Utilizing patient navigators to enhance oral chemotherapy education and safety for at-risk patients.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 43-43
Author(s):  
Mingqian Lin ◽  
Douglas W Hackenyos ◽  
Daqin Mao ◽  
Feng Qing Wang ◽  
John Kalil Erban ◽  
...  
Keyword(s):  
Supportive Care ◽  
Medical Center ◽  
Minority Group ◽  
Oral Chemotherapy ◽  
Chinese Patients ◽  
Cancer Center ◽  
Patient Centered ◽  
Drug Dosing ◽  
Patient Navigators ◽  
Patient Reported

43 Background: Oral anticancer drugs are increasingly being used as standard therapy. At Tufts Medical Center Cancer Center, 10% of patients on active cancer treatment are receiving oral chemotherapy. To address barriers to medication education and timely management of treatment effects, we began an initiative involving our pharmacy specialist who reviews newly-started oral chemotherapy treatments for safety concerns, dose appropriateness, and drug interactions. In response to the cultural-linguistic needs of our Chinese patients (20% of our patients, largest minority group) and unique challenges of our patients of lower SES (40% of our patients), we are also leveraging patient navigators (PN) to improve timely care and understanding of and adherence to oral cancer medications for our most vulnerable patients. Methods: PN regularly interact with patients and work closely with the care team to address patients’ concerns. Formal PN visits with patients in clinic are documented in the EMR. To assess the scope of issues related to oral chemotherapy and/or supportive care drugs (e.g. anti-nausea, anti-constipation) and the potential impact in using PN, we reviewed PN encounter notes from the first 6 months of 2016 to identify patient-reported issues. Results: In reviewing 492 PN encounter notes from the first 6 months of 2016 (111 patients were navigated), 138 (28%) of all patient encounters involved assistance related to oral chemotherapy, supportive care drugs, and/or comorbidities medications. Examples of patient-reported issues include confusion about purpose and/or type of drug, dosing scheduling, side effects management, and logistical challenges (e.g. refills, copays, specialty pharmacy orders). Conclusions: From the PN encounter notes, we identified a need for more formalized patient-centered interventions to enhance education, monitoring, and patient-provider communication about oral chemotherapy to proactively resolve medication-related issues. We are piloting an evidence-based approach involving pharmacist-PN-patient teaching sessions, tailored patient education tools, and scheduled check-ins between PN and patients adapted from the MASCC Oral Agent Teaching Tool model.

scholarly journals Implementation of a cloud-based electronic patient-reported outcome (ePRO) platform in patients with advanced cancer

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Olga Generalova ◽  
Mohana Roy ◽  
Evan Hall ◽  
Sumit A. Shah ◽  
Kristen Cunanan ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Supportive Care ◽  
Healthcare Utilization ◽  
Advanced Cancer ◽  
Data Privacy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Ease Of Use ◽  
Cancer Center ◽  
Patient Reported

Abstract Background Patient reported outcomes (PROs) have been associated with improved symptom management and quality of life in patients with cancer. However, the implementation of PROs in an academic clinical practice has not been thoroughly described. Here we report on the execution, feasibility and healthcare utilization outcomes of an electronic PRO (ePRO) application for cancer patients at an academic medical center. Methods We conducted a randomized trial comparing an experimental ePRO arm to standard of care in patients with advanced cancer in the thoracic, gastrointestinal, and genitourinary oncology groups at Stanford Cancer Center from March 2018 to November 2019. We describe the pre-implementation, implementation, and post-implementation phases of the ePRO arm, technological barriers, electronic health record (EHR) integration, clinician burden, and patient data privacy and security. Feasibility was pre-specified to be at least 70% completion of all questionnaires. Acceptability was based on patient and clinician feedback. Ambulatory healthcare utilization was assessed by reviewing numbers of phone messages, electronic portal messages, and referrals for supportive care. Results Of 617 ePRO questionnaires sent to 72 patients, 445 (72%) were completed. Most clinicians (87.5%) and patients (93%) felt neutral or positive about the ePRO tool’s ease of use. Exposure to ePRO did not cause a measurable change in ambulatory healthcare utilization, with a median of less than two phone messages and supportive care referrals, and 5–6 portal messages. Conclusions Web-based ePRO tools for patients with advanced cancer are feasible and acceptable without increasing clinical burden. Key lessons include the importance of pilot testing, engagement of stakeholders at all levels, and the need for customization by disease group. Future directions for this work include completion of EHR integration, expansion to other centers, and development of integrated workflows for routine clinical practice.

Understanding the interaction between physicians and pharmacists as a method of quality improvement.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 90-90
Author(s):  
Jessica Lynn Fontaine Calder ◽  
Vivian Choy ◽  
Denise Kwan ◽  
Sophia Li ◽  
Melissa Lo ◽  
...  
Keyword(s):  
Health Information System ◽  
Oral Chemotherapy ◽  
Professional Communication ◽  
Cancer Center ◽  
Patient Centered ◽  
System A ◽  
Medication Delivery ◽  
Centered Care ◽  
Pharmacy Technicians ◽  
Physician Order Entry

90 Background: Pharmacists and pharmacy technicians are essential to safe medication delivery. Filling prescriptions can be time consuming when the prescription is not complete or clear and requires inter-professional communication. To improve the quality and efficiency of dispensing medication we performed an audit of callbacks to physicians in the outpatient pharmacy associated with our cancer center with a focus on oral chemotherapy. Methods: The Princess Margaret is one of the largest cancer centers in the world, with an outpatient pharmacy on the premises that fills over 70,000 prescriptions a year. The pharmacists have access to the hospital’s Health Information System and chemotherapy prescribing system. A Prescription Audit Form was developed to track the mode of oral chemotherapy prescription (handwritten, preprinted, computerized physician order entry (CPOE), verbal) and reason for callback. The form was implemented from February 10th until March 7th, 2014 with coded data collection. The form was incorporated into the normal workflow of the outpatient pharmacy and concurrently used to document pharmacy interactions for billing purposes. Results: A total of 5,546 prescriptions were filled with 1,166 prescriptions for oral chemotherapy. Nine percent of prescriptions for oral chemotherapy required a callback to a physician and accounted for 32% of the total callbacks made to physicians. Of the 1,166 oral chemotherapy prescriptions; 39% were refills, 34% were handwritten, 22% were CPOE, 4% were verbal, 1% were preprinted, and 1% were not documented. The top two reasons for callbacks were; drug interaction (32%) and incorrect dose (24%). In the 9% of cases where the physician was contacted to clarify a prescription, the prescription was changed 43% of the time. Conclusions: Understanding the reasons for callbacks can be used to determine optimal data fields required in oral chemotherapy prescribing. Ensuring that prescriptions are appropriately completed will reduce the number of callbacks to physicians - significantly impacting the workflow and efficiency of the pharmacy. Reducing unnecessary callbacks will allow the pharmacy team to deliver timely, safe and effective patient centered care.

Patient-reported priorities for survivorship care and experience discussing available services.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 200-200
Author(s):  
Julia Rabin ◽  
Katharine Quain ◽  
Nora Horick ◽  
Garrett Chinn ◽  
Allison McDonough ◽  
...  
Keyword(s):  
Supportive Care ◽  
Early Stage ◽  
Female Gender ◽  
Cancer Center ◽  
Survivorship Care ◽  
Response Options ◽  
Cancer Symptoms ◽  
Factors Associated ◽  
Care Services ◽  
Patient Reported

200 Background: Despite the recognized need for high quality survivorship care, barriers to identifying and addressing patients’ needs still remain. We sought to evaluate cancer survivor care priorities, awareness of available services, and factors associated with care and informational needs. Methods: A needs assessment survey was distributed to patients presenting for routine follow-up care in adult oncology clinics at the MGH Cancer Center between February and August of 2016. The survey assessed sociodemographic characteristics, and preferences for care and communication. Care priorities were selected from a list of options including open ended response. Discussion of supportive care services was assessed by the item “have any of your providers informed you about the types of supportive care services that are available to cancer patients" with response options of “yes,” “no” or “don’t know.” Results: Among 637 total respondents, 339 patients with early stage cancer completed the survey. The majority of participants were between 50-69 years old (54%), white (89%), female (64%), and college educated (80%). Breast (32%) and hematological malignancies (21%) were the most prevalent diagnoses. Commonly endorsed priorities for care included: emotional concerns related to cancer (40%), strategies to increase self-care (33%), and management of physical cancer symptoms (30%). Demographic and clinical factors associated with endorsing emotional concerns as a care priority included female gender, and moderate or greater levels of fatigue, depression, or anxiety (all p< 0.01). Factors associated with endorsing management of physical cancer symptoms as a care priority included younger age, and moderate or greater levels of fatigue or depression (all p≤0.01). Despite these priorities for care, only 41% of patients reported receiving information from providers about available supportive care services. Conclusions: Cancer survivors’ preferences for emotional support and symptom management are strongly associated with self-reported depression and fatigue. Routine screening for these issues and improvement in communication regarding available services should be prioritized in survivorship care.

Electronic monitoring of patient-reported adherence and symptoms on oral chemotherapy at an academic and a community site.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 283-283
Author(s):  
Jim Doolin ◽  
Daniel Aaron Roberts ◽  
Christina Cibotti ◽  
Scott M Devlin ◽  
Holly Dowling ◽  
...  
Keyword(s):  
Median Time ◽  
Medical Center ◽  
Academic Medical Center ◽  
Symptom Assessment ◽  
Oral Chemotherapy ◽  
Community Practice ◽  
Financial Toxicity ◽  
Online Tool ◽  
Academic Medical ◽  
Patient Reported

283 Background: Monitoring of toxicity and adherence is often lacking for patients recently started on oral chemotherapy. National guidelines recommend active outreach to patients within a week after treatment start. We developed an online tool to actively reach out to patients newly started on oral chemotherapy at one academic medical center and community practice. Methods: A multi-disciplinary team, including patients, developed an online oral chemotherapy adherence, symptom, and financial toxicity assessment tool within REDCap. We implemented this tool for new oral chemotherapy prescriptions in May 2018 in the gastrointestinal oncology group of an academic medical center and a general community practice. To quantify the impact of this tool on symptom management, we completed a retrospective analysis of patients receiving new oral chemotherapy prescriptions at these same sites, in the 13 months immediately preceding clinical implementation of the online tool, May 2017 to May 2018. Results: In the pre-intervention historical cohort (n = 58) the median time to first symptom assessment by a clinician was 7 days (range 1 – 41 days, SD 7 days), median time to identifying a new or worsening symptom was 10 days (range 1-55 days, SD 10 days), and median time to clinical action regarding a new or worsening symptom was 10 days (range 1-104, SD 20 days). Our first intervention patient used the online tool in May 2018 to report symptoms of “nausea and fatigue,” 4 days after starting oral chemotherapy. This resulted in an oncology clinical nurse calling the patient to review symptom management by phone. Conclusions: The median time to first symptom assessment in our historical control cohort is 7 days, with standard deviation of 7 days, suggesting potential room for improvement. Thus far, the online tool has been completed by one patient. Further data will be reported regarding the uptake of this tool, the tool’s impact on quality measures, and patient reported symptoms, adherence, and financial toxicity.

A health system wide approach to the delivery of survivorship care plans.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 42-42
Author(s):  
Jennifer R. Klemp ◽  
Heather Vanbebber ◽  
Tanya Folker ◽  
Lisa Serig ◽  
Tim Metcalf ◽  
...  
Keyword(s):  
Health System ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cancer Center ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Clinical Patient ◽  
Care Plans ◽  
Accreditation Standards ◽  
Patient Reported

42 Background: Survivorship care plans (SCPs) are recognized by organizations including the American Society of Clinical Oncology and the American College of Surgeons Commission on Cancer, as a best practice for improving survivor care. Little evidence supports this and hospitals and cancer centers are scrambling to meet deadlines for SCP development and delivery. The University of Kansas Cancer Center (KUCC) addressed this utilizing electronic health record (EHR) integration, developing a health system wide approach to education and delivery, and building referral workflows to primary care and specialists. We report on this approach to developing and growing a survivorship care program. Methods: KUCC is a NCI designated cancer center within an academic medical center and health system, with 11 outpatient locations across the Kansas City. Under the guidance of a multidisciplinary team: providers, health care informatics, administrators, nursing, tumor registry, quality improvement, and researchers, KUCC developed a step-wise process to deliver comprehensive survivorship care across the health system. This multi-year initiative aligned with institutional accreditation standards and an ongoing focus on expanding evidence based, comprehensive cancer and supportive care. Results: In 2014 a formal survivorship program plan was put into action: Support from leadership, providers, research priority; Staff and patient survivorship education & training; Integrated delivery of survivorship care at all locations with direct interaction and feedback from cancer care teams; Short & long-term programmatic goals; Management and referral of late effects of cancer; EPIC integrated SCP template: auto-populated, customized, personalized; treatment summary uses tools that pull in data stored discreetly in the patient "file"; SCP delivery targeting COC phase-in timeline: 2015: n= 539 (10% projection n= 434); 2016: n= 1,355 (25% projection n=1,253). Conclusions: This step-wise, integrated approach to survivorship care has resulted in a health system wide delivery of SCPs and meeting national accreditation standards. Next steps include the evaluation of cost and clinical/patient reported outcomes.

scholarly journals Patient-Reported Quality of Supportive Care Among Patients With Colorectal Cancer in the Veterans Affairs Health Care System

2014 ◽  
Vol 32 (8) ◽  
pp. 809-815 ◽  
Author(s):  
Michelle van Ryn ◽  
Sean M. Phelan ◽  
Neeraj K. Arora ◽  
David A. Haggstrom ◽  
George L. Jackson ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Supportive Care ◽  
Cancer Care ◽  
Quality Measurement ◽  
Veterans Affairs ◽  
Health Administration ◽  
Patient Centered ◽  
Patient Reported ◽  
The Impact

Purpose High-quality supportive care is an essential component of comprehensive cancer care. We implemented a patient-centered quality of cancer care survey to examine and identify predictors of quality of supportive care for bowel problems, pain, fatigue, depression, and other symptoms among 1,109 patients with colorectal cancer. Patients and Methods Patients with new diagnosis of colorectal cancer at any Veterans Health Administration medical center nationwide in 2008 were ascertained through the Veterans Affairs Central Cancer Registry and sent questionnaires assessing a variety of aspects of patient-centered cancer care. We received questionnaires from 63% of eligible patients (N = 1,109). Descriptive analyses characterizing patient experiences with supportive care and binary logistic regression models were used to examine predictors of receipt of help wanted for each of the five symptom categories. Results There were significant gaps in patient-centered quality of supportive care, beginning with symptom assessment. In multivariable modeling, the impact of clinical factors and patient race on odds of receiving wanted help varied by symptom. Coordination of care quality predicted receipt of wanted help for all symptoms, independent of patient demographic or clinical characteristics. Conclusion This study revealed substantial gaps in patient-centered quality of care, difficult to characterize through quality measurement relying on medical record review alone. It established the feasibility of collecting patient-reported quality measures. Improving quality measurement of supportive care and implementing patient-reported outcomes in quality-measurement systems are high priorities for improving the processes and outcomes of care for patients with cancer.

Feasibility of long-term patient reporting of toxicities from home via the internet during routine chemotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6575-6575
Author(s):  
Timothy J Judson ◽  
Antonia V Bennett ◽  
Lauren J. Rogak ◽  
Laura Sit ◽  
Allison Barz ◽  
...  
Keyword(s):  
Performance Status ◽  
A Priori ◽  
Routine Care ◽  
Self Report ◽  
Cancer Center ◽  
Patient Centered ◽  
Technical Problems ◽  
Patient Reported ◽  
Centered Care

6575 Background: Patient-reported outcomes are increasingly used in routine outpatient cancer care to guide clinical decisions and enhance communication. Prior evidence suggests good patient compliance with reporting at scheduled clinic visits, but there is limited evidence about compliance with long-term longitudinal reporting between visits. Methods: Patients receiving chemotherapy for lung, gynecologic, genitourinary or breast cancer at a tertiary cancer center, with access to a home computer and prior email experience, were asked to self-report seven symptomatic toxicities via the web between visits. Email reminders were sent to participants weekly; patient-reported high-grade toxicities triggered email alerts to nurses; printed reports were provided to oncologists at visits. A priori threshold criteria were set to determine if this data collection approach merits further development, based on monthly compliance rates (75% or more participants reporting at least once per month on average) and weekly compliance rates (60% at least once per week). Results: Between September 2006 and November 2010, 286 patients were enrolled (64% female, 88% white, median age 58). Mean follow-up was 34 weeks (range 2-214). On average, monthly compliance was 83% and weekly compliance was 62%, without attrition until the month prior to death. Greater compliance was associated with older age and higher education, but not performance status. Compliance was greatest during the initial 12 weeks. Symptomatic illness and technical problems were rarely barriers to compliance. Conclusions: Monthly compliance with sustained home web reporting is high, even with only weekly email reminders, but weekly compliance is lower, warranting strategies to enhance compliance in routine care settings. Barriers are likely surmountable through further use of reminder systems and questionnaire access via portable media. Between-visit symptom reporting may lead to more patient-centered care, enhanced quality, and improved patient satisfaction. Clinical trial information: NCT00578006.

Patients’ perspectives and outcomes on an oral chemotherapy education and electronic monitoring program.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18007-e18007
Author(s):  
Noah Xavier Tocci ◽  
Jim Doolin ◽  
Daniel Aaron Roberts ◽  
Christina Cibotti ◽  
Rebekah A Hartwell ◽  
...  
Keyword(s):  
Electronic Monitoring ◽  
Medical Center ◽  
Academic Medical Center ◽  
Monitoring Program ◽  
Management Program ◽  
Oral Chemotherapy ◽  
P Value ◽  
Online Tool ◽  
Significant Difference ◽  
Patient Reported

e18007 Background: Patients on oral chemotherapy (OC) often lack consistent education and monitoring, risking toxicity and poor adherence. We developed an OC management program including education and an online tool for active outreach. Methods: In November 2017, we initiated pharmacist-led education for patients newly prescribed OC at a community practice and in the gastrointestinal oncology group at an academic medical center (AMC). An online tool assessing adherence, symptoms, and financial toxicity was emailed to patients three days after starting OC. Non-responders were contacted for phone interviews. A random sample of 28 patients newly started on OC at both sites before the intervention in 2017 was analyzed at baseline. A retrospective chart analysis was done to collect time to symptom assessment, identification and action. A report generated date of first emergency department (ED) visit or hospitalization within the AMC. We conducted a Mann Whitney U-Test, using a one-sided p value of 0.025 with Bonferroni correction. Results: Sixty-nine of 106 eligible patients (66%) received education, of whom 36 (52.1%) received the online tool, and 13 (36.1%) responded. There was a significant difference between the intervention and baseline median times to first new/worsening symptoms (p = 0.0105) but otherwise there were no outcome improvements. Eight of 23 patients who did not respond to the electronic tool were interviewed and indicated that their illness impeded their ability to check email (n = 2), and that they never check email (n = 2). Conclusions: This OC management program improved time to detect new/worsening symptoms and could potentially improve outcomes after further patient accrual. Future investigation should examine ways to improve patient responsiveness to electronic patient-reported symptom tools. [Table: see text]

Distress screening through PROMIS at an academic cancer center and network site: Implementation of a hybrid model.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2021-2021
Author(s):  
Mohana Roy ◽  
Joel W. Neal ◽  
Kelly Bugos ◽  
Christopher Sharp ◽  
Patricia Falconer ◽  
...  
Keyword(s):  
Supportive Care ◽  
Screening Tool ◽  
Cancer Center ◽  
Patient Portal ◽  
Supportive Services ◽  
Distress Screening ◽  
Positive Screen ◽  
Network Site ◽  
Care Services ◽  
Patient Reported

2021 Background: The NCCN guidelines recommend routine distress screening of patients with cancer, but the implementation of such programs is inconsistent. Up to one in three such patients experience distress, however fewer than half of them are identified and referred for supportive services. Methods: We implemented a hybrid (electronic and paper) distress screening tool, using a modified version of the PROMIS-Global Health questionnaire. Patients received either an electronic or in-clinic paper questionnaire to assess overall health and distress at the Stanford Cancer Center and its associated integrated network site. Iterative changes were made including integration with the electronic health record (EHR) to trigger questionnaires for appointments every 60 days. A consensus “positive screen” threshold was defined, with data collected on responses and subsequent referrals placed to a supportive care services platform. Results: Between June 2015 and December 2017, 53,954 unique questionnaires representing 12,744 distinct patients were collected, with an average completion rate of 58%. Approximately 30% of the questionnaires were completed prior to the visit electronically through a patient portal. The number of patients meeting the positive screen threshold remained ~ 40% throughout this period. Following assessment by the clinical team, there were 3763 referrals to cancer supportive services. Among the six most common referral categories, those with a positive screen were more likely to have a referral placed (OR 6.4, 95% CI 5.8-6.9 p- < 0.0001), with a sensitivity of 80% and a specificity of 61%. However, 89% of responses with a positive screen did not have a referral to supportive care services. Conclusions: The hybrid electronic and paper use of a commonly available patient reported outcome tool, as a high throughput distress screening tool, is feasible at a multi-site academic cancer center. Our positive screen rate for referrals was sensitive and consistent, but with a low positive predictive value. This screening also resulted in variable clinical response and overall increased clinical burden. Future directions for our group have included refining the threshold for a positive screen and implementation of a real-time response system, especially to address acute concerns.

scholarly journals Improved Adherence Rates and Clinical Outcomes of an Integrated, Closed-Loop, Pharmacist-Led Oral Chemotherapy Management Program

2018 ◽  
Vol 14 (6) ◽  
pp. e324-e334 ◽  
Author(s):  
Benyam Muluneh ◽  
Molly Schneider ◽  
Aimee Faso ◽  
Lindsey Amerine ◽  
Rowell Daniels ◽  
...  
Keyword(s):  
Closed Loop ◽  
Medical Center ◽  
Academic Medical Center ◽  
Medication Possession Ratio ◽  
Response Rates ◽  
Management Program ◽  
Oral Chemotherapy ◽  
Molecular Response ◽  
Major Molecular Response ◽  
Patient Reported

Purpose: To address the growing use of oral anticancer therapy, an integrated, closed-loop, pharmacist-led oral chemotherapy management program was created within an academic medical center. Methods: An integrated, closed-loop, pharmacy-led oral chemotherapy management program was established. From September 2014 until June 2015, demographic information, rates of adherence, patient understanding of treatment, pharmacist interventions, patient and provider satisfaction, and molecular response rates in patients with chronic myeloid leukemia (CML) were collected. Results: After full implementation, 107 patients were enrolled in our oral chemotherapy management program from September 2014 until June 2015. All patients were educated before starting oral chemotherapy, and using pre- and postassessment tests, comprehension of oral chemotherapy treatment increased from 43% to 95%. Patient-reported adherence was 86% and 94.7% for the GI/breast and malignant hematology patient populations, respectively, and these were validated with medication possession ratio, revealing adherence rates of 85% and 93.9% for the GI/breast and malignant hematology patient populations, respectively. A total of 350 encounters with a clinical pharmacist and 318 adverse effects were reported, which led to 235 interventions. This program led to a higher major molecular response rate (83%) in our CML population compared with published clinical trials (average major molecular response rates, 40% and 60% with 1- and 2-year follow-up, respectively). Conclusion: An innovative model was developed and resulted in improved patient knowledge regarding oral chemotherapy, improved adherence rates that exceeded nationally established thresholds, and superior major molecular response outcomes for patients with CML compared with published literature. As a result, this model has produced the gold standard in managing patients receiving oral chemotherapy.

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