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Beavis AL, Wethington SL, Yu R, Topel KM, Bielman ML, Olson S, Rositch AF. Differential utilization of the online patient portal for completion of health-related social needs screening during routine gynecologic cancer care. Cancer 2024. [PMID: 38943672 DOI: 10.1002/cncr.35376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/27/2024] [Accepted: 04/12/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Telehealth technologies offer efficient ways to deliver health-related social needs (HRSN) screening in cancer care, but these methods may not reach all populations. The authors examined patient characteristics associated with using an online patient portal (OPP) to complete HRSN screening as part of gynecologic cancer care. METHODS From June 2021 to June 2023, patients in a gynecologic oncology clinic completed validated HRSN screening questions either (1) using the OPP (independently before the visit) or (2) in person (verbally administered by clinic staff). The authors examined the prevalence of HRSN according to activated OPP status and, in a restricted subgroup, used stepwise multivariate Poisson regression to identify associations between patient and visit characteristics and using the OPP. RESULTS Of 1616 patients, 87.4% (n = 1413) had an activated OPP. Patients with inactive OPPs (vs. activated OPPs) more frequently reported two or more needs (10% vs 5%; p < .01). Of 986 patients in the restricted cohort, 52% used the OPP to complete screening. The final multivariable model indicated that patients were less likely to use the OPP if they were Black (vs. White; adjusted relative risk [aRR], 0.70; 95% confidence interval [CI], 0.59-0.83); not employed (vs. employed; aRR, 0.81; 95% CI, 0.68-0.97), or had low measures of OPP engagement (aRR, 0.80; 95% CI, 0.68-0.92). New versus established patients were 21% more likely to use the OPP (aRR, 1.21; 95% CI, 1.06-1.38). CONCLUSIONS Differential use of the OPP suggested that over-reliance on digital technologies could limit the ability to reach those populations that have social factors already associated with cancer outcome disparities. Cancer centers should consider using multiple delivery methods for HRSN screening to maximize reach to all populations.
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Affiliation(s)
- Anna L Beavis
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephanie L Wethington
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruoxi Yu
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kristin M Topel
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marie L Bielman
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Olson
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Letica-Kriegel AS, Rosen R, McNeil N, Thompson E, James M, Broach V, Roche KL, Riportella M, Ng S, Bernal C, Vaynrub M, Downey R, Voigt L, Epstein AS, Nelson J, Goldfrank D, Nash GM. Development and perception of surgery-specific goals of care discussions in the preoperative setting: A learning pilot. J Surg Oncol 2024; 129:1384-1389. [PMID: 38549286 DOI: 10.1002/jso.27632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Goals of care discussions are infrequently documented in the preoperative period. Furthermore, documentation does not consistently address what matters most to patients, although patient values (PV) are central to person-centered care. METHODS A multidisciplinary working group was formed. An electronic note comprised of (1) topics of discussion, (2) PV, and (3) advance care planning (ACP), was created and embedded into existing note templates for Gynecologic Surgical Oncology. Surgeons and advanced practice providers (APPs) were educated to conduct and document these conversations in preoperative clinic for patients undergoing cancer surgery for a pilot period. Data were collected regarding usage of the template. Focus groups with surgeons, APPs, and patients were conducted. Qualitative analysis was performed on transcripts. RESULTS During the pilot, 7 surgeon/APP teams utilized the template on a total of 55 notes. Average number of notes completed per surgeon was 7.8 (SD 8.5). Forty-six notes (84%) included topics of discussion, 15 (27%) included PV, 4 (7%) included ACP. Qualitative analysis of focus group transcripts revealed that clinicians and patients perceived the initiative to be useful and important, although implementation barriers were identified. CONCLUSION Creating a surgery-specific GOC template is feasible. Iterative revisions are needed to increase utility in clinic workflows.
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Affiliation(s)
| | - Roni Rosen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nita McNeil
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Errika Thompson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Monique James
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vance Broach
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kara Long Roche
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michaela Riportella
- Clinical Informatics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Susan Ng
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Camila Bernal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Max Vaynrub
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert Downey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Louis Voigt
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew S Epstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Judith Nelson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Deborah Goldfrank
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Garrett M Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Rosa WE, Gilliland J, McDarby M, Nelson JE, Desai AV, Epstein AS. Patient and Clinician Stakeholder Perspectives on a Patient Portal Questionnaire Eliciting Illness and Treatment Understanding and Core Health-Related Values. Palliat Med Rep 2023; 4:316-325. [PMID: 38089435 PMCID: PMC10712361 DOI: 10.1089/pmr.2023.0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 12/29/2023] Open
Abstract
Introduction Person-centered communication is foundational to cancer care. In pilot research, a questionnaire eliciting patients' illness and treatment understanding (ITU) and core health-related values (HRV) through the electronic patient portal demonstrated feasibility, acceptability, and efficacy. The aim of this study was to elicit stakeholder feedback to refine the design of the portal-based intervention, remain end-user centered, and optimize future system-wide integration. Methods Between April and June 2023, we purposively sampled patients and clinicians from a previous pilot study to participate in a 20-30-minute semistructured interview about their opinions of and experiences with the portal questionnaire on ITU and HRV. An interdisciplinary coding team used a two-phase rapid analysis to identify themes, subthemes, and illustrative participant quotations. Results Fourteen patients (mean age = 68 years) and 12 clinicians participated (total n = 26). Colorectal cancer was the commonest malignancy (64%) among patients. Clinicians were mostly physicians (50%), nurse practitioners (33%), and registered nurses (17%), with two-thirds having >15 years of experience in their specialty. Analysis generated four themes: (1) clinical utility of questionnaire, (2) barriers to questionnaire implementation, (3) considerations and strategies for modifying the questionnaire, and (4) considerations and strategies for questionnaire implementation. Themes captured key information about incorporating this questionnaire into clinical practice. Conclusion Patients with cancer and their clinicians found a portal-based ITU and HRV questionnaire clinically useful to improve multiple aspects of person-centered communication. Participant recommendations about questionnaire timing and sharing of questionnaire responses with the clinical team will inform future questionnaire implementation and scaling in clinical settings.
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Affiliation(s)
- William E. Rosa
- Department of Psychiatry, Behavioral Sciences and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jaime Gilliland
- Department of Psychiatry, Behavioral Sciences and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Meghan McDarby
- Department of Psychiatry, Behavioral Sciences and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Judith E. Nelson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Anjali V. Desai
- Oncology Palliative Care Services, Atlantic Health System, Morristown, New Jersey, USA
| | - Andrew S. Epstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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