Timing is everything: Improving the frequency, timeliness, and effectiveness of goals of care conversations for oncology patients in Manitoba.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 4-4
Author(s):  
Tara Carpenter-Kellett ◽  
Joel Roger Gingerich ◽  
Piotr Czaykowski ◽  
Alissa Loader ◽  
Oliver Bucher
Keyword(s):  
Curriculum Implementation ◽  
Significant Proportion ◽  
Stage Iv ◽  
Clinic Visit ◽  
Cancer Center ◽  
Clinical Workflow ◽  
Patient Centered ◽  
Chi Square ◽  
Centered Care ◽  
The Difference

4 Background: Advanced care planning (ACP) in oncology requires effective communication and coordination. Early and regular ACP discussions are endorsed by ESMO and can help facilitate quality, patient-centered care. Methods: An ACP curriculum was created at CancerCare Manitoba that included health care provider (HCP) engagement, HCP and patient education, improved ACP clinical workflow, and improved ease of ACP documentation in the medical record. We evaluated the occurrence and frequency of ACP discussions before implementation of the ACP curriculum using a random sample of 100 adult patients diagnosed with stage IV solid tumors in Manitoba, Canada during 2014. We compared this group to a similar group of patients from 2017 after ACP curriculum implementation. Differences between the two cohorts were tested using Chi-square and Fisher’s Exact tests. The time from a patient’s first clinic visit with an oncologist to their first ACP conversation was described using cumulative incidence curves with K-sample tests used to test for significant differences between the 2014 and 2017 cohorts. Results: Of the 200 patients selected, 153 were assessed at our provincial cancer center (76 in 2014 and 77 in 2017). The median age for this group was 68. 59% were male. 56% received at least 1 line of chemotherapy. ACP documentation increased from 29% in 2014 to 42% in 2017 (p = 0.10). Between 2014 and 2017, initial ACP discussions occurred at: Initial visit (18% vs. 41%), disease progression (27% vs. 31%) and referral to palliative care (55% vs. 28%). After curriculum implementation ACP documentation occurred earlier in the patient’s cancer journey (p = 0.04). Conclusions: After implementation of an ACP curriculum at our cancer center, ACP discussions occurred more often and earlier, but the difference was only significant for earlier ACP discussions. Even after ACP curriculum implementation, a significant proportion of patients did not have ACP documented in their patient record. Understanding and overcoming barriers related to ACP at our institution will be critical for further ACP documentation improvement.

“How I kept track of it of course was my business”: Cancer patient self-monitoring as self-stylized work

2013 ◽  
Vol 12 (5) ◽  
pp. 355-361 ◽  
Author(s):  
Carol J. Hermansen-Kobulnicky ◽  
Mary Anne Purtzer
Keyword(s):  
Cancer Patient ◽  
Cancer Patients ◽  
Cancer Center ◽  
Structured Interviews ◽  
Patient Centered ◽  
Work Lives ◽  
Self Monitoring ◽  
Centered Care ◽  
Cancer Experience ◽  
Present Opportunity

AbstractObjectives:Self-monitoring behaviors of cancer patients benefit patients, caregivers, and providers, and yet the phenomenon of self-monitoring from the cancer-patient perspective has not been studied. We examined cancer patients' self-monitoring preferences and practices, focusing on the meaning of self-monitoring within the cancer experience.Methods:Semi-structured interviews were conducted among adult cancer patients who had been seen at least once at a rural United States cancer center. Questions sought out the meaning of self-monitoring and its practical aspects. Qualitative data were analyzed by adapting the four-stepped method by Giorgi for empirical phenomenological analysis.Results:Twenty participants were interviewed (11 women and 9 men). Transcribed interviews revealed that cancer patient self-monitoring is self-stylized work that ranges from simple to complex, while being both idiosyncratic and routine. Participants reported using tools with systems for use that fit their distinctive lives for the purpose of understanding and using information they deemed to be important in their cancer care. Three conceptual categories were discerned from the data that help to elucidate this self-stylized work as fitting their individual priorities and preferences, reflecting their identities, and being born of their work lives.Significance of results:Findings highlight patients' unique self-monitoring preferences and practices, calling into question the assumption that the sole use of standardized tools are the most effective approach to engaging patients in this practice. Self-monitoring efforts can be validated when providers welcome or adapt to patients' self-stylized tools and systems. Doing so may present opportunity for improved communications and patient-centered care.

scholarly journals Is Telemedicine Suited for Lower Extremity Pathologies? An Analysis of Non-Urgent Follow-Up in a Foot and Ankle Practice

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
Wesley J. Manz ◽  
Rahul Goel ◽  
Omolola Fakunle ◽  
Sameh A. Labib ◽  
Jason T. Bariteau
Keyword(s):  
Patient Satisfaction ◽  
Clinic Visit ◽  
Continuous Data ◽  
Clinical Approach ◽  
Foot And Ankle ◽  
Office Visits ◽  
Chi Square ◽  
Fracture Care ◽  
Patient Reported ◽  
The Difference

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: A lack of access to care is predictably associated with negative outcomes in foot and ankle surgery. Despite recent advances in telecommunication technologies, the field of orthopaedics has been slow to adopt these resources in offsetting barriers to care. The COVID-19 pandemic has forced departments to change their clinical approach, lending unprecedented opportunity to better understand how telehealth may bridge this care gap in foot and ankle practices. The purpose of this study was to assess patient-reported outcomes of telemedicine encounters, including comfort and patient satisfaction. Our hypothesis was that patients would be significantly less satisfied with telemedicine when compared to in-office appointments for all non-emergent visit types. Methods: Retrospective analysis of patients seen via telemedicine between April 13, 2020, to June 19, 2020, by one surgeon in the Emory Orthopedics Foot and Ankle department was conducted. Patients were contacted by one of the study authors via telephone to complete a questionnaire; satisfaction and other visit characteristics were assessed with a modified Likert scale from 1 to 5. Patients were designated as either ‘New’ or ‘Established’ based on whether or not they had completed an in-office clinic visit within the last year. Anatomy and pathology of disorder were determined by chief complaint and billing code. Patient demographics were recorded, and data were analyzed using paired and independent t-tests for parametric continuous data, Fisher’s exact and chi-square tests for non-continuous data. Results: 338 eligible patients were contacted via telephone, with 216 (63.9%) completing the telemedicine questionnaire. The patient cohort had an average age of 50.6 (19-84) years old and was 73.6% female (n=159). Overall mean satisfaction for telemedicine visits (4.69) was significantly lower than in-office visits (4.86) (p<0.001). In a subgroup analysis of patient satisfaction, patients seeking fracture care had significantly higher telemedicine satisfaction when compared to those receiving non-fracture care (4.90 vs. 4.64, p=0.001). Telemedicine satisfaction was also significantly greater in patients traveling more than 50 miles from their home to clinic (4.96 vs. 4.67, p<0.001). Patients with median household income less than the Georgia state median ($55,679) were more satisfied with their telemedicine visits than those with greater income, though the difference was non-significant. Conclusion: our data suggest those with significantly hindered mobility such as increased distance from clinic, lower socioeconomic status, and those seeking care for fractures had higher telemedicine satisfaction than their peers. Further study is needed to detail the precise and safe use of telemedicine in practice, but these data illuminate the high ceiling telemedicine offers in expanding patient care. Our hope is that this study aids as a supportive rationale for the continued use of telehealth visits past the period of the pandemic and encourages a more nuanced view of what visit types may be best-suited for telehealthcare

Expectations of cancer patients about clinical trials in multidisciplinary clinics

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17563-e17563
Author(s):  
G. H. Kloecker ◽  
M. Janjua ◽  
J. Day ◽  
D. Lee
Keyword(s):  
Clinical Trials ◽  
Cancer Patients ◽  
Effective Interaction ◽  
Management Plan ◽  
Clinic Visit ◽  
Cancer Center ◽  
Academic Settings ◽  
The Difference ◽  
Multidisciplinary Conference ◽  
Multidisciplinary Clinics

e17563 Background: Progress in cancer treatment is very much dependent on the effective interaction of several specialties. To facilitate the process, more and more multidisciplinary clinics have been created over the last decade, especially in academic settings. This approach has been more established in the academic setting to help facilitate better patient accrual to clinical trials. Although there are studies confirming the effectiveness of this approach in fulfilling practice guidelines, there is however no study of patients’ expectations at a multidisciplinary clinic, especially in regard to the patients’ attitude towards clinical trials. This study examines patients’ preferences for services offered in an academic Methods: Surveys were handed to patients at the time of the first clinic visit and at time of progressive disease. The surveys were designed as a self directed questionnaire with the following questions that were rated on an ordinate scale from not at all important (score 1) to extremely important value (score 7): to see all doctors the same day; to be treated at a university-based cancer center; to have everything completely explained; to have the first appointment within 10 days; to know your cases will be discussed at conference; to have help with transportation and medical costs; and to participate in clinical trials. Results: 94 patients were surveyed at the GI and Thoracic Multimodality Clinic. Among patients the highest preference was “to have every thing explained,” score 6.7 (6.5–7.0, CI), immediately followed by the discussion at the multidisciplinary conference, score 6.6 (6.5–6.8, CI). Clinical trials ranked lowest, score 4.8 (4.4–5.2,CI). The difference was statistically significant, p = 0.012. There was no difference between GI and Thoracic Multimodality Clinic patients. Patients with progressive cancers showed a slightly higher interest in clinical trials, but still ranking trials below most other services. Conclusions: Patients value complete explanations of the disease and management plan far more than they value clinical trials. Considering that nationwide less than 5% of cancer patients are enrolled in clinical studies, it is important for physicians to explain the merit of clinical trials to patients and public. No significant financial relationships to disclose.

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.

scholarly journals Advancing Health Equity During the COVID-19 Pandemic through Digital Medical Interpretation Platforms

2021 ◽  
Author(s):  
Nazia Sharfuddin ◽  
Pamela Mathura ◽  
Emily Ling ◽  
Ellen Bruseker ◽  
Areej Rajeh ◽  
...  
Keyword(s):  
Health Equity ◽  
Clinical Assessment ◽  
Limited English Proficiency ◽  
Healthcare Providers ◽  
Accurate Information ◽  
Clinical Workflow ◽  
Patient Centered ◽  
Medical Interpretation ◽  
Centered Care ◽  
Improving Accuracy

Abstract Background: Medical Interpretation Services (MIS) is the gold-standard that should be used during clinical assessments with patients who have limited English proficiency (LEP) or have hearing loss. The COVID-19 pandemic has highlighted the urgent need for clear, concise medical communication between patients and clinicians to prevent the spread of COVID-19 and ensure public safety. Cost of MIS is covered by the provincial health authority in Alberta; however, it is not consistently utilized across the province.Aim: To implement digital MIS in the Emergency Department (ED) of one urban teaching hospital, improving accuracy of clinical assessment and to provide patient-centered communication. Methods: Applying quality improvement methodology, an intervention comprised of digital MIS technology and education was trialed for 6 months. To assess intervention effect, the number of MIS minutes and calls were measured monthly and a questionnaire was developed and administered to determine ED healthcare providers’ awareness, technology accessibility and perception of MIS integration into the clinical workflow. Results: Digital MIS was utilized consistently in the ED from the beginning of the COVID-19 pandemic (March 2020) and over the subsequent six months. The cost avoidance due to digital MIS usage was estimated to be $19,612.16. ED healthcare providers indicated that digital MIS helped smooth communication with patients and reduced the time it took to gather and provide accurate information. Conclusion: Providing digital MIS access, education and training is a means to advance health equity, by improving accuracy of clinical assessment and patient-centered care in the ED.

Assessing patient values first: Creating a platform for advance care planning (ACP) in the adult oncology population.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 99-99
Author(s):  
Sabrina Q. Mikan ◽  
Cynthia Taniguchi ◽  
J. Russell Hoverman ◽  
Susan Ash-Lee ◽  
Deb Harrison ◽  
...  
Keyword(s):  
Metastatic Cancer ◽  
Healthcare Providers ◽  
Cancer Center ◽  
Extensive Literature ◽  
Major Step ◽  
Patient Centered ◽  
Cross Sectional ◽  
Centered Care ◽  
Patient Values ◽  
Eol Care

99 Background: Patients, families and healthcare providers can be apprehensive about having end-of-life (EOL) conversations. However, asking patients about personal values regarding their healthcare goals may create a platform for more in depth conversations. A quantitative instrument to assess patient values and ACP readiness was developed and validated to complement a process for identifying patients appropriate for ACP. Methods: Recruitment was conducted at seven cancer center sites in The US Oncology Network over a 90-day pilot study period. Of 871 identified patients, 301 Texas Oncology patients engaged in ACP. A cross-sectional descriptive design was used in 301 metastatic cancer patients. Sixty-three participants completed the questionnaire. The 13-item instrument was created after an extensive literature review regarding EOL choices and interventions using a 5-point Likert scale. Descriptive statistics were examined, in addition to analysis of the relationships between items using Pearson’s r correlations. Results: Participants were primarily female (59%) and Caucasian (95%); with a mean age of 66 years. Sixty-eight percent reported it "Very Important" to be told they were dying. There was a significant association between willingness to discuss feelings about dying and being told by their physician when dying, (r= 0.373, p<0.01). Sixty-two percent reported it "Very Important" to be able to choose their EOL care location. EOL care location and level of burden for caregivers were significantly associated (r= 0.315, p<0.05). Also, 76% reported being able to select the person who makes EOL decisions for them as "Very Important." Conclusions: Recent studies have shown the importance of assessment of patient healthcare values in the metastatic oncology population. The values and readiness instrument allows healthcare providers to understand the patient’s wishes early in the course of care. ACP can be guided through review of the validated instrument in the adult metastatic population. This provides appropriate weight to both sides of the care equation and is a major step toward creating patient-centered care. Further development of the instrument is needed in this population.

scholarly journals Evaluation of PCMH Model Adoption on Teamwork and Impact on Patient Access and Safety

2016 ◽  
Vol 8 (2) ◽  
pp. 77-82 ◽  
Author(s):  
Niharika Khanna ◽  
Fadia T. Shaya ◽  
Priyanka Gaitonde ◽  
Andrea Abiamiri ◽  
Ben Steffen ◽  
...  
Keyword(s):  
Relevant Information ◽  
Patient Access ◽  
Learning Collaborative ◽  
Patient Centered ◽  
Chi Square ◽  
Significant Difference ◽  
Chi Square Test ◽  
The Difference ◽  
Strongly Agree ◽  
The Impact

Purpose: Each of the participating patient-centered medical home (PCMH) received coaching and participated in learning collaborative for improving teamwork. The objective of the study was to assess the impact of trainings on patient-centered teamwork. Methods: The Teamwork Perception Questionnaire (TPQ) was administered once in spring 2014 and then in fall 2015. The TPQ consists of 35 questions across 5 domains: mutual support, situation monitoring, communication, team structure, and leadership. Based on our objective we compared the frequencies of strongly agree/agree by domain. The difference was tested using chi-square test. We compared the scores on each domain (strongly agree/agree = 1; maximum score = 7) via Wilcoxon rank sum test. Results: The response rate for this survey was n = 29 (80.6%) in spring 2014, and n = 31 (86.1%) in fall 2015. We found that the practice members significantly ( P < .05) strongly agreed/agreed more in fall 2015 than spring 2014 for characteristics—“staff relay relevant information in a timely manner” (64.5% vs 83.9%) and “staff follow a standardized method of sharing information when handing off patients” (67.7% vs 90.3%) under communication domain and for characteristic—“staff within my practice share information that enables timely decision making” (74.2% vs 90.3%). However, there was no statistical significant difference observed in the scores for the overall TPQ at the 2 time points. Conclusion: Despite the statistical insignificance, the observations in PCMHs across the spectrum of practices participating in the Maryland Multi-Payer Program demonstrated enhanced teamwork specifically in communication and in leadership. This we believe will continue to result in enhanced patient access to care and safety.

Abstract P299: Heart Brain Clinic: Integrated Management of Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Muhammad Bilal Tariq ◽  
Kathleen Tulod ◽  
Anjail Z Sharrief ◽  
Abhijeet Dhoble ◽  
Sidhanta Gurung ◽  
...  
Keyword(s):  
Integrated Management ◽  
Routine Care ◽  
Outpatient Setting ◽  
Patient Centered ◽  
Chi Square ◽  
Chi Square Test ◽  
The Difference ◽  
Undetermined Etiology ◽  
Pfo Closure ◽  
Clinic Visits

Background: About 25% of acute ischemic strokes (IS) are categorized into stroke of undetermined etiology and many ultimately have a cardiac source for stroke. Neurologists and cardiologists can improve decision making, as has been shown with other multidisciplinary clinics. We report our experience in creating our Heart Brain Clinic (HBC) with a focus on patients with patent foramen ovale (PFO). Methods: Demographic and clinical data were collected retrospectively for patients with PFO evaluated for IS in the inpatient or outpatient setting. Patients were divided into routine care and HBC groups. We compared time from stroke to PFO closure and number of clinic visits prior to decision about closure. Nonparametric analysis was used to calculate difference between medians, while chi square test was used for categorical values. Results: HBC began in 12/2018 with coordination of administrative and staffing efforts between neurology and cardiology departments. From 2/17 to 7/20, 73 patients were evaluated for PFO (42 routine care, 31 HBC; Table 1). At the time of data analysis, 67 patients had received recommendations about PFO closure and 52 patients underwent PFO closure. More than 50% of all patients traveled from outside Houston. HBC patients required fewer clinic visits (p=0.023) prior to decision about closure; however, in patients who underwent PFO closure, there was no difference in weeks from stroke to closure. Patients seen in HBC were recommended to not undergo closure more often than routine care (p= 0.007) Conclusions: Our data demonstrates that a multidisciplinary, patient-centered approach to management of IS patients with PFO is feasible and may improve the quality of care in this younger patient population. The difference in recommendation to not pursue PFO closure between groups may reflect selection and referral bias. Additional work is needed to determine whether this approach improves other aspects of healthcare.

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.

Screening for cancer-related distress among women with newly diagnosed breast cancer (BC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 567-567
Author(s):  
Lauren Z. Rynar ◽  
Kristen B. Wendell ◽  
Patricia B. Mumby ◽  
Kathy S. Albain ◽  
Patricia A. Robinson ◽  
...  
Keyword(s):  
Screening Tool ◽  
Early Stage ◽  
Stage Iv ◽  
Cancer Staging ◽  
Cancer Center ◽  
Comprehensive Treatment ◽  
Poor Sleep ◽  
Newly Diagnosed ◽  
Chi Square ◽  
Supportive Oncology

567 Background: The Loyola University Chicago Cardinal Bernardin Cancer Center multidisciplinary Breast Oncology Center evaluates new patients (pts) for cancer-related distress using a needs-based screening tool, in accordance with Commission on Cancer (CoC) Standard 3.2. Identifying distress among newly diagnosed pre-surgical and pre-neoadjuvant pts allows for comprehensive treatment planning and establishment of a baseline for repeated assessments. Methods: Pts with newly diagnosed BC between May 2017 and June 2018 completed the “Patient Screening Questions for Supportive Care” (Coleman Supportive Oncology Collaborative, 2017), a consolidated screening tool based on validated instruments (NCCN Distress, PHQ-4, PROMIS), prior to initial provider visit. Cancer staging, demographics, and supportive oncology referrals were obtained from medical records. Descriptive statistics and chi-square were used. Results: 100 pts aged 30-94 (mean(SD) = 61.56(12.03)) completed the screening tool; 14.9% had Stage 0, 43.6% Stage I, 34.0% Stage II, 3.2% Stage III, and 4.3% Stage IV disease. 39% of pts screened positive for anxiety on the PHQ-4, and over 20% for depression. Anxiety was associated with cancer stage ( X2(df) = 12.20(4), p = .016). The most common practical concerns included living alone (19%), issues with work/school (16%), and paying for medical care (12%). Common physical concerns included difficulty with sleep (40%) and concentration/memory (17%), and tingling hands or feet (14%). Poor sleep was associated with depression ( X2(df) = 6.50(1), p = .011) and anxiety ( X2(df) = 7.17(1), p < .01). 57.7% reported at least "a little bit" of fatigue and 17.7% reported moderate to very severe pain. Nearly all pts wanted to better understand their diagnosis (87.8%), prognosis (87.8%), or treatment (91.8%). Conclusions: Pts with newly diagnosed, early stage BC experience high levels of physical and emotional distress at the earliest point in the treatment trajectory. This study captures BC patients at a unique time point and provides support for conducting routine screening for supportive oncology needs at initiation of care. Further studies should reassess needs sequentially to determine changes across the care continuum.

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