Implementation of virtual mentoring to optimize collection of patient-reported data in the COVID-19 era: A prospective cohort study with adaptive design.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24091-e24091
Author(s):  
Karineh Kazazian ◽  
Jessica Bogach ◽  
Wendy Johnston ◽  
Carol Jane Swallow
Keyword(s):  
Cohort Study ◽  
Adaptive Design ◽  
Completion Rate ◽  
Hard Copy ◽  
Cancer Center ◽  
Study Cohort ◽  
Tumor Site ◽  
Cross Sectional ◽  
Patient Reported ◽  
Edmonton Symptom Assessment Scale

e24091 Background: Prior to the COVID-19 pandemic, all patients attending ambulatory clinic at cancer centers in Ontario, Canada completed the Edmonton Symptom Assessment Scale (ESAS), as per governmental cancer agency mandate. At our center, completion was via touch pad, with assistance by clinic volunteers. As of mid-March 2020, clinic appointments were conducted virtually whenever possible, and touch pads removed from clinic. Our purpose here was to explore how these changes impacted the collection of patient-reported outcomes, in particular the recognition of severe symptoms. Methods: We performed a prospective cross-sectional cohort study to test the feasibility of remote completion of the ESAS by patients scheduled for appointments at a weekly surgical oncology clinic at a major cancer center. Patients were identified serially based on date of clinic appointment. Patients in the initial study cohort were asked to complete and return the ESAS virtually (V). Given low completion rates, the ensuing study cohort was asked to complete a hard-copy (HC) ESAS. For the final cohort, we used an adaptive approach, providing remote, personal mentoring by a member of the health care team to support virtual ESAS completion (virtual-mentored, VM). Results: Between May-July 2020, a total of 174 patients were included in the study: 53% were female, and median age was 62 (19-90) yrs. Age, gender and tumor site did not differ between the three cohorts. For the V cohort, 20/43 patients successfully completed and returned the ESAS electronically (completion rate 44%). For the HC cohort, 49/50 completed the form (98%). For the VM cohort (n=78), the completion rate was 74%. Questionnaire completion was not predicted by age, gender or tumor site, although patients who completed the ESAS were more likely to be under active investigation/treatment vs. surveillance (p=.04). Of the 127 ESAS forms completed in all patient cohorts, 117 reported at least 1 symptom score ≥1. There were no significant differences in individual symptom scores (e.g. tiredness, wellbeing-see Table) reported between cohorts. Of all completed forms, 42% had a depression score ≥2 and 27% an anxiety score ≥4, indicating significant psychosocial distress. Conclusions: We have identified significant barriers to the virtual completion of ESAS forms, with lack of predictive variables. The severe degree of psychological distress reported by ̃50% of respondents demonstrates the need for ongoing regular collection and review of these data.[Table: see text]

scholarly journals Remote Mentoring Optimizes Virtual Collection of Patient-Reported Data: A Prospective Cohort Study with Adaptive Design Conducted in COVID-19 Era.

2021 ◽  
Author(s):  
Karineh Kazazian ◽  
Jessica Bogach ◽  
Wendy Johnston ◽  
Deanna Ng ◽  
Carol J. Swallow
Keyword(s):  
Cohort Study ◽  
Adaptive Design ◽  
Negative Impact ◽  
Surgical Oncology ◽  
Active Management ◽  
Hard Copy ◽  
Study Cohort ◽  
Cross Sectional ◽  
Patient Reported ◽  
Edmonton Symptom Assessment Scale

Abstract Prior to the COVID-19 pandemic, patients attending ambulatory clinics at cancer centers in Ontario completed the Edmonton Symptom Assessment Scale (ESAS) at each visit. At our center, completion was via touch pad, with assistance by clinic volunteers. As of March 2020, clinic appointments were conducted virtually when possible and touch pads removed. We anticipated a negative impact on the collection of patient-reported outcomes (PROs), and the recognition of severe symptoms. Methods: We performed a prospective cross-sectional cohort study to test the feasibility of remote ESAS completion by patients with appointments at a weekly surgical oncology clinic. Patients in the initial study cohort were asked to complete and return the ESAS virtually(V). Given low completion rates, the ensuing cohort was asked to complete a hard-copy(HC) ESAS. For the final cohort, we used an adaptive approach, providing remote, personal mentorship by a member of the care team to support virtual electronic ESAS completion (virtual-mentored(VM) cohort). Results: Between May-July 2020, a total of 174 patient encounters were included in the study. For the V cohort, 20/46 patients (44%) successfully completed and returned the electronic ESAS, compared to 49/50 (98%) for the HC cohort. For the VM cohort (n=78), the completion rate was 74%. Questionnaire completion was not predicted by age, sex or tumor site, although patients who completed the ESAS were more likely to be in active management rather than surveillance(p=0.04). Of all completed forms, 42% revealed a depression score ³2, and 27% an anxiety score ³4. Conclusions: We identified significant barriers to the virtual completion of ESAS forms, with a lack of predictive variables. The severe degree of psychological distress reported by ~50% of respondents demonstrates the need for ongoing regular collection/review of these data. Innovative solutions are required to overcome barriers to virtual collection of PROs.

Salivary HPV Persistence Following Treatment of Oropharyngeal Squamous Cell Carcinoma

2021 ◽  
pp. 000348942110556
Author(s):  
Alexandra E. Quimby ◽  
Pagona Lagiou ◽  
Bibiana Purgina ◽  
Martin Corsten ◽  
Stephanie Johnson-Obaseki
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Hpv Infection ◽  
Oropharyngeal Squamous Cell Carcinoma ◽  
Cancer Center ◽  
Study Cohort ◽  
Curative Intent ◽  
Cross Sectional ◽  
Hpv Dna

Objective: To determine the persistence of human papillomavirus (HPV) infection following treatment of HPV-positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). Methods: A cross-sectional study was undertaken at The Ottawa Hospital (Ottawa, ON, Canada), a tertiary academic hospital and regional cancer center. Adult patients who were diagnosed with HPV + OPSCC between the years of 2014 and 2016 and treated with curative intent, and who were alive and willing to consent were eligible for inclusion. A saliva assay was used to test for the presence of HPV DNA in a random sample of patients. qPCR was used to amplify DNA from saliva samples. Results: Saliva samples were obtained from 69 patients previously treated with HPV + OPSCC. All patients had a minimum of 2 years of follow-up. 5 patients tested positive for HPV: 2 were positive for HPV-16, 2 for HPV-18, and 1 “other” HPV type. No patient in our study cohort had suffered recurrence post-treatment. Conclusions: This study is the first to demonstrate the prevalence of persistent oncogenic HPV DNA in saliva following treatment for HPV + OPSCC. This prevalence appears to be low, despite the fact that persistent HPV infection is a precursor for the development of HPV + OPSCC. This finding raises questions about what factors influence the clearance or persistence of HPV DNA in saliva after treatment for HPV + OPSCC, and may add to our understanding about the longitudinal effects of HPV infection in these cancers.

scholarly journals Use of patient-reported outcome measures (PROMs) by orthopedic surgeons in Saudi Arabia

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Fayez Alshehri ◽  
Abdulaziz Alarabi ◽  
Mohammed Alharthi ◽  
Thamer Alanazi ◽  
Ahmed Alohali ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Outcome Measures ◽  
Clinical Work ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Hard Copy ◽  
Clinical Activity ◽  
Cross Sectional ◽  
Orthopedic Surgeons ◽  
Patient Reported

Abstract Background There is increasing literature on the usefulness of patient-reported outcome measures (PROMs), but far fewer studies to determine their use by orthopedic surgeons and the barriers they face in applying PROMs in their daily clinical activity. Methods Cross-sectional study using a questionnaire that was distributed in both soft and hard copy formats to a sample of 262 orthopedic surgeons. Participants included orthopedic surgeons who are employed by the Ministry of Health (MOH) in Riyadh and the Eastern Province, Saudi Arabia. The questionnaire was distributed through on-site visitations to orthopedic departments in MOH hospitals as well as through online correspondence by email, WhatsApp, and social media. Results The study sample included 262 orthopedic surgeons (13.7% females and 86.3% males). Surgeons aged < 34, 35–44, and 45–54 years old represented 28.66%, 38.9%, and 20.2% of the study sample, respectively. The majority of the included surgeons did not use PROMs (69.1%), and some (17.2%) used it for research purposes. Only 5% used it regularly in daily clinical work. Conclusion The clinical use of PROMs among orthopedic surgeons was negligible, even though an overwhelming majority were interested in using PROMs. The reasons provided included a lack of knowledge on how to use PROMs and the perception that it is too time-consuming to add to regular clinical routine. There should be more efforts towards training surgeons on how to use PROMs, whereas increasing compatibility with existing software tools used by MOH hospitals may help offset time-related reservations.

Plasma levels of β2-microglobulin are associated with atherosclerosis in patients with systemic lupus erythematosus: a cross-sectional cohort study

Lupus ◽  
2018 ◽  
Vol 27 (9) ◽  
pp. 1517-1523 ◽  
Author(s):  
H C B Leffers ◽  
M L Hermansen ◽  
B Sandholt ◽  
A Fuchs ◽  
H Sillesen ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cohort Study ◽  
Lupus Erythematosus ◽  
Plasma Levels ◽  
High Plasma ◽  
Prior History ◽  
Study Cohort ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
Β2 Microglobulin

Objective The objective of this paper is to examine the association between plasma levels of β2-microglobulin (β2MG), a protein previously associated with atherosclerosis, and the presence of carotid plaque (CP) or coronary artery calcium (CAC) in a cross-sectional cohort study of patients with systemic lupus erythematosus (SLE). Methods Patients with SLE were enrolled between June 2013 and May 2014. The presence of CP and CAC was assessed with ultrasonography and computed tomography scan, respectively. The presence of CP or CAC in the SLE patients was analyzed with respect to plasma levels of β2MG and renal function expressed as the estimated glomerular filtration rate (eGFR). Results The study cohort consisted of 147 patients, 89% women and 95% Caucasians. The median age was 46 (range: 21–75) years with a median disease duration of 14 years. CP and CAC was observed in 29 (20%) and 57 (39%) of patients, respectively. CP or CAC was seen in 62 (42%) patients and was associated with the highest quartile of plasma β2MG in patients with eGFR ≥ 90 ml/min/1.73 m2; OR = 18 (95% CI: 1.7–181). β2MG adjusted for eGFR was also associated with presence of CP or CAC in the total cohort. The exclusion of 25 patients with a prior history of cardiovascular disease did not change the observed associations. Conclusion In this study, we found significant associations between imaging markers of atherosclerosis and high plasma levels of plasma β2MG. These data suggest that β2MG is a candidate for further study as a biomarker for atherosclerosis in SLE.

scholarly journals Patient-Reported Outcomes of Split-Thickness Skin Grafts for Floor of Mouth Cancer Reconstruction

ORL ◽  
2021 ◽  
pp. 1-8
Author(s):  
Andrew R. Larson ◽  
Mary Han ◽  
Katherine L. Webb ◽  
Edgar Ochoa ◽  
Gaelen Stanford-Moore ◽  
...  
Keyword(s):  
Early Stage ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Cancer Center ◽  
Split Thickness Skin Graft ◽  
Cross Sectional ◽  
Floor Of Mouth ◽  
Thickness Skin ◽  
Patient Reported ◽  
Tumor Involvement

<b><i>Introduction:</i></b> Patient-reported outcome measures (PROM) on quality of life (QOL) for early-stage floor of mouth carcinoma (FOM-CA) undergoing surgical resection and split-thickness skin graft (STSG) reconstruction have not been established. We have performed a cross-sectional QOL analysis of such patients to define functional postoperative outcomes. <b><i>Methods:</i></b> Patients with pathologic stage T1/T2 FOM-CA who underwent resection and STSG reconstruction at a tertiary academic cancer center reported outcomes with the University of Washington QOL (v4) questionnaire after at least 6 months since surgery. <b><i>Results:</i></b> Twenty-four out of 49 eligible patients completed questionnaires with a mean follow-up of 41 months (range: 6–88). Subsites of tumor involvement/resection included the following: (1) lateral FOM (L-FOM) (<i>n</i> = 17), (2) anterior FOM (A-FOM) (<i>n</i> = 4), and (3) alveolar ridge with FOM, all of whom underwent lateral marginal mandibulectomy (MM-FOM) (<i>n</i> = 3). All patients reported swallowing scores of 70 (“I cannot swallow certain solid foods”) or better. Ninety-six percent (23/24) reported speech of 70 (“difficulty saying some words, but I can be understood over the phone”) or better. A-FOM patients reported worse chewing than L-FOM patients (mean: 50.0 vs. 85.3; <i>p</i> = 0.01). All 4 A-FOM patients reported a low chewing score of 50 (“I can eat soft solids but cannot chew some foods”). Otherwise, there were no significant differences between subsite groups in swallowing, speech, or taste. <b><i>Conclusion:</i></b> STSG reconstructions for pathologic T1–T2 FOM-CA appear to result in acceptable PROM QOL outcomes with the exception of A-FOM tumors having worse chewing outcomes.

scholarly journals Use of Patient Reported Outcome Measures (PROMs) by Orthopedic Surgeons in Saudi Arabia

2020 ◽  
Author(s):  
Fayez Alshehri ◽  
Abdulaziz Alarabi ◽  
Mohammed Alharthi ◽  
Thamer Alanazi ◽  
Ahmed Alohali ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Outcome Measures ◽  
Clinical Work ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Hard Copy ◽  
Clinical Activity ◽  
Cross Sectional ◽  
Orthopedic Surgeons ◽  
Patient Reported

Abstract Background There is increasing literature on the usefulness of patient-reported outcome measures (PROMs), but far fewer studies to determine their use by orthopedic surgeons and the barriers they face in applying PROMs in their daily clinical activity.Methods Cross-sectional study using a questionnaire that was distributed in both soft and hard copy formats to a sample of 262 orthopedic surgeons. Participants included orthopedic surgeons who are employed by the Ministry of Health (MOH) in Riyadh and the Eastern Province, Saudi Arabia. The questionnaire was distributed through onsite visitations to orthopedic departments in MOH hospitals as well as through online correspondence by email, WhatsApp, and social media.Results The study sample included 262 orthopedic surgeons (13.7% females and 86.3% males). Surgeons aged < 34, 35 – 44, and 45 - 54 years old represented 28.66%, 38.9%, and 20.2% of the study sample, respectively. The majority of the included surgeons did not use PROMs (69.1%) and some (17.2%) used it for research purposes. Only 5% used it regularly in daily clinical work.Conclusion The clinical use of PROMs among orthopedic surgeons was negligible, even though an overwhelming majority were interested in using PROMs. The reasons provided included a lack of knowledge on how to use PROMs and the perception that it is too time-consuming to add to regular clinical routine. There should be more effort towards training surgeons on how to use PROMs, whereas increasing compatibility with existing software tools used by MOH hospitals may help offset time-related reservations.

scholarly journals Association Between Music Therapy Techniques and Patient-Reported Moderate to Severe Fatigue in Hospitalized Adults With Cancer

2020 ◽  
Vol 16 (12) ◽  
pp. e1553-e1557 ◽  
Author(s):  
Thomas M. Atkinson ◽  
Kevin T. Liou ◽  
Michael A. Borten ◽  
Qing S. Li ◽  
Karen Popkin ◽  
...  
Keyword(s):  
Music Therapy ◽  
Positive Affect ◽  
Care Utilization ◽  
Inpatient Setting ◽  
Free Text ◽  
Cross Sectional ◽  
Cancer Disease ◽  
Cancer Related Fatigue ◽  
Patient Reported ◽  
Edmonton Symptom Assessment Scale

PURPOSE: Cancer-related fatigue is a prevalent, debilitating symptom that contributes to increased health care utilization among hospitalized patients. Music therapy is a nonpharmacological intervention that uses active (eg, singing, selecting songs) and passive (eg, listening) techniques. Preliminary evidence from small trials suggests a potential benefit for cancer-related fatigue in the inpatient setting; however, it remains unclear which techniques are most effective. METHODS: A cross-sectional mixed-methods study was performed to compare cancer-related fatigue before and after active or passive music therapy. Cancer-related fatigue was captured via the Edmonton Symptom Assessment Scale fatigue item. Patients were asked to provide postsession free-text comments. RESULTS: A total of 436 patients (mean [standard deviation] age, 62.2 [13.4] years; n = 284 [65.1%] women; n = 294 [67.4%] white; active music therapy n = 360 [82.6%]; passive music therapy n = 76 [17.4%]) with a range of primary malignancies participated. Active music therapy was associated with a 0.88-point greater reduction in cancer-related fatigue (95% CI, 0.26 to 1.51; P = .006; Cohen’s D, 0.52) at postsession as compared with passive music therapy when restricting the analysis to patients who rated their baseline cancer-related fatigue as moderate to severe (ie, ≥ 4; n = 236 [54.1%]). Free-text responses confirmed higher frequencies of words describing positive affect/emotion among active music therapy participants. CONCLUSIONS: In a large sample of inpatient adults with diverse cancer disease types, active music therapy was associated with greater reduction in cancer-related fatigue and increased reporting of positive affect/emotions compared with passive music therapy. Additional research is warranted to determine the specific efficacy and underlying mechanisms of music therapy on cancer-related fatigue.

scholarly journals Suicidal risk and resilience in juvenile fibromyalgia syndrome: a cross-sectional cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sabrina Gmuca ◽  
Maitry Sonagra ◽  
Rui Xiao ◽  
Kimberly S. Miller ◽  
Nina H. Thomas ◽  
...  
Keyword(s):  
Cohort Study ◽  
Suicidal Ideation ◽  
Fibromyalgia Syndrome ◽  
Care Center ◽  
Tertiary Care ◽  
Pain Clinic ◽  
Significant Positive Association ◽  
Cross Sectional ◽  
Juvenile Fibromyalgia ◽  
Patient Reported

Abstract Background To characterize suicidality among youth with juvenile fibromyalgia syndrome (JFMS) receiving treatment from pediatric rheumatologists at a tertiary care center in order to determine the prevalence of suicidality in JFMS and to explore risk factors for persistent suicidal ideation. Methods We performed a cross-sectional cohort study of children 12–17 years old with JFMS seen in a specialty pediatric rheumatology pain clinic from 7/2017–9/2019. All subjects completed patient-reported outcomes measures, complemented by retrospective chart review. Subjects who endorsed item 8 on the Children’s Depression Inventory, 2nd Edition (CDI-2) were categorized as endorsing suicidal ideation. We assessed for differences between the suicidal and non-suicidal patients using Wilcoxon-rank sum test. Logistic regression modeling was performed to identify psychosocial factors associated with suicidality. Results Of the 31 subjects, more than one-quarter endorsed suicidality. Nearly 90% of teens with suicidal ideation were established in outpatient counseling. In bivariate analyses, suicidality was associated with lower resilience and greater depression and anxiety (all p < 0.05). Pain intensity trended towards a statistically significant positive association (OR: 1.16 [0.99–1.37]; p = 0.06). Lower resilience was independently associated with suicidality (OR: 0.90 [95% CI: 0.82–0.98]; p < 0.02). Conclusions Suicidality was prevalent among youth with JFMS and persistent despite concurrent receipt of mental health services. Higher patient-level resilience was independently associated with a reduced odds of suicidality. Future work should examine the role of resilience training on reducing psychological distress and mitigating the risk of suicidality in JFMS.

Utilizaton of patient reported outcomes measures (PROM) to characterize symptom burden and adherence associated with oral oncolytic therapy.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 210-210
Author(s):  
Emily R. Mackler ◽  
Taylor Weis ◽  
Kelly Marie Procailo ◽  
Vincent D. Marshall ◽  
Karen B. Farris
Keyword(s):  
Medication Adherence ◽  
Cancer Treatment ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Self Management ◽  
Improve Medication Adherence ◽  
Cross Sectional ◽  
Oncolytic Therapy ◽  
Patient Reported ◽  
Edmonton Symptom Assessment Scale

210 Background: The use of patient reported outcome measures (PROMs) to monitor cancer treatment tolerability has been shown to positively impact outcomes. The purpose of this study was to characterize the incidence and severity of side effects, patient self-management confidence, and medication adherence in patients receiving oral oncolytic therapy. Methods: This multicenter, cross-sectional, observational study was conducted across 6 Michigan oncology practices from July 2016-December 2018. Patients were eligible to complete PROMs during the course of their treatment if they were receiving an oral oncolytic medication (excluding endocrine therapy). Results: There were a total of 2252 PROMs completed in 695 patients. Patients were 48% female, a median age of 69 years, and most commonly receiving treatment with capecitabine (18%), palbociclib (10%), and lenalidomide (9%). 54% of PROMs had at least one Edmonton Symptom Assessment Scale (ESAS) symptom rated as moderate or severe. Patients indicated the presence of a most bothersome symptom (MBS) in 35% of PROMs. Most common MBSs were fatigue (26%), pain (16%), constitutional symptoms other than fatigue (15%), and nausea/vomiting (14%). Non-adherence was reported in 20% of PROMs. ESAS symptoms rated as moderate or severe, the presence of a MBS, and lower confidence scores all correlated with medication non-adherence. Conclusions: Patients taking oral oncolytics for their cancer treatment experience a high symptom burden with more than 50% experiencing a moderate to severe symptom. Optimizing symptom management and providing patient education that increases patient confidence in self-management may improve medication adherence and patient outcomes.

Implementation of an enhanced recovery program framework in medical oncology.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 66-66
Author(s):  
Brittany C Campbell ◽  
Yvette Ong ◽  
Jarrod Eska ◽  
Sharon Mathai ◽  
Noel Mendez ◽  
...  
Keyword(s):  
Medical Oncology ◽  
Enhanced Recovery ◽  
Functional Mobility ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Control Group ◽  
Surgical Patient ◽  
Quality Improvement Initiative ◽  
Patient Reported ◽  
Edmonton Symptom Assessment Scale

66 Background: Enhanced recovery programs (ERPs) apply multi-modal approaches to manage symptoms, decrease complications, and reduce length of stay (LOS). Widely adopted in surgical settings, there is limited evidence of their implementation in non-surgical patient cohorts. An ERP was implemented in a medical oncology population at a National Cancer Institute-designated comprehensive cancer center. The aim of this quality improvement initiative was to evaluate the implementation of an enhanced recovery framework and determine feasibility in medical oncology. Methods: Enhanced recovery in medical oncology (ERMO) was implemented using Plan, Do, Study, Act methodology. Implementation included introduction of integrative medicine, opioid sparing alternatives, fluid and nutrition management, and functional mobility. Outcome measures included symptom distress as measured by the Edmonton Symptom Assessment Scale (ESAS), return to intended oncologic therapy (RIOT), LOS, and opioid use, evaluated from January 2017 through April 2018. Results: A total of 50 patients were evaluated during the program implementation, and compared with 49 control patients retrospectively reviewed prior to ERMO implementation. Average LOS for ERMO patients was 7.3 days compared to 5.5 days for the control group. Time to RIOT averaged 18.9 days for control patients (n = 30) versus 20.8 days for ERMO patients (n = 17). Nineteen patients (38%) had a reduction in morphine equivalent daily dose (MEDD) from admission to discharge, with an average MEDD of 328.47 milligrams per patient. Conclusions: ERMO as a framework is feasible. The patient reported outcomes such as ESAS and RIOT, and barriers to implementation, including participant engagement and patient pain management perceptions, should be evaluated in the context of larger clinical trials.

Sign in / Sign up

Export Citation Format

Share Document