Incorporating geriatric patient reported outcomes into novel screening tool of distress and supportive care concerns.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 37-37
Author(s):  
James I Gerhart ◽  
Ana Gordon ◽  
Betty Roggenkamp ◽  
Paramjeet Khosla ◽  
Julia Rachel Trosman ◽  
...  
Keyword(s):  
Geriatric Patient ◽  
Patient Reported Outcomes ◽  
Screening Tool ◽  
Self Care ◽  
Specific Treatment ◽  
Average Score ◽  
Institute Of Medicine ◽  
Distress Screening ◽  
Patient Reported ◽  
Supportive Oncology

37 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. The Supportive Oncology Collaborative, collaborative of 100+ clinicians funded by The Coleman Foundation, developed a patient-centric screening tool (CSOC-ST) adapted from ASCO Distress, NCCN Distress Problem List, IOM report and CoC standards, and other validated sub-tools (Weldon, ASCO-Q 2017). The Collaborative then revised the CSOC-ST tool to align with geriatric guidelines. Methods: Literature and guidelines review of geriatric screening, added items to CSOC-ST, and piloted at 4 sites. Descriptive statistics and Fisher’s exact test used. Results: 473 patients screened with added geriatric relevant items to CSOC-ST: self-care concerns (PROMIS Instrumental Support), living alone (ASCO Distress 2014), and memory / cognition (PROMIS item bank). Treatment/care concern items were revised to identify health care power of attorney and advance directive interest. Geriatric related items endorsed by patients, see Table. PHQ4, Anxiety and Depression, average score 2.4 (mild > 3). Higher scores on the PHQ-4 were significantly associated with each of the following: self-care concerns, memory/cognition concerns and specific treatment/care concerns (p < .0001). Conclusions: Pilot results and comparison to geriatric guidelines identified important items to support geriatric patient reported outcomes screening. After pilot, added 3 items for falls/frailty. Eight sites implementing this CSOC-ST.[Table: see text]

Incorporating geriatric patient-reported outcomes into novel screening tool of distress and supportive care concerns.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 198-198
Author(s):  
Christine B. Weldon ◽  
Joanna Martin ◽  
Amy Scheu ◽  
Paramjeet Khosla ◽  
Betty Roggenkamp ◽  
...  
Keyword(s):  
Geriatric Patient ◽  
Patient Reported Outcomes ◽  
Screening Tool ◽  
Self Care ◽  
Specific Treatment ◽  
Average Score ◽  
Institute Of Medicine ◽  
Distress Screening ◽  
Patient Reported ◽  
Supportive Oncology

198 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. The Supportive Oncology Collaborative, collaborative of 100+ clinicians funded by The Coleman Foundation, developed a patient-centric screening tool (CSOC-ST) adapted from ASCO Distress, NCCN Distress Problem List, IOM report and CoC standards, and other validated sub-tools (Weldon, ASCO-Q 2017). The Collaborative revised the CSOC-ST tool to align with ASCO geriatric guidelines. Methods: Literature and guidelines review of geriatric screening, added items to CSOC-ST, and piloted at 4 sites. Descriptive statistics and Fisher’s exact test used. Results: 473 patients screened with added geriatric relevant items to CSOC-ST: self-care concerns (PROMIS Instrumental Support), living alone (ASCO Distress 2014), and memory / cognition (PROMIS item bank). Treatment/care concern items were revised to identify health care power of attorney and advance directive interest. Geriatric related items endorsed by patients, see Table. PHQ4, Anxiety and Depression, average score 2.4 (mild > 3). Higher scores on the PHQ-4 were significantly associated with each of the following: self-care concerns, memory/cognition concerns and specific treatment/care concerns (p < .0001). Conclusions: Pilot results and comparison to ASCO geriatric guidelines identified important items to support geriatric patient reported outcomes screening. After pilot, added 3 items for falls/frailty. Eight sites implementing this CSOC-ST.[Table: see text]

Results of implementing a novel supportive oncology screening tool for comprehensive evaluation of distress and other supportive care needs.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 61-61
Author(s):  
Paramjeet Khosla ◽  
Julia Rachel Trosman ◽  
James Gerhart ◽  
Urjeet Patel ◽  
Shelly S. Lo ◽  
...  
Keyword(s):  
Supportive Care ◽  
Physical Function ◽  
Screening Tool ◽  
Specific Treatment ◽  
Safety Net ◽  
Screening Tools ◽  
Anxiety And Depression ◽  
Distress Screening ◽  
Care Needs ◽  
Supportive Oncology

61 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. Screening tools are not standardized and often address only a portion of patients’ supportive oncology needs. Methods: A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric screening tool adapted from NCCN Distress Problem List, IOM report and CoC standards, with validated sub-tools: PHQ-4 for anxiety and depression and PROMIS short forms for pain, fatigue and physical function. Novel treatment/care and other concerns were included. The screening tool was implemented at 4 cancer centers (2 academic, 1 public & 1 safety-net). End points included correlation of PHQ-4 score with other supportive oncology needs. Descriptive statistics, Fisher’s exact test were used. Results: 2805 patients were screened. Average scores were: PHQ4 – Anxiety and Depression 1.8 (mild > 3), Pain 4.5 (mild > 4), Fatigue 8.8 (mild > 6), Physical Function 20.2 (mild < 20), see table for additional items. Higher scores on the PHQ-4 were significantly associated with each of the following: greater pain, fatigue, , nutritional and specific treatment/care concerns, and lower physical function (p<.0001). (See Table). Conclusions: Patients with higher anxiety and depression also have many other supportive oncology concerns. Our results support the use of a comprehensive tool capturing a spectrum of each patient’s unique concerns. This may enable earlier interventions and personalized delivery of supportive care. [Table: see text]

Results of implementing a novel supportive oncology screening tool for comprehensive evaluation of distress and other supportive care needs.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21644-e21644
Author(s):  
Julia Rachel Trosman ◽  
James Gerhart ◽  
Urjeet Patel ◽  
Paramjeet Khosla ◽  
Patricia A. Robinson ◽  
...  
Keyword(s):  
Supportive Care ◽  
Physical Function ◽  
Screening Tool ◽  
Specific Treatment ◽  
Safety Net ◽  
Screening Tools ◽  
Anxiety And Depression ◽  
Distress Screening ◽  
Care Needs ◽  
Supportive Oncology

e21644 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. Screening tools are not standardized and often address only a portion of patients’ supportive oncology needs. Methods: A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric screening tool adapted from NCCN Distress Problem List, IOM report and CoC standards, with validated sub-tools: PHQ-4 for anxiety and depression and PROMIS short forms for pain, fatigue and physical function. Novel treatment/care and other concerns were included. The screening tool was implemented at 4 cancer centers (2 academic, 1 public & 1 safety-net). End points included correlation of PHQ-4 score with other supportive oncology needs. Descriptive statistics, Fisher’s exact test were used. Results: 2805 patients were screened. Average scores were: PHQ4 – Anxiety and Depression 1.8 (mild > 3), Pain 4.5 (mild > 4), Fatigue 8.8 (mild > 6), Physical Function 20.2 (mild < 20), see table for additional items. Higher scores on the PHQ-4 were significantly associated with each of the following: greater pain, fatigue, nutritional and specific treatment/care concerns, and lower physical function (p<.0001). Conclusions: Patients with higher anxiety and depression also have many other supportive oncology concerns. Our results support the use of a comprehensive tool capturing a spectrum of each patient’s unique concerns. This may enable earlier interventions and personalized delivery of supportive care. [Table: see text]

Incorporating geriatric patient reported outcomes into novel screening tool of distress and supportive care concerns.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 10115-10115
Author(s):  
Christine B. Weldon ◽  
Joanna Martin ◽  
Amy Scheu ◽  
Paramjeet Khosla ◽  
Betty Roggenkamp ◽  
...  
Keyword(s):  
Supportive Care ◽  
Geriatric Patient ◽  
Patient Reported Outcomes ◽  
Screening Tool ◽  
Patient Reported

scholarly journals Clinical evaluation of pulmonary hypertension using patient-reported outcomes: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Miguel Ángel Amor-García ◽  
Sara Ibáñez-García ◽  
Xandra García-González ◽  
Teresa Mombiela ◽  
Cristina Villanueva-Bueno ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Hypertension ◽  
Clinical Evaluation ◽  
Patient Reported Outcomes ◽  
Specific Treatment ◽  
Tertiary Hospital ◽  
Functional Class ◽  
Cross Sectional ◽  
Patient Reported

Abstract Background Patients with pulmonary hypertension (PH) have progressive and disabling symptoms, as well as a burden of treatments and a difficult clinical evaluation that make health-related quality of life a particularly relevant endpoint in this disease. The objective of the study was to evaluate patient-reported outcomes of patients receiving specific treatment for PH in a tertiary hospital using a specific questionnaire (Cambridge Pulmonary Hypertension Outcome Review-CAMPHOR) in the pharmacy consultation. Methods A cross-sectional, observational, descriptive study was conducted. It included all patients receiving specific treatment for PH in a tertiary hospital in Madrid, Spain. The inclusion period comprised between August to December 2019. CAMPHOR questionnaires containing three domains: symptoms, activities and quality of life were completed by the patients at the pharmacy consultation. Demographic and clinical variables, including WHO Functional Class (WHO FC), PH-specific tests and hemodynamic parameters, were recorded. Non-parametric analyses to assess relations between variables and CAMPHOR domains were performed. Results Thirty-six patients consented to participate in the study and completed the questionnaire. Median scores for symptoms, activities, and quality of life domains were 5.5 (2.5–10), 8.0 (4.5–10.5) and 3.5 (1–7.5), respectively. Statistically significant differences were found in the three domains when comparing by WHO FC, in the activities domain for 6-m walking test and in the quality of life domain for patients who had emergency visits or hospitalizations in the last year. Conclusions The CAMPHOR questionnaire could be useful as a complementary test to achieve an integrated evaluation of PH patients, who could complete it easily during their routine pharmacy visits.

scholarly journals Patient-Reported Outcomes after Exosym Bracing (Intrepid Dynamic Exoskeletal Orthosis (IDEO)) in the Civilian Population

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0019
Author(s):  
Ryan Hadden ◽  
James Meeker ◽  
Jason Weiss ◽  
Austin Thompson
Keyword(s):  
Physical Function ◽  
Patient Reported Outcomes ◽  
Pain Modulation ◽  
Pain Interference ◽  
Average Score ◽  
Foot And Ankle ◽  
Kinetic Chain ◽  
Civilian Population ◽  
Patients Âgés ◽  
Patient Reported

Category: Ankle Arthritis, Orthosis Introduction/Purpose: When it comes to ambulation, the dynamic interplay of anatomy at the foot and ankle affords weight acceptance, stability and force production. The outcome is gait efficiency. Various musculoskeletal injuries challenge gait biomechanics. While surgical management may address the fault in kinetic chain, it may not fully address the problem of pain, functional outcome and patient satisfaction. Non-surgical interventions such as bracing using ankle foot orthoses (AFO) aim to assist, restore and redirect weightbearing forces with immobility in mind. As an energy-storing AFO, however, the IDEO was created to improve functional performance in veterans after limb salvage procedures. The goal of the study was to evaluate outcomes following use of Exosym (or IDEO) bracing for foot and ankle pathologies in the civilian population. Methods: Through review of one institution’s electronic medical record, 29 patients ages 18 years or older who were prescribed the Exosym brace by a single foot and ankle surgeon over a 5-year period were identified. A composite questionnaire including patient-reported outcomes of PROMIS SF Physical Function, PROMIS SF Pain Interference, Brace Use, and EQ-5D was obtained over the phone or by email. Results: A total of 29 patients were prescribed the brace over a 5-year period with only 18 patients receiving the brace. Insurance denying coverage was the most common reason (n=7) for patients not receiving the brace. Of the 18 patients that received the brace, 17 of them were willing to answer the questionnaire. The average age of patients with the Exosym brace was 42.3 (sd=13.8) years old with 6 (35%) being female. Patients with the Exosym brace reported an average score of 47.2 (sd=6.0) for the PROMIS Physical Function and 53.6 (sd=8.4) for the PROMIS Pain Interference. The average satisfaction with the Exosym brace was 65.5 (sd=17.6) out of a possible 100. Conclusion: Exosym bracing in various foot and ankle pathologies provides functionality and pain modulation in the civilian population that rivals respective subpopulation norms. One of the acknowledged limitations of the study is that not obtaining pre- bracing patient reported outcomes precluded evaluation of a minimum clinically important difference. However, the study was not designed to provide such data. It did, however, provide impetus to pursue a follow-up study evaluating plantar pressure changes with and without brace use, which is currently ongoing. Such knowledge may help identify which injuries would be best suited for Exosym bracing.

scholarly journals Effects on patient-reported outcomes of “Screening of Distress and Referral Need” implemented in Dutch oncology practice

2019 ◽  
Vol 28 (7) ◽  
pp. 3391-3398
Author(s):  
Floor M. van Nuenen ◽  
Stacey M. Donofrio ◽  
Marrit A. Tuinman ◽  
Harry B. M. van de Wiel ◽  
Josette E. H. M. Hoekstra-Weebers
Keyword(s):  
Patient Reported Outcomes ◽  
Distress Screening ◽  
Social And Emotional ◽  
Distress Level ◽  
Patient Reported ◽  
Specialized Care ◽  
Eortc Qlq C30 ◽  
Screening For Distress ◽  
Oncology Practice ◽  
Eortc Qlq

Abstract Purpose This study investigated the effect of the “Screening for Distress and Referral Need” (SDRN) process (completing a screening instrument; patient-caregiver discussion about the patient’s responses, regardless of distress level, and possible referral to specialized care), implemented in Dutch oncology practice on patient-reported outcomes (PROs). Methods A non-randomized time-sequential study was conducted to compare two cohorts. Cohort 1 respondents (C1) were recruited before and cohort 2 respondents (C2) after SDRN implementation in nine Dutch hospitals. Participants completed the EORTC-QLQ-C30, HADS, Patient Satisfaction Questionnaire-III, and the Distress Thermometer and Problem List (DT&PL). Descriptive analyses and univariate tests were conducted. Results C2 respondents (N = 422, response = 54%) had significantly lower mean scores on the practical (t = 2.3; p = 0.02), social (t = 2.3; p = 0.03), and emotional PL domains (t = 2.9; p = 0.004) compared with C1 (N = 518, response = 53%). No significant differences were found on quality of life, anxiety, depression, satisfaction with care, distress level, the spiritual and physical PL domains, or on referral wish. Conclusions After implementation of SDRN, patients report significantly fewer psychosocial (practical, social, and emotional) problems on the DT/PL but responses on the other patient-reported outcomes were comparable. These results add to the mixed evidence on the beneficial effect of distress screening. More and better focused research is needed.

A consolidated screening tool for supportive oncology needs and distress.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 72-72
Author(s):  
Amy Scheu ◽  
Lauren Allison Wiebe ◽  
Shelly S. Lo ◽  
Catherine Deamant ◽  
Betty Roggenkamp ◽  
...  
Keyword(s):  
Screening Tool ◽  
Safety Net ◽  
Screening Tools ◽  
Distress Screening ◽  
Chicago Area ◽  
Oncology Care ◽  
Screening Questions ◽  
Supportive Oncology ◽  
The Right ◽  
Patient Centric

72 Background: The IOM 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) standard 3.2 requires distress screening and indicated action. Screening tools are not standardized across institutions and often address only a portion of patients’ supportive oncology needs. Methods: A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric consolidated screening tool based on validated instruments (NCCN Distress Problem List, PHQ-4, PROMIS) and IOM and CoC. The screening tool was piloted at 6 practice improvement cancer centers in the Chicago area (3 academic, 2 safety-net, 1 public). Patients, providers assessing each patient’s screening results (assessors), and providers receiving referrals (referral providers) were surveyed after each use of the screening tool. Descriptive statistics were used to assess effectiveness of the tool. Results: Responders included 29 patients, 81 assessors and 26 referral providers (SW, chaplain, subspecialist). The majority of patients (22/29, 75%) completed the screening in < 10 minutes without assistance and will complete at every visit. Most assessors (59/77, 76%) spent < 5 minutes reviewing screening results. The majority of patients, assessors, and referral providers reported that the screening tool asked the “right questions”. Assessors reporting partial relevance of some screening questions for 34% (26/77) of patients, uncovered ≥ 1 relevant needs for 96% (25/26) of those patients (p = 0.002). Conclusions: Use of a consolidated supportive oncology screening tool across multiple institutions is feasible, discovered unmet patient needs, and was beneficial for assessors and providers. As the tool is adopted by collaborating institutions, variations in supportive oncology screening may decline, thus improving access to supportive oncology care with implications for national dissemination. [Table: see text]

Implementing and analyzing a distress screening tool (DST) in a community oncology setting: Breaking down barriers to comprehensive medical and psychosocial (PS) care—The Kaiser Permanente Lone Tree, CO (KP-LT) experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21553-e21553
Author(s):  
Scott Arthur Kono ◽  
Jammie Reichel ◽  
Alex R. Menter ◽  
Stephen Armond Mayer ◽  
Lillian Klancar ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Large Scale ◽  
Screening Tool ◽  
Distress Screening ◽  
Optimal Care ◽  
Kaiser Permanente ◽  
Community Oncology ◽  
Patient Reported ◽  
Before And After ◽  
Large Scale Screening

e21553 Background: PS distress (D) in cancer patients is an underestimated barrier to optimal care. The NCCN recommends D screening and intervention for D scores (DS) ≥4. KP is an ideal environment for large-scale screening. We sought to identify barriers in DST compliance, find a successful standardized workflow (SWF), and understand sources of D to elevate the standard of PS care. Methods: The DST was administered by the physician at completion of initial encounter to all new patients. Compliance recorded before and after implementing a SWF in 2/2016. Our DST utilizes 4 Major Categories of Distress (MCD) [Practical (P), Social (S), Health (H), Emotional (E)] to identify specific areas of D, and stratify DS by diagnosis [Benign (BH)-, Malignant- (MH) Hematology, Solid Tumor (ST)]. Clinic outreached any patient with a 4+ DS. DST was modified (mDST) 9/2016 to provide a DS for each MCD rather than 1 overall DS to improve practicality. Results: 936 DSTs completed from 6/2015-1/2017 (304/632 were mDST). DST compliance increased from 51% to 78% after the SWF. 289/632 (46%) scored 4+ (avg. DS 6.15). 153/304 (54%) mDSTs scored 4+ in ³ 1category. The avg. DS was 3.9 (n=936). Avg. DS for: BH= 3.67 (50% scored 4+, avg. 6.0), MH=3.79 (49% score 4+, avg. 6.14), and ST=4.02 (54% score 4+, avg. 6.18). The 3 most common concerns in each MCD are reported in Table 1. Most frequent outreach requests: Dietitian (n=88, 9%), LCSW (n=70, 7%), and Financial Counselor (n=50, 5%). Conclusions: Sources of D are a patient reported metric, not provider-assumed. DST use is feasible and essential to comprehensive cancer care. A SWF is crucial for success and led to a 27% increase in compliance. 4+ DS is frequent and was higher than expected in BH. Identifying specific stressors allows early intervention and improved resource utilization. [Table: see text]

Untangling a web of Electronic Patient Reported Outcomes data to support quality improvement.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 311-311
Author(s):  
Meggan Davis ◽  
Erik Winters ◽  
Lisa Acomb ◽  
Matt Palmgren ◽  
Kerry K McMillen ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Clinical Care ◽  
Program Improvement ◽  
Project Team ◽  
Distress Screening ◽  
Response Distribution ◽  
Data Infrastructure ◽  
Patient Reported ◽  
Volume Response ◽  
Data Tables

311 Background: Adoption of Electronic Patient Reported Outcomes (ePROs) as part of clinical care is aided by the ability to respond to feedback and develop solutions founded on data. This requires access to usage, volume, response, and system performance data, yet with limited resources the infrastructure needed to store and analyze these data is often an afterthought. The Seattle Caner Care Alliance followed an iterative process to create dashboards featuring content-specific metrics while improving the underlying infrastructure of patient-generated data collected via the ePRO program. Methods: For each dashboard, the project team followed 7 steps: 1) Clarify the purpose. 2) Brainstorm requirements with content-specific stakeholders. 3) Create initial drafts for review, testing, and validation. 4) Validate that metrics are clear and provide value. 5) Update dashboards and review with stakeholders. 6) Perform technical clean-up and improvement to data infrastructure. 7) Iterate until all stakeholders approve. Results: 27 data tables were linked to create four content-specific dashboards: Overall Key Performance Indicators (KPI), an experimental dashboard, and responses to chemotherapy symptom and distress screening surveys. The KPI dashboard featured completion rate, adoption rate, survey and intervention volumes with the ability to filter by ePRO type, diagnosis, and intervention. The experimental dashboard allowed the project team to test data points, visualizations and methodologies before creating dashboards or updating data structures. Chemotherapy symptom and distress screening dashboards displayed interventions by symptom or concern, severity, referrals, and response distribution. Conclusions: Data collected via an ePRO program offers an opportunity for improvement during implementation and ongoing program development. An iterative approach to analyzing these data and creating dashboards that engaged stakeholders and focused on data quality was an effective way to untangle a complex web of patient-generated data and to support program improvement. Future ePRO implementation would benefit from the inclusion of a flexible data development approach as part of planning and design.

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