Association Of Community Cancer Centers Research Articles

Learnings from a multiphase, mixed-methods lung cancer quality initiative in U.S. community cancer centers.

254 Background: Quality improvement (QI) in cancer care delivery requires understanding the setting, clearly defining problem(s), and identifying targeted solutions. The Association of Community Cancer Centers (ACCC) conducted a national project to identify and provide guidance on key issues in care for patients with stage III/IV non-small cell lung cancer (NSCLC). We report the problems and solutions identified after a mixed-methods baseline data evaluation. Methods: The multi-phase ACCC QI initiative was guided by an expert steering committee. A request for applications was advertised to all ACCC programs, with committee members ranking each site in pre-specified categories (ex., replicability, practice champion engagement). After selection of sites, baseline data assessed programs’ patient populations, current care delivery practices, processes of care, and biomarker testing rates. A full-day workshop was conducted with multidisciplinary team members and expert faculty to review baseline data, refine problem statements, and identify site-specific QI solutions. Results: The 6 participating US sites were regionally diverse with a rural/urban mix. In baseline data, median patient ages were 65-72 years and patients treated were 50% stage III/50% stage IV. Biomarker testing practices, use of multidisciplinary tumor board, and clinical care pathways varied across sites. Five key QI areas were identified: 1.Management of immune related adverse events (irAE), 2.Biomarker testing, 3.Emergency visit management (EVM), 4.Access to clinical trials, and 5.Smoking cessation. Two sites identified problems with irAE management during immunotherapy (IT). The first identified needs for proactive symptom identification, assessment, and management. Solutions included: 1. a patient questionnaire to identify early signs of irAEs and 2. pilot testing a nurse-administered questionnaire. A second site identified that front-line clinicians may not be properly identifying possible irAEs. Solutions included: 1. form an IT toxicity working group and 2. educate front-line clinicians about irAEs. Two sites focused on biomarker testing. The first problem identified was inefficient tracking of testing results. Solutions were: 1. assign a nurse navigator to track, enter, and communicate test results and 2. proactively coordinate appointments for patients with positive test results. The second site identified delayed care when inadequate tissue was obtained. Solutions included: 1. pathology-driven reflex testing and 2. liquid biopsy order at diagnosis. Similar problems/solutions were developed for EVM, clinical trial access, and smoking cessation. Conclusions: Challenges in lung cancer care delivery can be identified and addressed using an intentional QI approach. Clearly defining the problem and identifying potential solution(s) are critical steps and should occur before implementation.

Assessing comprehensive care deficits in United States (U.S.) ovarian cancer programs to inform quality improvement initiatives.

256 Background: Ovarian cancer is the leading cause of gynecologic cancer mortality in the US. Given the high burden of disease and complexities in the provision of quality care, a multidisciplinary team approach is critical to optimal care delivery. In 2019, the Association of Community Cancer Centers (ACCC) launched a multiphase, stakeholder-driven initiative to improve care for this patient population. Results of a national survey of cancer programs to identify the needs of patients are reported here. Methods: A 20 question survey was developed by an expert steering committee including gynecologic oncologists, pathologists, genetic counselors, a nurse navigator, and cancer center administrators. The instrument was designed to collect data about cancer programs, key ovarian cancer patient needs, and barriers to and opportunities for improving ovarian cancer care. The online survey was open for participation for 4 weeks using the Qualtrics platform and distributed via email to ACCC and Society of Gynecologic Oncology members. Results: We received 26 total responses from Comprehensive Community (26%), NCI-Designed Comprehensive (22%), Academic Comprehensive (22%), and Integrated Network (13%) Cancer Programs. Annual ovarian cancer cases ranged from 22 to 190 (median: 50.5). 85% of programs has a multidisciplinary team for ovarian cancer and 61% were part of a referral network. On average, programs has 1.5 phase II and 2 phase III clinical trials currently available for ovarian cancer (all programs had at least 1 trial available). Palliative care and comprehensive symptom management was integrated into the first appointment (15%), integrated at the time of recurrence (4%), and most frequently, available by consult (81%). We assessed genetic testing practices at each program. Aggregated across programs, 79% of patients received germline multipanel testing, 71% germline BRCA only, 50% somatic multigene, and 51% somatic BRCA only. The frequency of consultations included: genetic counseling (75%), nurse navigation (75%), social work (50%), dietetics (40%), financial counseling (25%). Genetic evaluations were typically ordered by Gynecologic Oncology (88%), genetic counseling (4%), or both (8%). When asked what topic they would choose for a quality improvement project, genetic testing and counseling was the most frequent choice (46%), followed by clinical trials enrollment and availability (23%), multidisciplinary team care (19%), education on best practices (15%), palliative care (15%), and ancillary services (15%). Conclusions: Multidisciplinary care for ovarian cancer was common across a range of cancer programs but integration of palliative care, social work, dietetics, and financial counseling could be improved. Expanding clinical trials and genetic testing and counseling were the most frequently identified opportunities to improve ovarian cancer care.

Identifying barriers to equitable biomarker testing in underserved patients with NSCLC: A mixed-methods study to inform quality improvement opportunities.

123 Background: Despite recent advances in cancer precision medicine, patients from underserved communities do not have equal access to biomarker testing and targeted therapies. This study used a mixed-methods approach to identify barriers to equitable precision medicine access among underserved patients with non-small cell lung cancer (NSCLC). Methods: Paired national surveys (one clinician-facing and one patient-facing) were developed respectively by the Association of Community Cancer Centers (ACCC) and LUNGevity Foundation. Administered online in spring/summer 2020, the surveys were designed to identify key attitudes/barriers related to biomarker testing, resource needs, and current practice patterns for pertinent stakeholders. Survey data was triangulated with data from focus groups (2 clinician and 6 patient) conducted in fall 2020. The study was approved by Advarra IRB. Results: A total of 99 clinicians responded, with 67% (66/99) representing oncologists from community cancer programs. 248 patients responded to the LUNGevity survey, with 161 coming from the general population and 87 from the LUNGevity network (patients with relatively high income and education levels). Most clinicians surveyed indicated they were “very” (34%) or “extremely” likely (44%) to discuss biomarker testing with NSCLC patients. Academic clinicians, however, were more likely than community-based clinicians to order testing at the time of initial biopsy (76% vs 52%, P =.02). Academic clinicians were also more likely to involve the patient’s family in biomarker testing discussions (85% vs 59%, P =.009). Patient survey results identified that medical oncologists are the primary source of biomarker testing information; 64% of LUNGevity-connected and 37% of underserved patients. Eighty-five percent of LUNGevity-connected patients receive biomarker testing versus 52% for general patients (p < 0.05). Notably, more than a quarter (27%) of underserved patients who have undergone biomarker testing do not know their results. Clinician focus group participants corroborated survey findings that most clinicians receive testing results in 7-14 days, but for 23% of community and 6% of academic clinicians the process can take over 2 weeks. They identified disparities in offering biomarker testing and results to patients with known or presumed low socioeconomic status (SES) and/or health literacy. This was supported by patient survey data, which showed biomarker testing was proactively offered to only 40% of low-SES patients. Conclusions: This study identifies key areas of ongoing need related to equitable biomarker testing. Quality-improvement opportunities exist to address both clinician and patient barriers to guideline-concordant biomarker testing for underserved patients with NSCLC.

Use of the Delphi method to develop a guideline-based geriatric oncology gap assessment.

236 Background: Older adults are more likely to be diagnosed with cancer than their younger counterparts. Because the underlying health status of older adults with cancer is generally heterogeneous, geriatric assessment (GA) is helpful for uncovering age-related vulnerabilities and guiding subsequent care planning. GA provides multidimensional, multidisciplinary evaluations of pertinent health domains. When used to evaluate an older adult with cancer prior to initiating therapy, GA and screening tools can help oncologists differentiate between fit and frail patients and tailor their treatment accordingly. Methods: The Association of Community Cancer Centers (ACCC) conducted a 4-round Delphi method to achieve expert consensus (≥75%) related to 9 domains of geriatric oncology care from a multidisciplinary perspective. A survey was conducted with 70 international clinicians working in geriatric oncology to assess perspectives on guideline-recommended GA tools in clinical practice. Facilitator led focus groups were conducted to review the results in a large group format and come to consensus. Aggregated results were shared back with the group to ensure effective capture of group discussion regarding validated clinical practice tools to include as resources in the gap assessment instrument. Results: A 32 question geriatric oncology gap assessment was developed in an online survey platform. This tool was beta tested by 30 individuals at cancer programs of various types and regions across the US. A final version was published and made accessible for multidisciplinary teams to self-assess care delivery for older adults with cancer in 9 domains: Functional Status; Cognition; Comorbidities; Decision Making: Screening, Life Expectancy, Chemo Toxicity; Pharmacy/Medication Management; Psychological Health; Nutrition; Patient Goals and Needs; and Communication and Workforce Training. Within each domain, respondents select the level (see Table) that most closely represents the practice(s) at their institution. A personalized report is generated. Sample Question. Conclusions: The ACCC geriatric oncology gap assessment offers cancer programs a validated way to evaluate care delivery for older adults with cancer. To optimize workflow, cancer programs should consider utilizing gap assessment results to develop and advance scalable quality improvement programs at their institution, taking into consideration resource level and infrastructure.[Table: see text]

Assessing effectiveness of a self-guided training program for oncology financial advocates.

271 Background: Financial toxicity can be a devastating side effect for patients with cancer and their families, and may impact access to and delivery of care, treatment compliance, and outcomes. Financial advocates mitigate financial toxicity for patients and their families, liaise between payers/providers/pharmacies/patients, support shared decision-making and care planning processes through provision of cost and coverage information, and mitigate institutional financial toxicity. Training on effective financial navigation interventions, financial health literacy, patient engagement, oncology fundamentals, and measurement of impact is critical for advocates. Methods: The Association of Community Cancer Centers (ACCC) Financial Advocacy Boot Camp is a self-paced eLearning program consisting of 9 modules designed to build knowledge and skills of financial advocates. Users interact with education across two levels within the ACCC Learning Management System. To evaluate effectiveness of this content, pre- and post-assessments and evaluation forms for registered learners from 1/1/2020 to 12/31/20 were exported and exploratory analysis was performed on this data set of 538 participants. Results: 51% of respondents are oncology financial advocates; 7% are industry representatives; and the remaining 42% are a mix of patient navigators, nurse navigators, social workers, pharmacists, APPs, and nurses. 363 participants fully completed at least one of two levels. Most participants agreed or strongly agreed that each of the modules improved their knowledge and skills: 94% increased their ability to incorporate effective screening methods to identify patients at risk of financial toxicity, 95% are better able to review the evolving landscape of health insurance provided by public and private payers, and 97% both increased their ability to find patient assistance programs and resources for patients and can describe how to guide patients through the process of improving insurance coverage. 79% identified specific examples of what they will do differently after the training, including implementing screening and follow-up protocols, adjusting communication approaches with patients, proposing quality improvement projects, and accessing resources. Conclusions: Training, such as the Financial Advocacy Boot Camp, that builds knowledge and skills in financial screening, communication, and navigation can help cancer programs improve staffs’ ability to mitigate patient and institutional financial toxicity. Future research efforts should further define financial advocacy competencies, measure patient and institutional impact of financial navigation interventions, and assess effective practices for implementation of financial advocacy training in cancer programs.

P53.06 A Multi-Phase Quality Initiative to Improve Processes of Care for Non-small Cell Lung Cancer (NSCLC) in US Community Cancer Centers

Accurate staging, biomarker identification, and high-fidelity processes of care are critical for evidence-based treatment of NSCLC. To this end, the Association of Community Cancer Centers (ACCC) conducted a national, multi-phase effort to identify and provide guidance on key issues related to optimal care for patients with stage III/IV NSCLC.

On Becoming an Ally

Earlier this year, I was asked to participate in a meeting titled “Virtual Summit to Define the Role of Oncology Advanced Practitioners in Equitable Cancer Care Delivery: A Closer Look at Care Coordination, Clinical Trials, and Implicit Bias” held by the Association of Community Cancer Centers (ACCC) and Harborside. This conversation brought together a diverse group of participants to discuss the unique difficulties that people of color and underrepresented populations face with a cancer diagnosis and potential pathways for improvement.

Understanding the barriers to quality care in ovarian cancer: results from a needs assessment and quality improvement initiative

Objectives: The Association of Community Cancer Centers (ACCC) launched an initiative to improve care for patients with ovarian cancer (OVCA) in the United States. The project was designed to identify areas of greatest need for quality improvement (QI) initiatives aimed at improving OVCA care. Methods: A needs assessment survey and workshop application was designed by a multidisciplinary committee and was administered online using Qualtrics. A full day onsite workshop was conducted with the care teams at each site which included a lecture by an OVCA expert, a guided discussion to identify problems and barriers to optimal care delivery, and development of a problem statement for the resulting project. A 6-month QI project utilizing Plan-Do-Study-Act Cycles was developed by each site with data benchmarks. Project specific data was collected and analyzed. Results: 26 programs submitted workshop applications. Program types varied, with the majority being Comprehensive Community Cancer Programs (n=6, 26.1%); Academic Comprehensive Cancer Programs (n=5, 21.7%); or NCI-Designated Comprehensive Cancer Programs (n=5, 21.7%). The median number of annual OVCA patients diagnosed per site was 50.5 (range 22-190). The median numbers of clinical trials per site were 0 Phase I, 1.5 Phase II, and 2 Phase III. Eighty-five percent of sites reported having OVCA multidisciplinary care teams. Genetic testing and counseling (GTC) was the most frequently requested topic for QI (see Table). Three sites were chosen for QI projects. Site 1 chose to improve GTC rates for patients with newly diagnosed OVCA by implementing an electronic medical record (EMR) notification. During the 6-month project, receipt of any genetic testing within 60 days of an initial encounter improved from 68% to 77% of patients. Site 2 also chose to improve the receipt and efficiency of GTC through the development and application of an EMR smartset. During the QI period, GTC improved from 4/27 (15%) retrospectively to 14/14 (100%) with time from diagnosis to GTC decreasing from 1-8 months to 0.5-2 months. The QI project at Site 3 was to improve enrollment onto clinical trials though insertion of an EMR phrase in the template relating to clinical trial eligibility. No change in clinical trials enrollment was identified during the QI period which spanned the initial phase of the COVID-19 pandemic. Download : Download high-res image (146KB) Download : Download full-size image Conclusions: Significant needs for the improvement of quality care delivery for patients with OVCA were identified across varied cancer care programs. Improved access to genetic testing and counseling was the most commonly identified need, followed by enhanced clinical trial enrollment. Using EMR tools, sites were able to rapidly increase rates of GTC. Increasing clinical trial enrollment using an EMR trigger was unsuccessful, largely due to effects of the COVID-19 pandemic. Ongoing work to improve the implementation of best practices in OVCA treatment is needed.

Genetic counseling and testing rates among community cancer programs for patients with breast cancer following site-directed quality improvement.

10529 Background: National Comprehensive Cancer Network (NCCN) guidelines recommend testing for highly penetrant breast/ovarian cancer genes in several scenarios, including women with early-onset (≤ 45 years) or metastatic HER-2 negative breast cancer regardless of family history. A 2018 Association of Community Cancer Centers (ACCC) survey (N = 95) showed that > 80% of respondents reported ≤ 50% testing rate of patients with breast cancer who met guidelines. To improve rates of genetic counseling(GC)/testing, ACCC partnered with 15 community cancer programs to support site-directed quality improvement (QI) interventions. Methods: Pre- and post-intervention data from 9/15 partner programs for genetically at-risk women with early-onset or HER-2 negative metastatic breast cancer (MBC) were analyzed. Pre-intervention data were collected between 01/01/2017 and 06/30/2019 while post-intervention data were collected as early as 07/01/2019 and as late as 10/01/2020. QI project scope ranged from creation of testing eligibility education to implementation of a virtual GC clinic. De-identified data collected included: family history documentation; GC appointment; test results; and timing of results relative to surgical date. Results: The pre-intervention cohort included 2691 women and the post- cohort included 3104 women who were eligible for GC. Early-onset patients in the post-intervention group attended a GC appointment 83% (331/401) of the time and 74% (296/401) had genetic test results, with 92% (271/296) receiving results before surgery. Sixty-one percent (1387/2267) of women with HER-2 negative MBC in the post-intervention group received GC, compared to 36% (658/1845) in the pre-intervention group. There was an overall increase in the number of MBC patients with documented test results following GC in the post-intervention cohort (55% (1243/2267) versus 15% (273/1845); p < 0.0001). Rates of GC appointments improved overall, regardless of family history documentation. Rates among those with a documented high-risk family history improved from 57% (729/1284) to 85% (1485/1741) following QI interventions (p < 0.0001). There was also a significantly higher rate of GC provided in the post-intervention group among women with negative family histories (40% (462/1155) versus 23% (181/778); p < 0.0001). GC also increased from 6% (35/629) to 45% (94/208) of women in the post-intervention cohort with no documentation of family history (p < 0.0001). Conclusions: Genetic testing is underutilized in women with breast cancer. Significant improvement was achieved with QI initiatives specifically designed to target easily identified populations meeting guidelines for GC/testing. This project demonstrates the importance of attention to practice-directed strategies aimed at improving identification of risk as well as follow through to GC/testing.

Barriers and facilitators to sexual orientation and gender identity (SOGI) data collection.

e18520 Background: Lack of sexual orientation and gender identity (SOGI) data collection is a barrier to inclusion of sexual and gender minority (SGM) patients in oncology. ASCO, NIH, and other groups have called for collection of SOGI data and documentation of SGM health disparities as a priority for clinical care and research. However, SOGI data are not routinely collected in most cancer care settings. The purpose of this study was to examine perceived barriers and facilitators to SOGI data collection among oncology professionals and researchers. Methods: An anonymous 54-item web-based survey was distributed to ASCO members which included two opened-ended items on barriers and facilitators to SOGI data collection. The survey was also promoted on listservs (Association of Community Cancer Centers, Association of Oncology Social Workers) and social media (e.g., Twitter, LinkedIn, Facebook professional groups). Responses to the open–ended items (n = 152) were coded by three coders using content analysis and constant comparison methods. Inter-rater reliability was 0.95. Results: The majority of respondents noted individual and organizational barriers to collecting SOGI data, including Culture (no support, expressed value or awareness of need from institution); Electronic Health Record (no location for SOGI or workflow challenges); Provider Discomfort (lack of knowledge on how/why to collect SOGI data, concerns about expressed bias); Patient Discomfort (privacy concerns, mistrust, refusal); Lack of Training or Resources; and Time (insufficient time to collect). Facilitators included a need for Protocols (intake process, patient-initiated disclosure); Training (how to collect and what to do with data); Culture change (institutional and/or provider priority); and improving Community Trust (patient trust, particularly in conservative areas of the country). A few respondents were concerned about patient safety in disclosure and some respondents noted culture change would require more representation of SGM staff and “safe spaces” in oncology settings. Three respondents made negatively biased comments about SGM patients. Conclusions: Overall, specific feedback from oncology providers identified barriers to SOGI data collection and suggested facilitators to resolve them, although not all respondents expressed value for SOGI data collection. Conservative culture and lack of leadership prioritization were cultural barriers; culture change (organizational and social) was noted as a potential facilitator for SOGI data collection. While workflow challenges and lack of a place to document SOGI in the EHR were barriers, protocols for documentation and patient-led disclosure were suggested facilitators. The study supports the need for leadership, processes, structured data fields, implicit bias and cultural humility training, and reduction of stigma to respond to the ASCO and NIH call to action.

Trending Now in Cancer Care: Findings from the 2020 ACCC Focus Groups

The common thread uniting members of the Association of Community Cancer Centers (ACCC) is the opportunity to amplify voices in ways that support one another. Coronavirus disease 2019 (COVID‐19) pr...

First person profile: Lori J. Pierce, MD: First African American, first female radiation oncologist to serve as American Society of Clinical Oncology president makes equity her theme.

First person profile: Lori J. Pierce, MD: First African American, first female radiation oncologist to serve as American Society of Clinical Oncology president makes equity her theme.

Resource and reimbursement barriers to comprehensive cancer care (CCC) delivery: An association of community cancer centers (ACCC) survey research analysis.

31 Background: CCC delivery is recommended in guidelines, required by accreditation bodies, and essential for high-quality cancer management. Barriers, such as insufficient reimbursement and lack of specialist staff, prevent consistent access to and delivery of CCC, particularly supportive oncology services. Challenges especially persist in community programs, where access to philanthropy and similar funding is limited. ACCC conducted a representative survey of its member programs to elucidate capacity and barriers to CCC delivery in the community/academic setting in order to inform policy and value-based payment reform. Methods: Survey development methodology included item generation with expert review, iterative piloting and cognitive interviews to achieve content and internal validity. An online survey was piloted at the ACCC 2018 Annual Meeting and sent to member programs via email link. The final survey included 22 questions on availability and funding for supportive services. Twenty-seven supportive oncology services were assessed for availability, reasons not offered, reimbursement/funding and patient payment. Analyses were conducted with SAS. Results: 172 of 704 ACCC member programs responded and completed the majority of survey as of 10/7/19. Despite a high proportion of programs offering supportive oncology services, gaps between cost and reimbursement were present for all (Table). Deficits in reimbursement are compensated by patient out-of-pocket payments, grants and donations. Most centers report needing more staffing in psychology (61%), social work (60%), navigation (59%), nutrition (57%), palliative care (56%), genetic counseling (52%), and financial counseling (53%). Gaps were observed regardless of region or practice type. Conclusions: There is a lack of sufficient reimbursement, staffing, and budget to provide CCC across the U.S., regardless of region or practice type. Oncology care models and reimbursement policies must include CCC services to optimize delivery of care.

Improving care for patients with stage III/IV NSCLC: Learnings for multidisciplinary teams from the ACCC National Quality Survey.

228 Background: Refinement of the multidisciplinary team (MDT) approach continues to offer significant potential for improving the quality of non-small cell lung cancer (NSCLC) care and adherence to guideline-recommended protocols. This opportunity arises, in part, from insufficient characterization of MDT practice patterns and barriers to optimal care provision within U.S. cancer programs. The Association of Community Cancer Centers (ACCC), therefore, conducted a national survey to improve understanding on how patients with stage III/IV NSCLC were diagnosed and managed across different practice settings, with the aim of informing the design and execution of process-improvement plans to address identified barriers. Methods: ACCC convened an expert steering committee of multidisciplinary specialists, including oncologists, thoracic surgeons, pathologists, pulmonologists, and representation from patient advocacy, for a comprehensive, double-blind, web-based survey (January–April 2019) to obtain insights on cancer care delivery for patients with NSCLC in a diverse set of U.S. community cancer programs. Results: Of 1211 questionnaires, 639 responses affiliated to 160 unique cancer programs across 44 U.S. states were suitable for analysis. In total, 41% (n = 261) of respondents indicated that their cancer program did not have a thoracic multidisciplinary clinic. Nurse navigators (P = 0.03) and radiation oncologists (P = 0.04) were significantly more likely to engage in shared decision-making practices than other disciplines. The average time to first therapeutic intervention in newly diagnosed patients was 4 weeks (range = 1–10 weeks; n = 298). A significant negative correlation between frequency of tumor board meetings and time to complete disease staging (P = 0.03) was observed. The most challenging barriers to delivering high-quality NSCLC care are listed (Table). Conclusions: Multiple opportunities exist to improve the delivery and quality of care for patients with stage III/IV NSCLC, including reducing barriers to effective care coordination and patient education, screening, diagnosis and biomarker testing, and adherence to evolving standards of care. [Table: see text]

Shared decision-making attitudes and practices in multidisciplinary cancer care teams.

180 Background: Patients who engage in decision making are more likely to experience confidence in treatment decisions, satisfaction with treatment, and trust in clinicians. The Association of Community Cancer Centers (ACCC) conducted a survey to explore multidisciplinary team attitudes and practices around shared decision-making (SDM) and health literacy. Methods: ACCC convened a steering committee of multidisciplinary specialists and advocacy representatives to guide this research. The survey included 26 mostly closed-ended questions and was open to multidisciplinary cancer programs from 10/29/19 to 2/20/20. Exploratory analysis was performed on this data set of 305 complete responses. Results: While most respondents reported engaging patients in decision-making to some degree, only 50% reported that SDM is a top organizational priority. 33% reported organizational efforts to formally integrate SDM into the clinical workflow, with only 15% indicating staff opportunities for basic SDM training. The three most frequently cited perceived barriers to engaging in SDM were patients feeling overwhelmed (53%), wanting to defer decisions to clinicians (46%), and having limited health literacy (46%). Only 13% indicated that lack of time was a barrier. Less than half (41%) of respondents reported using patient decision aids to support SDM. Respondents represented a wide range of multidisciplinary team members, though surgical oncologists and general surgeons (20% and 16% respectively) are overrepresented in the results. Conclusions: SDM is commonly accepted as essential to patient engagement but clarity in terminology and prioritizing formal integration of SDM into practice is limited. Strategies to improve integration of SDM into oncology practice should include: 1) Educational initiatives and tools to overcome barriers to SDM, including patient decision aids and SDM training, 2) Initiatives to address health literacy as it relates to patient and caregiver engagement in decision making, 3) Psychosocial support for patients whose emotional upset is a barrier to SDM, 4) Healthcare policies that encourage and incentive providers to engage in SDM. Future analyses will require concurrent assessment of patient, caregiver, healthcare professional, and administrator perspectives.

An Optimal Care Coordination Model (OCCM) for Medicaid patients with lung cancer: Finalization of the model and implications for clinical practice in the United States.

104 Background: In 2016, the Association of Community Cancer Centers (ACCC) launched a 3-year initiative to design, test, and refine an OCCM for Medicaid patients with lung cancer. The aim was to help cancer programs identify and reduce the barriers experienced by Medicaid patients by strengthening lung cancer care delivery systems. Methods: Phase I included Model development. Phases II and III included selection of 7 community-based cancer programs as testing sites to implement quality improvement projects, utilizing qualitative and quantitative assessments. Beta testing demonstrated the Model’s ability to offer practical guidance on improving care coordination to achievable target levels in high-impact areas such as patient access to care, prospective multidisciplinary case planning, and tobacco cessation. Opportunities were identified to improve care coordination beyond lung cancer to other tumor sites. Refinements for clarity of intent, ease of use, specificity, and uniformity across assessment areas were implemented, based on feedback from testing sites. Members of the Technical Expert Panel and the Advisory Committee, ACCC staff, and consultants revised the Model using consensus decision-making. Results: The final OCCM is composed of 12 inter-related assessment areas: patient entry into lung cancer program; multidisciplinary treatment planning; clinical trials; supportive care; survivorship care; financial, transportation, and housing needs; tobacco education; navigation; treatment team integration; physician engagement; electronic health records and patient access to information; and quality measurement and improvement. Each assessment area has 5 levels and corresponding metrics—level 1 represents the most basic provision of care, and level 5 represents optimal care coordination, which may be attainable for some cancer programs and aspirational for others. Progress implies cumulative and sustained fulfillment of lower level criteria. The OCCM can be deployed by cancer programs, regardless of size, setting, resource level, or cancer type. Dissemination to promote wider use is planned through an online benchmarking tool, blogs, a brochure, podcasts, and other resources. Conclusions: The OCCM can be utilized by cancer programs for objective self assessments of care delivery capabilities across 12 high-impact areas. Dissemination can advance multidisciplinary coordinated care delivery and improve clinical outcomes for patients nationwide, regardless of cancer type.

An Optimal Care Coordination Model (OCCM) for Medicaid patients with lung cancer: Results from the beta model testing phase of a multisite initiative in the United States.

105 Background: Medicaid patients with lung cancer have poorer outcomes than non-Medicaid patients, partly because of suboptimal care quality. The Association of Community Cancer Centers (ACCC) launched a project to develop, test, and refine an OCCM. Methods: The OCCM comprised 13 areas, spanning care access to supportive care/survivorship. Using the OCCM, 7 cancer programs in 6 US states conducted self-assessments of care delivery systems and implemented quality improvement projects. Sites worked with ACCC to conduct data benchmarked projects. Data collection and analysis were centralized. Statistical analyses used Kruskal−Wallis and chi-squared tests. Results: There were 926 patients (257 Medicaid/dual eligible; 669 non-Medicaid) across 7 sites. Medicaid/dual eligible patients were 52% male, 69% Caucasian, 48% active smokers, and 45% clinical stage III/IV. Prospective multidisciplinary case planning (PMCP), patient care access, and tobacco cessation were commonly selected for projects. PMCP evaluation used fortnightly tumor board (FTB), virtual tumor board (VTB), and multidisciplinary team huddle (MTH). Presentation of eligible patients was higher for VTB and MTH (FTB: 23%, VTB: 100%, MTH: 100%, p < 0.0001). While FTB and MTH discussed all cases prospectively, VTB achieved 80%. Median days (d) from diagnosis to presentation were 18 (FTB), 14 (VTB), and 9 (MTH, p = 0.14). Patient care access was evaluated with timeliness metrics at 2 sites. Site 1: Medicaid patients had a median of 13 d from lesion discovery to diagnosis and 21 d from diagnosis to treatment (not different from non-Medicaid; p = 0.96 and 0.38). 94% met the goal of treatment initiation within 45 d. Site 2: Medicaid patients had a median of 16 d from discovery to diagnosis and 27 d from diagnosis to treatment (not different from non-Medicaid; p = 0.68 and 0.83). Similar benchmarks were collected and compared for other assessment areas. Sites identified enhanced collaboration and improved programming (e.g., patient navigation) as successes. Challenges at project start included inadequate staffing and lack of centralized data collection and benchmarking. Importance of lung cancer–dedicated navigation, PMCP, and Medicaid patient needs were key transferable lessons. Conclusions: The OCCM is useful for cancer programs’ self-assessment of care delivery to Medicaid patients across 13 high-impact areas. Dissemination can advance multidisciplinary coordinated care delivery, but sites may need additional resources to evaluate outcomes.

Defining high-quality NSCLC care at U.S. cancer centers.

229 Background: While clinical guidelines for non-small cell lung cancer (NSCLC) provide recommendations on individual components of care and advocate multidisciplinary collaboration, guidance spanning the complete patient journey is lacking. We aimed to compile quality-focused recommendations for the multidisciplinary team and selected clinical criteria for ideal NSCLC care, and propose a new set of metrics encompassing the entire care continuum. These metrics would be used as a new benchmark for ideal NSCLC care via the Association of Community Cancer Centers’ (ACCC) national quality care initiative for patients with advanced (stage III/IV) NSCLC. Methods: The ACCC convened an expert steering committee of multidisciplinary specialists and representation from patient advocacy to compile evidence-based recommendations via a systematic search of clinical and quality care guidelines and peer-reviewed journals. Quality recommendations were organized within key care areas of the patient journey: care coordination and patient education, diagnosis and biomarker testing, staging and treatment planning, and survivorship. Results: A total of 32 recommendations were included across the 4 key NSCLC care areas. Key quality recommendations are listed (Table). Conclusions: The full set of recommendations define ideal NSCLC care and serve as a valuable guide for multidisciplinary practice and quality improvement initiatives. [Table: see text]

Role of oncology-advanced practitioners to enhance clinical research.

95 Background: Oncology Advanced Practitioners (APs), including Nurse Practitioners, Physician Assistants, Clinical Nurse Specialists, and Pharmacists are highly trained health care providers that contribute significantly to quality cancer care. Given low clinical trial enrollment among adult oncology patients, understanding current research responsibilities of APs could lead to identification of opportunities to leverage this workforce to enhance accrual and conduct of clinical trials. Methods: A 65-item validated survey addressing attitudes, beliefs and responsibilities of oncology APs participating in clinical research was distributed from January 22 through March 6, 2020. Outreach via the Association of Community Cancer Centers (ACCC) and Harborside was utilized to reach a sample set of 14,601 oncology APs’ emails. The survey was administered and data were analyzed using Survey Monkey. Results: 408 U.S. oncology APs completed the survey. Respondents were primarily white (83%), female (92%) and nurse practitioners (71%). Thirty-five percent practiced in an academic setting and 62% practiced in a community setting. Nearly all respondents believed that clinical trials are important to improve oncology care standards and more than 90% reported that clinical trials were available at their practice. Nearly 80% reported that they are comfortable discussing treatment options with patients, discussing clinical trials in general, and know where to find clinical trials. Furthermore, 80% participate in the care of patients enrolled on clinical trials. Only 60%, however, are comfortable discussing trials available at their practice and only 38% routinely explore whether a clinical trial is available for their patients. While 70% of APs approach eligible patients about clinical trials at their practice, only 20% reported doing so “a great deal” or “a lot”. Ninety percent of APs reported that they should play a role in clinical research and 75% would like to be more involved in the clinical trial process. Barriers to greater involvement in clinical trials include lack of time, inadequate awareness of clinical trial specifics, and under-representation on research committees. Conclusions: The majority of oncology APs are engaged and interested in clinical trials and believe that research is important to improve cancer care. However, they are not being utilized to their full scope. Multidisciplinary team integration, trials-related education, and policy change is needed to allow this group of skilled professionals to realize their full potential within cancer clinical trials.

Survey of cancer care providers' attitude toward care for older adults with cancer during the COVID-19 pandemic

Objectives: Care for older adults with cancer became more challenging during the COVID-19 pandemic. We sought to examine cancer care providers' attitudes toward the barriers and facilitators related to the care for these patients during the pandemic.Materials and Methods: Members of the Advocacy Committee of the Cancer and Aging Research Group, along with the Association of Community Cancer Centers, developed the survey distributed to multidisciplinary healthcare providers responsible for the direct care of patients with cancer. Participants were recruited by email sent through four professional organizations' listservs, email blasts, and messages through social media.Results: Complete data was available from 274 respondents. Only 15.4% had access to written guidelines that specifically address the management of older adults with cancer during the COVID-19 pandemic. Age was ranked fifth as the reason for postponing treatment following comorbid conditions, cancer stage, frailty, and performance status. Barriers to the transition to telehealth were found at the patient-, healthcare worker-, and institutional-levels. Providers reported increased barriers in accessing basic needs among older adults with cancer. Most respondents agreed (86.3%) that decision making about Do Not Resuscitate orders should be the result of discussion with the patient and the healthcare proxy in all situations. The top five concerns reported were related to patient safety, treatment delays, healthcare worker mental health and burnout, and personal safety for family and self.Conclusion: These findings demand resources and support allocation for older adults with cancer and healthcare providers during the COVID-19 pandemic.