Accepted Abstracts

*** Indicates accepted for podium presentation

Congratulations to our Podium Presenters!



Title:  Adaptation of Survivorship Care Plans in the Age of EMR's

First Author:  Anna Schaal, ARNP

                              DHMC - Norris Cotton Cancer Center

                              1 medical Center Drive

                              Lebanon, New Hampshire 03756

                              anna.d.schaal@hitchcock.org

 

Co-Authors: Elizabeth McGrath, DNP, D-H, Claire Pace, APRN, D-H, Jennifer Snide, D-H

Background: Cancer survivors and their Primary Norris Cotton Cancer Center (NCCC) has been providing such documents in select clinics, on only a small percentage of patients for the last 8 years, with little consistency among disease management groups (DMG). In 2014 a cancer survivorship subcommittee was formed to explore methods to expand the SCP program and develop continuity within the DMG. Care Providers (PCP’s) are faced with unique challenges following the completion of cancer therapy including complying with recommendations specific for cancer survivors and coordinating this care across multiple health care providers. It has been recommended by the Institute of Medicine and ASCO that patients be presented with a Survivorship Care Plan (SCP) at the completion of cancer care which outlines the specific therapies as well as a detailed plan of follow-up care.

Methods: Using the DMAIC process as a guide, the subcommittee has defined which patients will receiveSCP’s and have developed a comprehensive template following American Society of Hematology (ASCO) guidelines that is appropriate for all DMGs.

Results: A work flow has been developed utilizing an intradiciplinary team approach. Standardized template notes have been created across the disease management groups and are captured in the EMR. Work has also been done to improve our EPIC environment to best capture data provided in the SCP to further NCCC survivorship research initiatives. Future plans of the SCP office visit will also include comprehensive symptom assessment along with distress screening and referrals.

Conclusions: Challenges have been identified. These include SCP’s for patients on chronic oral chemotherapy, data links for outcomes based research and feasibility of providers ability to deliver SCP’s in consistently.


Title:  Screening processes and appropriate outcome measures for physical distress in outpatient rehabilitation referral in cancer survivorship: a case report

First Author:  Ashley Tomaswick, PT

University of New England

Portland, ME                              

Co-Authors: Ashley Tomaswick, SPT, University of New England, Sebastian Stoltzfus, SPT, University of New England, Margaret Masiak, SPT, University of New England, Erika Lopez, SPT, University of New England, Mary Leopold, SPT, University of New England, Alyssa Grigware, SPT, University of New England, Samantha Fisk, SPT, University of New England, Matthew Denning, SPT, University of New England

Background: In 2015, there were an estimated 14.2 million cancer survivors in the United States, and 8,810 new cancer diagnoses in the state of Maine. With five-year relative survival rate estimates at an all-time high (68%) and the number of survivors growing, the need to address issues facing cancer survivors has also grown in recognition. Several studies support the need for additional wellness and rehabilitation services for cancer survivors, but there is a discrepancy between the literature and current healthcare practice. The purpose of this student-led project, in collaboration with a local community cancer center, a rehabilitation center, and a wellness center in Central Maine, was to determine which physical distress screening tools and outcome measures are most appropriate to trigger wellness and/or rehabilitation referrals.

Methods: A literature review examined the available screening tools and outcome measures used to assess the many symptoms associated with cancer diagnosis and treatment, and key stakeholder meetings were conducted. Though differences in patient status and treatment environments may necessitate or inhibit the use of specific tools, some are more comprehensive than others.

Results: The Distress Thermometer was found to be the most comprehensive screening tool due to its inclusion of overall symptom burden and individual multi-system self-report. A score ≥4 should trigger an additional screening protocol for wellness and/or rehabilitation referral.

Conclusions: Tools are available to screen for the need for rehabilitation and wellness referrals, though implementation is dependent on environment and interprofessional medical team protocol utilization.


Title:  The Use of Volunteers in the Ambulatory Medical Oncology Setting***

First Author:  Emma Dann, RN, MS, OCN

                              Dana-Farber Cancer Institute/NHOH

                              Londonderry, New Hampshire 03053

Background: Since cancer has touched the lives of so many, some people would like to give back by volunteering at a cancer center.  There are many opportunities for a volunteer to assist in an ambulatory cancer center.  This can vary from being a patient ambassador to being an administrative resource support volunteer.  The Dana-Farber Cancer Institute/NHOH  created a volunteer program working in conjunction with the main campus of DFCI in Boston.  The program has been very well received by staff, patients and families, as well as the volunteers themselves.

Methods: The Nurse Director assessed the need and opportunity within DFCI/NHOH to have a defined volunteer program.  Once determining that there was a need, the Nurse Director partnered with the Volunteer Program Director in Boston to create a plan for how to initiate a volunteer program in Londonderry, NH.  Position descriptions, orientation requirements, and on-going performance requirements were all created.  The staff and patients/families were informed and asked for input.  Volunteer candidates applied, were interviewed and screened, and then selected for volunteer positions.

Results:  The volunteer program at DFCI/NHOH has been very well received.  There are currently more candidates to volunteer than we can accommodate.  The volunteers value their time while in the clinic, the staff find their contributions to be very helpful and the patients and families really enjoy visiting with the volunteers.

Conclusions: After careful planning and implementation, an ambulatory cancer center can benefit greatly through the use of volunteers to assist with supporting patients as well as administrative tasks.  The program does require oversight, but offers many enhancements to the care delivered to patients.


 

Title:  Oral Chemotherapy: Promoting Adherence

First Author:  Kathryn Hall, BSN, RN-BC, ONS-CCP

                              Lahey Oncology/Hematology at Parkland Medical Center

                              Derry, New Hampshire 03038

Co-Authors: Kathryn Hall, BSN, RN-BC, Barbara Umnasky, MSW, Colleen Summers, APRN

Background: In June 2015, ONS published guidelines and evidence-based recommendations to promote safe practices and improve adherence for oral chemotherapy.

Adherence to Oral Agents for Cancer (OACs) is an important topic in oncology care. OACs can have significant toxicities and pose safety risks without proper adherence. In efforts to meet this standard of care, our oncology clinic performed an Oral Oncology Program Quality PI.

Our goals were to create a formalized and consistent process, tracking all patients on oral cemotherapy. 

With a collaborative approach, we provide comprehensive patient education, ensure patient's ability to obtain medication with little to no cost and monitor adherence with timely follow-up.

Methods: The Oncology Nurse Navigator designated as point person to maintain/update oral chemo spreadsheet and spearhead multi-layer process

  • Created and initiated use of excel spreadsheet to track patients
  • Created Oral Chemo Tracking form (communication tool used for front of chart)
  • Created Patient Communication form to outline next steps in laymen terms
  • Performed formal chart audit to determine if patients on oral chemotherapy had signed consent and formal teaching documented.
  • Implemented follow-up nurse call within 7 days of therapy initiation to reinforce education and to assess toxicity and adherence.

Results:               

  • Improved tracking mechanism to monitor patients on oral chemotherapy
  • Collaborative team effort resulting in improved streamline communication and more efficient work flow
  • Increased patient satisfaction and safety when starting oral chemo with patient education and follow-up phone call

Conclusions: Through our PI project we were able to successfully implement an Oral Chemotherapy Program focusing on promoting adherence through education, excellent communication and scheduled follow-up.

A collaborative approach with the Social Worker, Nurse Navigator and Nurse Practitioner was instrumental to our success.


Title:  Informing and Engaging Patients:  Guide to building an introduction packet to clinic ***

First Author:  Nicholas Jaidar, Practice Supervisor

 The University of Vermont Medical Center, Burlington, VT 0540

Background: During the last year, multi-disciplinary members of the cancer center collaborated on the development of an introduction packet that would provide the baseline service and support systems available. Over the last few years we have struggled to capture critical and concise information that we can provide to patients and their families outlining this information.

Methods: Our approach was to solicit feedback from providers, clinical/non-clinical staff and external departments that may be impacted.  Furthermore, we decided to incorporate the thoughts and desires of the patient by conducting a patient focus group.

Results: During the activity, our marketing team put forth a draft of the document and interviewed various patients/caretakers concerning their emotional state, questions/concerns and resources/materials desired at each state of the disease process. The end result led to thoughtfully placing in patient tips and quotes within the document to drive personal engagement

We constructed a multifaceted approach to distributing the packet that included sending it in advance of the first appointment via email/mail to orient the patient, posting to our website to drive activity to the social media content and to provide to referring providers to ensure that patients have a warm introduction to clinic at the time of referral.

Conclusions: This document will now be used by patients as a reference and a repository to document their notes as they proceed through the care continuum.  More importantly we created a resource to inform and engage our patients.


Title:  The current dental and interprofessional management of geriatric patients undergoing head and neck cancer treatment in nursing home in the United States: Literature Review

First Author:  Rashidah Wiley, DDS

                              University of New England College of Dental Medicine

                              Portland, Maine 04102

Co-Authors: Vidushi Gupta, Riddhi Daftary, Jessfor, Baugh, Ahn Tran, Lynne Cataldo, Yang Kang DDS, PhD, Takashi Komabayahi DDS, MDS, PhD - University of New England College of Dental Medicine

Background: Head and Neck squamous cell carcinoma is the sixth most common cancer worldwide. Due to the  incidence and risk factors  associated, a dental approach  towards interprofessional  management, treatment planning,   and rehabilitation of diagnosed   individuals undergoing cancer   therapies is essential.

 Methods: In consideration of this respect,   the research literature review   focuses primarily towards:   (i.) pre-surgery oral hygiene  instructions, (ii.) pre-radiology/chemotherapy dental clearance, (iii.) during-radiology/chemotherapy dental complications and management,   (iv.) post-radiology/chemotherapy oral health care, and (v.) adjunctive health   care.

 Results:  The aforementioned sections specifically aim to affirm that the inclusion of a through evaluation process is  vital in understanding the overall  assessment and safe management for patients undergoing oncology treatment. Furthermore, this project  will assist in establishing  guidelines for nursing home health care teams in regards to oral health  care and interprofessional collaboration  on cancer patients.

 Conclusions: The implications defined will address how interprofessional health care providers can assist patients to achieve better quality of life in nursing homes.

Title:  Infusion Reactions:  Preparedness, Management and Safety***

First Author:  Lisa Chicko, RN, BA, OCN

                              Dana Farber/NH Oncology Hematology

                              Londonderry, New Hampshire 03053

Co-Authors: Emma Dann,  RN,MSN, OCN, Margaret Carney,  RPh, Vincent Byron, Senior Network Technician, Jeanna Walsh, MD

Background: Head and Neck squamous cell carcinoma is the sixth most common cancer worldwide. Due to the  incidence and risk factors  associated, a dental approach  towards interprofessional  management, treatment planning,   and rehabilitation of diagnosed   individuals undergoing cancer   therapies is essential.

 Methods: In consideration of this respect,   the research literature review   focuses primarily towards:   (i.) pre-surgery oral hygiene  instructions, (ii.) pre-radiology/chemotherapy dental clearance, (iii.) during-radiology/chemotherapy dental complications and management,   (iv.) post-radiology/chemotherapy oral health care, and (v.) adjunctive health   care.

 Results: The aforementioned sections specifically aim to affirm that the inclusion of a through evaluation process is  vital in understanding the overall  assessment and safe management for patients undergoing oncology treatment. Furthermore, this project  will assist in establishing  guidelines for nursing home health care teams in regards to oral health  care and interprofessional collaboration  on cancer patients.

Conclusions: The implications defined will address how interprofessional health care providers can assist patients to achieve better quality of life in nursing homes.



Title:  Patient-centered Oral Chemotherapy Education Program 

First Author:  Colleen Poirier, RN, OCN

Portsmouth Hematology and Oncology Associates

Goal:  To optimize compliance and insure best patient outcomes.

Background :  Need for dedicated oral oncology nurse with increased number of oral oncology agents.

Presentation method:  Poster

Methods/Process (DRAFT):

  1. MD appointment to discuss new treatment plan.
  2. Introduction to oncology nurse.
  3. Drug information, nurse’s contact information, assurances the medication will be affordable and the first delivery will be to our office.
  4. Appointment for a formal teaching session made.
  5. MD & Oncology Nurse discussion @ dose of medication, goals of treatment anticipated, and start date and then prescription obtained.
  6. Prescription to Specialty Pharmacy.
  7. Obtaining Prior Authorization from insurance company.
  8. Working to assure the cost is affordable and involving patient assistance programs if necessary.
  9. Frequent contact with patient to report progress and address concerns.
  10. Once the medication is approved and we are sure the patient has an affordable copay or an assistance program in place, the shipment to our office is arranged with specialty pharmacy and patient.
  11. Formal teaching session takes place with patient and family members to:     
    • A. Emphasize reporting side effects promptly so they can be addressed and patient can stay on therapy longer.
    • B.  Side effect profile, prevention & treatment and any prophylactic prescriptions given. 
    • C.  Written and verbal information on how to take medication, when to start, when the follow-up appointment with MD will be and when Oncology Nurse will call to check in and consent signed.
    • D.  Encourage and answer questions.

Results:  Improved compliance, communication and side effect management.

Conclusion:  Early and continued involvement with an oral oncology trained nurse promotes compliance and improves patient outcomes. 

 

 



Northern New England Clinical Oncology Society
P.O. Box 643
Sandown, NH 03873-0643
Telephone (603) 887-1948
info@nnecos.org

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