Sustaining change and defining the patient experience: A systemwide initiative to re-evaluate goals for timely patient navigation through medical oncology and infusion in a comprehensive cancer center.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. e18875-e18875
Author(s):  
David L Crosby ◽  
Megan Brown ◽  
Konstantin H. Dragnev ◽  
Megan Howe
Keyword(s):  
Patient Experience ◽  
Patient Navigation ◽  
Medical Oncology ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Sustaining Change

Stepwise examination of prostate clinical trials participation to reduce accrual barriers.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 157-157
Author(s):  
Dare Olatoye ◽  
Michael Anthony Carducci ◽  
Norma Kanarek
Keyword(s):  
Prostate Cancer ◽  
Clinical Trial ◽  
Clinical Trials ◽  
Medical Oncology ◽  
Local Therapy ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Trial Participation ◽  
Therapeutic Trial ◽  
Clinical Trial Participation

157 Background: Adequate and representative enrollment in therapeutic clinical trials is important to an NCI cancer center. Clinical trial participation is a string of 6 sequential patient and physician decisions beginning with an available therapeutic trial to enrollment in the trial. Opportunities for participation may be lost at any one of these steps. The objective of this study was to calculate transitional probabilities that measure patient, especially minority patient, accrual to clinical trials at the Sidney Kimmel Comprehensive Cancer Center and to describe the barriers for those dropping out at each step. Methods: Records for “first visit” medical oncology patients seen by three SKCCC physicians from January to April 2010 were abstracted. Prostate cancer case reports from the hospital cancer registry and a medical record review provided age, race, Hispanic ethnicity, place of residence, tumor characteristics, and prior treatment history. At each transition step, we calculated the proportion of patients who remained enrollable. Results: Overall, prostate cancer clinical trial participation was 17% (16/94). Minority accrual was similar to Caucasian accrual at 19% and 17% , respectively. Retention at each step of trial participation was highest for “discussed” (98%), “enrolled” (94%), “eligibility” for available trials (79%), and “consented” (71%). Two bottlenecks were qualitatively identified: “trial availability” (65%) and “patient interest” (51%). Forty-two percent of those for whom there was no trial available were older than 70 years and 33% were patients with rising PSA after local therapy and hormone-naïve. The “patient interest” step was shaped primarily by disinterest due to distance to SKCCC (83%). Conclusions: For prostate cancer patients, recruitment to medical oncology clinical trials is robust. Minority patients however are only 17% of all patients seen and half drop out when no trial is available and half of those remaining judged distance to be a problem (hence, no interest). This study approach has clarified which factors are likely to be barriers to participation and is likely useful to making adjustments that can reduce identified barriers by adding to trial portfolio as an example.

Less is more: Postoperative pain management using restrictive opioid protocols in all surgical services in a comprehensive cancer center.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 103-103
Author(s):  
Jason Ricciuti ◽  
Steven Gallo ◽  
Deanna Argentieri ◽  
Paul Visco ◽  
Kristopher Attwood ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Patient Experience ◽  
Postoperative Pain Management ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Control Group ◽  
Prescription Database ◽  
Opioid Prescription ◽  
Surgical Services

103 Background: Opioids are routinely given for postoperative pain management with limited evidence on the amount needed to be dispensed. Prescribed opioids increase the risk of chronic use, abuse, and diversion, which contribute to the opioid epidemic. We sought to demonstrate that postsurgical acute pain can be effectively managed across different surgical specialties with a markedly reduced number of opioids. Methods: A prospective case-control study of restrictive opioid prescription protocol (ROPP) was implemented in all surgical services from February 2019 through July 2019 at a tertiary comprehensive cancer center for all patients undergoing a surgery for which opioids would be routinely prescribed at discharge (n = 2,015). Data from surgeries performed by the same services from August 2018 through January 2019 were used for comparison (n = 2,051). At discharge, patients did not routinely receive opioids unless they had a maximally invasive procedure or if they required multiple doses of opioids during hospitalization (maximum 3-day supply). Compliance with the protocol was tracked by pharmacists daily. Patient demographics and surgical details were collected. State-run opioid prescription database was used to determine the number of opioids prescribed to all surgical patients within a 120-day surgical window. Validated patient satisfaction surveys were used at postoperative visits to assess patient experience. Results: After implementation of the ROPP, 45% less opioids were prescribed after surgery for all participating patients (323,674 morphine milligram equivalents (MME) vs 179,458 MME, p < 0.001). The majority of services complied with the ROPP in more than 95% of cases. There was no difference in postsurgical pain intensity between cohorts. Patients in the ROPP cohort had less refill requests compared to the control group (20.9% vs 17.9%, p value = 0.016). Surveys were completed by 338 patients in the control group (16.5%) and 360 in the ROPP group (17.9%). There was no significant difference in patient reported satisfaction with postoperative pain control or on the impact of pain on daily activities between the cohorts. Conclusions: Implementation of a ROPP by multiple surgical services at a tertiary cancer center was feasible and resulted in substantial decrease in the number of opioids prescribed while not compromising patient experience. Patients did not require more prescription refills despite being provided no opioids or a limited supply. This study provides evidence to support reducing the number of opioids routinely prescribed after surgery.[Table: see text]

Promoting quality breast cancer care: Psychosocial distress screening

2013 ◽  
Vol 12 (1) ◽  
pp. 75-80 ◽  
Author(s):  
M. Tish Knobf ◽  
Maureen Major-Campos ◽  
Anees Chagpar ◽  
Andrea Seigerman ◽  
Ruth Mccorkle
Keyword(s):  
Administrative Support ◽  
Medical Oncology ◽  
Surgical Oncology ◽  
Psychosocial Distress ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Distress Screening ◽  
Two Phase ◽  
Breast Center ◽  
Number Of Patients

AbstractObjective:To evaluate the feasibility of implementing psychosocial distress screening in a breast center of a comprehensive cancer center, using a model of structure (personnel, resources), process (screening), and outcome (number of patients screened, number referred).Methods:The first step in the project was to establish administrative support, educate and engage breast center staff, identify stakeholders and persons with expertise in the conduct of evidence based initiatives. A two-phase implementation approach was agreed upon with Phase I being screening of new patients in surgical oncology and Phase II being screening women in medical oncology.Results:A total of 173 patients were screened. The new patients screened in surgical oncology reported higher average distress scores compared to patients in medical oncology (5.7 vs. 4.0). However, a greater number of patients in medical oncology reported scores >4 compared to the new patients screened in surgery (54% vs. 35%). Psychological distress was the most commonly reported distress for patients in surgery. In contrast, 60% of scores >4 in medical oncology were symptom related, managed by the nurse or physician.Significance of results:Nurse led implementation of psychosocial distress screening is feasible, addressing this important quality indicator of patient-centered care.

The integrated care service: Impact of a multidisciplinary supportive care service for medical oncology patients in a NCI-designated cancer center.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 134-134
Author(s):  
Finly Zachariah ◽  
Denise Morse ◽  
Lucia Kinsey ◽  
Marianna Koczywas ◽  
Ravi Salgia ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Supportive Care ◽  
Integrated Care ◽  
Medical Oncology ◽  
Care Service ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Readmission Rates ◽  
Supportive Care Service ◽  
The Impact

134 Background: Palliative care (PC) has shown benefits to inpatient length of stay (LOS), symptom burden reduction, utilization decrease, and time on hospice. It has shown less impact on the rate of hospice referrals. We assessed the impact of an integrated care model on these outcomes. Methods: From Jan-July, 2018, the Department of Supportive Care Medicine collaborated with medical oncology (med onc), nursing and administration to create the Integrated Care Service (ICS). Multi-disciplinary rounds include med onc, supportive care (PC, social work, spiritual care, psychiatry, psychology, hospice liaison), nursing, case management, nutrition, and physical and occupational therapy. The admission criteria include: 1) Later-stage disease; 2) Non-curative intent therapy; 3) High distress burden; and 4) Poor prognosis. The ICS was designed to have geographic co-location, morning PC and med onc rounds, multidisciplinary rounds, and post-acute management. The ICS was compared with other med onc patients (non-ICS) and Mantel-Haenszel Chi-Square statistical significance (p<0.05) was calculated using Epi Info StatCalc. Results: In 6 months, 190 med onc patients (pts) were admitted to ICS versus 537 non-ICS pts. Compared with non-ICS, the ICS pts had a higher Case Mix Index (1.81 vs. 1.56) and metastatic disease incidence (95% vs. 78%, p=0.008). Discharge to hospice was higher from ICS versus non-ICS (23% vs. 7%, p=<0.001), and average time on hospice increased from 9 to 15 days. No chemotherapy was given in the last two weeks of life to any pts on ICS (0 vs. 6 non-ICS pts). Length of stay (LOS) was higher on ICS as compared to non-ICS (8.45 vs. 5.26 days) and readmission rates were similar (12% vs. 13%). Conclusions: For medical oncology pts in a comprehensive cancer center, the ICS, an integrated, multidisciplinary supportive care service, significantly improved discharge rates to hospice, increased LOS on hospice by almost a week, avoided patients receiving chemotherapy, and maintained similar readmission rates. LOS was higher for complex ICS patients as compared to non-ICS. Based on this pilot, the ICS is planning for expansion to include hematology and surgical services.

scholarly journals Augmenting the Patient Experience: Therapeutic Arts Interventions for Patients Undergoing Chemotherapy/Infusion

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2187-2187
Author(s):  
Fred Schiffman ◽  
Cynthia S Peng ◽  
Anna C Delamerced ◽  
Lauren V Ready ◽  
Kevin S Tang ◽  
...  
Keyword(s):  
Patient Experience ◽  
Conflicts Of Interest ◽  
Well Being ◽  
Reflective Writing ◽  
Assessment System ◽  
Free Form ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Emotional States ◽  
Writing Activity

Introduction Intravenous infusions and chemotherapy can be a stressful and emotionally-draining process. Prior studies have examined patient perceptions of care and how to improve patient experience during this time. Art interventions have been performed to enhance the patient experience and reduce negative side effects. This patient-centered study investigated the process by which two distinct art modalities - reflective writing and tile painting -- alleviated patients' symptom burden. Methods Chemotherapy patients at The Comprehensive Cancer Center at The Miriam Hospital (Providence, RI) were invited to participate in a therapeutic activity of their choice during their infusions - either painting a wooden tile or engaging in a reflective writing activity. The tile painting consisted of free-form painting with either acrylic paints or pastels. The reflective writing activity consisted of guided or personal reflections on a variety of predefined prompts. Patients completed the Edmonton Symptom Assessment System (ESAS) immediately before and immediately after engaging in their chosen activity, allowing a direct within-subjects comparison of associated symptomatology. Patients also completed a qualitative survey, which allowed them to expand upon their experience in their own words, write recommendations, and reflect upon the process. The activity and surveys were standardized to 30 minutes duration. After the post-activity survey, patients were allowed to continue writing or painting if they so desired. Patients were encouraged to keep the art materials and journal for further therapeutic benefit. Results Twenty-six participants were included in data analysis, with 9 choosing to journal and 17 choosing to paint. In the painting group, there was a significant reduction in the following ESAS measures: tiredness (p = 0.021), anxiety (p = 0.013), shortness of breath (p = 0.016), and a marked increase in feelings of well-being (p = 0.002). In the reflective writing group, there was a significant reduction in anxiety (p = 0.05). Conclusion Overall, both tile painting and reflective writing initiatives resulted in improved patient experience and sense of wellness. The tile painting activity led to a greater number of improved symptoms, whereas reflective writing led to a singular reduction in anxiety, illustrating perhaps the different mechanisms by which these activities foster healing. The tile painting may have served to distract the patient from the gravity of the current illness; its free-form nature allowed participants to be creative with pleasant imagery of their choice, and finishing a work of art perhaps elicited a sense of accomplishment. In comparison, reflective writing may have allowed patients to process their experience of living with their illness and delve deeply into emotional states, fostering a sense of resilience and introspection. Taken together, the specific mechanisms by which these activities provide solace may explain the differential nature of these contrasting yet ultimately beneficial therapies. Disclosures No relevant conflicts of interest to declare.

Implementation of an enhanced recovery program framework in medical oncology.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 66-66
Author(s):  
Brittany C Campbell ◽  
Yvette Ong ◽  
Jarrod Eska ◽  
Sharon Mathai ◽  
Noel Mendez ◽  
...  
Keyword(s):  
Medical Oncology ◽  
Enhanced Recovery ◽  
Functional Mobility ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Control Group ◽  
Surgical Patient ◽  
Quality Improvement Initiative ◽  
Patient Reported ◽  
Edmonton Symptom Assessment Scale

66 Background: Enhanced recovery programs (ERPs) apply multi-modal approaches to manage symptoms, decrease complications, and reduce length of stay (LOS). Widely adopted in surgical settings, there is limited evidence of their implementation in non-surgical patient cohorts. An ERP was implemented in a medical oncology population at a National Cancer Institute-designated comprehensive cancer center. The aim of this quality improvement initiative was to evaluate the implementation of an enhanced recovery framework and determine feasibility in medical oncology. Methods: Enhanced recovery in medical oncology (ERMO) was implemented using Plan, Do, Study, Act methodology. Implementation included introduction of integrative medicine, opioid sparing alternatives, fluid and nutrition management, and functional mobility. Outcome measures included symptom distress as measured by the Edmonton Symptom Assessment Scale (ESAS), return to intended oncologic therapy (RIOT), LOS, and opioid use, evaluated from January 2017 through April 2018. Results: A total of 50 patients were evaluated during the program implementation, and compared with 49 control patients retrospectively reviewed prior to ERMO implementation. Average LOS for ERMO patients was 7.3 days compared to 5.5 days for the control group. Time to RIOT averaged 18.9 days for control patients (n = 30) versus 20.8 days for ERMO patients (n = 17). Nineteen patients (38%) had a reduction in morphine equivalent daily dose (MEDD) from admission to discharge, with an average MEDD of 328.47 milligrams per patient. Conclusions: ERMO as a framework is feasible. The patient reported outcomes such as ESAS and RIOT, and barriers to implementation, including participant engagement and patient pain management perceptions, should be evaluated in the context of larger clinical trials.

Predictors of outpatients’ request for palliative care service at a medical oncology clinic of a German comprehensive cancer center

2018 ◽  
Vol 26 (10) ◽  
pp. 3641-3647 ◽  
Author(s):  
Mitra Tewes ◽  
Teresa Rettler ◽  
Nathalie Wolf ◽  
Jörg Hense ◽  
Martin Schuler ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Oncology ◽  
Care Service ◽  
Palliative Care Service ◽  
Comprehensive Cancer Center ◽  
Cancer Center

Impact of clinical pharmacists in an inpatient medical oncology service: A prospective study at a comprehensive cancer center in Jordan

2020 ◽  
pp. 107815522094327
Author(s):  
Nour Faqeer ◽  
Nour Mustafa ◽  
Noor Abd Al-jalil ◽  
Tasnim Qur’an
Keyword(s):  
Prospective Study ◽  
Medical Oncology ◽  
Cost Savings ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Clinical Pharmacists ◽  
Oncology Service ◽  
A Prospective Study ◽  
The Impact

Introduction Clinical pharmacy is considered an integral discipline in the health care system for optimizing therapy and reducing drug-related problems. The objective of this study was to evaluate the impact of clinical pharmacists in optimizing management in a medical oncology service. Methods A prospective study was conducted at King Hussein Cancer Center between July 2019 and September 2019 of patients admitted to the medical oncology service. The impact of clinical pharmacists was measured by evaluating their interventions, defined as actions that were expected to result in a change in patient management. Data were collected daily by routine review of patients' profiles and by recording clinical pharmacists’ interventions. The data collected were baseline characteristics of patients, numbers and types of clinical pharmacists’ interventions, their significance, medications involved, and rate of acceptance of clinical pharmacists’ interventions by physicians. The significance of each intervention was assessed by two clinical pharmacists on a Hatoum scale. Physicians’ acceptance was assessed by whether the recommendations were implemented. Results During the study period, 748 patients were included, of whom 605 required a total of 1683 clinical interventions. The mean age was 56.3 years (±15.5 SD). Of the interventions, 39% resulted in initiation of a drug and 25% in drug discontinuations. The drug group most commonly associated with clinical pharmacists’ interventions was antibiotics (26.5%). Physicians accepted 98% of the clinical pharmacists’ interventions, and 92.4% of the interventions brought care to a more appropriate level and were considered significant. Conclusion Most patients in the medical oncology service required clinical pharmacists’ interventions, as demonstrated by the high number of significant clinical pharmacists’ interventions. Studies should be conducted to follow up these findings with respect to patient outcomes and cost savings.

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