The impact of telemedicine on patient-reported outcomes in urologic oncology.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 200-200
Author(s):  
Adam John Gadzinski ◽  
Isabelle O. Abarro ◽  
Blair Stewart ◽  
John L. Gore
Keyword(s):  
Travel Time ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Care Delivery ◽  
Testis Cancer ◽  
Urologic Oncology ◽  
Time Costs ◽  
Patient Reported ◽  
The Impact ◽  
Travel Burden

200 Background: Nearly 20% of Americans live in rural communities. These individuals face barriers to accessing cancer care, including prevalent poverty and substantial travel burden to seeing cancer providers. We aimed to assess the impact of a rurally focused telemedicine program on patient outcomes in our urologic oncology outpatient clinic. Methods: We prospectively identified patients from rural Washington State, or who lived outside Washington, with a known or suspected urological malignancy being evaluated at the University of Washington Urology Clinic via an in person clinic or a telemedicine appointment. Patients were invited to complete a post-visit survey that assessed satisfaction, travel time, costs, and work absenteeism. We compared patient-reported outcomes between those seen as in-person versus telemedicine visits. Results: We invited 1453 eligible patients from August 2019–July 2020 to participate; 615 patients (42%) completed the survey. 198 patients had in person visits and 417 had telemedicine visits. Median age was 68, 89% were male, and 73% were white. 525 patients (85%) were from Washington; the remainder resided out-of-state. Patients were being evaluated for prostate cancer (62%), kidney cancer (14%), urothelial cancer (22%), and testis cancer (2%). Patient-reported outcomes are displayed in Table. Twenty-two patients coming for in-person visits (11%) paid ≥ $1000 in total travel costs. No differences were noted in patient satisfaction between in-person and telemedicine visit types. Conclusions: Patients traveling to our clinic from out-of-state and rural Washington incur significant travel time, costs, and time away from work to receive outpatient urologic cancer care. Telemedicine provides a medium for cancer care delivery that eliminates the significant travel burden associated with in-person clinic appointments. [Table: see text]

The impact of telemedicine on patient-reported outcomes in urologic oncology.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14154-e14154
Author(s):  
Adam John Gadzinski ◽  
Isabelle O. Abarro ◽  
Blair Stewart ◽  
John L. Gore
Keyword(s):  
Travel Time ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Care Delivery ◽  
Testis Cancer ◽  
Urologic Oncology ◽  
Time Costs ◽  
Patient Reported ◽  
The Impact ◽  
Travel Burden

e14154 Background: Nearly 20% of Americans live in rural communities. These individuals face barriers to accessing cancer care, including prevalent poverty and substantial travel burden to seeing cancer providers. We aimed to assess the impact of a rurally focused telemedicine program on patient outcomes in our urologic oncology outpatient clinic. Methods: We prospectively identified patients from rural Washington State, or who lived outside Washington, with a known or suspected urological malignancy being evaluated at the University of Washington Urology Clinic via an in person clinic or a telemedicine appointment. Patients were invited to complete a post-visit survey that assessed satisfaction, travel time, costs, and work absenteeism. We compared patient-reported outcomes between those seen as in-person versus telemedicine visits. Results: We invited 291 eligible patients from June 2019 – February 2020 to participate, 140 patients (48%) completed the survey. One-hundred and thirty-three patients had in person visits and 7 had telemedicine visits. Median age was 68, male 86%, and 69% Caucasian. Eighty-seven patients (62%) were from rural Washington; the remainder resided out-of-state. Patients were being evaluated for prostate cancer (57%), kidney cancer (18%), urothelial cancer (24%), and testis cancer (1%). Patient-reported outcomes are displayed in Table. Seventeen patients coming for in-person visits (13%) paid ≥ $1000 in total travel costs. No differences were noted in patient satisfaction. Conclusions: Patients traveling to our clinic from out-of-state and rural Washington incur significant travel time, costs, and time away from work to receive outpatient urologic cancer care. Telemedicine provides a medium for cancer care delivery that eliminates the significant travel burden associated with in person clinic appointments. [Table: see text]

Enhancing community capacity to improve cancer care delivery and the effect on patient-reported outcomes, healthcare utilization and total costs of care.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6522-6522
Author(s):  
Manali I. Patel ◽  
David Ramirez ◽  
Richy Agajanian ◽  
Hilda H. Agajanian ◽  
Jay Bhattacharya ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Health Plan ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Care Delivery ◽  
Mean Difference ◽  
Healthcare Use ◽  
Difference In Difference ◽  
Patient Reported ◽  
Over Time

6522 Background: To curb rising expenditures and improve patient-reported outcomes (PROs), we designed an intervention with patient, caregiver, provider, and payer input. The intervention is based on prior work using a lay health worker (LHW) to assess advanced cancer patients' symptoms. In this study, we trained the LHW to refer patients to palliative care and/or behavioral health services in response to positive assessments and expanded the intervention to all cancer stages. We implemented the intervention with a health plan and a community oncology group serving elderly racially/ethnically diverse patients to test the effect on symptoms, healthcare use, and total costs. Methods: We enrolled all newly diagnosed health plan beneficiaries with solid and hematologic malignancies from 10/2016 to 11/2017 and compared outcomes to all cancer patients diagnosed in the year prior to the intervention (control arm). Our primary outcome was change in patient-reported symptoms using the Edmonton Symptom Assessment Scale and Personal Health Questionnaire-9 at baseline, 6 and 12 months post-enrollment. Secondarily, we compared 12 month healthcare use and costs. All generalized linear regression models were adjusted for age, stage, comorbidities, diagnosis, and follow-up. Results: 425 patients were in the intervention; 407 in the control. In both groups, mean age was 79 years; 48% were non-Hispanic White, 43% Hispanic, 3% Black, 6% Asian/Pacific Islander; 60% had advanced stages; 28% had breast, 28% had gastrointestinal, and 10% had thoracic cancers. Intervention patients had significantly decreased symptom burden over time as compared with the control (Mean Difference: intervention (-0.77 +/- 0.28 p = 0.01) vs. control: (0.45 +/- 0.25 p = 0.06)); difference in difference: (-0.68 +/- 0.25 p = 0.007)). Depression scores also significantly decreased over time among intervention patients as compared with the control (Mean Difference: intervention (-1.10 +/- 0.38 p = 0.04)) vs control: (1.21 +/- 0.34 p = 0.01); (difference in difference: -2.03 +/- 0.3 p < 0.001)). As compared to the control arm, intervention patients had lower inpatient admissions (0.7 vs. 0.5 p = 0.01) and emergency department visits per thousand patients per year (0.6 vs. 0.42 p = 0.02), and lower median total healthcare costs ($32,270 versus $25,512 p = 0.01). Conclusions: An LHW intervention significantly improved patient-reported outcomes and the value of cancer care delivery and may be a solution to improve burdensome and costly care for patients.

scholarly journals PD25-11 THE IMPACT OF TELEMEDICINE ON PATIENT-REPORTED OUTCOMES IN UROLOGIC ONCOLOGY

2021 ◽  
Vol 206 (Supplement 3) ◽  
Author(s):  
Adam Gadzinski ◽  
Isabelle Abarro ◽  
Blair Stewart ◽  
John Gore
Keyword(s):  
Patient Reported Outcomes ◽  
Urologic Oncology ◽  
Patient Reported ◽  
The Impact

Using Stakeholder Engagement to Overcome Barriers to Implementing Patient-reported Outcomes (PROs) in Cancer Care Delivery

Medical Care ◽  
2019 ◽  
Vol 57 ◽  
pp. S92-S99 ◽  
Author(s):  
Angela M. Stover ◽  
Carrie Tompkins Stricker ◽  
Karen Hammelef ◽  
Sydney Henson ◽  
Philip Carr ◽  
...  
Keyword(s):  
Cancer Care ◽  
Stakeholder Engagement ◽  
Patient Reported Outcomes ◽  
Care Delivery ◽  
Patient Reported

scholarly journals Care for a Patient With Cancer As a Project: Management of Complex Task Interdependence in Cancer Care Delivery

2016 ◽  
Vol 12 (11) ◽  
pp. 1101-1113 ◽  
Author(s):  
Julia R. Trosman ◽  
Ruth C. Carlos ◽  
Melissa A. Simon ◽  
Debra L. Madden ◽  
William J. Gradishar ◽  
...  
Keyword(s):  
Project Management ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Early Stage ◽  
Care Delivery ◽  
Task Interdependence ◽  
Patient Centered ◽  
Patient Reported ◽  
Future Patient

Cancer care is highly complex and suffers from fragmentation and lack of coordination across provider specialties and clinical domains. As a result, patients often find that they must coordinate care on their own. Coordinated delivery teams may address these challenges and improve quality of cancer care. Task interdependence is a core principle of rigorous teamwork and is essential to addressing the complexity of cancer care, which is highly interdependent across specialties and modalities. We examined challenges faced by a patient with early-stage breast cancer that resulted from difficulties in understanding and managing task interdependence across clinical domains involved in this patient’s care. We used team science supported by the project management discipline to discuss how various task interdependence aspects can be recognized, deliberately designed, and systematically managed to prevent care breakdowns. This case highlights how effective task interdependence management facilitated by project management methods could markedly improve the course of a patient’s care. This work informs efforts of cancer centers and practices to redesign cancer care delivery through innovative, practical, and patient-centered approaches to management of task interdependence in cancer care. Future patient-reported outcomes research will help to determine optimal ways to engage patients, including those who are medically underserved, in managing task interdependence in their own care.

Self-reported patient barriers and the impact of digital health coaching on PRO in cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 189-189
Author(s):  
Matthew Allison ◽  
Stephen Burton ◽  
Dhiren Patel ◽  
Kelly Jean Brassil
Keyword(s):  
Medication Adherence ◽  
Access To Care ◽  
Healthy Eating ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Digital Health ◽  
Health Coaching ◽  
Financial Toxicity ◽  
Patient Reported ◽  
The Impact

189 Background: Barriers during cancer care include lack of social support, financial concerns, and communication with providers. While navigation has been identified as a way to address these concerns in the clinical context, opportunities exist to identify and address patient-reported barriers through digital health coaching to support patients beyond the clinical care setting. Methods: A retrospective analysis evaluated patient-reported barriers during cancer care for 708 individuals over the course of a digital health coaching program. Barriers were assessed in six domains, each represented by 5-10 questions in a company developed survey. The questions were administered prior to coaching on content aligned to the domains, specifically eating healthy, exercise, financial, access to care and medication adherence. Patients ranked both the presence and severity of the barrier. Patient reported outcomes such as exercise (Godin), health eating (Start the Conversation), financial toxicity (Comprehensive Score for Financial Toxicity (COST)) and physiologic and psychosocial outcomes (Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) 10) were measured and aligned to the barrier domains identified by the participants. Results: The eating healthy domain (2.43) received a significantly higher average score compared to other domains: financial (1.86), exercise (1.71), medication adherence (1.68) and access to care (1.65). Over the 12-week coaching program, physical activity increased by 56%, fatigue was reduced by 32%, financial toxicity was reduced by 8%, the healthy eating score improved by 17% and pain was reduced by 13%, as reflected in the PROMIS GH-10, Godin, STC and COST data. Conclusions: Outcomes suggest that healthy eating is a significant barrier identified by cancer patients during their treatment, followed by financial concerns and exercise, each of which demonstrated improvement over the course of digital health coaching. These results suggest digital health coaching provides a benefit to addressing barriers during cancer treatment and may improve patient reported outcomes, particularly as they relate to wellness behaviors such as healthy eating and exercise.

scholarly journals Virtual Cancer Care During the COVID-19 Pandemic in Alberta: Evidence From a Mixed Methods Evaluation and Key Learnings

2021 ◽  
pp. OP.21.00144
Author(s):  
Linda Watson ◽  
Siwei Qi ◽  
Andrea Delure ◽  
Claire Link ◽  
Eclair Photitai ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Cancer Care ◽  
Large Scale ◽  
Care Delivery ◽  
Cancer Center ◽  
Mixed Methods Evaluation ◽  
Virtual Care ◽  
Patient Reported ◽  
Virtual Visits ◽  
The Impact

PURPOSE This study reports on a mixed methods evaluation conducted within a provincial cancer program in Alberta, Canada. The purpose was to capture key learnings from a rapid virtual care implementation because of the COVID-19 pandemic and to understand the impact on patient and staff experiences. METHODS Administrative data were collected for 21,362 patients who had at least one virtual or in-person visit to any provincial cancer center from April 1, 2020, to June 10, 2020. Patient surveys were conducted with 397 randomly selected patients who had received a virtual visit. Surveys were also conducted with 396 Cancer Care Alberta staff. RESULTS 14,906 virtual visits took place in this period, and about 40% of weekly visits were virtual. Significant differences were observed in both patient-reported symptom questionnaire completion rates and referrals to supportive care services between patients seen in-person and virtually. Patients receiving active treatments reported significantly lower levels of satisfaction with virtual visits than those seen for follow-up, but overall 90% of patients indicated interest in receiving virtual care in the future. Staff thought virtual visits increased patients' access to care but less than one third (31.5%) felt confident meeting patients' emotional needs and having conversations about disease progression and/or end of life virtually. CONCLUSION The COVID-19 pandemic has driven the rapid implementation of virtual visits for cancer care delivery in health care settings. The findings from this mixed methods evaluation provide a concrete set of considerations for organizations looking to develop a large-scale, enduring virtual care strategy.

Overview of the Patient Perspective at OMERACT 10 — Conceptualizing Methods for Developing Patient-Reported Outcomes

2011 ◽  
Vol 38 (8) ◽  
pp. 1699-1701 ◽  
Author(s):  
JOHN R. KIRWAN ◽  
PETER S. TUGWELL
Keyword(s):  
Clinical Trials ◽  
Experimental Work ◽  
Patient Reported Outcomes ◽  
Patient Perspective ◽  
Methodological Issues ◽  
Instrument Selection ◽  
Patient Reported ◽  
The Impact ◽  
Choice Of Instruments ◽  
The Way

This overview draws out the main conclusions from the 4 workshops focused on incorporating the patient perspective into outcome assessment at the 10th Outcome Measures in Rheumatology (OMERACT 10) conference. They raised methodological issues about the choice of outcome domains to include in clinical trials, the development or choice of instruments to measure these domains, and the way these instruments might capture the impact of a disease and its treatment. The need to develop a more rigorous conceptual model of quantifying the way conditions affect health, and the need to ensure patients are directly involved in the decisions about domains and instruments, emerged clearly. The OMERACT participants voted to develop guidelines for domain and instrument selection, and conceptual and experimental work will be brought forward to revise and upgrade the OMERACT Filter.

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