Implementation and dissemination of a shared mental model of palliative oncology.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 58-58
Author(s):  
Sarah F. D'Ambruoso ◽  
John A. Glaspy ◽  
Neil Wenger ◽  
Christopher Pietras ◽  
Kauser Ahmed ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Mental Model ◽  
Care Delivery ◽  
Communication Training ◽  
Audit And Feedback ◽  
Goals Of Care ◽  
Shared Mental Model ◽  
Early Integration ◽  
Referral Rates ◽  
The Impact

58 Background: American Society of Clinical Oncology guidelines support early integration of palliative care (PC) into standard oncology practice; however, little is known as to whether improved outcomes can be achieved by modifying health care delivery and training oncology providers. Methods: We report our five year experience of embedding a nurse practitioner (NP) in an oncology clinic (March 2014-March 2019) to develop a shared mental model (SMM) of early, concurrent advance care planning (ACP) and PC as well as the collaborative effort to further disseminate this SMM throughout the Division of Hematology-Oncology using communication training, quality measurement, audit and feedback, leadership support, and monthly collaborative meetings. We developed PC quality metrics (process measures and end of life utilization measures) using a validated advanced cancer denominator. We used these measures to evaluate the impact of the PC-NP program (2014-2019) and provide individualized metric packets to each oncologist in the context of an annual half-day interactive communication training sessions (1-hr didactic, 3-hr small group role-play) each spring and monthly implementation team meetings from 2017-2019. Results: Compared to patients with advanced cancer not seen by the PC-NP program, patients who are enrolled in the program have higher rates of goals of care note documentation (80% vs. 17%, p < 0.01), higher rates of Physician Orders for Life Sustaining Treatment (POLST) completion (19% vs. 5%, p < 0.01), higher referral rates to the psychosocial oncology program (51% vs. 25%, p < 0.01), and higher referral rates to hospice (60% vs. 33%, p < 0.01). Among decedents, there was less hospital use (12 vs. 18 days) and ICU use (1.5 vs. 2.6 days) in the last 6 months of life. Since spring 2017, 19/21 NP’s, 64/68 physicians, and 17/20 fellows have participated in communication training. Among all patients with advanced cancer, goals of care note documentation has improved from 3% in March 2014 to 21% in March 2019. Conclusions: Embedding a trained PC-NP in oncology clinics to deliver upstream PC to patients on active treatment can lead to opportunities for development and dissemination of a SMM that translates into better primary and specialist PC.

Technology-Mediated Collaboration, Shared Mental Model and Task Performance

2012 ◽  
Vol 24 (1) ◽  
pp. 64-81 ◽  
Author(s):  
Hayward P. Andres
Keyword(s):  
Social Influence ◽  
Direct Observation ◽  
Mental Model ◽  
Social Impact ◽  
Model Development ◽  
Research Approach ◽  
Team Process ◽  
Shared Mental Model ◽  
Team Productivity ◽  
The Impact

This study takes a direct observation research approach to examine how the impact of collaboration mode on team productivity and process satisfaction is mediated by shared mental model. Team cognition and social impact theories are integrated to provide a framework for explaining how technology-mediated collaboration constrains or enhances team shared mental model development and its subsequent impact on task outcomes. Partial least squares analysis revealed that technology-mediated collaboration impacts shared mental model development. The results also demonstrate that timely and accurate development of shared mental model facilitates increases in both productivity and team process satisfaction. Direct observation of team process behaviors suggests that collaboration modes differ not only in their impact on communication facilitation but efficacy-based, motivational, and social influence factors (e.g., self-efficacy and team-efficacy, perceived salience and credibility of contributions, social influence on action, etc.) as well. Shared mental model development requires quality communication among team members that are motivated to participate by a positive team climate that promotes idea convergence.

scholarly journals DISCORDANCE IN GOALS OF CARE BETWEEN PATIENTS WITH ADVANCED CANCER AND THEIR CAREGIVERS: DOES AGE PLAY A ROLE?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S54-S54
Author(s):  
Amy R Lipson ◽  
Sara Douglas
Keyword(s):  
Quality Of Life ◽  
Advanced Cancer ◽  
Visual Analog Scale ◽  
Treatment Decisions ◽  
Analog Scale ◽  
Goals Of Care ◽  
The Impact

Abstract Cancer is considered a family disease as the caregivers (CG’s) role extends beyond providing care as they can also help facilitate treatment decisions. While much has been reported in the literature about patient (PT) goals of care (GoC), little is known about discordance between PT and CG GoC and the impact of PT age. The variables of interest were PT and CG identified GoC using a 100-point visual analog scale (VAS) with anchors of quality of life (0) and survival (100). Discordance was defined as a &gt; 40 point difference on the VAS. The GoC data reported here were those obtained at enrollment and prior to subject’s death. A sample of 235 PTs and CGs of PTs diagnosed with advanced cancers were included in the study. Mean age for the PTs was 64.7 (SD=10.5, range =21-88) with 54% being &gt; 65. At enrollment, 28.7% of the PT-CG pairs of those PTs 65 years (X2 (1)=1.06, p=.304). At death, 61.8% (X2 (1)=31.04 &lt;.001, Φ=.49) with discord at enrollment had discord at death. For patients who were older, 66.7% who had discord at enrollment also had discord at death and for patients

Integrating Concurrent Palliative Care into Cancer Care Delivery Settings

2018 ◽  
Author(s):  
Meagan Whisenant ◽  
Kathi Mooney
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Care Delivery ◽  
Scale Up ◽  
Fee For Service ◽  
National Guidelines ◽  
Reimbursement Mechanisms ◽  
Early Integration ◽  
Home Based

This case study reviews the evidence for adoption of concurrent palliative care (CPC) during treatment for advanced cancer. Increasing research evidence and expert panel consensus has resulted in national guidelines and professional society endorsement of early integration of palliative care into oncology care. However, there is variable uptake of these guidelines and penetration of CPC into practice. Barriers to implementation include the need to increase awareness of existing evidence and guidelines, stigma, adequacy of a workforce for scale-up, lack of models for integration and delivery, and restrictive reimbursement mechanisms. Changing health care models that emphasize value-based care over fee-for-service can accelerate adoption. Use of technology can also overcome barriers related to scalability and resource use. The case study concludes with the recommendation that implementation science methodologies be used to guide successful integration of CPC in outpatient and home-based settings for patients with advanced cancer and their family caregivers.

Does coaching goals of care discussion skills make a difference?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6586-6586
Author(s):  
Nina A. Bickell ◽  
Kerin B. Adelson ◽  
Jason Parker Gonsky ◽  
Sofya Pintova ◽  
Benjamin Philip Levy ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Communication Skills ◽  
Skills Training ◽  
Cancer Prognosis ◽  
Advanced Cancer Patients ◽  
Goals Of Care ◽  
Coaching Model ◽  
Model C ◽  
The Impact

6586 Background: Advanced cancer patients often have a poor understanding of their cancer prognosis. Goals of Care (GoC) discussions provide information about the cancer, its treatment & prognosis and elicit patient values. Little is known about the best ways to enhance patient understanding, clarify values and move GoC discussions earlier in the disease process. We report the effect of coaching oncologists on GoC discussions. Methods: We recruited oncologists & their advanced cancer patients with < 2 year prognosis to a RCT testing a coaching model communication skills training. Patients were surveyed after their post-imaging visit. We define GoC discussions as patient report that their doctor talked about their cancer prognosis and clarified things most important to them given their disease. Outcome variables assess the impact of GoC on patients’ knowledge on what to expect and clarity of values. Results: We enrolled 22/25 (88%) oncologists and 70% of eligible patients of whom 96 (55%) completed a survey. On average, doctors were 44 yrs old (32-66) and in practice 14.5 yrs (5-40). Patients’ mean age was 62 yrs (20-95), 40% females, 58% white, 24% Latino & 22 % black. Overall, 2/3 of patients reported their treatment’s goal was to cure their cancer; 14% reported cure to be unlikely. Patients felt more knowledgeable (79% vs 21%; p = 0.02) when their doctors discussed treatments, side effects & quality of life. When patients were asked about things important to them, they report being a bit clearer about their values (65% vs 35%; p = 0.16). Compared to controls, intervention patients felt more knowledgeable (78% v 63%; p = 0.17) but did not feel clearer about their values (60% v 54%; p = 0.59). Multivariate modeling found that poor health literacy (OR = 0.2; 95%CI: 0.07-0.82), having a GoC discussion (OR = 10.2; 1.7-63.1) and being in the intervention group (OR = 8.8; 1.4-55.2) significantly affected knowledge (model c = 0.88; p < 0.01). However, discussing what’s important to patients did not help patients feel clearer about their values (OR = 2.7; 0.6-12.2; model c = 0.82; p < 0.05). Conclusions: Using a coaching model to teach oncologists communication skills may improve patients’ understanding of what to expect with their cancer but does not impact their clarity of values. Clinical trial information: NCT02374255.

Does oncologist productivity impact goals of care discussions?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21675-e21675
Author(s):  
Sofya Pintova ◽  
Cardinale B. Smith ◽  
Kerin B. Adelson ◽  
Jason Parker Gonsky ◽  
Natalia Egorova ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Skills Training ◽  
Study Patient ◽  
Advanced Cancer Patients ◽  
High Quality ◽  
Goals Of Care ◽  
Imaging Results ◽  
Time Required ◽  
The Impact

e21675 Background: Oncologists are pressed to care for higher volumes of advanced cancer patients. Interviews with oncologists revealed their concern that goals of care (GoC) discussions take time. We studied the impact of oncologists’ productivity on their conduct of meaningful GOC discussions with patients. Methods: At academic, municipal and rural hospitals, we recruited & randomized solid tumor oncologists & their newly diagnosed advanced cancer patients with <2 year prognosis to participate in a RCT testing a coaching model of communication skills training. All oncologists were encouraged to have GoC discussions at the visit after imaging to restage. Patients are surveyed after that post-imaging visit. We define GoC discussions as patient report that their doctor talked about preferences for cancer treatment and clarified things most important to them given their illness. We measure quality of GoC discussions by patients’ rating. Productivity was measured by work revenue value units (wRVUs) per hour for the day each oncologist saw the study patient post-imaging. Results: We enrolled 22/25 oncologists (88%); to date 77 patients completed surveys. Productivity did not vary significantly by hospital though oncologists generated greater wRVUs at the municipal hospital (p=0.2203). Overall, 36% of patients report having a high quality GoC discussion. There was no significant relationship between level of productivity and conduct of high quality GoC discussion. Multivariate model controlling for hospital and intervention found no relationship between productivity and conduct of high quality GoC discussion. Conclusions: Despite concerns about the time required to conduct GoC discussions, we found that productivity did not affect oncologists’ ability to conduct high quality GoC discussions nor did conduct of a GoC reduce productivity. The prevalence of high quality GoC discussions was low. [Table: see text]

Evolving Goals of Care Discussions as Described in Interviews With Individuals With Advanced Cancer and Oncology and Palliative Care Teams

2020 ◽  
pp. 104990912096920
Author(s):  
Ellis C. Dillon ◽  
Amy Meehan ◽  
Catherine Nasrallah ◽  
Steve Lai ◽  
Natalia Colocci ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advanced Cancer ◽  
Hospice Care ◽  
Depth Information ◽  
Goals Of Care ◽  
Early Integration ◽  
Team Members ◽  
Palliative Care Teams ◽  
Pain Symptoms

Background: Individuals with advanced cancer and their families have negative end-of-life experiences when the care they receive is not aligned with their values and preferences. Objective: To obtain in-depth information on how patients with advanced cancer and the oncology and palliative care (PC) clinicians who care for them discuss goals of care (GoC). Design: The research team conducted in-depth interviews and qualitative data analysis using open coding to identify how perspectives on GoC discussions vary by stage of illness, and experience with PC teams. Setting/Subjects: Twenty-five patients and 25 oncology and PC team members in a large multi-specialty group in Northern California. Results: At the time of diagnosis participants described having establishing GoC conversations about understanding the goal of treatment (e.g. to extend life), and prognosis (“How much time do I have?”). Patients whose disease progressed or pain/symptoms increased reported changing GoC conversations about stopping treatment, introducing hospice care, prognostic awareness, quality of life, advance care planning, and end-of-life planning. Participants believed in the fluidity of prognosis and preferences for prognostic communication varied. Patients appreciated how PC teams facilitated changing GoC conversations. Timing was challenging; some patients desired earlier conversations and PC involvement, others wanted to wait until things were “going downhill.” Conclusion: Patients and clinical teams acknowledged the complexity and importance of GoC conversations, and that PC teams enhanced conversations. The frequency, quality, and content of GoC conversations were shaped by patient receptivity, stage of illness, clinician attitudes and predispositions toward PC, and early integration of PC.

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