Patient Care Information Research Articles

An Online Investigation Into Direct-to-Consumer Men's Health Clinics: The Who, What, and Where

ObjectiveTo characterize direct-to-consumer (DTC) men's health clinics by reviewing their online content. Increasing numbers of patients are seeking treatment for erectile dysfunction (ED) and hypogonadism from DTC “men's health” clinics. Treatments are often used off-label, with lack of transparency of provider credentials and qualifications. MethodsWe identified DTC Men's Health Clinics in the United States by internet search by state using the terms, “Men's Health Clinic,” and “Low T Center.” All stand-alone clinics were reviewed. ResultsTwo hundred and twenty-three clinics were reviewed, with 147 (65.9%) offered ED treatments and 196 (87.9%) offering testosterone replacement, and 120 (53.8%) offering both ED treatment and testosterone replacement. Of those clinics offering ED treatments, 93 (63.3%) advertised shockwave therapy and 84 (57.1%) PRP therapy. There were 56 (38%) who offered shockwave therapy and PRP. ICI was significantly more likely to be offered if there was a urologist on staff (p <.001).Clinic providers represented 20 different medical and alternative medicine specialties. Internal medicine was most common (17.4%), followed by family medicine (11.1%). A nonphysician (nurse practitioner or physician assistant) was listed as the primary provider in 10 clinics (4.5%) and 45 clinics (20.1%) did not list their providers. Urologists were listed as the primary provider in 10.3% of clinics. A naturopathic provider was listed as a staff member in 22 (11.6%) of clinics. ConclusionThere is significant heterogeneity and misinformation available to the public regarding men's health. Familiarity with and insight into practice patterns of “men's health” clinics will help provide informed patient care and counseling.

Patients Experience Significant and Meaningful Changes in Self-Report of Function During the First 2 Weeks After an Ankle Sprain Injury: A Report From the Athletic Training Practice-Based Research Network.

Ankle sprains are common during sport participation and associated with long-term deficits in self-report of function. However, little is known of short-term changes in self-report of function following injury. The authors aimed to assess statistical and clinically meaningful changes in self-report of function, as measured by the Foot and Ankle Ability Measure (FAAM), during the first 2weeks after an ankle sprain injury. A retrospective analysis of electronic medical records. Eighty-eight patients, who were diagnosed with an ankle sprain injury by an athletic trainer, received usual care from an athletic trainer, and completed the FAAM during treatment at weeks 1 and 2 postinjury. The authors calculated the percentage of patients who reported clinically meaningful changes and used Wilcoxon signed-rank tests to compare differences in FAAM scores between time points. Between weeks 1 and 2, significant differences were noted for the FAAM Activities of Daily Living (FAAM-ADL) (P < .001) and FAAM Sport (FAAM-Sport) (P < .001). At the patient level, 86.5% (64/74) and 85.2% (69/81) of patients reported changes that exceeded the minimal clinically important difference value for the FAAM-ADL and FAAM-Sport, respectively, between weeks 1 and 2. At week 2, 31.8% (28/88) and 47.7% (42/88) of patients reported a score below 90% on the FAAM-ADL and below 80% on the FAAM-Sport subscale, respectively. Also, 36.4% (32/88) and 25.0% (22/88) of patients reported a score of 100% on the FAAM-ADL and FAAM-Sport subscales, respectively, at week 2. Patients report statistically significant and meaningful improvements in self-report of function during the first 2weeks following ankle sprain injury. However, almost half of patients still report deficits in sport function at 2weeks postinjury. Patient-reported outcome measures such as the FAAM, can help capture the patient's perception of function and inform patient care decisions. Research efforts should explore individual response patterns to treatment.

Implementing IPASS Handoff to Improve Patient Safety in Pediatric Critical Care Transport

IntroductionThe aim of this study was to implement a standardized, hospital-based bedside handoff report (IPASS [Illness severity, Patient summary, Action items, Situational awareness, and Synthesis]) in prehospital pediatric critical care transport to increase patient safety by eliminating the risk of misreporting or omitting critical patient care information received before arrival at a tertiary care center. The setting for this project was a level 1 pediatric trauma center in the Southern United States. MethodsPre- and postsurveys were used to assess staff perception of clinical handoff comprehensiveness and satisfaction with the use of a standardized IPASS handoff tool. ResultsImprovement was identified in 6 of 8 survey items. Team members were better able to hear all the information provided in the handoff, the format was functional, and physical transfers of patients from the transport team to the ED went more smoothly. Overall, satisfaction of the handoff process increased by 80%. ConclusionMany factors contribute to patient safety events and errors in health care, with communication failures contributing to the majority. Overall, findings support the use of standardized IPASS handoffs in pediatric critical care transport to promote patient safety, increase comprehension of patient information, and increase staff satisfaction.

Social Dynamics of Advice-Seeking: A Network Analysis of Two Residency Programs

Phenomenon: Residents interact with their peers and supervisors to ask for advice in response to complicated situations occurring during patient care. To provide a deeper understanding of workplace learning, this study explores the structure and dynamics of advice-seeking networks in two residency programs. Approach: We conducted a survey-based social network study. To develop the survey, we conducted focus group discussions and identified three main categories of advice: factual knowledge, clinical reasoning, and procedural skills. We invited a total of 49 emergency medicine and psychiatry residents who had completed at least six months of their training, to nominate their supervisors and peer residents, as their sources of advice, from a roster. Participants identified the number of occasions during the previous month that they turned to each person to seek advice regarding the three broad categories. We calculated the density, centrality, and reciprocity measures for each advice category at each department. Findings: The response rates were 100% (n = 21) and 85.7% (n = 24) in the emergency medicine and psychiatry departments, respectively. The advice network of emergency medicine residents was denser, less hierarchical, and less reciprocated compared to the psychiatry residents’ network. In both departments, PGY-1s were the top advice-seekers, who turned to PGY-2s, PGY-3s, and supervisors for advice. The "procedural skills" network had the lowest density in both departments. There was less overlap in the sources of advice for different advice types in the psychiatry department, implying more selectivity of sources. Insights: Complex social structures and dynamics among residents vary by discipline and level of seniority. Program directors can develop tailored educational interventions informed by their departments’ specific network patterns to promote a timely and effective advice-seeking culture which in turn, could lead to optimally informed patient care.

This Month in Anesthesiology

This Month in Anesthesiology

A Microservice-based Software Architecture for Improving the Availability of Dental Health Records

In order to keep accessible, the patient care information recorded by a dental provider, a software architecture must be designed to allow availability among the different providers.&#x0D; In this research, a software architecture based on the Microservices approach is designed to enable the availability of dental medical records. The quality attributes and functional requirements were identified to design the architecture, determining that it should be composed of 4 Microservices, Patient, Dental Medical Record, Odontogram and Dental Service Provider; each microservice implements its database, the secure communication between the microservices and the clients is done through an API Gateway of HTTP resources and an authentication token.&#x0D; To evaluate the software architecture, a prototype was developed in which each component was deployed in containers using the Microsoft Azure App Service. On this prototype load tests were performed to evaluate Availability and Performance determining that up to 21 dental records per second can be available with 100% availability, and if the demand of requests increases the architecture scales automatically.

PubMed literacy: Developing skills for effective literature search

Health science professionals need exhaustive and up-to-date information for patient care and research. They depend much on electronic resources for meeting their information needs. PubMed is a premier open access health science database of US National Library of Medicine (NLM). PubMed indexes more than 5600 health science related journals. PubMed literacy is the information literacy on PubMed database. It helps the health science professionals and researchers in understanding various features of the PubMed database and accessing the required health science information more efficiently and effectively. PubMed literacy means to how to use PubMed for conducting literature search and includes having training in literature search skills and techniques which are essential for searching in PubMed. The present article helps to get familiarity with search features and functionality of PubMed database and to know the importance of PubMed literacy in conducting health science literature search.

Análisis de interacciones de actores de la red de gestión del conocimiento en malaria de Colombia

Analizar las interacciones de la Red de Gestión del Conocimiento, Investigación e Innovación en Malaria de Colombia. Materiales y métodos. Se hizo un análisis de redes sociales que permitió identificar la proximidad entre los actores y el grado de conocimiento entre ellos; se observaron indicadores de densidad, diámetro, distancia media y centralidad de grado. El corpus documental para el estudio estuvo constituido por 193 documentos técnicos publicados entre el 2016 y el 2021, que fueron analizados empleando técnicas de procesamiento de texto mediante el lenguaje de programación R. La categorización de la red se realizó a partir de cinco variables: atención integral a pacientes, diagnóstico, epidemiología y sistemas de análisis de información en salud, política pública, y promoción y prevención. El análisis de las interacciones indicó que la red la conformaban 99 actores, de los cuales 97 (98 %), mostraron más interés en la producción de conocimientos en epidemiología y sistemas de análisis de información en salud, seguido de la categoría de atención integral a pacientes con 79 (80 %). El 54 % de los actores llevó a cabo estudios de promoción y prevención, siendo esta la categoría de menor abordaje. Este estudio contribuye al fortalecimiento de estrategias clave en la divulgación del conocimiento sobre la malaria en Colombia.

Rapid Whole Genome Sequencing in Critically Ill Neonates Enables Precision Medicine Pipeline.

Rapid genome sequencing in critically ill infants is increasingly identified as a crucial test for providing targeted and informed patient care. We report the outcomes of a pilot study wherein eight critically ill neonates received rapid whole genome sequencing with parental samples in an effort to establish a prompt diagnosis. Our pilot study resulted in a 37.5% diagnostic rate by whole genome sequencing alone and an overall 50% diagnostic rate for the cohort. We describe how the diagnoses led to identification of additional affected relatives and a change in management, the limitations of rapid genome sequencing, and some of the challenges with sample collection. Alongside this pilot study, our site simultaneously established a research protocol pipeline that will allow us to conduct research-based genomic testing in the cases for which a diagnosis was not reached by rapid genome sequencing or other available clinical testing. Here we describe the benefits, limitations, challenges, and potential for rapid whole genome sequencing to be incorporated into routine clinical evaluation in the neonatal period.

Abstract 14787: Quantification of Flow and Biomechanics by Echocardiography (echo) in the Fetal Single Ventricle (sv)

Introduction: Echo-based ventricular flow and biomechanical analysis provides novel measurements of SV function that can be assessed serially. However, this analysis has not been applied to clinical studies. This study demonstrates a new workflow to measure ventricular flow and biomechanics from apical 4-chamber imaging for hypoplastic left heart syndrome [HLHS] patients and age-matched controls. Methods: We retrospectively collected echos at 33 weeks gestation prenatally and 7 days post-birth postnatally. Color Doppler echo of the LV/RV were evaluated using an in-house vector flow reconstruction algorithm, quantifying energy loss [EL] and vortex strength [VS]. B-mode echo of the LV/RV were evaluated for parameters including cardiac output [CO] and global longitudinal strain [GLS]. Results: 9 HLHS subjects and 11 age-matched controls were included. Prenatal HLHS patients exhibited elevated CO, EL, and VS (p&lt;0.01) but proportional GLS compared to the control LV/RV. The parameters serially increased postnatally (p&lt;0.01), consistent with transitional physiology. GLS in HLHS was differentiable from the normal RV only in postnatal studies, resembling normal LV values. Conclusions: Altered ventricular flow and biomechanics were observed for HLHS patients compared to controls during early life. These novel parameters can be serially evaluated using conventional echo imaging. We will perform longitudinal studies of this HLHS cohort as they progress through surgical palliation to fully understand how our integrated workflow can better inform SV patient care. Figure 1: Left – Comparison of ventricular flow and biomechanical markers between HLHS and control subjects, for prenatal (fetal) and postnatal (neonatal) ages. Right – Ventricular flow patterns for HLHS and control subjects for different ages.

84. Benefits of integrating an open-source knowledgebase in a precision oncology workflow

Next-generation sequencing is revolutionizing precision oncology, but vast amounts of sequence data must be processed and mined to reveal clinically relevant alterations that can inform patient care. The Personalized OncoGenomics (POG) program at BC Cancer utilizes whole genome and transcriptome analysis, providing a comprehensive view of advanced cancer patient tumours. This analysis relies on curated clinical knowledgebases linking cancer variants and their clinical relevance, but the breadth and utility of these can be limited by proprietary access or limited coverage. CIViC (Clinical Interpretation of Variants in Cancer) is an open-access, crowd-sourced knowledgebase of clinically relevant cancer variants that aims to address these limitations, and is one of several sources used for variant interpretation in POG. Based on a retrospective cohort of POG cases, we evaluated the knowledgebase coverage of genes and variants involved in treatment recommendations from the molecular tumour board (MTB). In a preliminary analysis, we found more than 95% of patients had an alteration considered clinically actionable by the MTB, demonstrating the benefit of combined genome and transcriptome analysis. We found that knowledge from CIViC represented nearly 50% of therapeutic evidence reported at the MTB, emphasizing the role of open-access knowledge in precision oncology. Additionally, by prospectively examining the levels and sources of evidence in patient reports, we identified areas where additional knowledgebase curation would most impact alignment with clinical utility, highlighting genome signatures as a critical area for future curation efforts. We also considered the impact of quality of evidence on MTB recommendations and patient treatments.

Cohort study protocol of the Brazilian collaborative research network on COVID-19: strengthening WHO global data

IntroductionWith the COVID-19 pandemic, hospitals in low-income countries were faced with a triple challenge. First, a large number of patients required hospitalisation because of the infection’s more severe symptoms. Second,...

Physicians' and advanced practice providers' perceptions of the impact of embedded clinical pharmacists on the work environment in ambulatory care clinics.

Clinical pharmacists are recognized as valuable team members in primary care clinics due to the variety of patient care services they provide. This study examined nonpharmacist healthcare providers' perceptions of how embedded clinical pharmacists impact the work environment in ambulatory care clinics. This was an exploratory mixed methods study consisting of semistructured interviews and a subsequent survey. Participants included attending and resident physicians, and advanced practice providers (APPs) practicing in clinics with an embedded clinical pharmacist. Coded interview transcripts were analyzed to identify themes that were used to develop a survey. Interview participants were not asked to complete the survey. Survey responses were analyzed utilizing descriptive statistics. Subgroup analysis assessed for differences in responses based on provider type, gender, clinical practice area, years of practice, and pharmacy services utilization. Fourteen physicians and APPs participated in the semistructured interviews, and 43 other providers completed the survey. In the interviews, participants stated the clinical pharmacist contributed positively in terms of work environment, workload, work-related stress, and burnout. The major themes identified were sharing patient care responsibilities, saving provider time, and being a knowledgeable resource. Survey responses were consistent with interview statements; however, the positive impact differed between nonusers and moderate to high utilizers of clinical pharmacy services. The main barrier to collaborating with clinical pharmacists was their limited availability. Embedded clinical pharmacists positively impact the work environment in ambulatory care clinics by reducing provider workload, work-related stress, and burnout. Participants also noted clinical pharmacists are a trusted resource for patient care and drug information questions.

The use of and need for data and information by health professionals supporting the delivery of palliative cancer care services in sub-Saharan Africa: A qualitative study.

The ability to develop and evaluate approaches to the management of advanced cancer in sub-Saharan Africa is limited by the lack of local, reliable and valid data to ensure that practice is evidence-based, replicable and reflects the needs of the population served. A secondary qualitative analysis of in-depth interviews with 59 health professionals delivering palliative cancer care in Nigeria, Uganda and Zimbabwe were conducted to determine the use and needs for data and information for patient care and service delivery. Framework analysis was used, informed by a conceptual model for data use in low and middle-income countries. Three meta-themes include: (1) Current practice in data gathering and use; (2) Gaps for capturing, storing information and supporting communication, and; (3) Needs and opportunities for data use. Deficits in current data access and use were identified, alongside targets for improving the quality, accessibility and utility of data to inform the development of palliative cancer care. The availability and use of relevant and reliable data relating to the current provision of palliative cancer care are requisite for the contextually appropriate and effective development of health services. The requirements and constraints articulated by participants can guide future development and optimisation of digital health approaches for palliative cancer care in the participating countries, with relevance to the wider sub-Saharan Africa region.

Abstract B027: The development of a multiscale transcriptional atlas of sarcoma

Abstract Objectives: Sarcomas are mesodermal cancers of bone and soft tissue of which there are &amp;gt;60 malignant varieties, many of which can be difficult to diagnose or subtype using traditional histopathology. A universal molecular definition of sarcoma types would therefore be an invaluable tool to the diagnostic pathologist. RNA has the potential to offer a complimentary perspective to cytogenetic- and methylation-based diagnostics, as it represents the active state of the disease at sampling and better reveals its phenotype. Recognizing the potential for RNA-based classification, we set out to create a first-generation transcriptional atlas of sarcoma. Methods: To develop transcriptional definitions of cancers with the potential to further subclassify tumor types, we designed a self-optimizing and scale-adaptive unsupervised method (RACCOON), which groups samples into hierarchically organized clusters. We used this approach on the UCSC Treehouse Childhood Cancer Compendium, a set of 2,178 pediatric and 9,400 adult tumors, 1,130 of which are sarcomas, as well as 1,735 non-neoplastic samples. We then trained an ensemble of convolutional neural networks to classify tumors to these transcriptional clusters. We have now added 624 more sarcoma samples from Toronto centers and international collaborators to better represent the breadth of sarcoma. We are actively sequencing 500 additional samples in partnership with the Gabriella Miller Kids First Research Program to yield an expanded cohort of &amp;gt;2,200 uniformly processed and analyzed sarcomas. Results: Sarcomas organize into two clusters at the highest hierarchical level: one characterized by entities which occur primarily in adults and resemble mature tissue, the other by primarily pediatric entities which exhibit high stemness and resemble embryonic tissue. Several included entities are not bona fide sarcomas but originate from the mesoderm (e.g., Wilms Tumor) signifying a common transcriptional identity for mesodermal neoplasms. Additionally, we demonstrate the first transcriptional subtypes of central osteosarcoma reflecting its major histotypes and representing divergent clinical courses. We also determine Ewing Sarcoma (ES) to be a distinct entity which clusters separately from all other cancers, raising questions of its origin and affinity to sarcoma. When classifying ongoing patients to the atlas, we correctly classified &amp;gt;85% of tumors and corrected the diagnosis of 7%. We find 14% of ES in our dataset were likely misdiagnosed CIC- or BCOR-driven sarcomas. Critically, assigned subtypes are consistent between primary and relapse pairs. Conclusion: RNA-seq is a promising tool for both subtype discovery and classifying sarcoma in ongoing patients. We have already included this tool in tumor boards to help inform patient care. Our method reveals the overarching organization of sarcoma for the first time and specifies its underlying biology. This atlas is ever-growing and is open to the community to contribute. Citation Format: Joshua O. Nash, Federico Comitani, Rose Chami, Sarah Cohen-Gogo, Astra Chang-Schwertschkow, Yael Babichev, Jodi Lees, Noa Alon, Nalan Gokgoz, Stephen Man Yu, Kyoko Yuki, Miranda Lorenti, Zhanqin Liu, Alaina McGoey, Famida Spatare, Bernarld Castro, Kim Tsoi, Hagit Peretz Soroka, Jack Brzezinski, Anita Villani, Albiruni Razak, Abha Gupta, Elizabeth Demicco, Gino Somers, Brendan C. Dickson, Jay S. Wunder, Irene L. Andrulis, David Malkin, Rebecca A. Gladdy, Adam Shlien. The development of a multiscale transcriptional atlas of sarcoma [abstract]. In: Proceedings of the AACR Special Conference: Sarcomas; 2022 May 9-12; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2022;28(18_Suppl):Abstract nr B027.

Comparable outcomes between face-to-face and online deliveries of an introduction to IPE event for occupational therapy and physical therapy students

Health, Interprofessional Practice and Education is a peer-reviewed, open access journal dedicated to increasing the availability of high-quality evidence to inform patient care and practitioner education from an interprofessional perspective. HIPE is aimed at academics, practitioners and student-practitioners who seek to become more knowledgeable and skilled at working with providers in other health disciplines for the purpose of providing compassionate, quality, integrated care to diverse patient populations.HIPE is published by Pacific University Libraries | ISSN 2641-1148

Fostering Clinical Judgement Ability among Nursing Students by Application of Concept Mapping in the City of Bangalore, India

Each clinical encounter demands competent clinical skills and expertise from a student nurse. This period also becomes the most challenging as many have trouble linking theory with practice. Thus, they experience less confidence at the bedside of patients. Delivering high-quality, safe nursing care at the bedside requires sound clinical judgement. Nurses with clinical judgement have evidence-based knowledge enabling them to identify intuitively salient patient care information and respond accordingly. Developing these critical clinical judgement abilities takes time, and many new nurses lack them. Concept mapping is a robust instructional technique that may assist novice nurses in making links between many aspects of nursing care concepts, allowing for the development of clinical judgement. This study aimed to determine the usefulness of the concept mapping approach to foster clinical judgement among nursing students in Bangalore, India. A quantitative, quasi-experimental pretest-post-test design with a control group was implemented among Bachelor of Science in Nursing students. The subjects were undergoing medical-surgical nursing courses in four nursing colleges in an urban setting. The allocation of four colleges to the control and experimental group was random. A sample size of 300 participants completed a questionnaire on baseline characteristics and the Lasater Clinical Judgement Rubric. The experimental group was taught using the concept mapping technique, and participants prepared a concept map for their assigned patient in the clinical area. The intervention group’s mean pretest clinical judgement score was 18.24 (SD = 3.17), while the control group’s was 20.18 (SD = 4.85). The intervention group’s mean post-test clinical judgement score (29.56, SD = 5.42) is greater than the control group’s (22.33, SD = 4.63). The experimental group had a substantially higher post-test clinical judgement score (t = 3.99, P&lt;0.001) than the control group. The findings imply that concept mapping will help nursing students improve their clinical judgement abilities.

Healthcare Research Priorities in the USA

What are the key healthcare research needs in the USA?&#x0D; One is that COVID-19 will remain a topic of interest. Be it in research on vaccines effectiveness, testing developments, clinical associations or social and economic impacts, the topic, like the virus, will not vanish of the research mapping in the USA. Additionally, on the back of its popularity, it is likely that the healthcare industry will support research on innovative technology solutions to help ensure healthcare equity. Health disparities between rural and urban populations in the U.S. has to be overcome. A critical success factor will be unlocking the vastness of unstructured healthcare data and making it widely accessible and actionable for stakeholders across care settings.&#x0D; A second topic is burnout affecting care teams as a key issue for healthcare organizations. Workforce shortages sweep the healthcare industry and the need for evidence on solutions remains high, especially studies on technology-based options for data management that can lower the pressure on healthcare professionals.&#x0D; A third topic stems from the need to generate more evidence on how Data from wearables can play a role in patient care. Wearable devices like watches and fitness trackers have brought increased health awareness to users and are generating new data that can be used to inform patient care and improve prevention services, especially at the primary care level. Mobile health technology needs further science applied to demonstrate its role in preventive medicine. &#x0D; A fourth is the need for evidence on Precision Health. Its adoption already demonstrated in cancer care, current trends are pushing the precision health focus to all areas of care delivery.&#x0D; A fifth topic is that of evidence on more options for care at home, especially building from new developments on evidence concerning clinical effectiveness and impacts on patients' quality of life.

Interprofessional Education Behavior Challenge in Pre-licensure Students Can Enhance Collaborative Care Practices

Health, Interprofessional Practice and Education is a peer-reviewed, open access journal dedicated to increasing the availability of high-quality evidence to inform patient care and practitioner education from an interprofessional perspective. HIPE is aimed at academics, practitioners and student-practitioners who seek to become more knowledgeable and skilled at working with providers in other health disciplines for the purpose of providing compassionate, quality, integrated care to diverse patient populations.HIPE is published by Pacific University Libraries | ISSN 2641-1148

Electronic capture of cancer-related distress in a community oncology program.

1577 Background: Cancer related distress can be seen in as many as one in two patients. Many organizations such as the Commission on Cancer require distress screening. National Comprehensive Cancer Network (NCCN) distress thermometer is a common tool used for screening. We studied feasibility of embedding the NCCN thermometer into oncology electronic health record (EHR) for routine patient care. We concurrently studied feasibility of using a mobile health tool for serial evaluation of cancer related distress. Methods: A flowsheet containing NCCN distress thermometer questions was created in Epic EHR (Epic Systems, Verona, WI). Oncology nurses used the flowsheet for routine patient assessment. Patients with distress level ≥ 4 answered additional questions. Ancillary care providers such as palliative care nurses or social workers addressed the identified needs by providing appropriate ‘services’. A field to capture these interventions was created. We also adapted our previously reported web based mobile tool [1] for monitoring cancer distress. Patients rated their distress on a 1-10 scale and highlighted the distress domain (physical, emotional, practical, family). Distress level ≥ 4 generated a color-coded flag for provider review and intervention. Data from both electronic tools was periodically analyzed to inform patient care and quality improvement. Results: Between January and December 2021, Epic EHR based distress flowsheet collected 28,594 distinct responses in 911 patients. 57.4%, 14.9%, 14.1%, 9.4% and 2.3% of the responses were in the physical, emotional, practical, familial and spiritual domains respectively. ‘Other’ responses were 1.4%. Cumulative frequency of non-physical problems was 42.5%. 1819 ‘services’ were provided with 357 emotional, 351 work, 351 housing, 350 transportation and 350 financial need-based interventions. Of 1231 patients who used the distress scale and provided additional comments, 315 (25.5%) had distress levels ≥ 4. The mobile tool captured 849 unique patient responses to the distress question between April 2020 and February 2022. Distress level ≥ 4 was flagged by 281 unique patients (33.09%). Average distress level was 2.7. Emotional domain problems generated the greatest distress level followed by family, physical and practical problems in decreasing order. Conclusions: We demonstrate feasibility of electronic capture of cancer related distress to facilitate holistic patient care in a community-based oncology program. EHR based and mobile tool distress evaluations generated concordant results. Distress caused by emotional, practical and familial domain problems was nearly as frequent and often more severe than distress caused by physical problems, underscoring the need for comprehensive cancer care.