Integrating family caregiver identification into a gynecologic oncology practice: An ASCO quality training program project.

Abstract

177 Background: Family caregivers (CGs) in gynecologic (gyn) cancer are essential members of the care team, but no formal systems exist to provide CGs with information and support. A needs assessment of family caregivers (CGs) in our clinic found 50% of CGs report > 9 distressing unmet needs, but chart reviews found only 19% of patients had a documented CG--the first step in mitigating unmet needs. Our ASCO QTP-supported project aim was to identify (ID) and document primary CGs for 85% of patients within 2 clinic visits of a gyn cancer diagnosis. Methods: An Interprofessional team reviewed baseline data, defined the problem and project aim, created process maps, and identified root causes of poor CG documentation. After securing stakeholder buy-in we implemented eight successive PDSA cycles to intervene on root causes. Biweekly team meetings were held to study results, troubleshoot, and plan each PDSA cycle. Primary outcome was the percentage of patients with a CG documented. Results: Root causes of poor CG ID were 1) no protocol for IDing CGs, 2) no designated EHR field for CGs, 3) no designated staff to “own” CG ID, and 4) lack of CG awareness of available support in clinic. Interventions to prepare for project launch (PDSA 1) included protocol development, staff training, spirit activities, and selection of staff ‘champions’. In PDSA 2 CGs were ID’d for 25.3% of all patients in the clinic. By PDSA 4, CG ID dropped to a low of 12.5%. Major changes to PDSA 5 sought to reduce staff burden by narrowing focus to newly diagnosed patients, with an increase in CG ID to 56% of new patients. PDSA cycles 6-8 focused on increasing process efficiency while broadening CG ID to other times of high CG stress (e.g. recurrence; inpatient stays); CG ID rate stabilized at 57-60% over the last 6 weeks. In total, 288 primary CGs were documented. Conclusions: Proportion of CGs ID’d increased initially and then again after PDSA 4 as process efficiency improved. Despite falling short of our benchmark, CG ID more than doubled and we are planning further PDSA cycles to continue this momentum. Our results demonstrate systematic CG ID is feasible in a high volume Gyn Onc clinc and sets the stage for CG assessment and intervention.