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Donnelly C, Or M, Toh J, Thevaraja M, Janssen A, Shaw T, Pathma-Nathan N, Harnett P, Chiew KL, Vinod S, Sundaresan P. Measurement that matters: A systematic review and modified Delphi of multidisciplinary colorectal cancer quality indicators. Asia Pac J Clin Oncol 2024; 20:259-274. [PMID: 36726222 DOI: 10.1111/ajco.13917] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 02/03/2023]
Abstract
AIM To develop a priority set of quality indicators (QIs) for use by colorectal cancer (CRC) multidisciplinary teams (MDTs). METHODS The review search strategy was executed in four databases from 2009-August 2019. Two reviewers screened abstracts/manuscripts. Candidate QIs and characteristics were extracted using a tailored abstraction tool and assessed for scientific soundness. To prioritize candidate indicators, a modified Delphi consensus process was conducted. Consensus was sought over two rounds; (1) multidisciplinary expert workshops to identify relevance to Australian CRC MDTs, and (2) an online survey to prioritize QIs by clinical importance. RESULTS A total of 93 unique QIs were extracted from 118 studies and categorized into domains of care within the CRC patient pathway. Approximately half the QIs involved more than one discipline (52.7%). One-third of QIs related to surgery of primary CRC (31.2%). QIs on supportive care (6%) and neoadjuvant therapy (6%) were limited. In the Delphi Round 1, workshop participants (n = 12) assessed 93 QIs and produced consensus on retaining 49 QIs including six new QIs. In Round 2, survey participants (n = 44) rated QIs and prioritized a final 26 QIs across all domains of care and disciplines with a concordance level > 80%. Participants represented all MDT disciplines, predominantly surgical (32%), radiation (23%) and medical (20%) oncology, and nursing (18%), across six Australian states, with an even spread of experience level. CONCLUSION This study identified a large number of existing CRC QIs and prioritized the most clinically relevant QIs for use by Australian MDTs to measure and monitor their performance.
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Affiliation(s)
- Candice Donnelly
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Michelle Or
- Radiation Oncology Network, Western Sydney Local Health District, Westmead, Australia
| | - James Toh
- Department of Surgery, Westmead Hospital, Westmead, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | | | - Anna Janssen
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | | | - Paul Harnett
- Westmead Clinical School, University of Sydney, Sydney, Australia
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, Australia
| | - Kim-Lin Chiew
- Ingham Institute for Applied Medical Research, Liverpool, Australia
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia
- South Western Clinical School, University of New South Wales, Randwick, Australia
- Princess Alexandra Hospital, Division of Cancer Services, Brisbane, Australia
| | - Shalini Vinod
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia
- South Western Clinical School, University of New South Wales, Randwick, Australia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, Westmead, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
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2
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Pooni A, Schmocker S, Brown C, MacLean A, Hochman D, Williams L, Baxter N, Simunovic M, Liberman S, Drolet S, Neumann K, Jhaveri K, Kirsch R, Kennedy ED. Quality indicator selection for the Canadian Partnership against Cancer rectal cancer project: A modified Delphi study. Colorectal Dis 2021; 23:1393-1403. [PMID: 33626193 DOI: 10.1111/codi.15599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
AIM It is well established that (i) magnetic resonance imaging, (ii) multidisciplinary cancer conference (MCCs), (iii) preoperative radiotherapy, (iv) total mesorectal excision surgery and (v) pathological assessment as described by Quirke are key processes necessary for high quality, rectal cancer care. The objective was to select a set of multidisciplinary quality indicators to measure the uptake of these clinical processes in clinical practice. METHOD A multidisciplinary panel was convened and a modified two-phase Delphi method was used to select a set of quality indicators. Phase 1 included a literature review with written feedback from the panel. Phase 2 included an in-person workshop with anonymous voting. The selection criteria for the indicators were strength of evidence, ease of capture and usability. Indicators for which ≥90% of the panel members voted 'to keep' were selected as the final set of indicators. RESULTS During phase 1, 68 potential indicators were generated from the literature and an additional four indicators were recommended by the panel. During phase 2, these 72 indicators were discussed; 48 indicators met the 90% inclusion threshold and included eight pathology, five radiology, 11 surgical, six radiation oncology and 18 MCC indicators. CONCLUSION A modified Delphi method was used to select 48 multidisciplinary quality indicators to specifically measure the uptake of key processes necessary for high quality care of patients with rectal cancer. These quality indicators will be used in future work to identify and address gaps in care in the uptake of these clinical processes.
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Affiliation(s)
- Amandeep Pooni
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Selina Schmocker
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Carl Brown
- Department of Colorectal Surgery, St Paul's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anthony MacLean
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Hochman
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Lara Williams
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nancy Baxter
- University of Toronto, Toronto, ON, Canada.,Department of Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Marko Simunovic
- Department of Surgery, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Sender Liberman
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Sébastien Drolet
- Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Katerina Neumann
- Department of Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Kartik Jhaveri
- University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, Mount Sinai Hospital and Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Richard Kirsch
- University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Erin D Kennedy
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
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3
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Mulder RL, van Kalsbeek RJ, Hudson MM, Skinner R, Kremer LCM. The Critical Role of Clinical Practice Guidelines and Indicators in High-Quality Survivorship After Childhood Cancer. Pediatr Clin North Am 2020; 67:1069-1081. [PMID: 33131535 DOI: 10.1016/j.pcl.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Childhood cancer survivors are at significant risk for late cancer treatment-related morbidity and mortality. Physicians involved in the care of childhood cancer survivors should be aware of these specific health problems and provide high-quality, long-term follow-up care to preserve and improve survivors' health. The steps required to achieve high-quality care include synthesizing evidence (systematic reviews are helpful in this regard), developing clinical policy from evidence into evidence-based clinical practice guidelines, disseminating and implementing clinical practice guidelines, and evaluating their impact on quality of care and survivor health outcomes with quality indicators. This article describes these cornerstones of evidence-based medicine.
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Affiliation(s)
- Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | | | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
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4
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Keikes L, Koopman M, Tanis PJ, Lemmens VE, Punt CJ, van Oijen MG. Evaluating the scientific basis of quality indicators in colorectal cancer care: A systematic review. Eur J Cancer 2017; 86:166-177. [DOI: 10.1016/j.ejca.2017.08.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/22/2017] [Accepted: 08/30/2017] [Indexed: 12/31/2022]
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5
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Tanvetyanon T, Lee JH, Fulp WJ, Schreiber F, Brown RH, Levine RM, Cartwright TH, Abesada-Terk G, Kim GP, Alemany C, Faig D, Sharp PV, Markham MJ, Malafa M, Jacobsen PB. Use of Adjuvant Cisplatin-Based Versus Carboplatin-Based Chemotherapy in Non-Small-Cell Lung Cancer: Findings From the Florida Initiative for Quality Cancer Care. J Oncol Pract 2015; 11:332-7. [PMID: 25991639 DOI: 10.1200/jop.2014.001750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE For patients with resected non-small-cell lung cancer, national guidelines recommend cisplatin-based doublet chemotherapy as the preferred treatment. However, many patients receive a carboplatin-based regimen instead. We aimed to identify factors associated with use of a cisplatin-based regimen and explore its association with other quality-of-care measures. METHODS This analysis was part of the Florida Initiative for Quality Cancer Care, an audit and feedback project among 11 medical oncology practices. Feedback-sharing sessions based on findings of year 2006 took place in 2008. Eligible patients were random samples of those with resected stage I to III non-small-cell lung cancer treated in 2006 and 2009. RESULTS In both years combined, 81 patients received adjuvant platinum-based doublets: 33 patients (41%) received cisplatin, and 48 patients (59%) received carboplatin. Use of a cisplatin-based doublet significantly increased in 2009 compared with 2006, from 24% to 56% (P = .006). Multivariable analysis determined that academic practices used cisplatin more frequently than nonacademic practices (odds ratios, 3.26; 95% CI, 1.19 to 8.91; P = .02). Moreover, patients treated in 2009 were more likely to receive cisplatin than those treated in 2006 (odds ratio, 4.89; 95% CI, 1.75 to 13.67; P = .002). No significant association between use of cisplatin and other quality-of-care measures was found. CONCLUSION In this study, academic practice status and treatment year predicted use of adjuvant cisplatin-based chemotherapy. The increase in use of cisplatin in 2009, as compared with 2006, suggests that audit and feedback may be effective ways to promote such use.
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Affiliation(s)
- Tawee Tanvetyanon
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
| | - Ji-Hyun Lee
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
| | - William J Fulp
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
| | - Fred Schreiber
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
| | - Richard H Brown
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
| | - Richard M Levine
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
| | - Thomas H Cartwright
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
| | - Guillermo Abesada-Terk
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
| | - George P Kim
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
| | - Carlos Alemany
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
| | - Douglas Faig
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
| | - Philip V Sharp
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
| | - Merry-Jennifer Markham
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
| | - Mokenge Malafa
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
| | - Paul B Jacobsen
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida College of Medicine, Gainesville, FL; and University of New Mexico, Albuquerque, NM
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6
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Quinn GP, Block RG, Clayman ML, Kelvin J, Arvey SR, Lee JH, Reinecke J, Sehovic I, Jacobsen PB, Reed D, Gonzalez L, Vadaparampil ST, Laronga C, Lee MC, Pow-Sang J, Eggly S, Franklin A, Shah B, Fulp WJ, Hayes-Lattin B. If you did not document it, it did not happen: rates of documentation of discussion of infertility risk in adolescent and young adult oncology patients' medical records. J Oncol Pract 2014; 11:137-44. [PMID: 25549654 DOI: 10.1200/jop.2014.000786] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The adolescent and young adult (AYA) population is underserved because of unique late-effect issues, particularly future fertility. This study sought to establish rates of documentation of discussion of risk of infertility, fertility preservation (FP) options, and referrals to fertility specialists in AYA patients' medical records at four cancer centers. METHODS All centers reviewed randomized records within the top four AYA disease sites (breast, leukemia/lymphoma, sarcoma, and testicular). Eligible records included those of patients: diagnosed in 2011, with no prior receipt of gonadotoxic therapy; age 18 to 45 years; with no multiple primary cancers; and for whom record was not second opinion. Quality Oncology Practice Initiative methods were used to evaluate documentation of discussion of risk of infertility, discussion of FP options, and referral to a fertility specialist. RESULTS Of 231 records, 26% documented infertility risk discussion, 24% documented FP option discussion, and 13% documented referral to a fertility specialist. Records were less likely to contain evidence of infertility risk and FP option discussions for female patients (P = .030 and .004, respectively) and those with breast cancer (P = .021 and < .001, respectively). Records for Hispanic/Latino patients were less likely to contain evidence of infertility risk discussion (P = .037). Records were less likely to document infertility risk discussion, FP option discussion, and fertility specialist referral for patients age ≥ 40 years (P < .001, < .001, and .002, respectively) and those who already had children (all P < .001). CONCLUSION The overall rate of documentation of discussion of FP is low, and results show disparities among specific groups. Although greater numbers of discussions may be occurring, there is a need to create interventions to improve documentation.
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Affiliation(s)
- Gwendolyn P Quinn
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Rebecca G Block
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Marla L Clayman
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Joanne Kelvin
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Sarah R Arvey
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Ji-Hyun Lee
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Joyce Reinecke
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Ivana Sehovic
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Paul B Jacobsen
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Damon Reed
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Luis Gonzalez
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Susan T Vadaparampil
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Christine Laronga
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - M Catherine Lee
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Julio Pow-Sang
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Susan Eggly
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Anna Franklin
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Bijal Shah
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - William J Fulp
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Brandon Hayes-Lattin
- Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
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7
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Jacobsen PB, Lee JH, Fulp W, Siegel EM, Shibata D, Laronga C, Gray J, Tanvetyanon T, Schreiber F, Brown R, Levine R, Cartwright T, Abesada-Terk G, Kim G, Alemany C, Faig D, Sharp P, Markham MJ, Malafa M. Florida Initiative for Quality Cancer Care: Changes in Psychosocial Quality of Care Indicators Over a 3-Year Interval. J Oncol Pract 2014; 11:e103-9. [PMID: 25352389 DOI: 10.1200/jop.2014.001525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Identifying and addressing psychosocial concerns is increasingly recognized as an important aspect of cancer care that needs to be improved. As part of the Florida Initiative for Quality Cancer Care, medical record reviews were conducted to evaluate cancer care, including psychosocial care, at oncology practices in Florida in 2006. Results were subsequently disseminated to the practices, and performance was reassessed at the same practices in 2009. METHODS Data were available for patients with colorectal, breast, and non-small-cell lung cancer first seen by a medical oncologist in 2006 (n = 1,609) and 2009 (n = 1,720) at the same 10 practice sites. Performance on each psychosocial indicator was evaluated for overall change over time and for variability in change based on practice site and cancer type. RESULTS The percentage of patients identified as having a problem in emotional well-being increased significantly over time, from 24% to 31% among those assessed (P = .002) and from 13% to 16% overall (P = .026). In contrast, there no significant changes over time in assessment of emotional well-being (53% to 51%, P = .661) or in action taken to address problems (57% to 45%, P = .098). CONCLUSION Findings suggest more intensive efforts than audit and feedback will be required to improve the quality of psychosocial care and that greater recognition of problems with emotional well-being may tax the ability of practices to link patients with appropriate services. Systematic research is needed to identify and disseminate effective strategies for implementing routine assessment of well-being and addressing the increased demands for care this will generate.
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Affiliation(s)
- Paul B Jacobsen
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Ji-Hyun Lee
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - William Fulp
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Erin M Siegel
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - David Shibata
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Christine Laronga
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Jhanelle Gray
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Tawee Tanvetyanon
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Fred Schreiber
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Richard Brown
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Richard Levine
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Thomas Cartwright
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Guillermo Abesada-Terk
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - George Kim
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Carlos Alemany
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Douglas Faig
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Philip Sharp
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Merry-Jennifer Markham
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
| | - Mokenge Malafa
- Moffitt Cancer Center, Tampa; Center for Cancer Care & Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Florida Cancer Affiliates, Ocala; Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Hospital Cancer Institute, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida/Shands Cancer Center, Gainesville, FL
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8
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Laronga C, Gray JE, Siegel EM, Lee JH, Fulp WJ, Fletcher M, Schreiber F, Brown R, Levine R, Cartwright T, Abesada-Terk G, Kim G, Alemany C, Faig D, Sharp P, Markham MJ, Shibata D, Malafa M, Jacobsen PB. Florida Initiative for Quality Cancer Care: improvements in breast cancer quality indicators during a 3-year interval. J Am Coll Surg 2014; 219:638-45.e1. [PMID: 25086813 DOI: 10.1016/j.jamcollsurg.2014.03.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/17/2014] [Accepted: 03/31/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Florida Initiative for Quality Cancer Care (FIQCC), composed of 11 practice sites across Florida, conducted its initial evaluation of adherence to breast cancer quality of care indicators (QCI) in 2006, with feedback provided to encourage quality improvement efforts at participating sites. In this study, our objective was to reassess changes over time resulting from these efforts. STUDY DESIGN Quality care indicators were derived from the Quality Oncology Practice Initiative, the National Comprehensive Cancer Network, the American College of Surgeons, and expert panel consensus. Medical records were reviewed for breast cancer patients first seen by medical oncologists in 2009 at the FIQCC sites, using the same performance indicators as in 2006. Statistical comparisons of 2006 vs 2009 data across sites were made by Pearson chi-square exact test using Monte Carlo estimation. RESULTS Charts of 602 patients in 2006 and 636 patients in 2009 were compared. Performance on medical oncology QCI improved over time for documentation of clinical trial participation discussion (p = 0.001), documentation of consent for chemotherapy (p = 0.047), definitive surgery done after neoadjuvant chemotherapy (p = 0.017), and planned dose of chemotherapy consistent with published regimens (p = 0.02). Improvements in surgical QCI were seen for documentation of specimen orientation (p < 0.001), inking of margins (p < 0.0001), and performance of sentinel lymph node biopsy (p = 0.035). CONCLUSIONS The 2006 FIQCC study identified several medical and surgical oncology QCI improvement needs. Quality improvement efforts resulted in better performance for numerous metrics, therefore speaking to the benefits of reassessment of adherence to performance indicators to guide QCI efforts.
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Affiliation(s)
| | | | | | | | | | | | - Fred Schreiber
- Center for Cancer Care & Research/Watson Clinic, Lakeland, FL
| | - Richard Brown
- Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota, FL
| | | | | | | | | | - Carlos Alemany
- Florida Institute of Research, Medicine & Surgery, Orlando, FL
| | - Douglas Faig
- North Broward Medical Center, Deerfield Beach, FL
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9
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Saturno P, Martinez-Nicolas I, Robles-Garcia I, López-Soriano F, Angel-García D. Development and pilot test of a new set of good practice indicators for chronic cancer pain management. Eur J Pain 2014; 19:28-38. [DOI: 10.1002/ejp.516] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 11/11/2022]
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10
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Siegel EM, Jacobsen PB, Lee JH, Malafa M, Fulp W, Fletcher M, Smith JCR, Brown R, Levine R, Cartwright T, Abesada-Terk G, Kim G, Alemany C, Faig D, Sharp P, Markham MJ, Shibata D. Florida Initiative for Quality Cancer Care: improvements on colorectal cancer quality of care indicators during a 3-year interval. J Am Coll Surg 2013; 218:16-25.e1-4. [PMID: 24275073 DOI: 10.1016/j.jamcollsurg.2013.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/26/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The quality of cancer care has become a national priority; however, there are few ongoing efforts to assist medical oncology practices in identifying areas for improvement. The Florida Initiative for Quality Cancer Care is a consortium of 11 medical oncology practices that evaluates the quality of cancer care across Florida. Within this practice-based system of self-assessment, we determined adherence to colorectal cancer quality of care indicators (QCIs) in 2006, disseminated results to each practice and reassessed adherence in 2009. The current report focuses on evaluating the direction and magnitude of change in adherence to QCIs for colorectal cancer patients between the 2 assessments. STUDY DESIGN Medical records were reviewed for all colorectal cancer patients seen by a medical oncologist in 2006 (n = 489) and 2009 (n = 511) at 10 participating practices. Thirty-five indicators were evaluated individually and changes in QCI adherence over time and by site were examined. RESULTS Significant improvements were noted from 2006 to 2009, with large gains in surgical/pathological QCIs (eg, documenting rectal radial margin status, lymphovascular invasion, and the review of ≥ 12 lymph nodes) and medical oncology QCIs (documenting planned treatment regimen and providing recommended neoadjuvant regimens). Documentation of perineural invasion and radial margins significantly improved; however, adherence remained low (47% and 71%, respectively). There was significant variability in adherence for some QCIs across institutions at follow-up. CONCLUSIONS The Florida Initiative for Quality Cancer Care practices conducted self-directed quality-improvement efforts during a 3-year interval and overall adherence to QCIs improved. However, adherence remained low for several indicators, suggesting that organized improvement efforts might be needed for QCIs that remained consistently low over time. Findings demonstrate how efforts such as the Florida Initiative for Quality Cancer Care are useful for evaluating and improving the quality of cancer care at a regional level.
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Affiliation(s)
- Erin M Siegel
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL.
| | - Paul B Jacobsen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Ji-Hyun Lee
- Department of Biostatistics, Moffitt Cancer Center, Tampa, FL
| | - Mokenge Malafa
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
| | - William Fulp
- Department of Biostatistics, Moffitt Cancer Center, Tampa, FL
| | - Michelle Fletcher
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | | | - Richard Brown
- Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota, FL
| | | | | | | | | | - Carlos Alemany
- Florida Institute of Research, Medicine, and Surgery, Orlando, FL
| | - Douglas Faig
- North Broward Medical Center, Deerfield Beach, FL
| | - Philip Sharp
- Tallahassee Memorial Healthcare, Tallahassee, FL
| | | | - David Shibata
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
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11
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Impact of a prostate multidisciplinary clinic program on patient treatment decisions and on adherence to NCCN guidelines: the William Beaumont Hospital experience. Am J Clin Oncol 2013; 36:121-5. [PMID: 22307214 DOI: 10.1097/coc.0b013e318243708f] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES In order to demonstrate the impact of multidisciplinary care in the community oncology setting, we evaluated treatment decisions after the initiation of a dedicated prostate and genitourinary (GU) multidisciplinary clinic (MDC). METHODS In March 2010, a GU MDC was created at William Beaumont Hospital with the goal of providing patients with a comprehensive multidisciplinary evaluation and consensus treatment recommendations in a single visit. Urologists, radiation, and medical oncologists along with ancillary support staff participated in this comprehensive initial evaluation. The impact of this experience on patient treatment decisions was analyzed. RESULTS During the first year, a total of 182 patients were seen. Compared with previous years, low-risk MDC patients more frequently chose external beam radiation therapy (41.1% vs. 26.6%, P=0.02), and active surveillance (14.3% vs. 6.1%, P=0.02) and less frequently prostatectomy (30.4% vs. 44.0%, P=0.03). Similar increases in external beam were seen in intermediate and high-risk patients. Increased use of hormonal therapy was found in high-risk patients compared with the years before the initiation of the MDC (76.2% vs. 51.1%, P=0.03). Increased adherence to National Comprehensive Cancer Network (NCCN) guidelines was seen with intermediate-risk patients (89.8% vs. 75.9%, P=0.01), whereas nonsignificant increases were seen in low-risk (100% vs. 98.9%, P=0.43) and high-risk patients (100% vs. 94.2%, P=0.26). CONCLUSIONS The establishment of a GU MDC improved the quality of care for cancer patients as demonstrated by improved adherence to National Comprehensive Cancer Network guidelines, and a broadening of treatment choices made available.
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12
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Bianchi V, Spitale A, Ortelli L, Mazzucchelli L, Bordoni A. Quality indicators of clinical cancer care (QC3) in colorectal cancer. BMJ Open 2013; 3:bmjopen-2013-002818. [PMID: 23869102 PMCID: PMC3717445 DOI: 10.1136/bmjopen-2013-002818] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Assessing the quality of cancer care (QoCC) has become increasingly important to providers, regulators and purchasers of care worldwide. The aim of this study was to develop evidence-based quality indicators (QIs) for colorectal cancer (CRC) to be applied in a population-based setting. DESIGN A comprehensive evidence-based literature search was performed to identify the initial list of QIs, which were then selected and developed using a two-step-modified Delphi process involving two multidisciplinary expert panels with expertise in CRC care, quality of care and epidemiology. SETTING The QIs of the clinical cancer care (QC3) population-based project, which involves all the public and private hospitals and clinics present on the territory of Canton Ticino (South Switzerland). PARTICIPANTS Ticino Cancer Registry, The Colorectal Cancer Working Group (CRC-WG) and the external academic Advisory Board (AB). MAIN OUTCOME MEASURES Set of QIs which encompass the whole diagnostic-treatment process of CRC. RESULTS Of the 149 QIs that emerged from 181 sources of literature, 104 were selected during the in-person meeting of CRC-WG. During the Delphi process, CRC-WG shortened the list to 89 QI. AB finally validated 27 QIs according to the phase of care: diagnosis (N=6), pathology (N=3), treatment (N=16) and outcome (N=2). CONCLUSIONS Using the validated Delphi methodology, including a literature review of the evidence and integration of expert opinions from local clinicians and international experts, we were able to develop a list of QIs to assess QoCC for CRC. This will hopefully guarantee feasibility of data retrieval, as well as acceptance and translation of QIs into the daily clinical practice to improve QoCC. Moreover, evidence-based selected QIs allow one to assess immediate changes and improvements in the diagnostic-therapeutic process that could be translated into a short-term benefit for patients with a possible gain both in overall and disease-free survival.
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Affiliation(s)
- Valentina Bianchi
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
| | - Alessandra Spitale
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
| | - Laura Ortelli
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
| | - Luca Mazzucchelli
- Cantonal Institute of Pathology, Clinical Pathology, Locarno, Switzerland
| | - Andrea Bordoni
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
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13
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Marshall JL, Cartwright TH, Berry CA, Stowell SA, Miller SC. Implementation of a performance improvement initiative in colorectal cancer care. J Oncol Pract 2012; 8:309-14. [PMID: 23277769 PMCID: PMC3439232 DOI: 10.1200/jop.2011.000461] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In the United States, colorectal cancer (CRC) is the third leading cause of cancer after breast and prostate cancer. Numerous improvement programs have been implemented to increase CRC screening rates, but few have focused on improving the care and management of patients with a diagnosis of this malignancy. As national medical organizations focus on quality of care, efforts are necessary to provide clinicians the opportunity for self-assessment and methods for practice improvement. With this goal in mind, a national continuing medical education-certified performance improvement initiative was conceived. METHODS THE INITIATIVE CONSISTED OF THREE STAGES: First, participants self-assessed their performance of predetermined topic measures through a review of patient charts. The topic areas included patient safety and supportive care, evidence-based surveillance, and evidenced-based treatment and were derived from current guidelines and other successful quality-improvement initiatives. Second, an actionable plan for practice improvement was developed in at least one of the three topic areas. Third, after a period of self-improvement, participants reassessed their performance of the same topic measures to determine tangible changes in patient care. RESULTS A total of 540 patient charts were reviewed by 27 clinicians. Notable results showed large gains in areas of supportive care, such as quantitative pain assessments and emotional well-being evaluations, which traditionally have been a minor focus of other quality-improvement initiatives. Participants also showed tangible improvements in the performance of leading measures of quality care. CONCLUSION These findings support the need for continued efforts toward performance improvement in both established and emerging areas of CRC patient care.
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Affiliation(s)
- John L. Marshall
- Georgetown University Hospital, Washington, DC; Ocala Oncology Center, Ocala, FL; New York University, New York, NY; and Med-IQ, Baltimore, MD
| | - Thomas H. Cartwright
- Georgetown University Hospital, Washington, DC; Ocala Oncology Center, Ocala, FL; New York University, New York, NY; and Med-IQ, Baltimore, MD
| | - Carolyn A. Berry
- Georgetown University Hospital, Washington, DC; Ocala Oncology Center, Ocala, FL; New York University, New York, NY; and Med-IQ, Baltimore, MD
| | - Stephanie A. Stowell
- Georgetown University Hospital, Washington, DC; Ocala Oncology Center, Ocala, FL; New York University, New York, NY; and Med-IQ, Baltimore, MD
| | - Sara C. Miller
- Georgetown University Hospital, Washington, DC; Ocala Oncology Center, Ocala, FL; New York University, New York, NY; and Med-IQ, Baltimore, MD
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14
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Siegel EM, Jacobsen PB, Malafa M, Fulp W, Fletcher M, Lee JH, Smith JCR, Brown R, Levine R, Cartwright T, Abesada-Terk G, Kim G, Alemany C, Faig D, Sharp P, Markham MJ, Shibata D. Evaluating the quality of colorectal cancer care in the state of Florida: results from the Florida Initiative for Quality Cancer Care. J Oncol Pract 2012. [PMID: 23180990 DOI: 10.1200/jop.2011.000477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The Florida Initiative for Quality Cancer Care (FIQCC) was established to evaluate the quality of cancer care at the regional level across the state of Florida. This study assessed adherence to validated quality indicators in colorectal cancer (CRC) and the variability in adherence by practice site, volume, and patient age. METHODS The FIQCC is a consortium of 11 medical oncology practices in Florida. Medical record reviews were conducted for 507 patients diagnosed with CRC and seen as new medical oncology patients in 2006. Thirty-five indicators were evaluated individually and categorized across clinical domains and components of care. RESULTS The mean adherence for 19 of 35 individual indicators was > 85%. Pathology reports were compliant on reporting depth of tumor invasion (96%; range, 86% to 100%), grade (93%; range, 72% to 100%), and status of proximal and distal surgical resection margins (97%; range. 86% to 100%); however, documentation of lymphovascular and perineural invasion did not meet adherence standards (76%; range, 53% to 100% and 39%; range, 5% to 83%, respectively). Among patients with nonmetastatic rectal cancer, documentation of the status of surgical radial margins was consistently low across sites (42%; range, 0% to 100%; P = .19). Documentation of planned treatment regimens for adjuvant chemotherapy was noted in only 58% of eligible patients. CONCLUSION In this large regional initiative, we found high levels of adherence to more than half of the established quality indicators. Although the quality of care delivered within FIQCC practices seems to be high, several components of care were identified that warrant further scrutiny on both a systemic level and at individual centers.
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15
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Tanvetyanon T, Corman M, Lee JH, Fulp WJ, Schreiber F, Brown RH, Levine RM, Cartwright TH, Abesada-Terk G, Kim GP, Alemany C, Faig D, Sharp PV, Markham MJ, Bepler G, Siegel E, Shibata D, Malafa M, Jacobsen PB. Quality of care in non-small-cell lung cancer: findings from 11 oncology practices in Florida. J Oncol Pract 2011; 7:e25-31. [PMID: 22379428 PMCID: PMC3219472 DOI: 10.1200/jop.2011.000228] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Limited data on the quality of care in non-small-cell lung cancer (NSCLC) are available. This study aims to assess the quality of care in NSCLC among 11 medical oncology practices in Florida and to explore the impact of practice volume on care. METHODS Clinical guidelines and existing indicators were reviewed, and an expert survey was conducted to identify a set of process-based quality of care indicators (QI). Medical records of new patients with NSCLC seen in 2006 were retrospectively reviewed for the adherence to these QIs. RESULTS We reviewed the compliance with a set of 11 QIs (four general and seven NSCLC specific) among 531 patients. The patient median age was 68 years; 51% were male, and 49% had advanced NSCLC. The median adherence rates to general QIs and NSCLC-specific QIs were 95% (range 69% to 99%) and 69% (range 29% to 91%), respectively. We identified three main areas of deficiencies: chemotherapy consenting (69%), brain staging for stage III NSCLC (59%), and performance status assessment for advanced stages (42%). Significant variation in the adherence rates across practice sites was observed in five of 11 QIs. CONCLUSION On the basis of this data set of participating institutions in Florida, several areas in the care of patients with NSCLC were identified as targets for future quality improvement efforts.
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Affiliation(s)
- Tawee Tanvetyanon
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Michelle Corman
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Ji-Hyun Lee
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - William J. Fulp
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Fred Schreiber
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Richard H. Brown
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Richard M. Levine
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Thomas H. Cartwright
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Guillermo Abesada-Terk
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - George P. Kim
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Carlos Alemany
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Douglas Faig
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Philip V. Sharp
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Merry-Jennifer Markham
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Gerold Bepler
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Erin Siegel
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - David Shibata
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Mokenge Malafa
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
| | - Paul B. Jacobsen
- H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research, Lakeland; Florida Cancer Specialists, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Cancer Centers of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL; Karmanos Cancer Institute, Detroit, MI
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Gray JE, Laronga C, Siegel EM, Lee JH, Fulp WJ, Fletcher M, Schreiber F, Brown R, Levine R, Cartwright T, Abesada-Terk G, Kim G, Alemany C, Faig D, Sharp P, Markham MJ, Shibata D, Malafa M, Jacobsen PB. Degree of variability in performance on breast cancer quality indicators: findings from the Florida initiative for quality cancer care. J Oncol Pract 2011; 7:247-51. [PMID: 22043190 PMCID: PMC3140448 DOI: 10.1200/jop.2010.000174] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2011] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The Florida Initiative for Quality Cancer Care (FIQCC) comprises 11 Florida practice sites that participate in comprehensive reviews of quality of care specific to patients with cancer. Here, we examined site adherence to performance indicators to assess quality of care for patients with breast cancer (BC). METHODS Quality indicators were scripted on the basis of accepted guidelines from the Quality Oncology Practice Initiative, National Comprehensive Cancer Network, American College of Surgeons, and site-specific expert panel consensus. Comprehensive chart reviews, including both medical and surgical oncology quality measures, were conducted for patients with BC first seen in 2006 by a medical oncologist at one of the sites. Statistical comparisons were made by the Pearson χ(2) exact test, using Monte Carlo estimation. RESULTS Charts of 622 patients were reviewed. Of the 34 indicators, seven for medical oncology and four for surgical oncology fell below the 85% level of adherence. A statistically significant difference (P < .001) in variation of performance across the sites was found for the following medical and surgical oncology indicators: documentation of menopausal status, family history, informed consent, planned chemotherapy regimen and flow sheet, American Joint Committee on Cancer staging, HER2/neu status, reporting of margin orientation and inking of the margins, histological grade, having a sentinel lymph node biopsy for invasive BC, and obtaining a mammogram within 14 months of definitive surgery. CONCLUSION The FIQCC has identified how multiple aspects of BC care can be improved. Findings are being used at the participating institutions to guide quality improvement efforts.
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Affiliation(s)
- Jhanelle E. Gray
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Christine Laronga
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Erin M. Siegel
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Ji-Hyun Lee
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - William J. Fulp
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Michelle Fletcher
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Fred Schreiber
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Richard Brown
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Richard Levine
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Thomas Cartwright
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Guillermo Abesada-Terk
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - George Kim
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Carlos Alemany
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Douglas Faig
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Philip Sharp
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Merry-Jennifer Markham
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - David Shibata
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Mokenge Malafa
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
| | - Paul B. Jacobsen
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL
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17
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Coleman N, Hession N, Connolly A. Psycho-oncology best practice guidelines and a service perspective: conceptualising the fit and towards bridging the gap. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/03033910.2011.613980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Jacobsen PB, Shibata D, Siegel EM, Lee JH, Fulp WJ, Alemany C, Abesada-Terk G, Brown R, Cartwright T, Faig D, Kim G, Levine R, Markham MJ, Schreiber F, Sharp P, Malafa M. Evaluating the quality of psychosocial care in outpatient medical oncology settings using performance indicators. Psychooncology 2010; 20:1221-7. [PMID: 20878724 DOI: 10.1002/pon.1849] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 08/12/2010] [Accepted: 08/13/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVE An American Psychosocial Oncology Society workgroup has developed indicators of the quality of psychosocial care that can be measured through review of medical records. The present report describes the first large-scale use of these indicators to evaluate psychosocial care in outpatient medical oncology settings. METHODS Medical records of 1660 colorectal, breast and non-small cell cancer patients first seen by a medical oncologist in 2006 at 11 practice sites in Florida were reviewed for performance on indicators of the quality of psychosocial care. RESULTS Assessment of emotional well-being was significantly less likely to be documented than assessment of pain (52 vs 87%, p<0.001). A problem with emotional well-being was documented in 13% of records and evidence of action taken was documented in 58% of these records. Ten of eleven practice sites performed below an 85% threshold on each indicator of psychosocial care. Variability in assessment of emotional-well being was associated (p<0.02) with practice site and patient gender and age while variability in assessment of pain was associated (p<0.001) with practice site and cancer type. CONCLUSIONS Findings illustrate how use of the psychosocial care indicators permits identification of specific practice sites and processes of care that should be targeted for quality improvement efforts. Additionally, findings demonstrate the extent to which routine assessment of emotional well-being lags behind routine assessment of pain in cancer patients.
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Jacobsen PB, Shibata D, Siegel EM, Lee JH, Alemany CA, Brown R, Cartwright TH, Levine RM, Smith JCR, Abesada-Terk G, Malafa MP. Initial Evaluation of Quality Indicators for Psychosocial Care of Adults with Cancer. Cancer Control 2009; 16:328-34. [DOI: 10.1177/107327480901600407] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Paul B. Jacobsen
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - David Shibata
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Erin M. Siegel
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Ji-Hyun Lee
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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