Family caregiver needs assessment in a gynecologic oncology practice: An ASCO quality training program project.

Abstract

178 Background: Family caregiver (CG) demands in gynecologic oncology (gynonc) put CGs at risk for anxiety, depression, and inability to care for loved ones. Resources exist to support patients, but systematic support for CGs is lacking. Fifty percent of CGs in our clinic report 9 or more distressing unmet needs. Thus, an ASCO Quality Training Program (QTP) project aimed to assess and intervene on the needs of 75% of gynonc family CGs (identified in a concurrent QTP project). Methods: An interprofessional team reviewed baseline data, defined the problem and project aim, created process maps, and identified root causes of poor CG documentation. With stakeholder buy-in we implemented eight successive PDSA cycles over 6 months to address root causes. Biweekly team meetings were throughout the PDSA cycles. Outcomes were percent of CGs with 1) needs assessed, and 2) intervention received. Results: Root causes of poor CG assessment included 1) no protocol to assess/respond to CG needs; 2) no designated staff to ‘own’ CG assessment; and 3) lack of understanding of the value of CG support among clinicians. PDSA 1 (pre- launch) included: develop CG assessment/intervention protocol; create CG tracking database; pursue EHR capabilities. PDSA cycle 2-3 prioritized information provision about resources (52-73% of CGs) over individualized assessment (20-23% of CGs) due to the large number of CGs identified. Subsequent PDSAs sought to increase assessment effectiveness by focusing assessment/intervention on CGs of newly diagnosed and high risk patients. While there was variability in outcomes across cycles (Table), by PDSA cycle 8, staff had assessed and intervened on 58% and 50% of CGs, respectively. In addition, multiple potential serious CG and patient mental health crises were avoided from team interventions. Conclusions: CG assessment improved from 28% at baseline to >50% post implementation. Further efforts to more fully integrate assessment and tracking into EHR to reduce the burden of CG tracking over time is underway. [Table: see text]