Barriers and facilitators to the implementation of routine ototoxicity screening for head and neck cancer patients.

Authors

null

Priya Bapat

Princess Margaret Cancer Centre Division of Medical Oncology and Hematology, Toronto, ON, Canada

Priya Bapat, Pansy Chow, Katrina Hueniken, Mary Mahler, M. Catherine Brown, Carolyn Falls, Andrew J. Hope, Aaron Richard Hansen, David Paul Goldstein, John Rutka, Doris Howell, Wei Xu, Geoffrey Liu

Organizations

Princess Margaret Cancer Centre Division of Medical Oncology and Hematology, Toronto, ON, Canada, Princess Margaret Cancer Centre, Toronto, ON, Canada, Western Univeristy, London, ON, Canada, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada, Centre for Advanced Hearing and Balance Testing, University Health Network, Toronto, ON, Canada, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada, Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada, Department of Otolaryngology-Head & Neck Surgery, University Health Network, Toronto, ON, Canada, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada, Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada

Research Funding

No funding received
None.

Background: Ototoxicity after cisplatin +/- radiation occurs in 22-58% of patients with head and neck cancers. Routine post-treatment hearing tests are useful in the early detection of hearing loss, allowing for possible early intervention. This study aimed to identify current hearing screening practices for follow-up, barriers to screening, and recommendations for its implementation. Methods: Stakeholders (physicians, nurses, coordinators, audiologists) identified barriers and facilitators to the implementation of a routine hearing screening follow-up program at Princess Margaret Cancer Centre. Themes were identified using an inductive approach and mapped to the Knowledge to Action (KTA) framework, which guides the implementation of new clinical practices. Results: The problem: While all patients received baseline hearing tests, follow-up testing was inconsistently performed in asymptomatic patients. Patients may also lack awareness of subclinical hearing loss. A formalized follow-up hearing test program was identified as the best approach by stakeholders. Barriers: Individual-level barriers included limited knowledge about intervals for hearing testing and lack of time during clinic visits. Institutional-level factors included personnel, financial resources and logistical supports. Patient travel distances and times were barriers, as well as scheduling tests on the same day as other clinic visits. Societal stigma of hearing loss was a possible barrier. Facilitators: These included greater staff and patient education, and designating a local clinic champion. Instructions for follow-up after identifying hearing loss was deemed essential. Adapting to the local context: Automated flagging post-treatment and auto-referrals to the Hearing Clinic through the electronic medical record system could facilitate increased rates of participation. Mail/phone reminders could be useful adjuncts. Conclusions: Participants supported a formal post-treatment hearing test program for patients with head and neck cancers treated with cisplatin +/- radiation. Individual and institutional barriers were identified, but could be mitigated by appropriate facilitators.

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Abstract Details

Meeting

2019 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session A: Cost, Value, and Policy; Health Equity and Disparities

Track

Cost, Value, and Policy,Health Care Access, Equity, and Disparities

Sub Track

Access to Care

Citation

J Clin Oncol 37, 2019 (suppl 27; abstr 127)

DOI

10.1200/JCO.2019.37.27_suppl.127

Abstract #

127

Poster Bd #

K2

Abstract Disclosures