Surveyed Health Care Providers Research Articles

Scoping review of healthcare professionals’ views on intimate partner violence in the Middle East and North Africa

ObjectivesThis scoping review aims to survey healthcare providers (HCPs) in the Middle East and North Africa (MENA) about their knowledge, attitudes and barriers to working with women who have experienced...

Enhanced Recovery after Surgery (ERAS) Implementation and Barriers among Healthcare Providers in France: A Cross-Sectional Study.

The implementation of Enhanced Recovery After Surgery (ERAS) is a challenge for healthcare systems, especially in case of patients undergoing major surgery. Despite a proven significant reduction in postoperative complications and hospital lengths of stay, ERAS protocols are inconsistently used in real-world practice, and barriers have been poorly described in a cohort comprising medical and paramedical professionals. This study aims to assess the proportion of French healthcare providers who practiced ERAS and to identify barriers to its implementation amongst those surveyed. We conducted a prospective cross-sectional study to survey healthcare providers about their practice of ERAS using an online questionnaire. Healthcare providers were contacted through hospital requests, private hospital group requests, professional corporation requests, social networks, and personal contacts. The questionnaire was also designed to explore barriers to ERAS implementation. Identified barriers were allocated by two independent assessors to one of the fourteen domains of the Theoretical Domains Framework (TDF), which is an integrative framework based on behavior change theories that can be used to identify issues relating to evidence on the implementation of best practice in healthcare settings. One hundred and fifty-three French healthcare providers answered the online questionnaire (76% female, median age 35 years (IQR: 29 to 48)). Physiotherapists, nurses, and dieticians were the most represented professions (31.4%, 24.2%, and, 14.4%, respectively). Amongst those surveyed, thirty-one practiced ERAS (20.3%, 95%CI: 13.9 to 26.63). Major barriers to ERAS practice were related to the "Environmental context and resources" domain (57.6%, 95%CI: 49.5-65.4), e.g., lack of professionals, funding, and coordination, and the "Knowledge" domain (52.8%, 95%CI: 44.7-60.8), e.g., ERAS unawareness. ERAS in major surgery is seldom practiced in France due to the unfavorable environment (i.e., logistics issues, and lack of professionals and funding) and a low rate of procedure awareness. Future studies should focus on devising and assessing strategies (e.g., education and training, collaboration, institutional support, the development of healthcare networks, and leveraging telehealth and technology) to overcome these barriers, thereby promoting the wider implementation of ERAS.

Life-Saving Treatments for Spinal Muscular Atrophy: Global Access and Availability.

Spinal muscular atrophy (SMA) is a neurodegenerative disorder manifesting with progressive muscle weakness and atrophy. SMA type 1 used to be fatal within the first 2 years of life, but is now treatable with therapies targeting splicing modification and gene replacement. Nusinersen, risdiplam, and onasemnogene abeparvovec-xioi improve survival, motor strength, endurance, and ability to thrive, allowing many patients to potentially attain a normal life; all have been recently approved by major regulatory agencies. Although these therapies have revolutionized the world of SMA, they are associated with a high economic burden, and access to these therapies is limited in some countries. The primary objective of this study was to compare the availability and implementation of treatment of SMA from different regions of the world. In this qualitative study, we surveyed health care providers from 21 countries regarding their experiences caring for patients with SMA. The main outcome measures were provider survey responses on newborn screening, drug availability/access, barriers to treatment, and related questions. Twenty-four providers from 21 countries with decades of experience (mean 26 years) in treating patients with SMA responded to the survey. Nusinersen was the most available therapy for SMA. Our survey showed that while genetic testing is usually available, newborn screening is still unavailable in many countries. The provider-reported treatment cost also varied between countries, and economic burden was a major barrier in treating patients with SMA. Overall, this survey highlights the global inequality in managing patients with SMA. The spread of newborn screening is essential in ensuring improved access to care for patients with SMA. With the advancement of neurotherapeutics, more genetic diseases will soon be treatable, and addressing the global inequality in clinical care will require novel approaches to mitigate such inequality in the future.

95 Do Not Attempt Resuscitation: all or nothing?

Abstract Background Do Not Attempt Resuscitation (DNAR) orders may be implemented when patients do not wish to receive Cardio-Pulmonary Resuscitation (CPR) or when CPR is deemed non-beneficial. Complex ethical and medical considerations influence these decisions, emphasising the need for accurate documentation as per national policies. Our aim was to assess comprehensive documentation of DNAR decisions and healthcare providers’ opinions on managing patients with DNAR orders. Methods We conducted a point-prevalence chart review of adult inpatients with a DNAR order on March 2nd, 2023.We surveyed healthcare providers using a structured tool and analysed the data using Excel. Results We identified 22 (n = 22) charts for review. All charts had a DNAR form, but only 31.8% (7) had documented discussion details. 54.5% (12) lacked a discussion with the patient regarding the DNAR decision, and 58.3% (7) lacked documentation explaining the reasoning. 72.7% (16) lacked clear documentation on the reasoning for the DNAR status decision. Regarding healthcare providers’ opinions on patients with DNAR status, we received 46 completed questionnaires (n = 46). Most respondents believed simple bedside investigations and non-invasive interventions were appropriate for DNAR patients. However, there was a discrepancy in opinion regarding more invasive interventions, such as Naso-Gastric Tube placement (52%) or inotropic support (48%). 84.8% (39) of staff believe there is a distinction between palliative patients and those designated as DNAR. 80.4% (37) of nursing staff reported hesitancy in discussing DNAR status with doctors when patients deteriorate. 58.7% (27) of staff believed their approach to care changes when a patient is labelled DNAR. Conclusion Our audit demonstrates the need for improved DNAR status documentation. Current practices do not meet national guidelines, creating ambiguity and subsequent confusion during emergencies. This may be exacerbated by disparities in hospital staff opinion regarding DNAR patients, highlighting the importance of establishing local policies to improve staff education and patient care.

Exercise Prescription Principles among Physicians and Physical Therapists for Patients with Impaired Glucose Control: A Cross-Sectional Study.

Exercise confers a multitude of benefits with limited adverse side effects, making it a powerful "medication" for a plethora of diseases. In people living with uncontrolled glucose levels, exercise can be an effective "medication" to assist in the management of hyperglycemia. We sought to survey healthcare providers (physicians and physical therapists) to determine the current state of exercise recommendation for people with glucose control issues. Healthcare providers were surveyed from six academic medical centers in the Midwest to determine the recommended exercise parameters (type, frequency, duration, intensity, and timing) for patients with glucose control issues. Data from 209 practitioners who completed the survey were used for analysis. Chi-square tests were used to determine differences in exercise recommendations between physical therapists (PTs) and physicians (MD/DOs). PTs and MD/DOs recommended similar exercise parameters. Of all respondents, 78.9% recommended exercise to patients with glucose control issues. Respondents who considered themselves to be active exercisers were more likely to recommend exercise than those who were not exercisers. Only 6.1% of all respondents recommended post-meal exercise. Healthcare providers overwhelmingly recommended exercise for people with glucose control issues, but the "timing" is not congruent with best practice recommendations.

Using a theory-informed approach to guide the initial development of a post-tuberculosis care package in British Columbia, Canada

BackgroundThe importance of addressing the long-term needs of tuberculosis (TB) survivors is gaining increasing attention. One promising approach to improving post-TB care is implementing a post-TB care package. With a specific focus on the perspectives of healthcare providers in British Columbia, Canada, this study aimed to (1) determine a set of components to be included in a post-TB care package, (2) explore barriers and facilitators influencing their implementation, and (3) propose potential solutions to overcome identified challenges.MethodsEmploying a multi-method approach guided by the Theoretical Domains Framework, we first conducted virtual workshops with TB care providers and utilized a modified Delphi process to establish a preliminary list of care package components. Then, we surveyed healthcare providers using closed-ended, Likert-scale questions to identify implementation barriers and enablers. Lastly, we mapped the identified barriers and enablers to establish behaviour change techniques to identify possible solutions to overcome the challenges identified.ResultsEleven participants attended virtual workshops, and 23 of 51 (45.1%) healthcare providers completed questionnaires. Identified components of the post-TB care package included:1. Linking people with TB to a primary care provider if they do not have one.2. Referring people with pulmonary TB for an end-of-treatment chest x-ray and pulmonary function testing.3. Referring people with TB who smoke to a smoking cessation specialist.4. Sharing a one-page post-TB information sheet with the patient's primary care provider, including a summary of post-TB health concerns, complications, and recommendations to prioritize age-appropriate screening for cardiovascular disease, lung cancer, and depression.Survey results indicated that domain scores for ‘environment, context, and resources’ were the lowest, suggesting potential implementation barriers. Care navigation services to help individuals overcome health system barriers while transitioning from TB care, information leaflets, and checklists summarizing key post-TB health concerns for patients and healthcare providers to help facilitate discussions may help overcome the identified barriers.ConclusionHealthcare providers in British Columbia acknowledge that post-TB care is integral to comprehensive health care but are limited by time and resources. Care navigation services, a post-TB checklist, and patient information leaflets may help resolve some of these barriers.

Top Ten Research Priorities for Psoriasis, Atopic Dermatitis and Hidradenitis Suppurativa: The SkIN Canada Priority Setting Initiative.

The Skin Investigation Network of Canada (SkIN Canada) is a new national skin research network. To shape the research landscape and ensure its value to patient care, research priorities that are important to patients, caregivers, and health care providers must be identified. To identify the Top Ten research priorities for 9 key skin conditions. We first surveyed health care providers and researchers to select the top skin conditions for future research within the categories of inflammatory skin disease, skin cancers (other than melanoma), and wound healing. For those selected skin conditions, we conducted scoping reviews to identify previous priority setting exercises. We combined the results of those scoping reviews with a survey of patients, health care providers, and researchers to generate lists of knowledge gaps for each condition. We then surveyed patients and health care providers to create preliminary rankings to prioritize those knowledge gaps. Finally, we conducted workshops of patients and health care providers to create the final Top Ten lists of research priorities for each condition. Overall, 538 patients, health care providers, and researchers participated in at least one survey or workshop. Psoriasis, atopic dermatitis and hidradenitis suppurativa (inflammatory skin disease); chronic wounds, burns and scars (wound healing); and basal cell, squamous cell and Merkel cell carcinoma (skin cancer) were selected as priority skin conditions. Top Ten lists of knowledge gaps for inflammatory skin conditions encompassed a range of issues relevant to patient care, including questions on pathogenesis, prevention, non-pharmacologic and pharmacologic management. Research priorities derived from patients and health care providers should be used to guide multidisciplinary research networks, funders, and policymakers in Canada and internationally.

Perspectives of physicians and medical assistants on the implementation of NAAT-based point-of-care testing for SARS-CoV-2 in primary care in Germany

IntroductionGiven their high diagnostic accuracy and fast turnaround time, rapid SARS-CoV-2 tests based on nucleic acid amplification technologies (NAAT) have great potential to expand access to testing and decrease delays in diagnosis of COVID-19. ObjectivesThe aim of this study was to investigate feasibility, acceptance, organizational consequences and other implementation aspects of the use of a NAAT-based SARS-CoV-2 rapid test (ID NOW™ COVID-19, Abbott Diagnostics) for symptomatic primary care patients with a suspected SARS-CoV-2 infection. MethodsCross-sectional survey among primary care physicians and medical assistants from Thuringia (Germany) during the third wave of the COVID-19 pandemic in March and April 2021. The health care providers surveyed had previously used the NAAT-based SARS-CoV-2 rapid test as part of a pilot study. ResultsEleven physicians (ten general practitioners and one paediatrician) and 22 medical assistants from Thuringia (Germany) participated in the written survey. Four physicians were additionally interviewed. The majority of the surveyed health care providers rated user-friendliness, integration into practice routine, impact on communication with patients and technical reliability of the NAAT-based SARS-CoV-2 rapid test as (very) positive. Greater workload and the costs for measuring devices were identified as disadvantages compared to PCR laboratory tests. Four out of ten physicians rated the lower sample turnover as unfavourable. ConclusionOur survey shows that NAAT-based point-of-care SARS-CoV-2 testing gained widespread acceptance among physicians and medical assistants, positively influences workflows, can improve patient communication and could therefore be successfully implemented into routine primary care.

Survey of Health Care Provider Understanding of Gene Therapy Research for Inherited Metabolic Disorders

The treatment of inherited metabolic disorders (IMDs) has traditionally relied on dietary interventions that are difficult to maintain, expensive, and socially isolating. The development of gene therapy for IMDs aims to provide sufficient gene activity to address the underlying causes of these conditions. This study surveyed health care providers (HCPs) to characterize their familiarity with gene therapy technologies and to identify educational needs across roles in a multidisciplinary care team. The link to a Web-based, 26-question survey was distributed to HCPs in North America and Europe who were involved in IMD patient care. Results were analyzed using descriptive statistics. Of the 590 survey link recipients, 64 completed the survey. Of these, 35 (55%) respondents were physicians, 23 (36%) were dietitians, 3 (5%) were nurse practitioners, 2 (3%) were genetic counselors, and 1 (2%) was a nurse. Most survey respondents (88% [n=56 of 64]) reported the belief that gene therapy for IMDs would be available within 5 years of study conduct. Although nearly all physicians (97% [n=34 of 35]) expressed awareness of gene therapy, rates of reported familiarity were lower among dietitians (57% [n=13 of 23]); confidence in conversations with colleagues and patients/caregivers was also discordant. Nearly all HCPs wanted education on gene therapy advancements, and the most preferred informational sources were published literature and congress presentations. There is an urgent need for education on topics related to gene therapy modalities. Professional education on gene therapies is desired across all specialties and will be important for unified treatment practices in IMD care.

PhenoPad: Building AI enabled note-taking interfaces for patient encounters

Current clinical note-taking approaches cannot capture the entirety of information available from patient encounters and detract from patient-clinician interactions. By surveying healthcare providers’ current note-taking practices and attitudes toward new clinical technologies, we developed a patient-centered paradigm for clinical note-taking that makes use of hybrid tablet/keyboard devices and artificial intelligence (AI) technologies. PhenoPad is an intelligent clinical note-taking interface that captures free-form notes and standard phenotypic information via a variety of modalities, including speech and natural language processing techniques, handwriting recognition, and more. The output is unobtrusively presented on mobile devices to clinicians for real-time validation and can be automatically transformed into digital formats that would be compatible with integration into electronic health record systems. Semi-structured interviews and trials in clinical settings rendered positive feedback from both clinicians and patients, demonstrating that AI-enabled clinical note-taking under our design improves ease and breadth of information captured during clinical visits without compromising patient-clinician interactions. We open source a proof-of-concept implementation that can lay the foundation for broader clinical use cases.

Providers at a Midwestern Academic System Report a Positive Experience with Telehealth During the COVID-19 Pandemic.

Introduction: Since the onset of the COVID-19 pandemic, there has been rapid expansion in the use of telehealth. As a result, many providers who had no prior experience using telehealth are now using it to provide patient care. The goal of this study was to survey health care providers on a wide range of telehealth topics including their experiences examining and connecting with patients digitally, identifying which types of patients may be best suited to telehealth, and identifying technical and logistical areas for improvement when using telehealth. Methods: Physicians and advanced practice providers (n = 944) at a large midwestern academic system were invited to complete an anonymous online survey during a 2-week period in October 2020. Results: Surveys, completed and analyzed (n = 178), indicated 86.6% of respondents felt confident in their clinical assessment, and 86.1% felt they formed an adequate personal connection with the patient in the majority of telehealth visits. A majority (58.5%) of providers felt telehealth was not effective for new patients, but 83% of providers felt it was effective for providing care to established patients. Respondents identified several areas for technological improvement including issues with video (27.5%) and audio (16.8%) quality. In 24.4% of visits, these technology issues were severe enough providers needed to convert an audiovisual appointment to telephone. Conclusions: Provider experience with telehealth has largely been positive at our institution. Although telehealth may not be appropriate for new patients, providers did feel it was an effective means of providing care for established patients. To continue improving the quality of telehealth, a multiteam approach should be considered, including members of technology and clinical operations teams working closely with those providers experienced in telehealth.

Awareness of genetic counseling and genetic testing for hereditary gynecologic cancers among Korean healthcare providers: A survey.

We conducted a survey to evaluate the awareness of genetic counseling and testing for hereditary gynecologic cancers among Korean healthcare providers. We performed an on-the-spot survey using 29 questions on respondents' basic information, awareness of pre/post-test genetic counseling, genetic information management, and related social issues. We surveyed healthcare providers who attended the 2019 Hereditary Gynecologic Cancer Symposium organized by the Korean Society of Gynecologic Oncology. Of the 108 attendees, 85 (78.7%) participated in the survey. Among them, 45% (37/83) and 40% (33/83) did not have a separate clinic and had a dedicated team for genetic counseling in their institutions, respectively. Most respondents (60/76, 79%) recommended genetic testing for all women diagnosed with epithelial ovarian cancer. Many respondents simultaneously (20/85, 24%) or sequentially (45/85, 53%) tested for both pathogenic somatic and germline variants, whereas a few respondents (2/85, 2%) checked for only pathogenic somatic variants using tissue samples. Only 20% (17/85) of the respondents recommended genetic testing for all women with endometrial cancer; meanwhile, 68% (58/86) offered the test based on the results of the screening test or family history. Risk-reducing salpingo-oophorectomy was recommended to unaffected women with pathogenic BRCA1/2 variants by 69.4% of the respondents (59/85). Most respondents (73/85, 85.9%) needed a manual on bioethics law; a few required a clinical update of hereditary cancer (73/85, 85.9%). The awareness of genetic counseling and testing and the pattern of clinical practice for hereditary gynecologic cancers differ among institutions and regions in Korea. A discussion on these issues and the development of an integrated manual for healthcare providers are required.

Development and initial implementation of electronic clinical decision supports for recognition and management of hospital-acquired acute kidney injury

BackgroundAcute kidney injury (AKI) is common in hospitalized patients and is associated with poor patient outcomes and high costs of care. The implementation of clinical decision support tools within electronic medical record (EMR) could improve AKI care and outcomes. While clinical decision support tools have the potential to enhance recognition and management of AKI, there is limited description in the literature of how these tools were developed and whether they meet end-user expectations.MethodsWe developed and evaluated the content, acceptability, and usability of electronic clinical decision support tools for AKI care. Multi-component tools were developed within a hospital EMR (Sunrise Clinical Manager™, Allscripts Healthcare Solutions Inc.) currently deployed in Calgary, Alberta, and included: AKI stage alerts, AKI adverse medication warnings, AKI clinical summary dashboard, and an AKI order set. The clinical decision support was developed for use by multiple healthcare providers at the time and point of care on general medical and surgical units. Functional and usability testing for the alerts and clinical summary dashboard was conducted via in-person evaluation sessions, interviews, and surveys of care providers. Formal user acceptance testing with clinical end-users, including physicians and nursing staff, was conducted to evaluate the AKI order set.ResultsConsiderations for appropriate deployment of both non-disruptive and interruptive functions was important to gain acceptability by clinicians. Functional testing and usability surveys for the alerts and clinical summary dashboard indicated that the tools were operating as desired and 74% (17/23) of surveyed healthcare providers reported that these tools were easy to use and could be learned quickly. Over three-quarters of providers (18/23) reported that they would utilize the tools in their practice. Three-quarters of the participants (13/17) in user acceptance testing agreed that recommendations within the order set were useful. Overall, 88% (15/17) believed that the order set would improve the care and management of AKI patients.ConclusionsDevelopment and testing of EMR-based decision support tools for AKI with clinicians led to high acceptance by clinical end-users. Subsequent implementation within clinical environments will require end-user education and engagement in system-level initiatives to use the tools to improve care.

Attitudes Toward Influenza Vaccination Administration in the Emergency Department Among Health Care Providers: A Cross-Sectional Survey

IntroductionInfluenza is a burdensome and vaccine-preventable infectious disease. Lack of time was reported as a common barrier by Canadians who did not receive their influenza vaccine. Increasing convenient access to vaccination increases uptake, and a potential setting for vaccine administration is the emergency department, where long wait times are common. MethodsA cross-sectional survey to gauge health care provider support and perceived barriers and facilitators to delivering influenza vaccine was conducted at 1 emergency and trauma center in Halifax, Nova Scotia. Anonymous questionnaires were completed by a convenience sample of emergency nurses, physicians, and paramedics (n = 82). ResultsIn total, 86% (n = 68) of health care providers supported vaccination in the emergency department when sufficient staffing and resources were available. When asked to consider implementation of influenza vaccination in the emergency department based on current staffing and resources, only 59% (n = 48) supported making vaccination available. Most surveyed health care providers preferred screening for vaccination at triage (57%) and supported a nurse-initiated protocol for vaccine administration (74%). After Bonferroni correction, there was no significant association between preference for when to vaccinate and being a nurse or physician (χ2(2) = 6.208, P = 0.05). The highest risk patient groups with the lowest provider endorsement of vaccination were people involved in poultry culling (77%) and pregnant women (83%). DiscussionSurveyed health care providers were supportive of ED influenza vaccination. However, this study revealed additional barriers that need to be addressed to effectively launch such a program.

Shining a light on the pathogenicity of health care providers' mobile phones: Use of a novel ultraviolet-C wave disinfection device

Mobile phones are known to carry pathogenic bacteria and viruses on their surfaces, posing a risk to healthcare providers (HCPs) and hospital infection prevention efforts. We utilize an Ultraviolet-C (UV-C) device to provide an effective method for mobile phone disinfection and survey HCPs about infection risk. Environmental swabs were used to culture HCPs' personal mobile phone surfaces. Four cultures were obtained per phone: before and after the UV-C device's 30-second disinfecting cycle, at the beginning and end of a 12-hour shift. Surveys were administered to participants pre- and poststudy. Total bacterial colony forming units were reduced by 90.5% (P = .006) after one UV-C disinfection cycle, and by 99.9% (P = .004) after 2 cycles. Total pathogenic bacterial colony forming units were decreased by 98.2% (P = .038) after one and >99.99% (P = .037) after 2 disinfection cycles. All survey respondents were willing to use the UV-C device daily to weekly, finding it convenient and beneficial. This novel UV-C disinfecting device is effective in reducing pathogenic bacteria on mobile phones. HCPs would frequently use a phone disinfecting device to reduce infection risk. In light of the ongoing coronavirus (COVID-19) pandemic, a standardized approach to phone disinfection may be valuable in preventing healthcare-associated infections.

Abstract C117: West Virginia Lung Cancer Project

Abstract Introduction: WVU Cancer Institute’s Cancer Prevention and Control (CPC) and the Patient Advocate Foundation (PAF) is working to address lung cancer disparities in West Virginia (WV). Their goal is to decrease lung cancer mortality, the leading cause of cancer deaths in WV, and improve early diagnosis of lung cancer in the state. Brief Description: In 2016 there was no infrastructure for lung cancer screening in WV. The rural state’s significant geographic barriers, low socioeconomic status, lack of lung cancer screening facilities, and limited provider knowledge regarding screening guidelines created substantial challenges. The major aim of the WV Lung Cancer Project (WVLCP) is to increase lung cancer screening among low-income and limited resourced individuals across WV. The project has three primary components: provider outreach and engagement; patient awareness and education; and case management support. Summary of Data: The WVLCP initially developed a case management (CM) protocol with one of the major Medicaid Managed Care Organizations (MCO) in the state in order to reach those eligible for screening and navigate them to primary care providers for care. The result of protocol implementation was the identification of lack of provider knowledge. The team then surveyed health care providers to further assess their knowledge, attitudes, beliefs, and practices regarding lung cancer screening. The results indicated a need for education on the screening guidelines, including recommended test, frequency, eligibility, and insurance coverage. As a result, project staff provided academic detailing to health care providers and created a continuing education webinar. Beyond the need to enhance health care provider understanding, there was a need to educate the public about lung cancer screening and the location of services. To enhance patient awareness and education, the project established and promoted the WV Lung Cancer CareLine and participated in community education events. Between 2016 and 2019, American College of Radiology (ACR) screening facilities increased from five to 24 sites. The WVLCP was able to facilitate the addition of 12 sites to the ACR Registry by working one-on-one with various health care entities during this time. Two of the MCOs fully implemented the CM protocol. Thousands of patients were assessed, hundreds referred to a primary care provider, tens were screened, and two cases of lung cancer were found. As a result, both companies incorporated the protocol into their operations and have case managers contacting patients to reduce barriers to screening. Conclusion: By partnering with care providers, the public, and health insurance payors, the project has expanded the lung cancer screening infrastructure in WV. As the project concludes in 2019, the state’s comprehensive cancer coalition, Mountains of Hope, will work to promote lung cancer screening in WV and continue the efforts of PAF and the WVUCI. Note: This abstract was not presented at the conference. Citation Format: Stephenie K Kennedy-Rea, Shonta Chambers, Lauren Hixenbaugh. West Virginia Lung Cancer Project [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C117.

Symptom burden among Northern Alberta radiotherapy patients with advanced cancer: mapping needs and gaps.

Patients with advanced cancer often experience symptoms including pain, nausea, anorexia, fatigue, and depression. High symptom burden can be alleviated by multidisciplinary palliative care (PC) teams practicing symptom-directed management. Patients who are unable to access such services may be at higher risk of increased symptoms and poor outcomes. A sequential exploratory mixed methods study was performed to explore the burden of symptoms experienced by Northern Alberta patients with advanced cancer. The symptom burden among patients from rural and remote communities was characterized in a retrospective review capturing basic demographic and clinicopathologic information, in addition to patient-reported outcomes. Symptom prevalence was evaluated against the nature and range of supportive care services available. Service accessibility was assessed at community level by surveying health care providers (HCPs) and performing thematic analysis on their responses. From January 1 to December 31, 2017, 607 outpatients were seen in consultation in an integrated palliative radiotherapy clinic in Edmonton, Alberta. A total of 166 (27.3%) patients resided in Alberta communities designated as rural or remote. Patient-reported symptom prevalence and intensity of scores did not differ significantly between rural/remote and urban populations. Unmet practical needs were flagged significantly more often by patients from rural communities (p = 0.05). HCPs from rural community health centers in Northern Alberta were knowledgeable regarding PC services availability and referral processes within their communities. Although the symptom burden experienced by patients living with advanced cancer in rural and remote areas of Northern Alberta does not differ significantly from their urban counterparts, and community HCPs are knowledgeable regarding PC services, unmet needs within these communities remain. Continuing support for PC services in rural communities, as well as establishing care pathways for patients from rural populations traveling to urban centers to receive treatment, will help to minimize the unmet needs these patients experience.

Abstract 385: Family Presence During Resuscitation: A Needs Assessment

Introduction: Evidence is mounting that appropriate family presence during resuscitation (FPDR) can be beneficial to patients and their families including lower rates of post-traumatic stress disorder after the event. Despite this, FPDR has not been widely adapted and continues to have legitimate barriers. Therefore, the focus of this quality improvement project was to conduct an organizational needs assessment at Duke University to create a systematic FPDR guideline that can be consistently implemented across the hospital. Methods: A 17-question survey tool was created using Ottowa Decision Making Framework and distributed to all members of a Cardiothoracic Intensive Care Unit code team including physicians, advanced practice providers, nurses, respiratory therapists, chaplains, perfusionists, pharmacists and social workers. The questions addressed FPDR experience, decision making influencers, situational comfort, and demographics. Results: There was a total of 200 responses. 46.6% Registered Nurses, 7.3% were Advanced Practice Providers, 7.8% Attending Physician, 6.2% Resident Physicians, 19.2% Respiratory therapists, 2.5% Chaplains. Four themes emerged - comfort based on experience, support for early chaplain involvement, need of family facilitator role, and absolute resistance. Multiple concerns were raised by the surveyed healthcare providers including logistics, risk for legal retribution, distraction from resuscitation, family suffering, and ill preparedness regarding FPDR. 72% of the respondents endorsed utilizing a family facilitator role to support the practice of FPDR. There was wariness regarding using the term ‘protocol’ for the guideline document. Conclusions: There are varying levels of comfort and support regarding the practice of FPDR amongst the resuscitation team. Many healthcare professionals acknowledge a need for family facilitation with a dedicated staff member, while others respond with a resolute unwillingness to practice FPDR. There is a need for education and publication of guidelines to assist staff in gaining consistency and confidence in the practice of FPDR.

1152. Leveraging Human Factors Engineering to Optimize Low-level Disinfection of Bedside Medical Tools

BackgroundInadequate cleaning and disinfection of shared medical equipment can lead to healthcare-associated infections and outbreaks. Stethoscopes were identified as the most commonly used piece of shared equipment at our institution, but cleaning practices were inconsistent among providers. We aimed to assess provider attitudes and practices around stethoscope disinfection and to subsequently implement a test of change (TOC) supported by human factors observations to improve cleaning consistency and frequency.MethodsWe conducted an anonymous electronic survey via SurveyMonkey paired with human factors observations in a free-standing children’s hospital. We surveyed physicians, nurses, and advanced practice providers to identify barriers to regular stethoscope cleaning. Quantitative results, human factors observations, and workflow simulations on a single unit were used to design an intervention to standardize low-level disinfection. Small mesh baskets holding alcohol prep pads labeled with brightly colored signage were installed by the exit of each patient room on one trial unit. Following implementation, a postsurvey and direct observations on the unit were conducted.ResultsOf those surveyed healthcare providers who completed the pre-survey (n = 383), 92% believed stethoscopes pose an infection risk to patients. However, only 38% of respondents reported cleaning their stethoscope between patient encounters. The most cited barrier to cleaning was a lack of easily accessible cleaning product (49%). After the unit-based TOC, alcohol from baskets were utilized by 80% of the 25 surveyed providers; 74% reported increased frequency of cleaning due to accessibility. Additionally, the brightly colored signage was a visual cue to disinfect equipment. Increased satisfaction of families reinforced the behavior. Direct observations revealed an increased frequency of cleaning while qualitative interviews elicited increased awareness from staff.ConclusionLeveraging human factors engineering to inform the placement and design of easily accessible disinfection supplies correlated with increased frequency of stethoscope cleaning by healthcare providers. Future steps include implementation in all inpatient care areas.Disclosures All authors: No reported disclosures.

Perceptions of Nursing Facility Providers on the Utility of Deprescribing.

Potentially inappropriate medications carry significant burden and costs to nursing facility residents and health systems. The goal of this study was to survey nursing facility providers from across the United States to describe the current utilization of deprescribing, and perceptions and desired components of a deprescribing program, in nursing facilities to reduce potentially inappropriate medications. We surveyed health care providers who attended the 2017 AMDA-The Society for Post-Acute and Long-Term Care Medicine Annual Conference-in Phoenix, Arizona. Returned surveys were entered into an electronic database from paper copies. Survey responses were summarized using descriptive statistics. Of the 1,431 conference attendees, 637 surveys were returned for a 45% response rate. Most respondents were physicians (n = 563, 88%). Respondents indicated a strong agreement with the potential for deprescribing to reduce cost to residents and nursing administration time and burden, while disagreeing that deprescribing may be depersonalizing. Respondents indicated clear preference for deprescribing programs to target medications that are no longer indicated and are "high risk," and that such programs should include discussions with the resident. Respondents also agreed that deprescribing programs are successful if the resident, or the resident's family and/or caregivers, reports an improvement in quality of life. Among respondents there was a high degree of confidence in the potential impact of deprescribing initiatives, as well as a broad consensus of desired components. This information may increase consultant pharmacist engagement and drive future proactive deprescribing initiatives.