scholarly journals Cancer Center Clinic and Research Team Perceptions of Identity and Interactions

2017 ◽  
Vol 13 (12) ◽  
pp. e1021-e1029 ◽  
Author(s):  
Torsten Reimer ◽  
Simon J. Craddock Lee ◽  
Sandra Garcia ◽  
Mary Gill ◽  
Tobi Duncan ◽  
...  
Keyword(s):  
Group Dynamics ◽  
The Other ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Research Staff ◽  
Research Teams ◽  
Team Members ◽  
Clinic Staff ◽  
Impact Function ◽  
Shared Information

Purpose: Conduct of cancer clinical trials requires coordination and cooperation among research and clinic teams. Diffusion of and confusion about responsibility may occur if team members’ perceptions of roles and objectives do not align. These factors are critical to the success of cancer centers but are poorly studied. Methods: We developed a survey adapting components of the Adapted Team Climate Inventory, Measure of Team Identification, and Measure of In-Group Bias. Surveys were administered to research and clinic staff at a National Cancer Institute–designated comprehensive cancer center. Data were analyzed using descriptive statistics, t tests, and analyses of variance. Results: Responses were received from 105 staff (clinic, n = 55; research, n = 50; 61% response rate). Compared with clinic staff, research staff identified more strongly with their own group ( P < .01) but less strongly with the overall cancer center ( P = .02). Both clinic staff and research staff viewed their own group’s goals as clearer than those of the other group ( P < .01) and felt that members of their groups interacted and shared information within ( P < .01) and across ( P < .01) groups more than the other group did. Research staff perceived daily outcomes as more important than did clinic staff ( P = .05), specifically research-related outcomes ( P = .07). Conclusion: Although there are many similarities between clinic and research teams, we also identified key differences, including perceptions of goal clarity and sharing, understanding and alignment with cancer center goals, and importance of outcomes. Future studies should examine how variation in perceptions and group dynamics between clinic and research teams may impact function and processes of cancer care.

scholarly journals Definition and Coordination of Roles and Responsibilities Among Cancer Center Clinic and Research Personnel

2020 ◽  
Vol 16 (1) ◽  
pp. e64-e74
Author(s):  
Simon J. Craddock Lee ◽  
Torsten Reimer ◽  
Sandra Garcia ◽  
Erin L. Williams ◽  
Mary West ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Physician Attitudes ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Research Staff ◽  
Research Personnel ◽  
Delivery Of Care ◽  
Roles And Responsibilities ◽  
Clinic Staff ◽  
Staff Members

PURPOSE: Effective enrollment and treatment of patients in cancer clinical trials require definition and coordination of roles and responsibilities among clinic and research personnel. MATERIALS AND METHODS: We developed a survey that incorporated modified components of the Survey of Physician Attitudes Regarding the Care of Cancer Survivors. Surveys were administered to clinic nursing staff and research personnel at a National Cancer Institute–designated comprehensive cancer center. Results were analyzed using χ2-tests, t tests, and analyses of variance. RESULTS: Surveys were completed by 105 staff members (n = 50 research staff, n = 55 clinic staff; 61% response rate). Research staff were more likely to feel that they had the skills to answer questions, convey information, and provide education for patients on trials (all P < .05). Both clinic and research staff reported receipt of communication about responsibilities in fewer than 30% of cases, although research staff reported provision of such information in more than 60% of cases. Among 20 tasks related to care of patients in trials, no single preferred model of responsibility assignment was selected by the majority of clinic staff for nine tasks (45%) or by research staff for three tasks (15%). Uncertainty about which team coordinates care was reported by three times as many clinic staff as research staff ( P = .01). There was also substantial variation in the preferred model for delivery of care to patients in trials ( P < .05). CONCLUSION: Knowledge, attitudes, and perception of care and responsibilities for patients on clinical trials differ between and among clinic and research personnel. Additional research about how these findings affect efficiency and quality of care on clinical trials is needed.

Cancer center clinic and clinical research team perceptions of identity and interactions.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18215-e18215
Author(s):  
David E. Gerber ◽  
Torsten Reimer ◽  
Sandra Garcia ◽  
Mary Gill ◽  
Tobi Duncan ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Research ◽  
Information Sharing ◽  
Care Delivery ◽  
Clinical Care ◽  
The Other ◽  
Cancer Center ◽  
Cancer Clinical Trials ◽  
Research Staff ◽  
Clinic Staff

e18215 Background: As evidenced by the NCI-ASCO Teams in Cancer Care Delivery initiative, there is growing interest in applying an emerging science of teams to oncology clinical care. Treatment of patients on cancer clinical trials requires coordination and cooperation among research and clinic teams. However, little empirical research has examined issues of goal alignment, diffusion of responsibility, and perceived rivalries in this setting. Methods: We developed a survey incorporating modified components of the Adapted Team Climate Inventory, the Measure of Team Identification, and the Measure of In-group Bias. Surveys were administered to research staff and clinic staff. Survey responses were analyzed using t tests and ANOVAs. Results: Responses were received from 104 staff (54 clinic, 50 research). Median duration of professional experience was 8.3 years, and median time in current position was 2.0 years. Research staff identified more strongly with their own group ( P< 0.01) but less strongly with the Cancer Center ( P= 0.02) compared to clinic staff. Both clinic and research staff viewed their own group’s goals as clearer than those of the other group ( P< 0.01). Both clinic staff and research staff felt that members of their groups shared information among themselves more than the other group ( P< 0.01). Research staff felt information sharing occurred to a greater extent in both groups than did clinic staff ( P< 0.01). Similar results were noted regarding information sharing with the other group ( Ps< 0.01). Staff indicated that members of their own groups interacted more often with each other than did members of the other group ( P< 0.01), with research staff perceiving higher interaction rates in both teams than clinic staff ( P< 0.01). Research staff perceived daily outcomes to be more important than did clinic staff ( P =0.05), in particular research-related outcomes ( P =0.07). Conclusions: Clinical research staff and clinic staff identify more strongly with their own groups and feel that their own group’s goals are clearer than those of the other group. Further study of interactions, perceptions, and attitudes between research staff and clinic staff is essential to provision of quality care to patients on cancer clinical trials.

scholarly journals Navigating uncharted waters: Developing a standardized approach for evaluating and implementing biosimilar products at a comprehensive cancer center

2020 ◽  
Author(s):  
Mara N Villanueva ◽  
Jennifer E Davis ◽  
Stacey M Sobocinski
Keyword(s):  
Transition Period ◽  
Treatment Protocol ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Specific Product ◽  
Team Members ◽  
Research Protocols ◽  
Institutional Review ◽  
Multiple Challenges ◽  
Coordinate Changes

Abstract Purpose The processes for formulary implementation and electronic health record (EHR) integration of biosimilar products at a comprehensive cancer center are described. Implications for research protocols are also discussed. Summary The existing literature focuses on practical considerations for formulary addition of biosimilar products, but there is a lack of guidance on how to implement the change, particularly within the EHR. Before building the ordering tools for biosimilars, the clinical and informatics teams should determine the role of biosimilars at the institution, identify drug-specific product characteristics that affect medication build, and characterize implications of future formulary changes or drug shortages. Leveraging an orderable record provides the ability to include logic that maps to multiple products and also allows for future implementation of changes within the medication record rather than requiring “swaps” at the treatment protocol level. The institutional review board should coordinate changes in affected research protocols and consent forms and work with principal investigators to amend protocols when necessary. Pharmacy leaders should develop processes to oversee inventory during the transition period and minimize the risk of errors. Conclusion The development of a standardized approach for evaluating and implementing biosimilar products improves efficiency and collaboration among the various team members responsible for the products’ integration into existing workflows, including implications for clinical research. Implementing biosimilars for agents used to treat cancer will pose new challenges and require additional considerations. Partial implementation of biosimilars continues to pose multiple challenges in the provision of patient care.

Snapshot of an outpatient supportive care center at a comprehensive cancer center.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 145-145
Author(s):  
Lindsey E Pimentel ◽  
Maxine Grace De la Cruz ◽  
Angelique Wong ◽  
Debra Castro ◽  
Eduardo Bruera
Keyword(s):  
End Of Life ◽  
Care Center ◽  
Case Manager ◽  
Symptom Assessment ◽  
Assessment Tools ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Early Integration ◽  
Team Members ◽  
Outpatient Supportive Care

145 Background: Integration of Palliative Care (PC) in oncology has been found to improve symptom distress, quality of life and survival in patients with advanced cancer. Early integration is most appropriate in the outpatient (OP) setting. However, most PC services in the U.S. do not have an OP component. Our study aims to provide a snapshot of the type of patients that are referred to this novel setting for the delivery of early PC. Methods: We reviewed a day in the SCC to illustrate the structure and process involved in the delivery of outpatient PC. We highlighted 9 patients seen that day to show the variety of patients, scope of services, and the unique roles that PC interdisciplinary team members perform. Results: 41 patients were seen that day in the SCC: 10 scheduled consults, 22 scheduled follow-ups, 9 (22%) same-day unscheduled patients: 4 follow-ups, 1 consult and 4 nurse triages. There were also 31 telephone encounters. Most patients seen were for routine follow-up and symptom assessment. However, 10 presented with worsening symptoms with one needing hospital admission. 21 patients required additional counseling: 2 for hospice transitioning, 12 for psychosocial distress, 7 for opioid education. PC was delivered predominantly by physicians and nurses with collaboration with our pharmacist, counselors, and case manager. Conclusions: Traditionally, PC has been delivered predominantly to patients with advanced disease and to aid in transition to end of life. In recent years, OP centers have dramatically changed the nature of PC work as in our snapshot. In addition to patients regarded as traditional PC patients, such as those transitioning to end of life, there are now patients who come in soon after arrival to a cancer center requiring specialized care to address a variety of symptom and educational needs, thus requiring adaptation of structure and processes to allow access for frequent follow ups and counseling and flexibility for walk-in visits. Our findings suggest that SCC needs to practice in a very different way which requires certain skills and assessment tools that are not conventionally present in traditional oncology clinic setting. More research is needed to identify the type of patients that would benefit most from a PC referral.

Implementation of chemotherapy treatment plans (CTP) in a large comprehensive cancer center (CCC): The key roles of infrastructure and data sharing.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 20-20 ◽  
Author(s):  
Julie M. Bryar ◽  
Carole Kathleen Dalby ◽  
Susan Anastas ◽  
Lauren Brady ◽  
Michael J. Hassett ◽  
...  
Keyword(s):  
Performance Status ◽  
High Volume ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Tumor Characteristics ◽  
Communication Tool ◽  
Chemotherapy Treatment ◽  
Team Members ◽  
Patient Diagnosis ◽  
Treatment Plans

20 Background: ASCO recommends that prior to initiating chemotherapy, a synoptic CTP should be created. At a large CCC, there was no tool to consistently or clearly communicate chemotherapy plans within the electronic health record (EHR). Methods: In 2011, a structured tool was created in the EHR to document patient diagnosis, tumor characteristics, planned regimen, side effects, performance status, and other elements when starting a new chemotherapy. Completion of a CTP generates a synoptic note in the EHR, pre-populates a chemotherapy consent form and computerized chemotherapy ordering template, helping to integrate CTPs into normal workflow and removing steps for possible errors. Completed CTPs can be accessed by care team members and sent to external referring providers. Implementation strategy included education on the importance of and how to complete CTPs and sending monthly compliance reports to disease centers (DC) and regional sites (RS). Compliance was defined as number completed CTPs / number new chemotherapy starts. Results: The CTP tool was introduced in a staggered rollout in mid-2011 (compliance reporting began in 2012). Six DC and 3 RS presently complete and use CTPs. 3,569 CTPs were completed since 2012. The table shows compliance by quarter, demonstrating significant variation among DC and RS. We attribute increased compliance to introduction of formal feedback reports that allow for identification of high-volume providers not completing CTPs, triggering individual interventions, especially targeted re-education. We also suspect shared reporting led to competition among providers, further improving performance. No incentives were provided for CTP completion. Conclusions: By creating a tool within the existing workflow and providing formal feedback, CTPs have been implemented as a communication tool at a CCC. [Table: see text]

Development and use of a staffing model for clinical research teams at an NCI Comprehensive Cancer Center.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e18267-e18267
Author(s):  
Erin Fenske Williams ◽  
Joan H. Schiller ◽  
Joyce D Bolluyt ◽  
David E. Gerber
Keyword(s):  
Clinical Research ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Research Teams ◽  
Staffing Model

A staff leadership model in an NCI-designated comprehensive cancer center: Quality begins with the team.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 73-73
Author(s):  
Juee Kotwal ◽  
Matthew J. Loscalzo ◽  
Karen L. Clark ◽  
William Dale ◽  
Natalie Schnaitmann
Keyword(s):  
Cultural Change ◽  
High Performance ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Team Approach ◽  
Leadership Model ◽  
Team Members ◽  
Complex Needs ◽  
Management Staff

73 Background: Patients with cancer face a range of complex biopsychosocial needs and challenges. To manage the complex needs of such “high-risk, high-cost” patients, an integrated interdisciplinary team approach is crucial. Although team members are highly skilled, cancer settings are emotionally charged environments which may create high levels of distress in providers. In 2007, the Department of Supportive Care Medicine (DSCM) at City of Hope (COH) developed the nation’s first Staff Leadership Model (SLM) to enhance relationships among team members which has been demonstrated to improve both the quality of patient care and safety. Within this model, the focus was on creating a high-performance team where team members are as valued as patients and families. Methods: DSCM implemented methods centered on maximizing team engagement by creating trusting relationships, detoxifying conflicts, depersonalizing feedback, and taking personal accountability. Cultural change was achieved by implementing the following interventions: communication skills to manage conflict, frequent team check-ins to identify areas of growth, non-management staff assuming responsibility for meetings and annual retreats and a “buddy” system to orient new team members. Results: Gallup scores increased from 4.46 in 2015 to 4.62 in 2017 (much higher than COH overall). Transition to Press Ganey in 2018 resulted in 2nd highest engagement score across COH departments (4.42 compared to COH overall 4.16). Conclusions: Results suggest support for the relationship between the SLM and the high quality of team relationships as reflected by the consistent increase in engagement scores. The department philosophy focuses on consciously, systematically and strategically activating the best of each team member in an environment of courageous, compassionate and relentless honesty.

Performance teamwork training in ambulatory oncology.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16559-e16559
Author(s):  
Anne Gross ◽  
Susan Mann ◽  
Michael Kalfin ◽  
Sharon Lane ◽  
Saul Weingart ◽  
...  
Keyword(s):  
Data Collection ◽  
Multimodality Treatment ◽  
Team Training ◽  
Training Data ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Team Members ◽  
Communication Task ◽  
Ambulatory Oncology ◽  
Patient Reported

e16559 Background: Increasingly complex diagnostic and multimodality treatment algorithms have yielded superior outcomes, but also magnified the risk for adverse events precipitated by failures of communication and coordination. We implemented team training principles in 14 outpatient oncology practices across 3 campuses (community and academic) to reduce the risk of errors and increase operational efficiency and quality. Methods: Over 950 physicians, nurses, pharmacists, and staff were trained in evidence-based concepts of teamwork. Intervention included 1) baseline data collection regarding key clinical processes, (e.g. non-communication of same-day chemotherapy order changes); 2) observations/interviews with care team members; 3) process meetings to identify vulnerabilities and develop agreements and tools to support them; 4) Train the Trainer methodology; 5) staff training; 6) post-training data collection. Results: Despite the infrequency of non-communicated same-day changes in chemotherapy orders at baseline (~2%), a trend toward improvement was seen (chi-square p=0.068). The incidence of missing chemotherapy orders for infusion visits not associated with an MD visit decreased significantly. Staff reported improved practice efficiencies and a more respectful, safer environment. Press Ganey patient-reported perceptions of teamwork improved significantly. Conclusions: Team training improved communication, task coordination, perceptions of efficiency, quality, safety and interactions among team members, as well as patient perception of teamwork in both community and academic environments of a comprehensive cancer center. [Table: see text]

Teamwork and Electronic Health Record Implementation: A Case Study of Preserving Effective Communication and Mutual Trust in a Changing Environment

2016 ◽  
Vol 12 (11) ◽  
pp. 1075-1083 ◽  
Author(s):  
Anne H. Gross ◽  
Ryan K. Leib ◽  
Anne Tonachel ◽  
Richard Tonachel ◽  
Danielle M. Bowers ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Effective Communication ◽  
Similar Process ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Health Record ◽  
Mutual Trust ◽  
Team Members ◽  
Electronic Health

This article describes how trust among team members and in the technology supporting them was eroded during implementation of an electronic health record (EHR) in an adult outpatient oncology practice at a comprehensive cancer center. Delays in care of a 38-year-old woman with high-risk breast cancer occurred because of ineffective team communication and are illustrated in a case study. The case explores how the patient’s trust and mutual trust between team members were disrupted because of inaccurate assumptions about the functionality of the EHR’s communication tool, resultant miscommunications between team members and the patient, and the eventual recognition that care was not being effectively coordinated, as it had been previously. Despite a well-established, team-based culture and significant preparation for the EHR implementation, the challenges that occurred point to underlying human and system failures from which other organizations going through a similar process may learn. Through an analysis and evaluation of events that transpired before and during the EHR rollout, suggested interventions for preventing this experience are offered, which include: a thorough crosswalk between old and new communication mechanisms before implementation; understanding and mitigation of gaps in the communication tool’s functionality; more robust training for staff, clinicians, and patients; greater consideration given to the pace of change expected of individuals; and development of models of collaboration between EHR users and vendors in developing products that support high-quality, team-based care in the oncology setting. These interventions are transferable to any organizational or system change that threatens mutual trust and effective communication.

scholarly journals Clinical Outcomes in Relapsed/Refractory Multiple Myeloma Patients Receiving Sequential Elotuzumab and Daratumumab: A Single Center Experience

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 24-24
Author(s):  
Fahmin Basher ◽  
Yonette Paul ◽  
James E. Hoffman
Keyword(s):  
Multiple Myeloma ◽  
Monoclonal Antibody ◽  
Cell Activation ◽  
Killer Cell ◽  
Previous Treatment ◽  
The Other ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Therapy Regimen ◽  
Refractory Multiple Myeloma

Daratumumab and elotuzumab are monoclonal antibodies approved by the FDA in November 2015 for the treatment of relapsed/refractory multiple myeloma (RRMM). Daratumumab was approved as a single therapy targeting plasma cell surface CD38, while elotuzumab was approved as part of combination therapy (with lenalidomide), targeting SLAMF7 to impact natural killer cell activation. While both therapies are involved in the recruitment of cellular cytotoxic mechanisms against multiple myeloma, the efficacy of each after a patient has relapsed on the other therapy is unclear. We conducted a retrospective analysis of 26 patients with RRMM at the University of Miami Sylvester Comprehensive Cancer Center that received both elotuzumab and daratumumab between January 2016 and December 2018 to determine if progression-free survival (PFS) with each monoclonal antibody is affected by previous treatment with the other. Median age at time of treatment was 59.7 years, and 58% of patients were female. Median number of treatments prior to first monoclonal antibody was 4, and median time to first monoclonal antibody was 58 months. Seventeen patients received daratumumab prior to elotuzumab, while nine patients received elotuzumab prior to daratumumab. Patients that received daratumumab first received on average 2 treatments before receiving elotuzumab, while patients receiving elotuzumab first received 1 treatment on average before receiving daratumumab, and time between treatments was significantly shorter for patients receiving daratumumab first (3.7 months vs. 12.4 months, p = 0.0009). Overall survival (OS) and cumulative PFS trended higher in patients receiving elotuzumab first but did not reach significance (OS 37 months vs. 21.7 months, p = 0.07, and PFS 15.5 months vs. 7.6 months, p = 0.09). PFS with initial elotuzumab was higher than with initial daratumumab (11.9 months vs. 3.5 months, p = 0.0124). PFS on daratumumab trended favorably when elotuzumab was administered first (9.4 months vs. 3.0 months), although not significant (p = 0.19). In patients receiving daratumumab, 47% initially demonstrated response, all with eventual progression, with 40% responding to later elotuzumab therapy. Conversely, 56% of patients receiving elotuzumab first demonstrated a response, with 44% eventually progressing over time, and 56% responding to subsequent daratumumab therapy. These results generate a plausible hypothesis related to a possible potentiating effect of elotuzumab that extends after therapy regimen has changed and warrants further investigation into the sequencing of these two therapies in RRMM and the interplay of their different immunologic impact. Disclosures Hoffman: Seattle Genetics: Research Funding; Loxo: Current equity holder in publicly-traded company; Celgene: Honoraria, Speakers Bureau.

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