Overcoming suvivorship care planning implementation challenges through decentralization.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 38-38
Author(s):  
Carol A. Rosenberg ◽  
Thomas A. Hensing ◽  
Bruce Brockstein ◽  
Linda Green ◽  
Anisha Patel ◽  
...  
Keyword(s):  
Care Quality ◽  
Current Evidence ◽  
Cancer Center ◽  
Evidence Based ◽  
Care Providers ◽  
Curative Intent ◽  
Implementation Challenges ◽  
Care Plans ◽  
Number Of Patients ◽  
Centralized Model

38 Background: To meet Commission on Cancer accreditation requirements, cancer programs must implement processes to monitor the dissemination of survivorship care plans (SCP) for patients with Stages I-III cancers who were treated with curative intent and completed active therapy. Challenges of SCP delivery across disease sites include lack of designated/trained staff, time burden, knowledge of current evidence-based guidelines, and sustainability. We describe the challenges NorthShore University HealthSystem Kellogg Cancer Center (NKCC) and their Living in the Future (LIFE) Cancer Survivorship Program faced in meeting this standard and how evolving the SCP delivery process has resulted in a sustainable model. Methods: LIFE implemented a technology-based SCP tool using a centralized consultative model led by a nurse practitioner (NP) with specialized survivorship training. Physicians referred eligible patients to the survivorship clinic for an education visit where they received a SCP from the NP. Since the centralized model was dependent on one person for delivery, a more sustainable model was needed. NKCC transitioned to a decentralized process, moving SCP creation and delivery responsibility to all oncology care providers (OCPs). Although not all OCPs had specialized survivorship training, care quality was supported by automated SCP creation based on evidence-based care recommendations embedded in the technology. Results: To date, 143 evidence-based SCPs have been delivered since tool implementation in April 2017. During the centralized model (April 25– June 30) 67 SCPs were created by the lead LIFE NP; 76 were created during the decentralized process while the lead NP was on leave (July 3 – Oct 1). By using a technology-based SCP, OCPs incorporated SCP delivery into their workflow and no longer had to refer patients to a separate clinic. Conclusions: This project demonstrates the feasibility of a sustainable, decentralized process using a technology-based SCP as an option for augmenting centralized SCP delivery. A comparable number of patients received a SCP during both processes with an equivalent number of SCPs being delivered via the decentralized model by OCPs supported by evidence-based technology.

scholarly journals Evidence-Based Guidelines for Management of Head and Neck Mucosal Malignancies during the COVID-19 Pandemic

2020 ◽  
Vol 163 (1) ◽  
pp. 16-24 ◽  
Author(s):  
Dana L. Crosby ◽  
Arun Sharma
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Current Evidence ◽  
Evidence Based ◽  
Sources Of Information ◽  
Care Plans ◽  
Increased Risk ◽  
National Organizations ◽  
Meta Analyses

Objective Due to the current coronavirus disease 2019 (COVID-19) pandemic, otolaryngologists face novel challenges when treating patients with head and neck cancer. The purpose of this review is to evaluate the current evidence surrounding the treatment of these patients during this pandemic and to provide evidence-based recommendations with attention to increased risk in this setting. Data Sources A review of the literature was performed with PubMed. Because recently published articles on this topic may not yet be indexed into PubMed, otolaryngology journals were hand searched for relevant articles. Guidelines from national organizations were reviewed to identify additional relevant sources of information. Review Methods Two groups of search terms were created: one with terms related to COVID-19 and another with terms related to head and neck cancer and its management. Searches were performed of all terms in each group as well as combinations of terms between groups. Searches and subsequent exclusion of articles were performed in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Additional articles were identified after relevant journals and guidelines from national organizations were reviewed. Conclusions Patients with head and neck mucosal malignancy require continued treatment despite the current pandemic state. Care must be taken at all stages of treatment to minimize the risk to patients and health care workers while maintaining focus on minimizing use of limited resources. Implications for Practice Patient care plans should be guided by best available evidence to optimize outcomes while maintaining a safe environment in the setting of this pandemic.

Examining the role of treatment complexity in survivorship care planning.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 242-242
Author(s):  
Nicole Marie Mahr ◽  
Karen Marie de Sola-Smith ◽  
Janice Bell
Keyword(s):  
Primary Care Providers ◽  
Additional Treatment ◽  
Care Quality ◽  
Future Research ◽  
Special Focus ◽  
Survivorship Care ◽  
Care Providers ◽  
Long Term Effects ◽  
Lower Odds ◽  
Care Plans

242 Background: The cancer survivor population will reach 19M by 2025, increasing demand on primary care providers to manage late and long-term effects of treatment. To improve care quality, the IOM recommends survivorship care plans (SCPs) that include two components: a treatment summary (TS) detailing disease and treatment characteristics; and evidence based follow up care instructions (FCI). SCPs remain underutilized despite evidence they enhance physician communication, increase self-efficacy and improve health outcomes of cancer survivors. Little is known about treatment related and socio-demographic factors associated with receipt of SCPs and their components. The purpose of this study was to examine the relationship between care complexity, operationalized as multiple cancers or treatments, and survivor reported SCP receipt. Methods: This was a secondary analysis of data collected in the 2012 LIVESTRONG Survey for People Affected by Cancer, an online self-selection survey. Descriptive statistics and multivariate regression were used to examine relationships between survivor characteristics and SCP receipt among 3,599 respondents. Results: Half (52%) of survivors received a complete SCP. Care complexity was significantly associated with lower odds of SCP receipt. Each additional treatment modality lowered odds of receipt by 8% (95% CI 0.86-0.99). Survivors with multiple diagnoses had 19% lower odds of receipt than those with single diagnoses (CI 0.68-0.95). Other predictors of SCP receipt were being female (OR 0.56; 95% CI 0.48-0.65), having at least a bachelor’s degree (OR 0.77; CI 0.60-0.99), age over 66 years (OR 1.38; CI 1.01-1.89), and race of “other” (OR 1.56; CI 1.14-2.13). Similar results were found for receipt of TS alone. Conclusions: Only 52% of survivors received SCPs as recommended by the IOM. Increased case complexity was associated with lower odds of SCP receipt, suggesting patients at highest risk are least likely to receive coordination. Results indicate the need to identify and eliminate barriers to SCP implementation, with special focus on high risk patients. Future research should investigate these findings in diverse populations and identify specific characteristics associated with SCP receipt.

Creation of an APN-led cancer survivorship clinic in a community cancer center.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 61-61
Author(s):  
Pamela Jane Vetter
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Side Effect ◽  
Assessment Tool ◽  
Primary Care Providers ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Care Providers ◽  
Care Plans

61 Background: The Institute of Medicine (IOM) report From Cancer Patient to Cancer Survivor: Lost in Transition, noted cancer patients often lacked the ability to successfully navigate the transition from patient to survivor (2006). To assist patients with understanding their disease and follow up, managing side effects and connecting with resources, the IOM recommends a survivorship care plan (SCP). The Commission on Cancer (CoC) is requiring accredited cancer programs provide SCPs to curative patients while giving them full discretion on structuring these programs. Methods: After researching survivorship components, a consultative model serving the adult cancer patients curatively treated at my facility was chosen. My goals included increasing patient satisfaction and connection to resources, fulfilling accreditation requirements, as well as financial benefits. I secured champions and procured budgetary approval. An assessment tool was created, a SCP program chosen, and a schedule created with IT. I gathered resources, reviewed side effect management, chose evaluation metrics and created educational materials and a tracking system. Results: 235 patients were seen in the first year of the clinic. Through nine months of 2017, 67.9% of eligible patients were provided with a SCP. Downstream revenue included patients changing to an Aspirus Primary Care Provider and referrals to various providers. Patients were connected to community and facility resources. Side effect assistance given; multiple medical issues addressed; additional Advanced Care Plans completed. Patients and Primary Care Providers are complimentary of the service. Conclusions: Successful start to survivorship clinic; will meet CoC accreditation. Many eligible patients who did not receive a SCP were seen at an unaffiliated Urology clinic. Moving forward, plan to work with their clinic to provide SCPs. Other challenges included time spent tracking patients, which should ease with a newly implemented electronic medical record.

scholarly journals Identifying the know-do gap in evidence-based neonatal care practices among informal health care providers—A cross-sectional study from Ujjain, India

2020 ◽  
Author(s):  
Isaac Gikandi Mungai ◽  
Sumit Singh Baghel ◽  
Suchi Soni ◽  
Shailja Vagela ◽  
Megha Sharma ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Service Providers ◽  
Neonatal Resuscitation ◽  
Neonatal Care ◽  
Evidence Based ◽  
Care Providers ◽  
Cross Sectional ◽  
Evidence Based Practices ◽  
Number Of Patients

Abstract Background More than a quarter of global neonatal deaths are reported from India, and a large proportion of these deaths are preventable. However, in the absence of robust public health care systems in several states in India, informal health care providers (IHCPs) with no formal medical education are the first contact service providers. The aim of this study was to assess the knowledge of IHCPs in basic evidence-based practices in neonatal care in Ujjain district and investigated factors associated with differences in levels of knowledge. Methods A cross-sectional survey was conducted using a questionnaire with multiple-choice questions covering the basic elements of neonatal care. The collective score per question among the respondents was calculated. The score achieved by each respondent was calculated, grouped into either “fair” or “low”, and then checked for association with the practitioners’ age and years of experience, number of patients examined per day, and whether they attended children in their practice. Results Of the 945 IHCPs approached, 830 (88%) participated in the study. Of the potential 39,840 points, only an average of 18,483 (46%) were achieved, indicating a knowledge gap. Although these providers could identify key tenets of enhancing survival chances of neonates, they scored low on the specifics of cord care, breastfeeding, vitamin K use to prevent neonatal hemorrhage, and identification and care of low-birth-weight babies. The practitioners particularly lacked knowledge about neonatal resuscitation, and only a small proportion reported following up on immunizations in children they attended. Fair knowledge of IHCPs was significantly associated with attending more than 10 but less than 50 patients per day and of being aged between 35 and 45 years. Offering pediatric consultations was not significantly associated with achieving a fair score. Conclusions The present study highlighted that know-do gap exists in evidence-based practices for all key areas of neonatal care tested among the IHCPs. The study provides the evidence that educational interventions targeting IHCPs can improve neonatal care services and is an innovative way to reach a large rural population in the study setting.

Developing an adolescent and young adult (AYA) cancer program in an Italian adult high-volume cancer center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18034-e18034
Author(s):  
Alexia Bertuzzi ◽  
Andrea Marrari ◽  
Vittorio Quagliuolo ◽  
Ferdinando Cananzi ◽  
Umberto Cariboni ◽  
...  
Keyword(s):  
High Volume ◽  
Program Improvement ◽  
Adolescent And Young Adult ◽  
Hospital Environment ◽  
Cancer Center ◽  
Published Data ◽  
Psychosocial Issues ◽  
Care Providers ◽  
Optimal Care ◽  
Number Of Patients

e18034 Background: Given the lack of survival improvement and the several unmet clinical/psychosocial issues, programs for AYA (15 to 39 yo) are underway, involving local resources and organizations. Conventionally the healthcare system address inadequately the needs of AYAs. Humanitas Research Hospital is a high volume Cancer Center for adult patients with long lasting expertise in rare cancers based on a multidisciplinary approach. Methods: We conducted a retrospective evaluation of the number of patients followed in our Institute from 2010 to 2017 to assess our potential as an AYA referral center. In February 2017 we started a dedicated program, focused on medical and psychosocial issues of AYA and supported by an interdisciplinary team including medical oncologists, psychologists, surgeons, radiation oncologists, fertility experts, cardiologists, genetic consultants, endocrinologist, palliative care providers, social workers, and liason nurses . Results: From 2010 to 2017 more than 6600 AYA pts were seen in Humanitas. The epidemiology reflects the published data. Since the beginning of the program (February 2017), more than 2000 new AYA pts were referred to our dedicated clinic. Based on a patient-focused model of care, the aims of the first access are the comprehension of the complex pathways to diagnosis often delayed, the access to optimal care including clinical trial, the recognition of the unique psychosocial context, the counselling on key issues for AYA (fertility, cardiology, nutrition, smoking, financial). We created a dedicated physical space where pts, families and caregivers can spend time together, reducing the feeling of isolation. They meet also specialists trained to deal with their needs, to reduce the adverse impact of the diagnosis and to improve the adherence to treatment. Daily activities, such as cooking and photography class, professional writing and acting, are also offered. Conclusions: Humanitas AYA project modified the hospital environment making it more comfortable for our pts and improved the awareness of the healthcare providers to AYA unmet needs. Outcome and research program improvement are long-term endpoints to bridge the clinical gap of AYA pts.

scholarly journals Online patient feedback: a scoping review and stakeholder consultation to guide health policy

2019 ◽  
Vol 25 (2) ◽  
pp. 122-129 ◽  
Author(s):  
Anne-Marie Boylan ◽  
Veronika Williams ◽  
John Powell
Keyword(s):  
Health Care ◽  
Scoping Review ◽  
Online Reviews ◽  
Care Quality ◽  
Current Evidence ◽  
Care Providers ◽  
Stakeholder Consultation ◽  
Patient Feedback ◽  
Current Evidence Base ◽  
Online Feedback

Objective To provide a synthesis of the current evidence base of online patient feedback using a scoping review and a consultation of stakeholders in England, UK. Methods We searched MEDLINE, EMBASE, PsycINFO, CINAHL and the Social Science Citation Index and conducted hand searches up to January 2018. We included primary studies of internet-based reviews and other online feedback (e.g. social media and blogs) from patients, carers or the public about health care providers (individuals, services or organizations). Key findings were extracted and tabulated for further synthesis guided by the themes arising from a stakeholder consultation. Results The review found that awareness and usage of online feedback is increasing. Most feedback is about physicians, and is typically positive. Online reviews and ratings are used by some service users to inform choice of provider or treatment while providers tend to be concerned about the validity and representativeness of feedback. Reviewed studies found that those who post feedback are generally not representative of the general population, tending to be younger and more educated, but online feedback does broadly correlate with some other measures of health care quality. Conclusions In an increasingly digital society, where citizens provide and use feedback for a range of goods and services, online patient feedback can offer a convenient, low cost and widely accessible mechanism to capture experiences of health care, while being mindful to avoid issues of digital exclusion. This review provides important insights to inform policy development seeking to harness the opportunities offered by online feedback.

scholarly journals Chemotherapy Treatment Modifications During the COVID-19 Outbreak at a Community Cancer Center in New York City

2020 ◽  
pp. 1298-1305
Author(s):  
Dong D. Lin ◽  
Trishala Meghal ◽  
Pooja Murthy ◽  
Lan Mo ◽  
Ashley D’Silva ◽  
...  
Keyword(s):  
New York ◽  
Health Care Providers ◽  
Negative Impact ◽  
Cancer Center ◽  
Care Providers ◽  
Curative Intent ◽  
Treatment Modification ◽  
Treatment Regimens ◽  
Patients With Cancer ◽  
Common Strategy

PURPOSE As a result of their immunocompromised status associated with disease and treatment, patients with cancer face a profound threat for higher rates of complications and mortality if they contract the coronavirus disease 2019 infection. Medical oncology communities have developed treatment modifications to balance the risk of contracting the virus with the benefit of improving cancer-related outcomes. METHODS We systemically examined our community cancer center database to display patterns of change and to unveil factors that have been considered with each decision. We studied a cohort of 282 patients receiving treatment and found that 159 patients (56.4%) had treatment modifications. RESULTS The incidence of treatment modification was observed in patients undergoing adjuvant and neoadjuvant (41.4%), palliative (62.9%), or injectable endocrine or bone-modulating only (76.0%) treatments. Modifications were applied to regimens with myelosuppressive (56.5%), immunosuppressive (69.2%), and immunomodulating (61.5%) potentials. These modifications also affected intravenous (54.9%) and subcutaneous injectable treatments (62.5%) more than oral treatments (15.8%). Treatment modifications in 112 patients (70.4%) were recommended by providers, and 47 (29.6%) were initiated by patients. The most common strategy of modification was to skip or postpone a scheduled treatment (49%). Among treatment with no modifications, treatment regimens were maintained in patients who tolerated treatment well (37.0%), in treatments with curative intent (22%), and in symptomatic patients who required treatment (14%). CONCLUSION Our observation and analysis suggested that the primary goal of treatment modification was to decrease potential exposure. The pattern also reflected the negative impact of the pandemic on health care providers who initiated these changes. Providers have to consider individualized recommendations incorporating multiple factors, such as tolerance, potential toxicity, treatment nature and route, and disease severity.

scholarly journals Implementing Practice Guidelines: A Workshop on Guidelines Dissemination and Implementation with a Focus on Asthma and COPD

2006 ◽  
Vol 13 (suppl a) ◽  
pp. 5A-47A ◽  
Author(s):  
Louis-Philippe Boulet ◽  
Allan Becker ◽  
Dennis Bowie ◽  
Paul Hernandez ◽  
Andrew McIvor ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Practice Guidelines ◽  
Guideline Implementation ◽  
Current Evidence ◽  
Quebec City ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Care Providers ◽  
The World ◽  
Evidence Based Guidelines

The present supplement summarizes the proceedings of the symposium “Implementing practice guidelines: A workshop on guidelines dissemination and implementation with a focus on asthma and COPD”, which took place in Quebec City, Quebec, from April 14 to 16, 2005. This international symposium was a joint initiative of the Laval University Office of Continuing Medical Education (Bureau de la Formation Médicale Continue), the Canadian Thoracic Society and the Canadian Network for Asthma Care, and was supported by many other organizations and by industrial partners. The objectives of this meeting were to examine the optimal implementation of practice guidelines, review current initiatives for the implementation of asthma and chronic obstructive pulmonary disease (COPD) guidelines in Canada and in the rest of the world, and develop an optimal strategy for future guideline implementation. An impressive group of scientists, physicians and other health care providers, as well as policy makers and representatives of patients’ associations, the pharmaceutical industry, research and health networks, and communications specialists, conveyed their perspectives on how to achieve these goals.This important event provided a unique opportunity for all participants to discuss key issues in improving the care of patients with asthma and COPD. These two diseases are responsible for an enormous human and socioeconomic burden around the world. Many reports have indicated that current evidence-based guidelines are underused by physicians and others, and that there are many barriers to an effective translation of recommendations into day-to-day care. There is therefore a need to develop more effective ways to communicate key information to both caregivers and patients, and to promote appropriate health behaviours. This symposium contributed to the initiation of what could become the “Canadian Asthma and COPD Campaign”, aimed at improving care and, hence, the quality of life of those suffering from these diseases.It is hoped that this event will be followed by other meetings that focus on how to improve the transfer of key recommendations from evidence-based guidelines into current care, and how to stimulate research to accomplish this.

Clinical tools to enhance survivorship cancer.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 245-245
Author(s):  
Katherine Ramsey Gilmore ◽  
Guadalupe R. Palos ◽  
Paula A. Lewis-Patterson ◽  
Patricia Chapman ◽  
Delrose Jones ◽  
...  
Keyword(s):  
Primary Care Providers ◽  
Cancer Site ◽  
Cancer Center ◽  
Survivorship Care ◽  
Care Providers ◽  
Patient Centered ◽  
Treatment Pathways ◽  
Health Maintenance ◽  
Care Plans ◽  
Clinical Tools

245 Background: Clear patient-centered recommendations for follow-up and health maintenance is a primary goal of ASCO’s model for survivorship and palliative care. The Commission on Cancer also sought to improve the quality of survivorship care by requiring accredited programs to implement survivorship care plans (SCPs) and treatment summaries by 2015. Our aim is to describe the SCP's components and metrics collected in 12 survivorship clinics of an academic cancer center. Methods: A multidisciplinary team was convened to develop clinical practice tools to guide providers on transitioning patients to a survivorship clinic. These tools were based on 4 IOM's domains: surveillance, risk reduction, late effects management, and emotional function.Algorithms are supported with a Passport Plan for Health (Passport) specifically designed for each disease. These clinical tools allowed clinicians to provide recommendations for each survivor. Tools were electronically available to survivors and their primary care providers. Descriptive statistics were used to summarize metrics in this analysis. Results: To date, 44 cancer-site specific algorithms and 19 Passports have been launched and used by clinicians in 12 survivorship clinics.Metrics collected are: a) number of Passports completed, b) providers’ completion of SCPs, and c) dates with counseling recommendations outlined in the treatment pathways. Since FY08, 25,912 Passports were distributed to 13,105 survivors. In FY14, 6,160 Passports were issued (80.7% provider completion rate). Passport completion varied by provider (7%-97%). Survivors were counseled for recommendations related to colonoscopy (97% of the time), skin screening (98%), mammogram (97%), gynecological screening (95%), and prostate screening (74%). Conclusions: Algorithms and SCPs serve as clinical tools to help providers and survivors manage physical and emotional issues. These tools increase standardization in the delivery of survivorship care, safety, quality, and promote communication among survivors and providers across clinical settings.

Implementation of survivorship care plans in the pediatric oncology clinic.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 55-55 ◽  
Author(s):  
Christine Moore Smith ◽  
Barron L. Patterson ◽  
Debra L. Friedman
Keyword(s):  
Pediatric Oncology ◽  
Standard Of Care ◽  
Primary Care Providers ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Survivorship Care ◽  
Care Providers ◽  
Care Plans

55 Background: Quality survivorship care and follow up have been well described in the pediatric oncology population to improve overall health of cancer survivors. Typically, a key component is the delivery of a survivorship care plan (SCP) in a dedicated survivorship program. Creation of an SCP in the immediate post-treatment period has not been commonly adopted. To address the Commission on Cancer's (CoC) requirement to provide SCPs within six months of ending therapy, our pediatric oncology clinic has used quality improvement (QI) methods to incorporate SCPs into clinic workflow with subsequent survivorship program referral. Our aim is to meet the CoC’s benchmark of 50% of eligible patients receiving SCPs by December 31, 2017. Our secondary goal is to improve the timeliness of delivery to patients, families, and primary care providers (PCP). Methods: Registry data from our cancer center was utilized to identify eligible patients. Upcoming appointments were then identified for a panel of eligible patients using the electronic medical record (EMR). Providers use a standardized SCP template which includes the components required by the CoC. The SCP is then reviewed with families, electronically sent to the PCP, and saved in the EMR. Evaluation of the process included subjective feedback from providers and Plan-Do-Study-Act cycles. Based on this feedback and cycles, iterations of the template have been progressively streamlined and the EMR panel has been updated. Results: Care plan creation and delivery is ongoing. At baseline, 28% of eligible patients had SCPs previously created in the survivorship program. After implementation of our QI methods, to date, we have increased the proportion of eligible patients with an SCP to 40.3%, approaching our goal of 50% by December 31, 2017. We have also decreased the time from end of therapy to delivery of a care plan from 22.9 months to 14 months. This is expected to further improve as the process continues. Conclusions: The QI process has been successful in implementing a new standard of care for delivery of SCPs. Ongoing use of QI methods will increase compliance with the CoC standards and result in improved survivorship care.

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