scholarly journals The Emergence of a Sustainable Tobacco Treatment Program across the Cancer Care Continuum: A Systems Approach for Implementation at the University of California Davis Comprehensive Cancer Center

2020 ◽  
Vol 17 (9) ◽  
pp. 3241 ◽  
Author(s):  
Elisa K. Tong ◽  
Terri Wolf ◽  
David T. Cooke ◽  
Nathan Fairman ◽  
Moon S. Chen
Keyword(s):  
Treatment Program ◽  
Cancer Care ◽  
University Of California ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Cancer Centers ◽  
Care Continuum ◽  
Tobacco Treatment ◽  
Cancer Care Continuum ◽  
The University

Tobacco treatment is increasingly recognized as important to cancer care, but few cancer centers have implemented sustainable tobacco treatment programs. The University of California Davis Comprehensive Cancer Center (UCD CCC) was funded to integrate tobacco treatment into cancer care. Lessons learned from the UCD CCC are illustrated across a systems framework with the Cancer Care Continuum and by applying constructs from the Consolidated Framework for Implementation Research. Findings demonstrate different motivational drivers for the cancer center and the broader health system. Implementation readiness across the domains of the Cancer Care Continuum with clinical entities was more mature in the Prevention domain, but Screening, Diagnosis, Treatment, and Survivorship domains demonstrated less implementation readiness despite leadership engagement. Over a two-year implementation process, the UCD CCC focused on enhancing information and knowledge sharing within the treatment domain with the support of the cancer committee infrastructure, while identifying available resources and adapting workflows for various cancer care service lines. The UCD CCC findings, while it may not be generalizable to all cancer centers, demonstrate the application of conceptual frameworks to accelerate implementation for a sustainable tobacco treatment program. Key common elements that may be shared across oncology settings include a state quitline for an adaptable intervention, cancer committees for outer/inner setting infrastructure, tobacco quality metrics for data reporting, and non-physician staff for integrated services.

scholarly journals Tailoring Therapies: Improving the Outcome of Breast Cancer in a Comprehensive Cancer Center in West Africa—The University of Nigeria Teaching Hospital Experience

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 163s-163s
Author(s):  
N. Lasebikan ◽  
N. Iloanusi ◽  
T. Onyeka ◽  
C. Ilo ◽  
K. Nwankwo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Palliative Care ◽  
Cancer Care ◽  
Multidisciplinary Approach ◽  
Treatment Options ◽  
Management Strategies ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Care Continuum ◽  
Cancer Care Continuum

Background and context: Early detection and improved treatments are associated with a reduction in breast cancer mortality and morbidity. UNTH is a leading comprehensive cancer center in Nigeria with referrals from the entire southeast and south south regions. Our goal is to offer high quality comprehensive cancer care services across the cancer care continuum from public health awareness campaigns and provision of screening services all the way to palliative care and survivorship. This is the first attempt by any institution in the country to standardize and harmonize available treatment options for breast cancer. Aim: To optimize, standardize and harmonize treatment options and management strategies for breast cancer using a multidisciplinary approach by developing guidelines adapted to our peculiar infrastructure and health system. Strategy/Tactics: The practice guideline was specifically developed for UNTH using a multidisciplinary approach and taking into consideration circumstances peculiar to UNTH, including the following: UNTH's specific patient population; UNTH's services and structure; and UNTH's clinical information. Program/Policy process: The process used recognized methods that are robust, objective, scientifically valid, consistent and adaptable to UNTH and engaged all identified multisectoral and multidisciplinary stakeholders involved in the care of patients with breast cancer. Outcomes: We reviewed substantial evidence on documented and proven strategies for community screening and prevention, less expensive and only marginally less effective diagnostic tools, locoregional and systemic therapies for the management of breast cancer. The team also recommended all patients receive psycho-oncology support through a dedicated team and through the breast cancer support group. It was agreed that palliative care be incorporated within the first 8 weeks of commencing treatment in line with the current ASCO guidelines and receive consultation from the exercise immunology unit. What was learned: Institutionalized care offers better management strategies and standardized treatment in line with best global practices of care for patients with breast cancer across the cancer care continuum which will ultimately translate to better treatment outcomes.

scholarly journals An Evaluation of the Process and Quality Improvement Measures of the University of Virginia Cancer Center Tobacco Treatment Program

2020 ◽  
Vol 17 (13) ◽  
pp. 4707 ◽  
Author(s):  
Kara P. Wiseman ◽  
Lindsay Hauser ◽  
Connie Clark ◽  
Onyiyoza Odumosu ◽  
Neely Dahl ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Tobacco Use ◽  
Treatment Program ◽  
Disease Recurrence ◽  
Cancer Center ◽  
Second Primary ◽  
University Of Virginia ◽  
Clinical Workflow ◽  
Tobacco Treatment ◽  
The University

Tobacco use after a cancer diagnosis can increase risk of disease recurrence, increase the likelihood of a second primary cancer, and negatively impact treatment efficacy. The implementation of system-wide comprehensive tobacco cessation in the oncology setting has historically been low, with over half of cancer clinicians reporting that they do not treat or provide a referral to cessation resources. This quality improvement study evaluated the procedures for assessing and documenting tobacco use among cancer survivors and referring current smokers to cessation resources at the University of Virginia Cancer Center. Process mapping revealed 20 gaps across two major domains: electronic health record (EHR), and personnel barriers. The top identified priority was inconsistent documentation of tobacco use status as it impacted several downstream gaps. Eleven of the 20 gaps were deemed a high priority, and all were addressed during the implementation of the resulting Tobacco Treatment Program. Prioritized gaps were addressed using a combination of provider training, modifications to clinical workflow, and EHR modifications. Since implementation of solutions, the number of unique survivors receiving cessation treatment has increased from 284 survivors receiving cessation support during Year 1 of the initiative to 487 in Year 3. The resulting Tobacco Treatment Program provides a systematic, personalized, and sustainable comprehensive cessation program that optimizes the multifaceted workflow of the Cancer Center and has the potential to reduce tobacco use in a population most in need of cessation support.

scholarly journals Cancerpedia: A Framework for Implementing Comprehensive Cancer Centres

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 244s-244s
Author(s):  
N. Abdelmutti ◽  
A. Chudak ◽  
M. Merali ◽  
T. Sullivan ◽  
M. Escaf ◽  
...  
Keyword(s):  
Palliative Care ◽  
Best Practices ◽  
Cancer Care ◽  
Care Delivery ◽  
Cancer Control ◽  
System Level ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Cancer Centers ◽  
Comprehensive Cancer Centers

Background and context: Comprehensive cancer centers or programs form a nucleus of cancer care delivery. Although there are frameworks for population cancer control, no similar published framework exists for cancer centers. Aim: We sought to develop a framework for designing and implementing a comprehensive cancer center or program within the context of a population-based model of cancer control that spans diagnosis, treatment, supportive care, and palliative care as well as integration with primary care and the community. Strategy/Tactics: The framework was constructed with the patient at the center and provides a system-level perspective as well as a granular view of the fundamental resources and structures needed to build and maintain individual cancer centers and programs. Due to its breadth, we focused the framework on essential information while linking to a wide range of vetted publications that detail additional standards, guidelines and best practices. Program/Policy process: “Cancerpedia” emerged as a cohesive framework for the delivery of high-quality cancer care within and beyond the cancer center. It provides an overview of the cancer control and care delivery framework, describes cancer care services (e.g., radiotherapy, chemotherapy, palliative care) and details infrastructure and core services (e.g., physical facilities, human resources). In addition to these services, the framework presents guidelines for governance that ensure oversight and quality, describes the critical need for integrating education and research and presents the best practices for engaging in philanthropy. Cancerpedia also outlines the role of the comprehensive cancer center in integration with the community and influencing policy and regulation. Over 30 chapters provide a detailed description of each element and include a description of the service or function, resources requirements such as people, equipment and facilities, management structures, quality performance guidelines and future trends in innovation. Outcomes: To our knowledge, no comparable published framework exists as a reference for developing comprehensive cancer centers. Cancerpedia was designed to serve as a global public good and is adaptable and applicable to diverse contexts and healthcare environments. It is relevant to high-, middle- and low-income countries alike and provides a reference point from which to structure a plan for growth. What was learned: While it is important to describe the various elements required for cancer care delivery, it is critical to consider and address the integration and interdependencies of these various elements. Future opportunities for learning include seeking input from a global audience to gauge the utility and applicability of Cancerperdia to local contexts.

Tobacco Treatment Program Implementation at NCI Cancer Centers: Progress of the NCI Cancer Moonshot-Funded Cancer Center Cessation Initiative

2019 ◽  
Vol 12 (11) ◽  
pp. 735-740 ◽  
Author(s):  
Heather D'Angelo ◽  
Betsy Rolland ◽  
Robert Adsit ◽  
Timothy B. Baker ◽  
Marika Rosenblum ◽  
...  
Keyword(s):  
Treatment Program ◽  
Program Implementation ◽  
Cancer Center ◽  
Cancer Centers ◽  
Tobacco Treatment

Combining two implementation strategies to increase reach for tobacco treatment with cancer patients: Ask-Advise-Connect and closing care gaps.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 242-242
Author(s):  
Terri Wolf ◽  
Elisa Tong ◽  
Susan L Stewart ◽  
Moon Chen
Keyword(s):  
Cancer Patients ◽  
Treatment Program ◽  
Radiation Oncology ◽  
Cancer Care ◽  
Management Education ◽  
Health Management ◽  
Implementation Strategies ◽  
Cancer Center ◽  
Tobacco Treatment ◽  
Care Gaps

242 Background: Tobacco treatment is an important component of cancer care, and pragmatic strategies are needed. The University of California Davis Comprehensive Cancer Center (UCD CCC) was selected to join the National Cancer Institute Cancer Center Cessation Initiative (NCI C3I) to integrate tobacco treatment with cancer care. As a matrix cancer center, UCD had tobacco treatment workflows established in primary care, with Health Management Education group classes and a quitline order, but less so in cancer care. Methods: We use the RE-AIM framework for our study evaluation. During the two-year study period (1/2018-12/2019) patient data were reported in 6-month periods to NCI C3I from core Cancer Center clinics including medical, surgical, and radiation oncology. Three strategies were implemented serially and in convergence. Strategy #1 involved cancer provider and staff education and training, Strategy #2 initiated the Ask-Advise-Connect workflow with medical assistants assessing and referring within the clinic encounter, and Strategy #3 conducted Closing Care Gaps outreach to contact “unassisted” smokers outside of the clinic encounter. Stakeholder perspectives for implementation readiness across units were engaged at least bi-monthly by multidisciplinary members of the Cancer Committee, led by the physician-in-chief. Implementation strategies were developed in partnership with clinic management and Health Management Education staff with monthly rapid feedback reports for referral orders. Results: Our project Reach improved tobacco assessment from 83.6% to 96.4% and tobacco treatment program orders and outreach by 6-fold (from 40 to 254) over the four NCI C3I 6-month reporting periods. For tobacco treatment program Effectiveness, among 118 patients who engaged in treatment (January 2018-June 2019), past-week abstinence at 6 months was 22.9% (missing data assumed to be smoking) Adoption and Implementation of tobacco treatment program referrals were highest in medical (5-10 fold) and surgical oncology (3-fold) annual increases. In contrast, radiation oncology referrals remained low due to a different clinic workflow and electronic health record module. Booster trainings have helped to Maintain referrals in the clinic. Conclusions: A matrix cancer center can rapidly adopt and implement tobacco treatment strategies that are internal and external to the clinic visit, with the goal of offering tobacco treatment and maximizing reach to all cancer patients who smoke.

scholarly journals Rapid Utilization of Telehealth in a Comprehensive Cancer Center as a Response to COVID-19

2020 ◽  
Author(s):  
Peter E. Lonergan ◽  
Samuel L. Washington ◽  
Linda Branagan ◽  
Nathaniel Gleason ◽  
Raj S. Pruthi ◽  
...  
Keyword(s):  
San Francisco ◽  
Video Conferencing ◽  
University Of California ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Health Record ◽  
Primary Language ◽  
Patient Demographics ◽  
Race Ethnicity ◽  
The University

AbstractBackgroundThe emergence of the coronavirus disease 2019 (COVID-19) pandemic in March 2020 created unprecedented challenges in the provision of scheduled ambulatory cancer care. As a result, there has been a renewed focus on video consultations as a means to continue ambulatory care.ObjectiveTo analyze the change in video visit volume at the University of California, San Francisco (UCSF) Comprehensive Cancer Center in response to COVID-19 and compare demographics/appointment data from January 1, 2020 and in the 11 weeks after transition to video visits.MethodsPatient demographics and appointment data (dates, visit types, and departments) were abstracted from the Electronic Health Record reporting database. Video visits were performed using a HIPAA-compliant video conferencing platform with a pre-existing workflow.ResultsIn 17 departments and divisions at the UCSF Cancer Center, 2,284 video visits were performed in the 11 weeks before COVID-19 changes with an average (SD) of 208 (75) per week and 12,946 video visits were performed in the 11 week post-COVID-19 period with an average (SD) of 1,177 (120) per week. The proportion of video visits increased from 7-18% to 54-72%, between the pre- and post-COVID-19 periods without any disparity based on race/ethnicity, primary language, or payor.ConclusionsIn a remarkably brief period of time, we rapidly scaled the utilization of telehealth in response to COVID-19 and maintained access to complex oncologic care at a time of social distancing.

scholarly journals Introduction: Understanding and Influencing Multilevel Factors Across the Cancer Care Continuum

2012 ◽  
Vol 2012 (44) ◽  
pp. 2-10 ◽  
Author(s):  
S. H. Taplin ◽  
R. Anhang Price ◽  
H. M. Edwards ◽  
M. K. Foster ◽  
E. S. Breslau ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Continuum ◽  
Cancer Care Continuum

scholarly journals Easier Said Than Done: Keys to Successful Implementation of the Distress Assessment and Response Tool (DART) Program

2016 ◽  
Vol 12 (5) ◽  
pp. e513-e526 ◽  
Author(s):  
Madeline Li ◽  
Alyssa Macedo ◽  
Sean Crawford ◽  
Sabira Bagha ◽  
Yvonne W. Leung ◽  
...  
Keyword(s):  
Cancer Care ◽  
Large Scale ◽  
Performance Indicator ◽  
Evaluation Framework ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Successful Implementation ◽  
Psychosocial Needs ◽  
Electronic Screening ◽  
Screening For Distress

Purpose: Systematic screening for distress in oncology clinics has gained increasing acceptance as a means to improve cancer care, but its implementation poses enormous challenges. We describe the development and implementation of the Distress Assessment and Response Tool (DART) program in a large urban comprehensive cancer center. Method: DART is an electronic screening tool used to detect physical and emotional distress and practical concerns and is linked to triaged interprofessional collaborative care pathways. The implementation of DART depended on clinician education, technological innovation, transparent communication, and an evaluation framework based on principles of change management and quality improvement. Results: There have been 364,378 DART surveys completed since 2010, with a sustained screening rate of > 70% for the past 3 years. High staff satisfaction, increased perception of teamwork, greater clinical attention to the psychosocial needs of patients, patient-clinician communication, and patient satisfaction with care were demonstrated without a resultant increase in referrals to specialized psychosocial services. DART is now a standard of care for all patients attending the cancer center and a quality performance indicator for the organization. Conclusion: Key factors in the success of DART implementation were the adoption of a programmatic approach, strong institutional commitment, and a primary focus on clinic-based response. We have demonstrated that large-scale routine screening for distress in a cancer center is achievable and has the potential to enhance the cancer care experience for both patients and staff.

scholarly journals Multilevel Factors Affecting Quality: Examples From the Cancer Care Continuum

2012 ◽  
Vol 2012 (44) ◽  
pp. 11-19 ◽  
Author(s):  
J. Zapka ◽  
S. H. Taplin ◽  
P. Ganz ◽  
E. Grunfeld ◽  
K. Sterba
Keyword(s):  
Cancer Care ◽  
Factors Affecting ◽  
Care Continuum ◽  
Cancer Care Continuum
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