scholarly journals Evaluation of Health Care Professional Response To Patient-Reported Distress In Gynecologic Oncology Clinics At An Academic Cancer Centre

2021 ◽  
Author(s):  
Soha Atallah ◽  
Jackie Bender ◽  
Anthony Fyles ◽  
Kathy Han ◽  
Michael Milosevic ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professional ◽  
Gynecologic Oncology ◽  
Significant Proportion ◽  
Assessment System ◽  
Oncology Patients ◽  
Symptom Screening ◽  
Patient Reported ◽  
Report Symptom ◽  
Subsequent Intervention

Abstract Objective: To evaluate health care professional (HCP) documentation of elevated patient-reported symptoms and subsequent intervention in gynecologic oncology clinics. Methods: This was a retrospective chart review of gynecologic oncology patients within a single institution. Prior to their clinical encounter, patients complete the validated Edmonton Symptom Assessment System revised (ESAS-r) questionnaire. Patients with any ESAS-r symptom score ≥4 (moderate-severe) were eligible for analysis. A stratified sampling method was used: 100 patients were randomly selected with 20 patients per year from 2012 to 2016. Patient, tumor and treatment characteristics were extracted from medical records. Health care provider (HCP) documentation of elevated symptoms and subsequent intervention were evaluated. Descriptive statistics were used to report symptom prevalence, HCP documentation and intervention. Fisher’s exact test evaluated documentation and intervention rates according to symptom severity and total ESAS-r score. Results: Between January 2012 and December 2016, 5849 patients completed the ESAS-r. Symptoms scores were ≥ 4 in 3216 patients (55%). In our sample of 100, ovarian (42%) and endometrial (34%) malignancies were most common. Median age was 55 years (range 47-63). Median ESAS-r score was 24 (range: 5-84), with tiredness being the most prevalent symptom reported by patients. HCP documented at least one elevated symptom in 50 patients (50%), most commonly for pain (71%) and least commonly for nausea (4%). Subsequent interventions were offered to only 32 patients (32%), most commonly for pain (56%). Higher median total ESAS-r score was associated with higher rate of documentation (p=0.004) and higher rate of intervention (p<0.001). Conclusions: A significant proportion of gynecologic oncology patients report symptom that should prompt an intervention. However, HCPs documented symptoms in only half of patients and reported interventions in only one third. These results highlight gaps and opportunities for improving symptom screening and response in the “real-world” setting.

Population-based standardized symptom screening: Cancer Care Ontario’s Edmonton Symptom Assessment System and performance status initiatives.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 56-56
Author(s):  
Sean Molloy ◽  
Jose Pereira ◽  
Esther Green ◽  
Deborah Jane Dudgeon ◽  
Doris Howell ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Symptom Management ◽  
Symptom Assessment ◽  
Assessment System ◽  
Evidence Based ◽  
Care Providers ◽  
Symptom Screening ◽  
Patient Reported ◽  
Evidence Based Guidelines

56 Background: The goal of the collaborative is to improve the quality and consistency of physical and emotional symptom management across the cancer journey. Objectives are: (a) promote the adoption of electronic symptom assessment using a standardized tool and (b) increase the clinical use of evidence based guidelines to effectively manage patient identified symptoms. Methods: The actions taken for this initiative are to manage cancer symptoms through a patient reported measurement tool; improve the quality of symptom management through the uptake of symptom management guides and algorithms for care; and drive improvement through the adoption of an electronic symptom assessment platform The following aims were established for this work: (1) Aim for symptom screening and assessment (70% of ambulatory cancer clinic patients are screened for symptom severity using ESAS at least once/month) (2) aim for symptom management (evidence from chart audits show intervention as per evidence based guidelines for patients reported symptom scores) (3) aim for patient satisfaction (90% of target population indicates that their health care team took their scores into consideration when developing a care plan) and (4) aim for evidence of use (90% of patients state that their doctor or nurse spoke with them about their symptom screen). Results: 60% of cancer patients are screened each month representing over 28,000 people. Six of fourteen cancer regions are above the provincial target of 70%, with some close to 90%. 92% of patients felt ESAS was important to complete to help health care providers know how they are feeling. Conclusions: Cancer Care Ontario has been able to drive improvements in symptom management through the implementation of system wide electronic symptom assessment. For other jurisdictions interested in adopting this approach, the following areas are critical for success. (a.) Leadership at all levels of the system; (b.) clinical tools at the point of care; (c) engagement of patients in the design of care; (d) communications support to spread information to all stakeholders; and (e) using to data to drive performance improvement and accountability.

Refining Patient-Centered Measures of End-of-Life Care Quality for Children With Cancer

2021 ◽  
Author(s):  
Prasanna Ananth ◽  
Sophia Mun ◽  
Noora Reffat ◽  
Soo Jung Kang ◽  
Sarah Pitafi ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Care Quality ◽  
Life Care ◽  
Children With Cancer ◽  
Symptom Screening ◽  
Palliative Care Consultation ◽  
Patient Reported

PURPOSE: There are no existing quality measures (QMs) to optimize end-of-life care for children with cancer. Previously, we developed a set of 26 candidate QMs. Our primary objective in this study was to achieve stakeholder consensus on priority measures. METHODS: We conducted an iterative, cross-sectional electronic survey, using a modified Delphi method to build consensus among clinician and family stakeholders. In each of the two rounds of surveys, stakeholders were asked to rate QMs on a 9-point Likert scale, on the basis of perceived importance. Health care professionals were additionally asked to rate measures on perceived feasibility. After each round, we computed median scores on importance and feasibility of measurement, retaining QMs with median importance scores ≥ 8. RESULTS: Twenty-five participants completed both rounds of the survey. In round 1, participants were asked to rate 26 QMs; nine QMs, including QMs pertaining to health care use, were removed because of median importance scores < 8. Two new measures were proposed for consideration in round 2, on the basis of participant feedback. Following round 2, 17 QMs were ultimately retained. QMs related to symptom screening and palliative care consultation were rated highly in importance and feasibility. QMs related to communication were rated highly important, yet less feasible. Measuring whether a patient's needs were heard by their health care team was rated among the least feasible. CONCLUSION: Childhood cancer stakeholders prioritized QMs pertaining to patient-reported outcomes, deeming measures of health care resource use less important. Future research should seek to develop novel tools for quality assessment to enhance feasibility of implementing priority measures.

scholarly journals Implementing a Patient-Reported Outcome Measure for Hemodialysis Patients in Routine Clinical Care

2020 ◽  
Vol 15 (9) ◽  
pp. 1299-1309 ◽  
Author(s):  
Jenna M. Evans ◽  
Alysha Glazer ◽  
Rebecca Lum ◽  
Esti Heale ◽  
Marnie MacKinnon ◽  
...  
Keyword(s):  
Outcome Measure ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Patient Reported Outcome ◽  
Assessment System ◽  
Edmonton Symptom Assessment System ◽  
Patient Reported Outcome Measure ◽  
Symptom Screening ◽  
Patient Reported ◽  
Patient Provider Communication

Background and objectivesThe Edmonton Symptom Assessment System Revised: Renal is a patient-reported outcome measure used to assess physical and psychosocial symptom burden in patients treated with maintenance dialysis. Studies of patient-reported outcome measures suggest the need for deeper understanding of how to optimize their implementation and use. This study examines patient and provider perspectives of the implementation process and the influence of the Edmonton Symptom Assessment System Revised: Renal on symptom management, patient-provider communication, and interdisciplinary communication.Design, setting, participants, & measurements Eight in-facility hemodialysis programs in Ontario, Canada, assessed patients using the Edmonton Symptom Assessment System Revised: Renal every 4–6 weeks for 1 year. Screening and completion rates were tracked, and pre- and postimplementation surveys and midimplementation interviews were conducted with patients and providers. A chart audit was conducted 12 months postimplementation.ResultsIn total, 1459 patients completed the Edmonton Symptom Assessment System Revised: Renal; 58% of eligible patients completed the preimplementation survey (n=718), and 56% of patients who completed the Edmonton Symptom Assessment System Revised: Renal at least once completed the postimplementation survey (n=569). Provider survey response rates were 71% (n=514) and 54% (n=319), respectively. Nine patients/caregivers from three sites and 48 providers from all sites participated in interviews. A total of 1207 charts were audited. Seven of eight sites had mean screening rates over 80%, suggesting that routine use of the Edmonton Symptom Assessment System Revised: Renal in clinical practice is feasible. However, the multiple data sources painted an inconsistent picture of the value and effect of the Edmonton Symptom Assessment System Revised: Renal. The Edmonton Symptom Assessment System Revised: Renal standardized symptom screening processes across providers and sites; improved patient and provider symptom awareness, particularly for psychosocial symptoms; and empowered patients to raise issues with providers. Yet, there was little, if any, statistically significant improvement in the metrics used to assess symptom management, patient-provider communication, and interdisciplinary communication.ConclusionsThe Edmonton Symptom Assessment System Revised: Renal patient-reported outcome measure may be useful to standardize symptom screening, enhance awareness of psychosocial symptoms among patients and providers, and empower patients rather than to reduce symptom burden.

A tale of 2,000 charts: Measuring provider response to patient-reported outcome measures.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 157-157
Author(s):  
Gillian Hurwitz ◽  
Zahra Ismail ◽  
Lesley Moody ◽  
Lisa Catherine Barbera
Keyword(s):  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Physical Symptoms ◽  
Patient Reported Outcome ◽  
Assessment System ◽  
Screening Methods ◽  
Depression And Anxiety ◽  
Chart Audit ◽  
Symptom Screening ◽  
Patient Reported

157 Background: Patients undergoing cancer treatment often experience physical and psychosocial symptoms that go undetected by clinicians, which highlights the need to incorporate patient-reported outcome measures (PROMs) in routine care. Systematic symptom screening for cancer patients using the Edmonton Symptom Assessment System (ESAS) is standard practice in Ontario. However, provider response to PROMs is essential to addressing symptom burden. To measure provider response, Regional Cancer Centre (RCC) Leads and Cancer Care Ontario developed a chart audit process. The objective was to determine whether the clinical team acknowledged, assessed and/or addressed symptoms identified by ESAS screening. Methods: RCCs received a chart audit tool with preset options and a data dictionary. Sites audited at least 140 charts for seven of the ESAS symptoms. Sites used a business intelligence tool to access patient charts based on sampling parameters. RCCs were required to audit charts of patients whose ESAS symptom scores were moderate to severe (4-10), with at least five charts in the moderate range (4-6). Results: 2,380 charts from 13 RCCs were audited based on ESAS scores from September to December 2016. Symptoms were most often acknowledged when the intensity was severe (69.9%), regardless of symptom type. Acknowledgement (71.5%), assessment (67.7%) and intervention (55.8%) were most often offered to patients reporting pain. Patients reporting depression and anxiety were the least likely to have the symptom acknowledged (44.5%, 45.0%, respectively) and be offered assessments (45.8%, 50.1%, respectively) and interventions (35.7%, 36.6%, respectively). Patients reporting moderate to severe depression and anxiety most commonly declined interventions (7.8%, 7.7%, respectively). Conclusions: These data show that providers disproportionately respond to physical symptoms, which may be easiest to treat due to clear management plans and referral pathways. To truly offer person-centred care, the emotional burden related to cancer must also be addressed, and providers must be trained to properly respond to psychosocial symptoms. Chart audits identify gaps in symptom management and areas for quality improvement.

Super-utilization of health care resources among gynecologic oncology patients

2017 ◽  
Vol 145 ◽  
pp. 169-170
Author(s):  
C.M. Hay ◽  
R.P. Edwards ◽  
J.L. Kelley ◽  
J.T. Comerci
Keyword(s):  
Health Care ◽  
Gynecologic Oncology ◽  
Oncology Patients ◽  
Health Care Resources

scholarly journals Perioperative trajectory of patient reported symptoms: A pilot study in gynecologic oncology patients

2015 ◽  
Vol 136 (3) ◽  
pp. 440-445 ◽  
Author(s):  
Larissa A. Meyer ◽  
Alpa M. Nick ◽  
Qiuling Shi ◽  
Xin Shelley Wang ◽  
Loretta Williams ◽  
...  
Keyword(s):  
Pilot Study ◽  
Gynecologic Oncology ◽  
Oncology Patients ◽  
Patient Reported

A person-centered e-proms multi-faceted intervention to improve patient experience and health outcomes: A multi-site implementation study in diverse ambulatory oncology practices.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 182-182 ◽  
Author(s):  
Doris Howell ◽  
Madeline Li ◽  
Zeev Rosberger ◽  
Nicole Montgomery ◽  
Carole Mayer ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Patient Experience ◽  
Clinical Care ◽  
Emergency Department Visits ◽  
Practice Change ◽  
Assessment System ◽  
Team Collaboration ◽  
Symptom Screening ◽  
Ambulatory Oncology ◽  
Patient Reported

182 Background: The Improving Patient Experience and Health Outcomes Collaborative (iPEHOC) aims to improve health outcomes through uptake of electronic patient reported outcome measures (e-PROMs) in oncology practices in Ontario and Quebec. Building on screening with the Edmonton Symptom Assessment System (ESAS), e-PROMs were triggered based on cut scores to focus multidimensional assessment and management of pain (BPI), fatigue (CFS), anxiety (GAD-7) and depression (PHQ-9). Methods: Multifaceted implementation strategies and practice change coaching facilitated the use of e-PROMs to improve symptom outcomes. A mixed-method, pre-post quasi-experimental design assessed process and impact of the intervention on symptom screening rates, symptom burden, patient experience and activation, clinician satisfaction, team collaboration and health care use. Mann-Whitney U statistics examined significance of change from baseline to the 8-month post comparison. Qualitative data explored uptake of e-PROMs in practice. Results: Over the implementation period 10,248 ESAS screens were completed in iPEHOC clinics; 17.5% triggered an additional e-PROM. A slight improvement was noted in person-centeredness of communication (mean change of 1.43 to 1.37; four-point scale of 1 = very satisfied, 4 = very dissatisfied) and in team collaboration. A significant increase in patient activation levels (p = 0.045) was related to decreased emergency department visits (2% pre/post change, p = 0.81) and hospitalization within 30 days of an e-PROMs completion (2.2% change, p = 0.034) in Ontario. Patients and clinicians perceived e-PROMs as valuable to focus communication in the clinic visit and for shared treatment planning. Focus group data suggests that patients use e-PROMs as a ‘self-check-in’, to communicate their symptoms and normalize disclosure of depression in clinical care. Conclusions: Uptake of e-PROMs in diverse settings is complex and demanding. Improving symptom management quality requires PROM data to be fed-back for ‘real-time’ use in the clinical encounter and practice change facilitation for meaningful use in routine care.

Identification of Patient-Reported Outcome Phenotypes Among Oncology Patients With Palliative Care Needs

2021 ◽  
pp. OP.20.00849
Author(s):  
Tara L. Kaufmann ◽  
Kelly D. Getz ◽  
Jesse Y. Hsu ◽  
Antonia V. Bennett ◽  
Samuel U. Takvorian ◽  
...  
Keyword(s):  
Palliative Care ◽  
Latent Profile Analysis ◽  
Clinical Care ◽  
Patient Reported Outcome ◽  
Assessment System ◽  
Moderate Pain ◽  
Care Needs ◽  
Oncology Patients ◽  
Patient Reported ◽  
Palliative Care Needs

PURPOSE: Despite evidence-based guidelines recommending early palliative care, it remains unclear how to identify and refer oncology patients, particularly in settings with constrained access to palliative care. We hypothesize that patient-reported outcome (PRO) data can be used to characterize patients with palliative care needs. To determine if PRO data can identify latent phenotypes that characterize indications for specialty palliative care referral. METHODS: We conducted a retrospective study of self-reported symptoms on the Edmonton Symptom Assessment System collected from solid tumor oncology patients (n = 745) referred to outpatient palliative care. Data were collected as part of routine clinical care from October 2012 to March 2018 at eight community and academic sites. We applied latent profile analysis to identify PRO phenotypes and examined the association of phenotypes with clinical and demographic characteristics using multinomial logistic regression. RESULTS: We identified four PRO phenotypes: (1) Low Symptoms (n = 295, 39.6%), (2) Moderate Pain/Fatigue + Mood (n = 180, 24.2%), (3) Moderate Pain/Fatigue + Appetite + Dyspnea (n = 201, 27.0%), and (4) High Symptoms (n = 69, 9.3%). In a secondary analysis of 421 patients, we found that two brief items assessing social and existential needs aligned with higher severity symptom and psychological distress phenotypes. CONCLUSION: Oncology patients referred to outpatient palliative care in a real-world setting can be differentiated into clinically meaningful phenotypes using brief, routinely collected PRO measures. Latent modeling provides a mechanism to use patient-reported data on a population level to identify distinct subgroups of patients with unmet palliative needs.

scholarly journals Multidisciplinary Health Care Professionals' Perceptions of the Use and Utility of a Symptom Assessment System for Oncology Patients

2011 ◽  
Vol 7 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Daryl Bainbridge ◽  
Hsien Seow ◽  
Jonathan Sussman ◽  
Greg Pond ◽  
Lorraine Martelli-Reid ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Symptom Burden ◽  
Multidisciplinary Care ◽  
Symptom Assessment ◽  
Assessment System ◽  
Oncology Patients ◽  
Edmonton Symptom Assessment System ◽  
Cancer Centers

This study examines the value of the Edmonton Symptom Assessment System (ESAS), a measure of symptom burden adopted by Ontario's cancer centers, among clinical teams and barriers to its use in the enhancement of multidisciplinary care.

scholarly journals Province-wide analysis of patient reported outcomes for stage IV non-small cell lung cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12092-12092
Author(s):  
Michael Chandra Tjong ◽  
Mark Doherty ◽  
Hendrick Tan ◽  
Wing Chan ◽  
Haoyu Zhao ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Low Income ◽  
Stage Iv ◽  
Well Being ◽  
Assessment System ◽  
Shortness Of Breath ◽  
Symptom Screening ◽  
Patient Reported ◽  
Nsclc Patients ◽  
High Comorbidity

12092 Background: Stage IV NSCLC patients have significant disease and treatment-related morbidity. In Ontario, Canada, cancer patients complete Edmonton Symptom Assessment System (ESAS) questionnaires, a tool that elicits patients’ self-reported severity of common cancer-associated symptoms at clinical encounters. ESAS domains are: anxiety, depression, drowsiness, appetite, nausea, pain, shortness of breath, tiredness and well-being. The purpose of this study is to examine moderate-to-severe symptom burden in the 12 months following a diagnosis of stage IV NSCLC. Methods: Using administrative databases and unique encoded identifiers, stage IV NSCLC diagnosed between January 2007 and September 2018 were evaluated for symptom screening with ESAS in the 12 months following diagnosis. Proportion of patients reporting moderate-to-severe score (i.e. ESAS ≥4) in each domain within 12 months were calculated. Patients reporting moderate-to-severe within the different ESAS domains of were plotted over time. Multivariable (MV) Poisson regression models with potential covariates such as age, sex, Elixhauser comorbidity index, income quintiles, and lung cancer treatments received were constructed to identify factors associated with moderate-to-severe symptoms. Results: Of 22,799 stage IV NSCLC patients, 13,289 (58.3%) had completed ESAS (84,373 unique assessments) in the year following diagnosis. Patients with older age, high comorbidity, and not receiving active cancer therapy were less likely to complete ESAS. Most (94.4%) reported at least 1 moderate-to-severe score. Most prevalent moderate-to-severe ESAS symptoms within 12 months after diagnosis were tiredness (84.1%), lack of wellbeing (80.7%), low appetite (71.7%), and shortness of breath (67.8%); nausea was the least prevalent (34.6%). Most symptoms peaked at diagnosis and persisted in the year after diagnosis. On adjusted MV analyses, patients with high comorbidity, low income, and urban residency were associated with increased moderate-to-severe symptoms. Moderate-to-severe scores in all ESAS symptoms were associated with delivery of radiotherapy within 2 weeks prior, while moderate-to-severe nausea, drowsiness, tiredness, low appetite, and lack of wellbeing were associated with delivery of systemic therapy within preceding 2 weeks. Conclusions: In this population-based analysis of stage IV NSCLC PROs in the year following diagnosis, moderate-to-severe symptoms were highly prevalent and persistently high, underscoring the need to address supportive requirements in this at-risk population.

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