Department of Gastroenterology and Multiorgan Transplant Institute, Oschner Medical Center, New Orleans, LA
George Therapondos , Christine B. Weldon , Lingling Du , Jonathan Mizrahi , Carol Palmer , Amanda Medina , Tyler Allan Sandow , Juan Gimenez , Ari Cohen , Michelle O'Brien , Amie Tan , Julia R. Trosman
Background: The 4R Oncology Model (4R=Right information/care/patient/time) supports patient self-management1 and quality improvement.2 Here we report the impact of using 4R Care Sequence plans for patients with primary liver cancer cared for by a multi-disciplinary liver cancer team. Methods: We tested the impact of 4R care sequence plans on patient self-management and care delivery referrals at a liver cancer program via patient surveys. 4R Plans were provided to patients with primary liver cancer from Jan – Aug ’23 (4R cohort). Patient-reported data were analyzed to compare the control cohort of patients who received care pre-4R, Jan - Dec ’22 (N=42) to the 4R cohort (N=17). Statistical analysis used Fisher’s exact test. Results: Patient survey response rates: Control cohort 54% (42/78), 4R cohort 55% (17/31). Comparing the control cohort to the 4R cohort respectively, patients were male (52%, 65%), White (64%, 64%), Black (26%, 18%), average age (63.2, 64.7), and reported income less than $30,000 (45%, 53%). The 4R cohort significantly improved care delivery in three metrics, and directionally improved in the other care delivery metrics as compared to the control cohort (table). All four patient self-management metrics significantly improved in the 4R cohort vs. the control cohort (Table). Conclusions: The use of 4R Care Sequence plans for patients with primary liver cancer facilitated improvements in care delivery and patient self-management metrics. While there were directional improvements in all metrics, there is opportunity and room for additional improvements. The team will continue to work on efforts to improve these metrics and optimize the use of 4R Care Sequence plans for patients with primary liver cancer. 1. Trosman, JCOOP 2021. 2. Liu, JCOOP 2022.
Control Cohort % N=42 | 4R Cohort % N=17 | P value | ||
---|---|---|---|---|
Care Delivery | Emotional distress or worry assistance referral | 36 | 76 | 0.005 |
Primary care provider referral | 76 | 88 | 0.3 | |
Practical, financial, or insurance help referral | 43 | 59 | 0.2 | |
Receipt of side-effect information before starting treatment | 74 | 94 | 0.07 | |
Receipt of printed liver cancer information | 67 | 100 | 0.004 | |
Receipt of information about cancer.net | 38 | 94 | 0.0001 | |
Patient Self-Management | Understand the goal of care | 79 | 100 | 0.04 |
Able to understand, participate in care | 60 | 88 | 0.03 | |
Felt in control of my care | 76 | 100 | 0.02 | |
Able to manage and organize one’s care | 36 | 82 | 0.001 |
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Abstract Disclosures
2023 ASCO Annual Meeting
First Author: George Therapondos
2022 ASCO Annual Meeting
First Author: Stephanie L. Graff
2012 ASCO Annual Meeting
First Author: Fran Zandstra
2023 ASCO Quality Care Symposium
First Author: Anthony DiDonato