Improving oral chemotherapy compliance and documentation in a safety-net oncology clinic.

Authors

null

Robert Harrison Hester

University of Texas MD Anderson Cancer Center, Houston, TX

Robert Harrison Hester, Lindsey Leigh Farmer, Rohit Vivek Goswamy, Natalie Chen, Sophia Seo-hyeon Lee, Quinne Sember, Raamis Khwaja, Akshar Dash, Daniel Nguyen, Christina S. Haddad, Andrew James Wiele, Hilary Y. Ma

Organizations

University of Texas MD Anderson Cancer Center, Houston, TX, University of Texas Health Science Center McGovern Medical School, Houston, TX, Lyndon B. Johnson Hospital, Houston, TX

Research Funding

No funding received
None

Background: Barriers to safe delivery of oral chemotherapy in a safety net hospital population include lack of health insurance, delays in medication delivery, and language barriers. Baseline chart review at the Lyndon B. Johnson Hospital oncology clinic revealed sparse documentation of oral chemotherapy education and compliance. Our team conducted the present quality improvement project to improve documentation of toxicity assessment, patient education, and compliance with the oral chemotherapy agents capecitabine, palbociclib, and sorafenib by 25% from October through December 2020. Methods: A set of standardized questions designed to assess for the above domains were generated in the form of an auto-populated electronic medical record phrase ("dot phrase," see Figure 1). Using weekly timed email notifications, physicians were reminded to incorporate these questions in their documentation during clinic visits. Chart review was performed to assess usage frequency of the dot phrase. A post-intervention survey was administered to assess providers' experience with use of the dot phrase, and assess barriers to consistent documentation. Results: 41 patients over 3 months were identified as taking the oral chemotherapy drugs capecitabine (68%), palbociclib (29%) or sorafenib (3%). 63% were non-English speakers. 49% had breast cancer, 39% GI cancers, and 12% other cancers. 12% of clinic visits correctly incorporated use of the dot phrase. Education on the dosing and schedule for oral chemo was addressed for 48% of patients, documentation of adverse effects was performed for 34% of patients, and assessment of medication adherence was documented for 22% of patients. While 73% of providers felt that documentation of oral chemotherapy compliance is important, 70% cited failure to remember to incorporate the dot phrase in real time as the primary reason for failure to use the dot phrase for oral chemotherapy documentation. Conclusions: Despite providers' view of documentation of oral chemotherapy toxicities and compliance as important, low uptake of the dot phrase was observed. The main barrier to use of the dot phrase was providers' forgetting to incorporate the dot phrase prior to and during their clinic charting. Future efforts should focus on automated reminders and regular assessments to increase compliance to this important quality domain.

Oral chemotherapy compliance dot phrase.

Is this patient new to the therapy?
{Yes/No with start date}
Which oral chemotherapy?
{chemotype}
Dosing and schedule of chemotherapy addressed?
{YES/NO/N/A}
Chemotherapy calendar provided to the patient?
{YES/NO/N/A}
Patient education on possible adverse effect given?
{YES/NO/N/A}
Patient education on when and how to contact clinic given?
{YES/NO/N/A}
Missed dose addressed?
{YES/NO/N/A}
Adverse effect experienced by patient?
{YES/NO/N/A}
Barriers to medication adherence assessed and addressed?
{YES/NO/N/A}

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2021 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B: Patient Experience; Quality, Safety, and Implementation Science; Technology and Innovation in Quality of Care

Track

Technology and Innovation in Quality of Care,Patient Experience,Quality, Safety, and Implementation Science,Cost, Value, and Policy,Health Care Access, Equity, and Disparities

Sub Track

Standardization and Technology Efforts to Improve Safety

Citation

J Clin Oncol 39, 2021 (suppl 28; abstr 263)

DOI

10.1200/JCO.2020.39.28_suppl.263

Abstract #

263

Poster Bd #

D13

Abstract Disclosures

Similar Abstracts

Abstract

2016 ASCO Quality Care Symposium

Documentation of pharmacist-provided patient education for oral chemotherapy.

First Author: Anderson Jennifer

First Author: Anika Bhargava