Outpatient Oncology Setting Research Articles

Comparative validation of the nutriscore and nutrition risk screening (NRS-2002) tools in the outpatient oncology setting: a single center study

Comparative validation of the nutriscore and nutrition risk screening (NRS-2002) tools in the outpatient oncology setting: a single center study

Nurse-patient communication experiences from the perspective of Iranian cancer patients in an outpatient oncology clinic: a qualitative study

BackgroundEffective communication between nurses and cancer patients is essential for patient satisfaction and optimal health outcomes in outpatient oncology settings. This study explored the communication experiences of Iranian cancer patients receiving outpatient treatment.MethodsSemi-structured interviews were conducted with 14 adult cancer patients undergoing chemotherapy, radiotherapy, or follow-up treatment at an outpatient clinic in Urmia, Iran. Qualitative content analysis was used to analyze the data. This study adhered to the standards set forth in the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.ResultsThree main categories emerged from the interviews with Iranian cancer patients: communication dynamics, barriers to communication, and effective communication outcomes. Patients expressed a desire for nurses who actively listen, provide emotional support, and offer thorough education about their disease and treatment options. However, they also identified barriers to effective communication, including negative nurse behaviors (such as lack of empathy), heavy workloads, gender and language discordance, and logistical challenges within the clinic setting. When communication was positive, patients reported increased commitment to their treatment plans, improved coping mechanisms, reduced stress levels, and greater satisfaction with their overall care.ConclusionsThis study revealed the multifaceted nature of communication in outpatient oncology settings from the patient’s perspective. Findings underscore the need for interventions that enhance nurse communication skills, address workload issues, promote cultural sensitivity, and optimize clinic logistics. These efforts can significantly improve patient experiences and treatment outcomes during cancer treatment.

Death Anxiety in Patients With Advanced Cancer and Their Family Caregivers

ContextDeath anxiety is associated with fears of suffering and uncertainty at the end of life. It is also relevant to patients’ family caregivers, who can experience fears about the patients’ death and dying. ObjectivesThis study investigates the prevalence of death anxiety in advanced cancer patients and their family caregivers and its association with sociodemographic and medical characteristics. MethodsWe recruited patients with UICC stage IV solid tumors from in- and outpatient oncology and palliative care settings. We administered the Death and Dying Distress Scale to assess clinically significant death anxiety. We analyzed its association with sociodemographic and medical characteristics using simultaneous multiple linear regression analyses. ResultsDeath anxiety was prevalent in 37% of patients (N = 481) and 75% of family caregivers (N = 140). Most frequent death anxiety concerns were “feeling distressed about the impact of one's own death on loved ones” (52% of patients) and “feeling distressed about running out of time with their loved one” (69% of family caregivers). Patients who experienced high death anxiety were more likely to be younger (standardized β = -0.1; P=0.005) and have known about their diagnosis for less time (standardized β = -0.1; P=0.046). Being female predicted higher death anxiety in patients (β = 0.12; P=0.041) and family caregivers (β = 0.32; P=0.002). ConclusionThe results indicate that death anxiety is a common, clinically significant problem in patients with advanced cancer and their family caregivers, emphasizing the need for targeted psychological support.

Implementation of a pharmacogenetic panel-based test for pharmacotherapy-based supportive care in an adult oncology clinic.

The University of Florida Health conducted a pragmatic implementation of a pharmacogenetics (PGx) panel-based test to guide medications used for supportive care prescribed to patients undergoing chemotherapy. The implementation was in the context of a pragmatic clinical trial for patients with non-hematologic cancers being treated with chemotherapy. Patients were randomized to either the intervention arm or control arm and received PGx testing immediately or at the end of the study, respectively. Patients completed the MD Anderson Symptom Inventory (MDASI) to assess quality of life (QoL). A total of 150 patients received PGx testing and enrolled in the study. Clinical decision support and implementation infrastructure were developed. While the study was originally planned for 500 patients, we were underpowered in our sample of 150 patients to test differences in the patient-reported MDASI scores. We did observed a high completion rate (92%) of the questionnaires; however, there were few medication changes (n = 6 in the intervention arm) based on PGx test results. Despite this, we learned several lessons through this pragmatic implementation of a PGx panel-based test in an outpatient oncology setting. Most notably, patients were less willing to undergo PGx testing if the cost of the test exceeded $100. In addition, to enhance PGx implementation success, reoccurring provider education is necessary, clinical decision support needs to appear in a more conducive way to fit in with oncologists' workflow, and PGx test results need to be available earlier in treatment planning.

Ambulatory care hematology/oncology pharmacy services: A comprehensive review by the Saudi Oncology Pharmacy Assembly

AbstractSaudi Vision 2030 has driven significant changes in ambulatory care pharmacy services in the Kingdom of Saudi Arabia (KSA), transitioning pharmaceutical care from inpatient to outpatient settings. With a growing need to address non‐communicable diseases, particularly cancer, ambulatory care oncology pharmacy services are of paramount importance. This study aims to evaluate the potential benefits and challenges of establishing such services in the KSA and offers recommendations for clinical pharmacists. A comprehensive literature search was conducted using PubMed, MEDLINE, EMBASE, and Google Scholar, encompassing research from inception to September 2023. The search focused on English language studies related to ambulatory care oncology/hematology pharmacy services. Among the 1351 studies found, those assessing the impact of clinical pharmacists on patient outcomes in outpatient oncology clinics were included. The review of the literature highlights the substantial impact of clinical pharmacists in outpatient hematology/oncology settings. A selection of several studies revealed their role in improving patient care, reducing health care costs, and enhancing treatment outcomes. Notable findings include a high acceptance rate of pharmacist interventions with significant cost savings, increased pharmacist involvement in patient encounters, and reduced emergency department visits and inpatient admissions due to pharmacist interventions. These results showed the valuable contributions of clinical pharmacists in the international outpatient oncology setting. Establishing ambulatory care hematology/oncology pharmacy services in Saudi Arabia is critical, considering the rising cancer burden. The value of specialized oncology clinical pharmacists in the outpatient setting is emphasized by various studies conducted in the United States. This review proposes a framework for patient‐centered oncology practices, serving as a valuable resource for the strategic development of ambulatory care oncology pharmacy services in Saudi Arabia. These efforts align with Saudi Vision 2030's broader goals of enhancing health care quality and patient care.

Outpatient oncology settings: the distinctive contribution of supportive design to patient experience and wellbeing

ABSTRACT The concept of patient-centred care is increasingly shaping healthcare practices, particularly within oncology settings. Its implications extend to a hospital's constructed environment and how it is designed, yet few studies have explored patient experience of such sensitive settings, and even fewer have examined outpatient oncology facilities. This study researched how the hospital built environment affects cancer patient wellbeing using in-depth interviews with 24 patients across Australia and Egypt. Analysis of patient-narrated experiences shed light on the potential latent impact of the built environment on patient health-related outcomes, such as pre-treatment anxiety and treatment-induced sensitivities and stresses. Three overarching themes were identified, including the built environment capacity to contribute to incidences of positivity; balancing the unavoidable (necessary) presence in the hospital; and encouraging reasons to return – potentially enhancing treatment compliance. The study further demonstrates how such support may contribute to experiencing a desired climate of patient-centred care, affording additional grounds for patients to cope with the potential burdens of treatment and its side effects.

Investigating the safety and feasibility of osteopathic manipulative medicine in hospitalized children and adolescent young adults with cancer.

Children and adolescents young adults (AYAs) undergoing treatment for oncologic diagnoses are frequently hospitalized and experience unwanted therapy-induced side effects that diminish quality of life. Osteopathic manipulative treatment (OMT) is a medical intervention that utilizes manual techniques to diagnose and treat body structures. Few studies have investigated the implementation of OMT in the pediatric oncology outpatient setting. To date, no studies have investigated the safety and feasibility of OMT in the pediatric oncology inpatient setting. The objective of this study is to investigate the safety and feasibility of OMT in the pediatric oncology inpatient setting. This is a prospective, single-institution pilot study evaluating children and AYAs aged≥2 years to≤30 years with a diagnosis of cancer hospitalized at Riley Hospital for Children (RH) from September 2022 to July 2023. Approval was obtained from the Indiana University Institutional Review Board (IRB). Patients were evaluated daily with a history and physical examination as part of routine inpatient management. Patients who reported chemotherapy side effects commonly encountered and managed in the inpatient setting, such as pain, headache, neuropathy, constipation, or nausea, were offered OMT. Patients provided written informed consent/assent prior to receiving OMT. OMT was provided by trained osteopathic medical students under the supervision of a board-certified osteopathic physician and included techniques commonly taught in first- and second-year osteopathic medical school curricula. Safety was assessed by a validated pain (FACES) scale immediately pre/post-OMT and by adverse event grading per Common Terminology Criteria for Adverse Events (CTCAE) 24 h post-OMT. All data were summarized utilizing descriptive statistics. A total of 11 patients were screened for eligibility. All patients met the eligibility criteria and were enrolled in the study. The majority of patients were male (n=7, 63.6 %) with a median age of 18.2 years at time of enrollment (range, 10.2-29.8 years). Patients had a variety of hematologic malignancies including B-cell acute lymphoblastic leukemia (ALL) (n=5, 45.5 %), T-cell ALL (n=1, 9.1 %), acute myeloid leukemia (AML) (n=2, 18.2 %), non-Hodgkin's lymphoma (n=2, 18.2 %), and Hodgkin's lymphoma (n=1, 9.1 %). All patients were actively undergoing cancer-directed therapy at the time of enrollment. There were 40 unique reasons for OMT reported and treated across 37 encounters, including musculoskeletal pain (n=23, 57.5 %), edema (n=7, 17.5 %), headache (n=5, 12.5 %), peripheral neuropathy (n=2, 5.0 %), constipation (n=2, 5.0 %), and epigastric pain not otherwise specified (n=1, 2.5 %). Validated FACES pain scores were reported in 27 encounters. Of the 10 encounters for which FACES pain scores were not reported, 8 encounters addressed lower extremity edema, 1 encounter addressed peripheral neuropathy, and 1 encounter addressed constipation. The total time of OMT was documented for 33 of the 37 encounters and averaged 9.8 min (range, 3-20 min). Hospitalized children and AYAs with cancer received OMT safely with decreased pain in their reported somatic dysfunction(s). These findings support further investigation into the safety, feasibility, and efficacy of implementing OMT in the pediatric oncology inpatient setting and to a broader inpatient pediatric oncology population.

Effectiveness of a computer-facilitated intervention on improving provider delivery of tobacco treatment in a thoracic surgery and oncology outpatient setting: A pilot study.

Effective tobacco treatments are available but are often not delivered to individuals with an actual or potential diagnosis of thoracic malignancy. The specific aims of this study were to identify the prevalence of tobacco use and examine the effectiveness of the Clinical and community Effort Against Smoking and secondhand smoke Exposure (CEASE), a system-level computer-facilitated intervention, to improve provider delivery of tobacco treatment in a thoracic surgery and oncology outpatient setting. A pre-post-test design was used to assess the effectiveness of CEASE. A 3-step approach was used to integrate tobacco treatment into routine care: ask about tobacco use, assist with cessation, and refer to a quitline. An end-of-visit survey was conducted to collect prevalence of tobacco use and delivery of tobacco treatment. Descriptive statistics and Fisher's exact test were used for analysis. A total of 218 individuals were enrolled; 105 participants were in usual care (UC) and 113 were in the CEASE group. Of those who enrolled, 27.6% were never smokers in UC and 27.7% in CEASE, 60% were former smokers in UC and 50% in CEASE, and 12.4% were current smokers in UC and 21.4% in CEASE. Significant differences were noted in delivery of tobacco treatment with 15.4% having received tobacco treatment in UC compared to 62.5% in CEASE (p<0.004). A computer-facilitated intervention increased provider delivery of tobacco treatment in a thoracic surgery and oncology outpatient setting. This intervention provided a low-resource approach that has the potential to be scaled and implemented more broadly.

Methods for Identification of Blood Product Transfusions in a Cohort of Myelofibrosis Patients: An Assessment of Data Capture Using Insurance Claims and Electronic Health Record Abstraction

Introduction Transfusion data completeness is critical in assessing real-world response and progression in myeloid malignancies. In the real-world setting transfusion data can be collected via insurance claims or by Electronic Health Record (EHR) abstraction. Transfusion events captured from claims have previously been shown to be 71% sensitive and 92% specific compared to EHR abstraction in the community hospital setting, however this has not been evaluated in outpatient community oncology setting (Howard DH, et al. Transfusion Medicine. 2016;26:457-459). Our objective was to assess the completeness of transfusion data from claims in the The Komodo Healthcare Map™(KHM) to EHR abstraction in the Flatiron Health Research Database (FHRD) in a group of patients with myelofibrosis (MF). Methods This study used the nationwide Flatiron Health EHR-derived de-identified database and The Komodo Healthcare Map™, a database of de-identified claim-based healthcare encounters from insured patients in the US (2015-2022).This is a cross-sectional study of a cohort of patients with MF that underwent EHR abstraction (EHRC) (n = 507) from FHRD, capturing transfusion dates, and number of units from date of diagnosis up to data cutoff on 30 November 2022 (observation window). Those patients were linked to KHM to create a Linked Claims Cohort (LCC), and a sub-cohort of patients with any closed claims during the observation window to make a Closed Claims Cohort (CCC), where transfusions were assessed by reviewing transfusion-related HCPCS and ICD codes. Analyses were performed on the matched patients in the LCC and CCC, respectively. To assess the level of concordance between claims and EHR data sources on the number of transfusions per patient the intraclass correlation coefficient (ICC) was used. Also, percent overlap and sensitivity, specificity, and positive and negative predictive values were calculated. Results Out of a total of 507 in the EHRC, 498 were found in KHM and included in the LCC, and 245 had closed claims and comprised the CCC. Demographics are listed below (Table 1) and are similar between groups, however the CCC had a higher percentage of patients with more recent diagnosis. A total of 319 (64%) vs 168 (34%) in the LCC, and 143 (58%) vs 95 (39%) patients in the CCC had at least one transfusion identified by EHR and claims data sources, respectively (Table 2). In the LCC, there was 64.1% agreement of having a transfusion across data sources, with a kappa of 0.34 (p = 0), and in the CCC, there was 72.24% agreement, with a kappa of 0.47 (p = 0). The unweighted kappa for the number of transfusions recorded during the observation period was 0.11 (p = 0) in the LCC and 0.18 (p = 0) in the CCC. Treating the EHR source as the source of truth, the claims data source in LCC had a sensitivity of 48.28%, specificity of 92.18%, PPV of 91.67%, and NPV of 50% to identify transfusion events, while the claims in CCC had a sensitivity of 59.44%, specificity of 90.20%, PPV of 89.47%, and NPV of 61.33% Conclusions There was an observed low agreement between transfusions identified via EHR abstraction and Claims data sources, with the EHR having more transfusions identified, but a moderate agreement when selecting for patients with closed claims. As a source for transfusion data EHR provided more data points during the observation window for this group of patients. Future investigation of transfusions in patients with continuous closed claims during the observation window is warranted to determine if it improves data capture. This study demonstrates that EHR abstraction may have higher utility for identifying transfusions with lower attrition in a cohort of MF patients with long observation periods, and with variable insurance coverage in the outpatient oncology setting.

The Development and Implementation of an Effective Outpatient Oncology New Graduate Nurse Orientation Program.

Historically, outpatient oncology settings have not hired new graduate RNs (NG-RNs). However, with staffing shortages, outpatient oncology clinics have hired NG-RNs who required orientation from formal onboarding programs. Us.

Clinical Characteristics, Treatment Trends, and Outcomes of Patients with HHV-8-Negative/Idiopathic Multicentric Castleman Disease Treated with Siltuximab in a Machine Learning-Selected Real-World Cohort

Background HHV-8-negative/Idiopathic Multicentric Castleman Disease (iMCD) is a rare lymphoproliferative disorder with limited treatment options and poor outcomes. Siltuximab remains the only FDA approved treatment for the disease (April 2014), but its uptake and associated outcomes outside of clinical trials remain unclear. Further, constructing a large enough cohort of patients with iMCD to better understand siltuximab use in real-world practice is a challenge due to its low incidence, lack of a Castleman Disease (CD)-specific ICD code until 2017, and effort required for manual chart abstraction. We built a natural language processing-based machine learning (ML) model to select patients with iMCD from a nationwide electronic health record (EHR)-derived database and described their clinical characteristics, treatment trends, and real-world overall survival (rwOS). Methods Across a cohort of over 3.5 million patients in the EHR-derived, Flatiron Health database (which comprises de-identified patient-level structured and unstructured data from ~280 US cancer clinics and ~800 sites of care), patients with ML-extracted diagnoses and dates of diagnoses for iMCD and a visit on or after 2011 were selected. Precision (positive predictive value) of the ML-selected cohort was measured on 50 human abstracted charts. Descriptive statistics summarized patient characteristics and treatment trends. Treatment patterns were assessed among patients diagnosed on or before January 31, 2023 to allow a minimum of 3 months for treatment initiation. Changes over time in first-line (1L) treatment status were measured by diagnosis year category (&amp;lt;2014, 2014-2018, 2019-2023), and were chosen based on siltuximab approval date (2014) and publication of treatment guidelines for iMCD (2018). 1L regimens were grouped into one of the following mutually exclusive categories in hierarchical order: siltuximab-containing regimen, rituximab-containing regimen, and primary chemotherapy-containing regimen. 5-year rwOS rates for the entire iMCD cohort (indexed to diagnosis date), as well as patients with 1L-siltuximab or non-siltuximab regimens (indexed to treatment start date) were estimated using the Kaplan-Meier estimator. Patients with a diagnosis date before 2011 were excluded from survival analyses to avoid immortal time bias. Results The ML model selected 267 patients as having iMCD across the Flatiron network. The precision of the model was 90% for a CD diagnosis (including unicentric, HHV-8-associated multicentric, or unclassified CD) and 76% for the iMCD cohort. Patients with iMCD were predominantly male (55%), white (53%), and had a median age at diagnosis of 52. Compared to patients treated with non-siltuximab 1L therapy (N=122), patients treated with siltuximab-based regimens in 1L (N=67) were more likely to have been diagnosed more recently, seen in the community setting, and have a documented ECOG performance status (p&amp;lt;0.05) but were otherwise similar (Table 1). Among patients with evidence of treatment, use of 1L siltuximab-based regimens increased from 35% of patients diagnosed 2014-2018 to 46% diagnosed 2019-2023 while 1L rituximab-based regimen use dropped from 46% to 35%. 1L primary chemotherapy-based regimen use dropped from 41% prior to 2014 to 19% post 2014 (Figure 1). Among patients diagnosed after 2014 and who had evidence of treatment, 51% (77/151) received siltuximab at any point. Unadjusted 5-year rwOS rate for the entire iMCD cohort, including patients without evidence of treatment, was 84% [95% CI: 78-90%]. For patients treated with a 1L siltuximab-containing regimen, unadjusted 5-year rwOS was 86% [95% CI: 78%-96%], whereas for patients treated with non-siltuximab based 1L therapy, unadjusted 5-year rwOS was 81% [95% CI: 72%-90%]. Conclusion ML extraction allowed for the largest analysis of real-world patients with iMCD to date. While use of siltuximab in the 1L setting is increasing over time, only half of patients with evidence of treatment receive it at any point. Unadjusted 5-year rwOS rates for those treated with both siltuximab and non-siltuximab based 1L therapy was higher than previously reported. This may be due to the inclusion of other CD subtypes in the cohort or sicker patients not being seen in an outpatient oncology setting. Future work should explore the drivers of poor outcomes for patients as well as the factors associated with lack of receipt of siltuximab.

Opportunities and challenges to using a cross-sectional, patient-reported experience measure of shared decision making to evaluate the impact of an intervention centered on serious illness conversations in oncology.

317 Background: Patient-reported experience measures (PREMs) are an important quality metric for healthcare delivery, even more so for the assessment of the quality of serious illness conversations (SIC) in oncology. We deployed a validated, 3-item PREM for shared decision-making (SDM), CollaboRATE, as part of the assessment for an intervention aimed at increasing the conduct of routine SIC in the outpatient oncology clinic. The use of CollaboRATE sought to identify patient-reported differences in SDM potentially attributable to this intervention. Methods: During the 12-month project period, CollobaRATE was included in outpatient oncology experience surveys (PressGaney) sent to patients who attended visits at the main campus. Surveyed patients were selected at random, mailed the survey, and were not resurveyed on the same clinician for a minimum of 6 months. We used a top score method for our primary outcome (e.g., selecting the highest mark on all three CollaboRATE items). Incomplete survey items were scored below the top score. We analyzed survey results for all patients and those identified as SIC-eligible by a clinician (i.e., radio button function within the electronic health record (EHR)). We also stratified results by SIC intervention versus non-SIC intervention clinicians. We used a chi-square test of independence with a statistical significance threshold of p≤0.05 to assess any association. Results: From 8/1/2021 to 7/31/2022, we received 1309 CollaboRATE surveys representing an overall response rate of 25%. During this period, SIC intervention clinicians represented 19% (8/43) of the oncology clinicians (e.g. MD/DO, APRN, PA) practicing at this site, and compromised 19% (247/1309) of outpatient surveys collected. Among all surveyed cancer patients, the proportion selecting the top score for all items was not significantly different at 73% (181/247) for SIC intervention clinicians versus 68% (720/1062) for non-SIC intervention clinicians (p=0.09). Among patients identified as SIC-eligible in the EHR, the proportion selecting top-box scores for all items was statistically significant at 75% (97/130) for SIC intervention clinicians versus 59% (31/53) for non-SIC intervention clinicians (p=0.031). Conclusions: CollaboRATE has been used in primary care to benchmark clinician and clinic performance in SDM, however, its use as an assessment strategy in serious illness communication in oncology is unique. Caution should be made when interpreting the SIC-eligible patient analysis, as the control group is small (i.e. likely undercounted) given the reliance on clinicians to identify patients as SIC-eligible within the EHR to be included. The collection and analysis of PREMs for SDM were feasible in an outpatient oncology setting.

The use of simulation-based learning to increase the confidence level of oncology advanced practice providers when discussing palliative care.

265 Background: The increase in cancer cases globally has dramatically strengthened the need in introducing palliative care upon a cancer diagnosis. Oncology advanced practice providers (APPs) are essential in integrating palliative care concurrently with treatment. SinceAPPs have limited to no hands-on training in palliative care, they often feel unprepared and less confident in discussing palliative care with cancer patients, resulting in a gap in care. This can result in a decreased in quality of life (QoL), absence of symptom management, increased healthcare costs and usage of healthcare resources, increased emergency room visits and hospital admissions. This quality improvement (QI) project sought to increase the confidence level of APPs, when discussing palliative care using simulation-based training in an effort to address this educational gap and provide palliative care support alongside standard of care. Methods: The project utilized a sample of 15 APPs working in an academic outpatient oncology facility. Participants completed a pre-and post-survey consisting of 12 Likert-type questions to measure their confidence level in palliative care before and after the simulation training session. Simulation-based learning with standardized participants (SPs) was utilized to increase the confidence level of APPs in the outpatient oncology setting. A pancreatic cancer patient case was utilized for the simulation. The Wilcoxon’s signed-rank test was used to compare the results of the pre and post test scores. Results: The results showed positive changes between the pre- and post-survey results in confidence level. Post-survey results were statistically significant (p value of &lt; 0.05) and respondents reported greater confidence following the simulation-based training. Referrals also increased to palliative care post simulation. Conclusions: Palliative care simulation with SPs closed educational gaps and improved the APPs confidence levels when discussing palliative care with cancer patients. As a result, simulation-based learning is an effective strategy to train newly hired oncology APPs or enhance skill deterioration as needed to integrate palliative care concurrently with treatment as the standard for cancer patients. Furthermore, from this QI project, a computer-based module was developed for new oncology APPs onboarding to the organization. Future directions are to expand to non-oncology APPs that directly care for cancer patients.

Utility of Respiratory Pathogen Panels in the Outpatient Oncology Setting

Oncology patients presenting for outpatient evaluation of a respiratory tract infection (RTI) are often tested for a variety of viruses with a respiratory pathogen panel (RPP) in addition to influenza and SARS-CoV-2. This triad of testing is expensive and uncomfortable because it requires 2 nasal swabs. Little evidence supports the use of an RPP in outpatient settings, but it is routinely ordered. This retrospective chart review analyzed 183 RPPs performed at Jefferson between April 2020 and November 2021 in outpatient oncology patients presenting with RTI. Data collected included patient demographics, symptoms, and exam findings at time of RPP, additional testing completed, results of RPP, antibiotic and antiviral use before and after RPP results, and patient outcomes 30 days after RPP. Descriptive statistics were calculated. Of the 183 RPPs analyzed, 16.9% (31) were positive for at least 1 respiratory virus. Fifty-two patients (28.4%) started antibiotics before results of the RPP. Of those, 2 patients (3.8%) had a change in antibiotic plan after RPP results returned. Zero patients were started on antiviral medication before results of the RPP. One patient started antiviral treatment after RPP results returned. In total, only 3 patients (1.6%) had an RPP-driven change in medication management. This study suggests limited utility in use of RPPs for oncology patients presenting to the office with RTI symptoms. Targeted testing with a single nasal swab for influenza, RSV, and SARS-CoV-2 may be more clinically relevant. The authors hope to use these data to implement a quality improvement initiative to reduce RPP utilization in this population.

Implementation of the Web-Enabled Cancer & Aging Resilience Evaluation (WeCARE) in an outpatient oncology setting

IntroductionAlthough geriatric assessments (GAs) are recommended for use in older adults with cancer, their integration into oncology practice remain suboptimal. Here, we report our experience integrating web-enabled GA (WeCARE) into oncology practice as an augmented delivery method and provider interface format to overcome implementation barriers. Materials and MethodsOlder patients (≥60 years) with a gastro-intestinal (GI) malignancy presenting for an initial visit to medical oncology clinic at a single institution between December 7, 2021 and October 10, 2022 were contacted by staff two days in advance of their visits and sent a link to the WeCARE GA, rather than the paper version used previously. Results were directly embedded into the medical record. We describe our initial implementation outcomes and the results of a provider usability survey. ResultsOf 266 eligible patients, 221 (83.1%) were successfully contacted by telephone and 200 (75.2%) completed the WeCARE prior to their appointment. More than one phone call was required to make contact for 35.7% of patients, with a mean duration of phone conversation of 2.8 min. Most patients preferred email delivery to text (63% vs 31%); 4.5% were unable to access surveys due to inadequate technology, and 25.7% brought up additional logistical concerns. Among GI oncology providers surveyed, all six found the WeCARE tool and dashboard acceptable, appropriate, and feasible. However, only a third of providers often or always used the dashboard to inform treatment decisions and guide interventions. DiscussionWith nearly three-quarters of patients completing the WeCARE prior to their visits with minimal staff support and time required, this method of administration may be a viable format to overcome barriers to GA implementation. Additional work is needed to integrate the results meaningfully into clinical practice.

Consultation patterns before and after embedding pediatric palliative care into a pediatric hematology/oncology clinic.

Palliative care is a critical component of pediatric oncology care. Embedded pediatric palliative care (PPC) is relatively new in pediatric hematology/oncology (PHO) and may improve access, utilization, and quality of PPC. In June 2020, the Mayo Clinic PPC service transitioned from an afternoon, physically independent clinic to an all-day clinic embedded within PHO. Retrospective chart review was used to quantify consultation rates from PHO to PPC in 12-month study periods before and after establishment of an embedded clinic. Changes in descriptive statistics and consult patterns were calculated. Study periods were compared using either chi-square or Fisher's exact tests for categorical variables and Wilcox rank sum tests for continuous variables. There was an 89% increase in consultations from PHO to PPC after initiation of an embedded clinic (n=20 vs. n=38 per 12months). The absolute number of completed outpatient consults increased from three (15% of visits) pre-embedment to fourteen (37%) post-embedment (p=.082). The median number of days from first oncology visit to PPC assessment was unchanged after embedment (36 vs. 47days, p=.98). Consults for solid tumors increased from 22% (n=4) pre-embedment to 60% (n=18) post-embedment (p<.05). Consults for symptom management increased from 60% (n=12) to 87% (n=33) (p<.05). Embedment of PPC into a PHO workspace was associated with an increased number of total consults, outpatient consults, solid tumor consults, and consults for symptom management. Our "partial-PPO" model allowed for provision of PPC in the outpatient oncology setting in a clinic where there is not enough volume to support a full-time oncology-focused clinician team.

A Mixed-Methods Study to Evaluate the Feasibility and Acceptability of Implementing an Electronic Health Record Social Determinants of Health Screening Instrument into Routine Clinical Oncology Practice.

Routine screening for social determinants of health (SDOH) in the outpatient oncology setting is uncommon. The primary goal of this study was to prospectively evaluate the feasibility and acceptability of implementing an electronic health record (EHR) SDOH screening instrument into routine, clinical, oncology practice. Adult patients with newly diagnosed gastrointestinal cancer presenting to a regional cancer center (November 2020 to July 2021) were eligible. Based on the consolidated framework for implementation research, feasibility measures included screening completion, median clinic visit time, and acceptability by the inter-professional care team and patients as measured by semistructured, qualitative interviews and surveys. Secondary outcomes included SDOH needs identified. Of 137 eligible patients, 112 (81.8%) were screened for SDOH. Demographics of the cohort included: 41.1% black (n = 46), 48.2% rural (n = 54), 4.5% uninsured (n = 5), and 6.3% Medicaid-insured (n = 7) patients. Median visit time was 97min (95% CI 70-107min) before and 100min after implementation (95% CI 75-119min; p = 0.95). In total, 95.5% (n = 107) reported at least one SDOH need. Clinicians (7/10) reported that SDOH screening was not disruptive and were supportive of ongoing use. Patients (10/10) found the screening acceptable. Screening staff (5/5) reported workflow barriers. Patients and staff also recommended revision of specific instrument questions. Routine collection of SDOH in an outpatient oncology setting using an EHR instrument is feasible and does not result in increased visit time for patients or clinicians. However, staff perceptions of clinic workflow disruption were reported. Further investigation to determine whether standardized SDOH assessment can improve cancer care delivery and outcomes is ongoing.

Implementation of a Patient Acuity Tool and Safe Staffing Model in an Outpatient Oncology Clinical Trials Unit.

Appropriate staffing in the outpatient oncology setting contributes to the delivery of quality care. Objective measures of acuity and nursing workload can assist with developing staffing models; however, measuring acuity in a.

Efficacy of smartphone-based virtual reality relaxation in providing comfort to patients with cancer undergoing chemotherapy in oncology outpatient setting in Indonesia: protocol for a randomised controlled trial

IntroductionPatients with cancer undergoing chemotherapy experience various physical and psychological problems and discomfort. Virtual reality (VR) can be used in technology-based non-pharmacological therapy that can serve as a potential distractor...

Trainees Associated with Improved Wait Times and Patient Satisfaction in a Multidisciplinary Clinic.

To determine variables associated with longer wait times and decreased patient satisfaction. To determine the association of trainees with clinic wait times and patient satisfaction scores in an academic center. Cross-sectional study. We recruited 266 study participants from an interdisciplinary Head and Neck Cancer outpatient clinic setting. Trained observers recorded observations related to wait times, time with individual health care practitioners, and total time spent in clinic. An 11-question survey was given to patients at the end of their visit assessing each patient's satisfaction with their visit, subjective wait time, and their likelihood to recommend the health care provider. Increased objective wait times were associated with new patients (p = 0.006) and based on the physician they saw (p < 0.001). Patients who saw a trainee spent less time waiting to see a physician (p = 0.023), more total time with a physician (p = 0.001), and reported higher wait time satisfaction scores (p = 0.001). There was no difference in total visit time if patients saw a trainee (p = 0.42). Patient satisfaction with wait time was correlated with all other aspects of patient satisfaction (p < 0.001). On multivariable analysis, the subjective wait time was associated with the likelihood to recommend (p < 0.001). Prolonged objective wait times in a multidisciplinary oncology outpatient setting were associated with several factors including specific physicians and new patient status. Trainee interaction with patients led to shorter wait times and improved patient satisfaction scores with wait times. Satisfaction with wait time was positively correlated with all aspects of patient satisfaction and 'likelihood to recommend' scores. NA Laryngoscope, 134:178-184, 2024.