scholarly journals Easier Said Than Done: Keys to Successful Implementation of the Distress Assessment and Response Tool (DART) Program

2016 ◽  
Vol 12 (5) ◽  
pp. e513-e526 ◽  
Author(s):  
Madeline Li ◽  
Alyssa Macedo ◽  
Sean Crawford ◽  
Sabira Bagha ◽  
Yvonne W. Leung ◽  
...  
Keyword(s):  
Cancer Care ◽  
Large Scale ◽  
Performance Indicator ◽  
Evaluation Framework ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Successful Implementation ◽  
Psychosocial Needs ◽  
Electronic Screening ◽  
Screening For Distress

Purpose: Systematic screening for distress in oncology clinics has gained increasing acceptance as a means to improve cancer care, but its implementation poses enormous challenges. We describe the development and implementation of the Distress Assessment and Response Tool (DART) program in a large urban comprehensive cancer center. Method: DART is an electronic screening tool used to detect physical and emotional distress and practical concerns and is linked to triaged interprofessional collaborative care pathways. The implementation of DART depended on clinician education, technological innovation, transparent communication, and an evaluation framework based on principles of change management and quality improvement. Results: There have been 364,378 DART surveys completed since 2010, with a sustained screening rate of > 70% for the past 3 years. High staff satisfaction, increased perception of teamwork, greater clinical attention to the psychosocial needs of patients, patient-clinician communication, and patient satisfaction with care were demonstrated without a resultant increase in referrals to specialized psychosocial services. DART is now a standard of care for all patients attending the cancer center and a quality performance indicator for the organization. Conclusion: Key factors in the success of DART implementation were the adoption of a programmatic approach, strong institutional commitment, and a primary focus on clinic-based response. We have demonstrated that large-scale routine screening for distress in a cancer center is achievable and has the potential to enhance the cancer care experience for both patients and staff.

scholarly journals Implementing Precision Medicine in Community-Based Oncology Programs: Three Models

2019 ◽  
Vol 15 (6) ◽  
pp. 325-329 ◽  
Author(s):  
Laura A. Levit ◽  
Edward S. Kim ◽  
Barbara L. McAneny ◽  
Lincoln D. Nadauld ◽  
Kathryn Levit ◽  
...  
Keyword(s):  
Precision Medicine ◽  
Cancer Care ◽  
Large Scale ◽  
Administrative Support ◽  
Clinical Pathways ◽  
Clinical Decision ◽  
Successful Implementation ◽  
Precision Oncology ◽  
Community Based ◽  
Tumor Boards

The use of precision medicine and the number of genomic-based treatments and immunotherapies is increasing. Nevertheless, oncology providers face challenges to implementing precision medicine, including in community practices, where most patients receive treatment. On January 31, 2018, ASCO hosted Precision Medicine: Expanding Opportunities, the inaugural event in ASCO’s new State of Cancer Care in America (SOCCA) event series. This article draws from the inaugural SOCCA event and the experiences of the SOCCA event participants to summarize the opportunities and challenges of precision medicine, and to highlight three successful models of implementing precision oncology in large, multisite community practices or networks: (1) Intermountain Healthcare, (2) Levine Cancer Institute, Atrium Health, and (3) National Cancer Care Alliance. The experience of these practices suggests that practice innovations that offer clinical decision support through molecular tumor boards and clinical pathways, and administrative support for prior authorization and clinical trial matching are key to successful implementation of large-scale, community-based precision medicine programs.

Pastoral care of cancer patients: Defining utilization of services at a comprehensive cancer center.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24171-e24171
Author(s):  
Elizabeth Palmer ◽  
Anghela Paredes ◽  
Madison Hyer ◽  
Timothy M. Pawlik
Keyword(s):  
Pastoral Care ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Spiritual Care ◽  
Cancer Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Spiritual Needs ◽  
Active Listening ◽  
Patients With Cancer

e24171 Background: Addressing the religious/spiritual needs of patients is an important component of comprehensive cancer care. Patients often report that providers infrequently engage them about their needs during treatment. In addition, providers cite inadequate training as a significant barrier to providing spiritual care. While patients may benefit from the presence of a spiritual care specialist during cancer treatment, the utilization and content of these services are not well defined. We sought to characterize utilization of pastoral care (PC) services, as well as delineate differences in PC utilization among patients with cancer. Methods: Data on patients being treated for cancer at a Comprehensive Cancer Center between 2015-2018 were obtained from the electronic medical record. Overall utilization, type of PC services utilized, as well as factors associated with use of PC were assessed. Analyses included descriptive statistics and logistic regression. Results: Among 14,322 cancer patients, roughly one-third (n = 5166, 36.1%) had at least one PC encounter during their cancer treatment. Interventions most frequently provided by PC included supportive presence (93.5%) and active listening (86.6%), while the most frequently explored topics were treatment expectations (59.8%), issues with faith/beliefs (42.9%), and available coping mechanisms (35.4%). Patients diagnosed with colorectal (OR:1.42, 95%CI:1.07-1.89), liver (OR:2.41, 95%CI:1.80-3.24), or pancreatic cancer (OR:1.43, 95%CI:1.02-2.00) were more likely to utilize PC services compared with other cancers. Patients that identified as Catholic (OR:1.47, 95%CI:1.17-1.84) or Christian (OR:1.73, 95%CI:1.39-2.15) were more likely to request PC services (both p < 0.001) than individuals who had no religious preference/affiliation. Among surgical patients (n = 1,174), the majority of encounters with PC services were in the postoperative setting (n = 801, 70.6%). Patients most often reported that PC helped with verbalization of their feelings (93.6%) and helped reduce stress (76.9%). Conclusions: Over one-third of patients with cancer interacted with PC and received services that often addressed both psychosocial and spiritual concerns. Overall PC utilization and types of PC services rendered varied relative to demographic and religious factors. Providers should be aware of varying patient religious/spiritual needs so as to optimize the entire cancer care experience for patients.

Advanced cancer patients' (CP) attitudes and perceptions regarding reasons for outpatient supportive care (SC) referral at a comprehensive cancer center: A randomized controlled study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24135-e24135
Author(s):  
Angelique Wong ◽  
Frank V. Fossella ◽  
George R. Simon ◽  
Rama Maddi ◽  
Zhanni Lu ◽  
...  
Keyword(s):  
Supportive Care ◽  
Cancer Care ◽  
Comprehensive Cancer Center ◽  
Controlled Study ◽  
Cancer Center ◽  
Cancer Type ◽  
Attitudes And Perceptions ◽  
Outpatient Supportive Care

e24135 Background: Current ASCO guidelines propose early access to SC in all CP to improve quality of care, quality of life, and symptoms. Very few studies have evaluated patients’ perceived criteria for referral to outpatient SC and perceptions of patients who are referred early in their disease trajectory. Methods: In this study we evaluated CP attitudes and perceptions regarding the role of and access to outpatient Supportive Care clinic (SCC) at a comprehensive cancer center. CP with life expectancy of greater than 6 months (as determined by the oncologist) and who are newly registered at MD Anderson Cancer Center were randomized to either obtain an educational brochure that explained the role of the SCC or no brochure. Both groups then completed a survey regarding the role and access to of outpatient SCC. After completion of the survey, patients were asked if they would like to be seen by the SC team. If so, they were scheduled by their oncologist for a SC consult. Results: 288 patients were evaluable: median age was 63, 43% were female, 84% were Caucasian, and the most common cancer type was lung cancer (39%). Median survival was 15 months. Patients who received a brochure reported more understanding of the role of SC vs those who did not receive a brochure (63% vs 37%, p = 0.04). Both groups felt that SC could help to address physical (47% vs 54%) and psychosocial (50% vs 50%) symptoms. Both groups felt SC could help to address questions regarding prognosis (50% vs 50%) and future care (53% vs 47%). Both groups did not feel that time (50% vs 50%) nor financial concerns (49% vs 51%) would be barriers to access SC. Both groups did not feel that receiving SC would impede their cancer care (60% vs 40%) nor change their oncologists’ perspective of them (25% vs 75%). Both groups felt they could receive SC and cancer care simultaneously (50% vs 50%). Approximately half of the patients in both groups perceived it was not too early for a referral to SC. There were no statistical differences in these groups for these findings. Conclusions: Patients who received a brochure had a better understanding of the role of SC. A very significant proportion in both groups had limited awareness of the value of SC. Oncologist driven referral and education of SC may facilitate better understanding of the value of SC. Further studies are needed.

scholarly journals Multidisciplinary Cancer Care: Development of an Infectious Diseases Physician Assistant Workforce at a Comprehensive Cancer Center

2010 ◽  
Vol 6 (6) ◽  
pp. e31-e34 ◽  
Author(s):  
Candice N. White ◽  
Roy A. Borchardt ◽  
Mary L. Mabry ◽  
Kathleen M. Smith ◽  
Victor E. Mulanovich ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Patient Care ◽  
Cancer Care ◽  
Physician Assistant ◽  
Physician Assistants ◽  
Physician Satisfaction ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Care Services ◽  
Care Development

The authors outline the process through which the infectious diseases department at The M. D. Anderson Cancer Center successfully integrated physician assistants into patient care services, as judged by an overall increase in departmental productivity, broadened patient care coverage, and physician satisfaction with midlevel services.

scholarly journals Implementing a Multidisciplinary Approach for Older Adults with Cancer: Geriatric Oncology in Practice

2019 ◽  
Author(s):  
Carolyn Presley ◽  
Jessica Krok-Schoen ◽  
Sarah Wall ◽  
Anne Noonan ◽  
Desiree Jones ◽  
...  
Keyword(s):  
Older Adults ◽  
Cancer Care ◽  
Multidisciplinary Approach ◽  
Geriatric Oncology ◽  
Clinic Visit ◽  
Sensory Loss ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Multiple Chronic Conditions ◽  
Care Clinic

Abstract Background: Evidence-based practice in geriatric oncology is growing, and national initiatives have focused on expanding cancer care and research to improve health outcomes of older adults. However, there are still gaps between knowledge and practice for older adults with cancer. Methods: The Cancer and Aging Resiliency (CARE) clinic is a multidisciplinary approach for implementing geriatric-driven health care for older adults with cancer. The CARE clinic was developed as a direct response to recommendations targeting key multifactorial geriatric health conditions (e.g. falls, nutritional deficits, sensory loss, cognitive impairment, frailty, multiple chronic conditions, and functional status). We review the influence of these factors across the cancer care trajectory, including at screening, diagnosis, and treatment and discuss ways in which these conditions may be targeted to improve cancer care in older adults. Results: The CARE clinic was implemented at The Ohio State University Comprehensive Cancer Center (OSUCCC) and targets modifiable risk factors affecting outcomes in older adults with cancer: weight loss, polypharmacy, physical impairments, social support, and mood symptoms. The multidisciplinary team at the CARE clinic discusses and delivers a comprehensive set of recommendations, all in one clinic visit, to minimize burden on the patient and the caregiver. The CARE clinic is part of a set of initiatives that feature education of future leaders in geriatric oncology, survivorship care for an aging population, and outcomes research. Conclusions: Older adults with cancer have a unique set of needs that need to be taken into account throughout their cancer care. The CARE clinic model is an important example of an approach that may combat these difficulties and lead to better outcomes among older adults with cancer.

Growing Healing Touch as supportive cancer care in western New York.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 176-176
Author(s):  
Suzanne M Hess ◽  
Lynda M. Beaupin
Keyword(s):  
New York ◽  
Cancer Care ◽  
Symptom Relief ◽  
Physical Symptom ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Healing Touch ◽  
Energy Medicine ◽  
Supportive Cancer Care ◽  
Energy Field

176 Background: Healing Touch (HT) is a specific energy medicine modality that incorporates several techniques to balance the human energy field to help promote healing. It is a safe and non-invasive therapy that complements traditional, standard care and is recognized by NIH’s National Center for Complementary and Integrative Health. HT was first introduced to cancer survivors at our NCI-designated Comprehensive Cancer Center in 2013. We demonstrate HT is well-received and easy to integrate into traditional cancer care. Methods: A Certified Healing Touch Practitioner taught pediatric survivors and families HT techniques, as well as trained staff and volunteers to participate in the pilot program and to offer HT sessions throughout the year. Results: See Table. Qualitative analysis of participant’s feedback indicate benefits in the following themes: 1. Physical Symptom Relief 2. Emotional Issue Relief 3. Spiritual/Grief Support 4. Recommendation to Other Patients. Conclusions: Healing Touch is an energy medicine modality that is easy to teach, simple to integrate into routine cancer care, and beneficial for caregivers and survivors alike. [Table: see text]

A virtual tumor board-driven synaptic knowledge network.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 89-89
Author(s):  
Laurence J. Heifetz ◽  
Ahrin B. Koppel ◽  
Elaine Melissa Kaime ◽  
Daphne Palmer ◽  
Thomas John Semrad ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Rural Areas ◽  
Cancer Care ◽  
Knowledge Network ◽  
Tumor Board ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Hospital District ◽  
Number Of Patients ◽  
Tumor Boards

89 Background: In 2006, Tahoe Forest Hospital District—a 25-bed hospital in Truckee, CA, a mountain resort community one hour from regional and two hours from academic cancer services—designed and implemented an oncology program utilizing effective telecommunications with a committed academic partner, the UC Davis Comprehensive Cancer Center in Sacramento. Methods: The UC Davis Cancer Care Network was established with four remote cancer programs, enabling participation in daily virtual tumor boards, clinical trial enrollment, and quality assurance assistance. (Richard J. Bold, et. al., Virtual tumor boards: community-university collaboration to improve quality of care. Community Oncol 10(11):310-315, November 2013.; Laurence J. Heifetz, MD, et. al., A Model for Rural Oncology. J Oncol Pract, 7:168-171, May 2011.). An increasing number of patients were observed to in-migrate to Truckee from even more remote rural areas in the mountains. In 2013, the now Gene Upshaw Memorial Tahoe Forest Cancer Center developed four remote telemedicine clinics to allow even more physically distant patients the capacity to be followed locally. Results: Since we opened the remote telemedicine clinics, our Sullivan-Luallin patient satisfaction scores have averaged 4.82/5.00 for “overall satisfaction with the practice” and 4.90/5.00 for “recommending your provider to others”; our in-migration rate of patients from outside our primary catchment area increased from 43% to 52%: and clinical trial accrual rate averaged 10%. Conclusions: Reducing cancer health disparities is an ASCO mission. (cover, ASCO Connection, July 2014; Laurence J. Heifetz, MD. Country Docs with City Technology Can Address Rural Cancer Care Disparities. Oncol, 29(9):641-644, September 2015.). We believe this synaptic knowledge network effectively addresses that mission for rural communities. This model can be scaled in many configurations to address the inherent degradation of quality care as a function of physical distance to an academic center that rural doctors and patients deal with on a daily basis. The key is to insist on a cultural shift – Do something smart at lunch every day. Attend a virtual tumor board.

Pharmacy contributions to improving care and sustaining change in a comprehensive cancer center.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 150-150
Author(s):  
Megan Brown ◽  
David L. Crosby ◽  
Megan H. Howe ◽  
Konstantin H. Dragnev
Keyword(s):  
Performance Indicator ◽  
Project Work ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Drug Preparation ◽  
Start Time ◽  
Process Measures ◽  
Efficient Treatment ◽  
Delivery Of Care ◽  
Time Performance

150 Background: Delivery of care in an outpatient hematology/oncology clinic is complex and requires the coordination of numerous services for timely and efficient treatment of patients. The Norris Cotton Cancer Center in Lebanon, NH, began a comprehensive assessment of clinic and infusion operations in 2012 and developed a system-wide initiative to address inconsistent performance in infusion, clinic and pharmacy services. Methods: Cancer center staff and leadership were trained on lean six-sigma methodology to initiate system-wide improvements through targeted project work. We collaborated with quality improvement experts and our analytics team to obtain and analyze data from our EMR. Then we established process measures for all operational areas and a key performance indicator (KPI) for hem/onc infusion: “on time performance.” The pharmacy contributed to on-time performance by focusing improvement initiatives on turn-around time (TAT) for clinical reviews and order verification, TAT for drug preparation, and initiating a process for pre-making chemotherapy. Results: "On-time performance” was initially defined as the percentage of patients whose first medication began within 45 minutes of their scheduled infusion start time. The baseline of 63% in 2012 was improved to 86% in 2018. Through sustained process improvement work and concerted efforts to further improve the patient experience and utilization of resources, an interdisciplinary team targeted a 15 minute on-time performance measurement; this baseline of 28% was improved to 47% in less than a year. In 2012 the pharmacy set a goal of reviewing and verifying orders within 30 minutes, and completing drug preparation within 45 minutes of order verification. The baseline percentage of orders reviewed within 30 minutes was 47% and this increased to 93% in 2018. Our baseline percentage of doses prepared within 45 minutes was 37% and the current median time for drug preparation across all orders is 45 minutes. The pharmacy currently pre-makes approximately 11% of doses. Conclusions: The cancer center pharmacy increased efficiency and improved on-time performance in delivery of care by using data-driven continuous improvement methods.

The cancer care network clinical trials program: Rising from the camp fire ashes.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 168-168
Author(s):  
Ofilio Ramon Vigil ◽  
Dana Ann Little ◽  
Kristin J. Mensonides ◽  
Richard J. Bold
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Rural Communities ◽  
Cancer Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Trial Participation ◽  
Care Network ◽  
Research Oversight ◽  
The City

168 Background: The UC Davis Health Cancer Care Network (CCN) in Sacramento improves quality through partnerships with community cancer centers and the UC Davis Comprehensive Cancer Center (UCDCCC). The UCDCCC, as an NCI Lead Academic Participating Site (LAPS) grant recipient, lists Adventist Health Rideout Cancer Center (RCC) in Marysville (42 miles north of Sacramento) as a component. The Adventist Health Feather River Cancer Center (FRCC) and the town of Paradise were devastated by the 2018 Camp Fire, forcing FRCC’s relocation to the city of Chico (49 miles north of Marysville). FRCC was forced to disband its local IRB and unable to continue clinical trials research operations during the aftermath of this natural disaster. The CCN established an affiliation with the FRCC in April 2019. Future plans include establishing an IRB agreement and adding FRCC as a LAPS component. The CCN identified strategies to facilitate the participation of FRCC patients in clinical trials. Methods: The CCN identified 13 NCTN clinical trials with 34 enrolled patients that were in need of appropriate research oversight. Four of these trials were previously never activated at the UCDCCC or its affiliates. CCN staff engaged leaders at the various institutions involved: Quality Assurance (QA) Managers at each NCTN research base, the CIRB, the local IRB, the CTSU, and other leaders within UC Davis and Adventist Health. Results: Stakeholders acknowledged the unusual and urgent nature of our requests and questions, while contributing to the development of a plan allowing patients to continue clinical trial participation. QA managers approved a plan transferring patients to the RCC, allowing research staff to collect and submit data while patients continue receiving care closer to home. Together we developed a notification letter to inform patients of this plan. Conclusions: The relocation of facilities and patients brought rare challenges while conducting clinical research in rural communities. We learned that the cooperation and flexibility of all parties involved was crucial in supporting the continued care for FRCC's clinical trial patients and research contributions.

Spiritual Motivations to Practice Medicine: A Survey of Cancer Care Providers

2021 ◽  
pp. 104990912110498
Author(s):  
Elizabeth Palmer Kelly ◽  
Brian Myers ◽  
Joseph Kelly-Brown ◽  
Brittany L. Waterman ◽  
Erin Stevens ◽  
...  
Keyword(s):  
Religious Identity ◽  
Cancer Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Intrinsic Religiosity ◽  
Care Providers ◽  
Provider Type ◽  
Cross Sectional Survey ◽  
Practice Of Medicine ◽  
The Relationship

Background: There is increased interest in the role of spirituality in the cancer care context, but how it may inspire individuals to pursue a career as a healthcare provider is unknown. We sought to determine the relationship between intrinsic religiosity, religious identity, provider role, and spiritual motivations to practice medicine. Methods: A cross-sectional survey was administered to healthcare providers at a large, Midwest Comprehensive Cancer Center. The relationship between provider type, intrinsic religiosity, religious identity, and spiritual motivations to practice medicine was assessed with binary logistic regression. Results: Among 340 participants, most were female (82.1%) or Caucasian (82.6%) and identified as being religious (57.5%); median age was 35 years (IQR: 31-48). Providers included nurses (64.7%), physicians (17.9%), and “other” (17.4%). Compared with physicians, nurses were less likely to agree that they felt responsible for reducing pain and suffering in the world (OR: 0.12, p = 0.03). Similarly, “other” providers were less likely than physicians to believe that the practice of medicine was a calling (OR: 0.28, p = 0.02). Providers with a high self-reported intrinsic religiosity demonstrated a much greater likelihood to believe that the practice of medicine is a calling (OR:1.75, p = 0.001), as well as believe that personal R&S beliefs influence the practice of medicine (OR:3.57, p < 0.001). Provider religious identity was not associated with spiritual motivations to practice medicine (all p > 0.05). Conclusion: Intrinsic religiosity had the strongest relationship with spiritual motivations to practice medicine. Understanding these motivations may inform interventions to avoid symptoms of provider burnout in cancer care.

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