co-morbidities (CCI median 1, SD 1.95, range 0-8); 57% require assistance with IADLs and 37% require assistance with ADLs. Based on Palumbo score, 36% of participants were frail (n = 13), 33% intermediate (n = 12), and 31% fit (n = 11). Providers report mGA results influenced treatment decision (54%, n = 28) and frailty score was the most frequently cited result to impact treatment decision-making (61%, n = 39). The most common way the mCGA influenced decision-making was to reduce dose/dose intensity (25%, N = 8). Clinicians on average spent 5 minutesreviewing the mGA results. Patients reported an average of 7 minutes to complete the survey, most independently (83%, n = 30), and were satisfied with the electronic program overall (80%, n = 29), including how easy it was to use (88%, n = 32). Conclusions: Preliminary data support feasibility, usability, and acceptability of the tablet-based mGA and that frailty score influences provider decision-making ≥50% of the time. Future analyses will explore the relationship of the mGA with toxicity, dose modification and/or treatment discontinuation in OAs with MM.

scholarly journals Managing Multiple Myeloma in Older Adults Using Real World Evidence and Clinical Integration of a Geriatric Assessment Tool in Clinical Practice

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 5019-5019
Author(s):  
Smith Giri ◽  
D'Ambra Dent ◽  
Kelly N. Godby ◽  
Luciano J. Costa ◽  
Susan Bal ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Multiple Myeloma ◽  
Geriatric Assessment ◽  
Daily Living ◽  
Research Funding ◽  
Treatment Decision ◽  
Kappa Statistic ◽  
Activity Of Daily Living ◽  
Cohen's Kappa

Abstract Background: Over two thirds of patients with Multiple Myeloma (MM) are ≥ 65 years old at the time of diagnosis. Older adults are at greater risk for treatment related toxicity and inferior survival; such risks are inadequately explained by chronologic age and performance status. In 2015, the International Myeloma Working Group (IMWG) proposed a geriatric assessment (GA) based frailty index to identify older adults with MM at greatest risk of toxicities. Yet, routine implementation of GA in busy oncology practice remains challenging. We have previously shown the feasibility of a tablet-based modified Geriatric Assessment (mGA), capturing the Charlson Comorbidity Index (CCI), Katz Activity of Daily Living (ADL) Score, and Lawton Instrumental Activity of Daily Living (IADL) score, and its impact on clinical decision-making and treatment outcomes (Nathwani, et al. JOP. 2020). In the prior study, physicians recommended integration of the mGA into the electronic medical record (EMR) to improve usefulness at the clinic. Methods: We conducted a single institution pilot study to test the feasibility of integrating an electronic care planning system within the EMR such that with a single sign on, the dashboard showing results of the mGA was visualized within the EMR. Eligible patients had symptomatic MM, > 60 years old, and seeing their oncology providers to make a decision about treatment. After completing informed consent, patients completed a tablet-based mGA in clinic just prior to seeing the physician. Survey results were compiled and were immediately available for evaluation on a dashboard within the EMR. Providers reviewed the mGA results before meeting with the patient and completed a short survey after the visit regarding their own subjective impression of frailty and how the mGA influenced their treatment decision making. Agreement between provider's subjective vs mGA based frailty categorization was measured using Cohen's Kappa statistic. We measured relevant toxicity outcomes at 3 months post treatment initiation. Results: 25 patients were enrolled, with a median age of 68 (range=61-82), 52% (n=13) female, and 68% (n= 17) white. One patient did not complete the mGA survey and was not included in the analysis. The remaining patients completed the mGA successfully without interrupting clinic flow and mGA was immediately available for providers to review during the clinic visit. The average time providers spent reviewing results was of 5 (range 1-10) minutes. Providers subjectively categorized patients as 42% (n=10) fit, 58% (n=14) intermediate fit, and 0% (n=0) frail. According to the mGA, patients were 50% (n=12) fit, 29% (n=7) intermediate fit, and 21% (n=5) frail. There was an overall 46% (n=11) concordance between physician and mGA result. The most agreement was in fit status (58%, n=7) and least was frail (0%, n=0). There was 33% (n=4) agreement on intermediate fit status. The unweighted Cohen's kappa statistic was 0.09 indicating only slight agreement between the two methods. Providers reported mGA influenced their treatment decision in 33% (n=8), with the decision being either chemotherapy modification (n=6) or reduced dose transplant (n=2). One patient, who was frail and received induction treatment, died during the 3-month study period. The remaining patients (n=23) received treatment as planned. Discussion: In this study, we report the feasibility of an EMR integrated mGA tool completed by the patient prior to meeting with the physician. Patients completed the survey with assistance and without disrupting the clinic workflow. The mGA results were reviewed by providers in real time and influenced treatment decisions one third of the time. Nearly all patients (96%, n=24) completed therapy as planned. Providers tended to view the patients as more fit than the mGA result, suggesting that the mGA uncovers additional information related to the patient's ability to tolerate therapy. Toxicity follow up is ongoing and will be updated at the time of presentation. Disclosures Giri: CareVive: Honoraria, Research Funding; PackHealth: Research Funding. Costa: BMS: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria, Research Funding, Speakers Bureau; Karyopharm: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria, Speakers Bureau.

scholarly journals Integrating a Touchscreen-Based Assessment and Screening Tool for Adults with Multiple Myeloma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2373-2373 ◽  
Author(s):  
Tanya M Wildes ◽  
Carrie T. Stricker ◽  
William Dudley ◽  
Diana Harris ◽  
Nitya Nathwani ◽  
...  
Keyword(s):  
Decision Making ◽  
Multiple Myeloma ◽  
Geriatric Assessment ◽  
Research Funding ◽  
Predictive Ability ◽  
Treatment Decision ◽  
Touch Screen ◽  
Consensus Building ◽  
Knowledge Gaps ◽  
Treatment Decision Making

Abstract Background: More than 60% of multiple myeloma (MM) diagnoses and nearly 75% of deaths occur in patients over 65 years old. Because older adults (OAs) experience more treatment-related toxicities, treatment disruptions or dose reductions may be based on age and performance status alone, despite their poor predictive value for patient outcomes. Comprehensive Geriatric Assessment (CGA), including frailty indices, has shown predictive validity for toxicity and survival in OAs with MM, but is not routinely used in practice due to time and complexity, a lack of clarity about optimal tools and technologies to implement them, and clinician knowledge gaps on how to incorporate CGA into decision-making and care. Purpose: This project aims to address these gaps by pilot testing a tablet-based modified (m)CGA in 120 patients that presents compiled CGA results, including a frailty score, back to clinicians interacting with patients at the time of a treatment decision. Outcomes include feasibility, usability, utility, and impact on treatment decision-making, from both patient and provider perspectives. Pre-study implementation processes and milestones, including development of the mCGA, clinical workflow planning processes, training and other site-initiation activities are presented herein. Methods: The mCGA was developed using an iterative and dynamic consensus-driven process that included: 1) literature review and expert input to identify CGA domains for potential inclusion and 2) consensus building within a multi-disciplinary panel of gero-oncology experts, nurse scientists, and psychometricians. Domains and measures were selected based on predictive ability, length, and ability to administer via patient self-report so as to reduce clinician assessment burden. Study training and implementation procedures were developed using the same approach, as well as through workflow analysis and clinical team consensus building at the participating sites. Results: The Palumbo frailty index (FI) was chosen as the core of the mCGA tool given correlation with clinical outcomes specifically in OAs with MM. In addition to the 4 mGA measures comprising the Palumbo FI (age, comorbidity, ADL, and IADL), other GA variables were also chosen based on their strong predictive ability, clinical feasibility, and relevance to the MM population. This summary of results is displayed for ease of provider use within the Carevive dashboard (see Figure 1). Given prevalent knowledge gaps in use of CGA for MM treatment decision-making and care, a certified medical education self-study course was developed for training prior to the study intervention. Four geographically-dispersed academic and community hospitals who treat high volumes of diverse MM patients are participating to date. All 4 sites developed a process for ensuring treating providers would have easy access to the platform. Conclusions: Real-world, comprehensive and innovative solutions, combining education, geriatric assessment (GA) tools to determine a patient's fit/frailty status, realistic clinical work flow processes, and technology tools are needed to support and enhance treatment-decision making for patients with MM as well as their providers. Figure 1 Screenshot: Touch-screen based dashboard results display example Figure 1. Screenshot: Touch-screen based dashboard results display example Disclosures Wildes: Carevive Systems: Consultancy. Stricker:Carevive Systems, Inc.: Employment, Equity Ownership. Dudley:Carevive Systems, Inc.: Consultancy. Harris:Carevive Systems, Inc.: Consultancy. Nathwani:Carevive Systems, Inc.: Research Funding. Brant:Carevive Systems, Inc.: Research Funding. Kurtin:Carevive Systems, Inc.: Research Funding. Hurria:Boehringer Ingelheim Pharmaceuticals: Consultancy; GTx, Inc: Consultancy; Carevive: Consultancy; Celgene: Other: Research; Optum Health Care SOlutions: Consultancy, Other: Conference panel, research; Sanofi: Consultancy; Novartis: Other: Research.

scholarly journals Lay Referral Patterns Involved in Cardiac Treatment Decision Making Among Middle-Aged and Older Adults

2003 ◽  
Vol 43 (4) ◽  
pp. 493-502 ◽  
Author(s):  
N. E. Schoenberg ◽  
C. H. Amey ◽  
E. P. Stoller ◽  
S. B. Muldoon
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Treatment Decision ◽  
Middle Aged ◽  
Referral Patterns ◽  
Treatment Decision Making

scholarly journals Role of Health Information Technology in the Engagement Process of Older Adults’ Cancer Treatment Decision Making

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 101-101
Author(s):  
Maryum Zaidi ◽  
Priscilla Gazarian ◽  
Heather Mattie ◽  
Lisa Kennedy Sheldon ◽  
C Ann Gakumo
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Treatment Decision ◽  
Treatment Decision Making ◽  
Engagement Process ◽  
Diagnosis Of Cancer

Abstract This study investigates the role of Health Information Technology (HIT) in the process of patient engagement in treatment decision making in older adults in cancer care. Despite the role of HIT in patient engagement processes and government incentives for HIT development, research regarding HIT is lacking among older adults. The following study is a secondary data analysis of a subset of the Health Information National Trend Survey (HINTS 4, Cycle 3), including individuals 65 years old and above. Chi-square tests, logistic regression, and linear regression models were fit to study several sociodemographic, socioeconomic, and psychosocial variables in this study. The results show that education, poverty status, and self-management domain of the patient activation (which is a precursor of the engagement process) were significantly associated with access to and utilization of HIT. No significant differences between access to and utilization of HIT and the diagnosis of cancer were found. However, fatalistic beliefs about the diagnosis of cancer significantly impacted the use of HIT in all models, including those controlling for cancer diagnosis and access to HIT. Specifically, a one-point increase in cancer fatalism score is associated with a 59% decrease in the utilization of HIT, giving evidence that fatalistic beliefs about cancer can drive engagement behaviors regardless of a diagnosis of cancer. Our study provides vital information for providers and policy researchers to take into account for future implementation and development strategies of HIT in cancer care for older adults.

Sign in / Sign up

Export Citation Format

Share Document