Key features to ensure sustainability of a tele-oncology program at a national cancer center.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13613-e13613
Author(s):  
Chevon Rariy ◽  
Lynn Truesdale ◽  
Jennifer Greenman ◽  
Julian C. Schink
Keyword(s):  
Patient Satisfaction ◽  
Hybrid Model ◽  
Symptom Management ◽  
Clinical Care ◽  
Effective Means ◽  
Use Cases ◽  
Cancer Center ◽  
Provider Education ◽  
Specialty Area ◽  
Satisfaction Rates

e13613 Background: Prior to COVID-19, there were few telehealth services offered in the oncology specialty area. During the pandemic, we at a national cancer center rapidly scaled our oncology telehealth program to meet the needs of our patients. At the peak of the pandemic, telehealth initially served as a risk-mitigation strategy providing continued care to our patients while socially distancing, yet additionally, we have embedded necessary processes in place to create a sustained a telehealth oncology program that encompasses a hybrid model including face to face visits augmented with telehealth visits, where appropriate. Here we describe the key telehealth program features that have enabled a national cancer center to evolve into a hybrid model of oncology care across its five geographically distinct hospitals. Methods: Transitioning into a sustainable hybrid telehealth model of care involves a foundation of clinical leadership and partnerships among multiple departments. The telehealth oncology program leaders collaborate with the operations, technology, finance, clinical care teams, and governance council to implement telehealth growth initiatives and nimbly troubleshoot and ameliorate issues. A concierge service provides telehealth readiness checks to ensure timely resolution of issues. Workflows are followed to standardize processes. Telehealth use-cases ensure patients who need on-site services keep their in-person appointments, allowing telehealth visits for symptom management to enhance patient outcomes. A provider education session includes training on telehealth technology and “webside manner” training to ensure we preserve the personal touch with our patients in each telehealth encounter. Program data is regularly collected and reviewed to track the program’s success and opportunities for improvement. Results: After the initial peak of telehealth visits driven by the COVID pandemic, we continue to see a sustained 10-fold increase in service volume versus Jan/Feb 2020. There were 25,328 total telehealth visits from Mar. 2020-Jan. 2021, 75 clinical trial visits between July-Dec. 2020, and 848 readiness check escalations from Nov. 2020-Dec. 2021. Service lines expanded from 2 to 33, including growing rural health partnerships and a home chemotherapy infusion model. Use-cases expanded to bridge to on-site care, rapid initial visits, preop/postop checks, symptom management, and surveillance. Press Ganey patient satisfaction rates are as high as 92% and 90% of providers reported overall satisfaction with the telehealth consultations. Conclusions: Our key program features have enabled the growth and success of our enterprise tele-oncology program. One of the most promising indicators of success is the positive provider and patient satisfaction rates. Telehealth provides an effective means to provide a bridge to onsite cancer care even for our complex oncology patients.

Psychology Staffing at Cancer Centers: Data From National Comprehensive Cancer Network Member Institutions

2020 ◽  
Vol 16 (11) ◽  
pp. e1343-e1354
Author(s):  
Laura Melton ◽  
Diana Krause ◽  
Jessica Sugalski
Keyword(s):  
National Comprehensive Cancer Network ◽  
Patient Care ◽  
Clinical Care ◽  
The United States ◽  
Direct Patient Care ◽  
Cancer Center ◽  
Network Member ◽  
Full Time ◽  
Cancer Centers ◽  
Cancer Network

PURPOSE: The field of psycho-oncology is relatively undeveloped, with little information existing regarding the use of psychologists at cancer centers. Comprising 30 leading cancer centers across the United States, the National Comprehensive Cancer Network (NCCN) set out to understand the trends in its Member Institutions. METHODS: The NCCN Best Practices Committee surveyed NCCN Member Institutions regarding their use of psychologists. The survey was administered electronically in the spring/summer of 2017. RESULTS: The survey was completed by 18 cancer centers. Across institutions, 94% have psychologists appointed to provide direct care to their cancer center patients. The number of licensed psychologist full-time equivalents (FTEs) on staff who provide direct patient care ranged from < 1.0 FTE (17%) to 17.0-17.9 FTEs (6%). Regarding psychologist appointments, 41% have both faculty and staff appointments, 41% have all faculty appointments, and 18% have all staff appointments. Forty-three percent of institutions indicated that some licensed psychologists at their centers (ranging from 1%-65%) do not provide any direct clinical care, and 57% indicated that all licensed psychologist on staff devote some amount of time to direct clinical care. The percent of clinical care time that is spent on direct clinical care ranged from 15%-90%. CONCLUSION: There is great variability in psychology staffing, academic appointments, and the amount of direct patient care provided by on-staff psychologists at cancer centers.

scholarly journals Development of a Surgical Video Atlas for Resident Education: 3-Year Experience

OTO Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. 2473974X2093906
Author(s):  
C. Scott Brown ◽  
Calhoun D. Cunningham ◽  
Walter T. Lee ◽  
Liana Puscas
Keyword(s):  
Operating Room ◽  
Teaching And Learning ◽  
Resident Education ◽  
Surgical Simulation ◽  
Clinical Care ◽  
Effective Means ◽  
The United States ◽  
Surgical Video ◽  
Key Indicator ◽  
Work Hour

Objective To create a high-quality annotated online surgical video atlas of key indicator otolaryngology cases and assess its use and overall journal trends over time. Methods Videos are recorded from multiple viewpoints within the operating room and compiled into a single stream. Postediting includes chaptering videos and overlaying relevant text annotations. Videos are published online and viewership trends analyzed. Results Over 3 years, 29 otolaryngology videos were published out of 161 journal publications (18%). Eight of the 14 key indicator procedures are included (57%). From the beginning of 2017 to the end of 2019, viewership of otolaryngology pages increased from 548 to 11,139 views per month, totaling >150,000 views. These now represent 10% of the total journal monthly views and 10% of the overall views. Users originate from the United States and from >10 other countries. Discussion Residents and faculty face challenges of providing the highest standard of clinical care, teaching, and learning in and out of the operating room. Inherent difficulties of surgical training, high-fidelity surgical simulation, and imposed work hour restrictions necessitate additional, more efficient and effective means of teaching and learning. Surgical videos demonstrating key anatomy, procedural steps, and surgical dexterity with hand positioning are increasing in their popularity among learners. Implications for Practice Surgical video atlases provide a unique adjunct for resident education. They are enduring and easily accessible. In a climate of work hour restrictions or elective case reduction, they may supplement how residents learn to operate outside the operating theater.

scholarly journals Study protocol for a randomised controlled feasibility trial of a virtual intervention (STRIDE) for symptom management, distress and adherence to adjuvant endocrine therapy after breast cancer

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041626
Author(s):  
Jamie M Jacobs ◽  
Chelsea S Rapoport ◽  
Arielle Horenstein ◽  
Madison Clay ◽  
Emily A Walsh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Symptom Management ◽  
Adjuvant Endocrine Therapy ◽  
Feasibility Trial ◽  
Cancer Center ◽  
Control Group ◽  
Evidence Based ◽  
Pill Bottle ◽  
Randomised Controlled

IntroductionPatient adherence to adjuvant endocrine therapy (AET) after a diagnosis of hormone-sensitive breast cancer is poor. Previous interventions have failed to produce changes in adherence, address patient preferences or include theoretically informed and evidence-based components. Therefore, we iteratively developed a patient-centred, evidence-based, small-group, videoconference intervention to improve adherence and symptom management as well as reduce distress for patients taking AET after breast cancer (Symptom-Targeted Randomised Intervention for Distress and Adherence to Adjuvant Endocrine Therapy, STRIDE).Methods and analysisThe current study is a non-blinded, randomised, controlled, feasibility trial of STRIDE compared with a medication monitoring control group. The primary objective is to examine the feasibility and acceptability of STRIDE, while secondary objectives are to assess changes in objective and subjective adherence, symptom distress and satisfaction with AET. Patients will be recruited from the Massachusetts General Hospital Cancer Center in Boston, Massachusetts. The total number of patients accrued will be 75, with ≥60 patients completing the study. All patients will store their AET in an electronic pill bottle for objective adherence monitoring. Patients randomly assigned to the STRIDE intervention will receive 6 weekly 1-hour sessions, in small groups of two, delivered via videoconferencing by a trained mental health professional. Patients assigned to the control group will store their medication in the electronic pill bottle and receive follow-up oncology care as usual. All participants will complete self-report psychosocial measures at baseline, 12 weeks and 24 weeks postbaseline.Ethics and disseminationThe study is funded by the National Cancer Institute of the National Institutes of Health and is approved by the Dana-Farber/Harvard Cancer Center Institutional Review Board (Protocol #18–603, V.1.2, first approval date 1 February 2019). The study will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials. Results will be published in peer-reviewed academic journals, presented at scientific meetings and disseminated to patient organisations and media outlets.Trial registration numberNCT03837496; Pre-results.

scholarly journals First Metatarsophalangeal Joint Arthrodesis

2018 ◽  
Vol 3 (3) ◽  
pp. 247301141775267 ◽  
Author(s):  
Paola Filomeno ◽  
Julio López
Keyword(s):  
Patient Satisfaction ◽  
Plate Fixation ◽  
Metatarsophalangeal Joint ◽  
Functional Improvement ◽  
Dorsal Plate ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Joint Fusion ◽  
Vas Scores ◽  
Satisfaction Rates

Background: First metatarsophalangeal (MTP) joint arthrodesis can be fixed using either a dorsal plate or crossed screws. However, there is considerable difference in the cost of these implants, and it is not known if there is sufficient difference in outcome that might justify this cost difference. Our aim was to compare the functional results and patient satisfaction rates after first MTP joint arthrodesis in a group of patients using the same surgical technique except for the fixation devices. Methods: A prospective cohort of 27 patients who underwent first MTP joint fusion by the same surgeon using 2 crossed screws or a single screw with a dorsal plate was recruited over a 3-year period. Demographic information, patient satisfaction rates, complications, and union rates were evaluated. American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scoring systems were used pre- and postoperatively to compare the functional outcomes. Thirty consecutive procedures (screws, n = 15; plate, n = 15) were performed. Age (55.8 ± 11.1 vs 63.3 ± 12.4 years for screws and plate respectively; P = .091) and female gender percentages (80% and 73%, P = .666) were similar between groups. Results: The overall union rate was 93% with no differences between groups. AOFAS and VAS scores improved significantly postoperatively for each technique, and no differences were found between the two in the improvement in AOFAS (42.4 ± 8.0 vs 44.3 ± 8.2, screws and plate respectively; P = .520) and VAS scores (66.0 ± 5.4 vs 69.0 ± 6.9; P = .195). The implant cost for screws was $40 and for dorsal plate, $328. Conclusions: First MTP joint fusion using either screws or plate fixation results in an improvement in AOFAS and VAS scores. Functional improvement and patient satisfaction did not differ between the 2 techniques, despite a considerable difference in cost between the two methods of fixation. Level of Evidence: Level III, prospective comparative study.

Challenging Conversations in Palliative Care

2018 ◽  
Author(s):  
Kimberson Tanco ◽  
Daniel Epner
Keyword(s):  
Palliative Care ◽  
Patient Satisfaction ◽  
Wide Spectrum ◽  
Clinical Care ◽  
Physician Communication ◽  
Critical Element ◽  
Medical Conditions ◽  
Sitting Posture ◽  
Routine Clinical Care ◽  
Communication Techniques

Palliative care specialists manage a variety of difficult medical and psychosocial situations across a wide spectrum of medical conditions. Patient–physician communication is a critical element for the provision of quality palliative care and improving patient satisfaction. It is essential for palliative care clinicians to be aware of the various challenging conversions they will encounter in their routine clinical care and to develop the necessary skill set to adequately address these. Several communication techniques, such as a sitting posture during a conversion, proper use of silence, listening, and recognizing emotional movements and responding to them, are important so as to improve clinical care for patients and their families.

Patient and Provider Perceptions of a Patient Navigation Program to Improve Postpartum Care Among Publicly Insured Women

2019 ◽  
Author(s):  
Fengling Hu ◽  
Angelina Strohbach ◽  
Noelle G. Martinez ◽  
Melissa A. Simon ◽  
Lynn M. Yee
Keyword(s):  
Patient Satisfaction ◽  
Low Income ◽  
Patient Navigation ◽  
Clinical Care ◽  
Comparative Method ◽  
Interpersonal Relationship ◽  
Program Satisfaction ◽  
Provider Perceptions ◽  
Navigation Program ◽  
Publicly Insured

Abstract Objective This study was aimed to assess patient and provider perceptions of a postpartum patient navigation program. Study Design This was a mixed-method assessment of a postpartum patient navigation program. Navigating New Motherhood (NNM) participants completed a follow-up survey including the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I) scale and an open-ended question. PSN-I scores were analyzed descriptively. Eighteen provider stakeholders underwent in-depth interviews to gauge program satisfaction, perceived outcomes, and ideas for improvement. Qualitative data were analyzed by the constant comparative method. Results In this population of low-income, minority women, participants (n = 166) were highly satisfied with NNM. The median PSN-I score was 45 out of 45 (interquartile range [IQR]: 43–45), where a higher score corresponds to higher satisfaction. Patient feedback was also highly positive, though a small number desired more navigator support. Provider stakeholders offered consistently positive program feedback, expressing satisfaction with NNM execution and outcomes. Provider stakeholders noted that navigators avoided inhibiting clinic workflow and eased clinic administrative burden. They perceived NNM improved multiple clinical and satisfaction outcomes. All provider stakeholders believed that NNM should be sustained long-term; suggestions for improvement were offered. Conclusion A postpartum patient navigation program can perceivably improve patient satisfaction, clinical care, and clinic workflow without burden to clinic providers.

scholarly journals Self-reported awareness and attitude of cancer patients towards clinical nurse coordinators

2017 ◽  
Vol 7 (7) ◽  
pp. 95 ◽  
Author(s):  
Ahmad Deeb ◽  
Mohammad O. AlKaiyat ◽  
Emad Abu Hlal ◽  
Areej Attari ◽  
Rania Mahaireh ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Positive Attitude ◽  
Clinical Care ◽  
Negative Attitude ◽  
Patient Characteristics ◽  
Cross Sectional Study ◽  
Cancer Center ◽  
Cross Sectional ◽  
Clinical Nurse ◽  
Roles And Responsibilities

Background and objective: Lack of knowledge or poor perception towards the roles and responsibilities of clinical nurse coordinators among cancer patients might lead to a decrease in seeking their services. The objective of the study was to assess the knowledge, perception and attitude towards clinical nurse coordinators among cancer patients at a specialized cancer center in Jordan.Methods: This is a cross sectional study that was conducted by distributing a self-reported and anonymous survey to 240 cancer patients visiting the center. The survey questioned some patient characteristics such as sex, age, educational level, marital status, disease type and duration, type of therapy. The patients’ knowledge (12-statement), the perception (9-statement) regarding the actual roles/responsibilities of coordinators and the attitude (5-statement) towards seeking their services were measured. Responses on Likert scales were converted to percentage mean scores.Results: The overall percentage mean scores ± standard deviation of knowledge was 59 ± 17, perception towards clinical nurse coordinators (79 ± 14) and attitude towards seeking their services (69 ± 16). Linear regression showed that participants on chemotherapy had significantly better perception (higher scores) compared to participants on concurrent therapies (β = -3.91, p = .049). Participants with higher knowledge scores had better perception indicating a better comprehension about the clinical nurse coordinators’ roles, compared to those with lower knowledge percentage mean scores (β = 0.13, p = .019). Female patients had higher percentage mean score of attitude compared to male particpants (β = -3.77, p = .034). Better perception of Clinical nurse coordinators (CNCs) among cancer patients was significantly more associated with  a more positive attitude towards seeking CNC services (β = 0.72, p < .001).Conclusions: Patients’ knowledge about the roles and responsibilities of nurse coordinators is associated with a better patients’ perception towards coordinators, which in return is associated with a more positive attitude towards seeking their services. Special consideration should be paid for patients on concurrent therapies who were more likely to have poorer perception towards clinical care coordinators compared to patients on chemotherapy. In addition, coordinators are expected to observe a more negative attitude towards seeking their services among male cancer patients.

A Defined Esophagectomy Perioperative Clinical Care Process Can Improve Outcomes and Costs

2017 ◽  
Vol 83 (1) ◽  
pp. 103-111 ◽  
Author(s):  
David T. Cooke ◽  
Royce F. Calhoun ◽  
Valerie Kuderer ◽  
Elizabeth A. David
Keyword(s):  
Clinical Care ◽  
Hospital Costs ◽  
Similar Rate ◽  
Patient Care Team ◽  
Benign Disease ◽  
Care Process ◽  
Provider Education ◽  
Before And After ◽  
Similar Patient ◽  
End Stage

Esophagectomy (EG) is a high-risk therapy for esophageal cancer and end-stage benign disease. This study compares the results of EG before and after implementation of a perioperative clinical care process including a health provider education program (EP) and institutional uncomplicated postoperative clinical pathway (POP) for purpose quality improvement. This is a single institution retrospective cohort study. The EP was provided to critical care and telemetry unit nurses and the POP was imbedded in the electronic health record. Patients undergoing elective EG with reconstruction with the stomach for benign disease or cancer were included from 2005 to 2011. Cohorts were pre- and postimplementation (PreI and PostI) of an EP and 8-day POP (August 2008). Patient, tumor and peri/postoperative-specific variables were compared between cohorts, as well as resource utilization and hospital costs. We identified 33 PreI and 41 PostI patients. Both cohorts had similar patient demographics, preoperative comorbidities, majority cancer diagnosis, and for cancer patients, majority adenocarcinoma and IIB/III pathologic stage. Both groups had one death and similar rate of discharge to home. The PostI cohort demonstrated reduced 30-day readmission rate (2.4% vs 24.2%); P < 0.05. In regard to clinical outcomes, the PostI group exhibited reduced deep venous thrombosis/pulmonary emboli (2.4% vs 18.2%); P < 0.05. The PostI group demonstrated significantly reduced radiographic test utilization and costs, as well as total overall 30-day readmission costs. A defined perioperative clinical process involving educating the patient care team and implementing a widely disseminated POP can reduce complications, 30-day readmission rates, and hospital costs after EG.

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