Recognizing that each nurse approaches patient education differently, a team of nurses at Dana-Farber Cancer Institute satellite facilities employed quality improvement strategies to develop a standardized approach to patient education. The goal was to eliminate variation in teaching and improve patient satisfaction scores.
136 Background: Variation of chemotherapy teaching at three affiliated regional oncology centers was associated with a low patient satisfaction PS; Press Ganey Survey for Adult Oncology score of 83.7% in understanding what to expect during chemotherapy treatment and 72.9% in how to manage chemotherapy side effects. Nursing staff collaborated to standardize content to improve PS and quality of care. Methods: Chemotherapy teaching tools varied across practice locations. From September-January 2012, three plan-do-study-act cycles were implemented. 1) A standardized teaching checklist, 2) electronic patient calendars, 3) 3 weeks later a patient education assessment survey (EAS). The teaching checklist detailed: 1) relevant chemotherapy information; 2) calendars listing (clinic appointments, symptoms requiring MD/NP notification, how to contact providers); and 3) ES assessed patient’s level of comprehension. Results: We used logistic regression for each PS score, estimating the time-trend of scores for each period and compared the time trend slopes pre versus post using a two-sided test for interaction. For each item, the Table displays the slope estimate (log odds-ratio per month) for each relevant intervention period, the associated 95% confidence intervals and the interaction test p-value. Negative slope indicates decreasing score trend with time while positive slope indicates increasing trend. The interaction test for each PS measure showed statistically significantly different slopes when comparing pre versus post periods for each PS item. Post intervention, scores for what to expect during chemotherapy rose 83.7% to 92.1%. Explanation of how to manage chemotherapy side effects rose 72.9% to 91.9%. Staff reported high satisfaction, highlighting its benefit to patients. Conclusions: Standardizing chemotherapy teaching improves PS as evidenced by statistically significant improvement in scores. Future endeavors will involve sharing chemotherapy teaching tools throughout the institution to improve PS scores for chemotherapy education. [Table: see text]
Background: High Dose Chemotherapy with Autologous Hematopoietic Progenitor Cell Support (HDC/AutHPCS) is a cancer treatment which provides potential for improved survival and risk for short and long term treatment side effects. Self report of QOL outcomes can guide risk assessment and system improvements to optimize care and rehabilitation. Purpose: This study examined and compared over time, the quality of life outcomes for patients who have undergone this treatment. Design: The Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT v.3) was the survey instrument used to measure QOL. Respondents were also asked to report their performance status based on the Eastern Co-operative Oncology Group (ECOG) and the New York Heart Association (NYHA) Performance status scales. Two open-ended questions were asked: what ”Good”, or “Bad” things occurred related to the treatment. Additional questions were asked about sleep problems that occurred after transplant, and whether a structured exercise program would have helped after discharge. Method: A survey was mailed in November, 2005. Sample: Patients (n=145) who had this treatment at our institution were contacted by mail. Diagnoses included acute myeloid leukemia, lymphoma, multiple myeloma, amyloid, breast cancer, and testicular cancer. Data analysis: Scores for the FACT-BMT were analyzed using SPSS 14 (SPSS Inc., Chicago IL). Qualitative responses were analyzed using NVivo v.7 software. Results: The return rate was 57% (n=81). The FACT-BMT Scores, subscales and total scores were comparable to other findings in similar studies and populations. FACT BMT SCORES 2006 FactG Score (Mean+/−SD) Range(0–112) 89.24+/−17.32 (45–112) FACT BMT Score (Mean+/−SD Range (0–40) 29.14+/−6.37 (16–40) FACTG/BMT Total (Mean+/−SD) Range (0–152) 118.29+/−22.78 (61–152) There were no statistically significant differences in scores from past studies with this population at this institution. Significant correlations were found between the scores of items in the FACT-BMT for which ≥ 25% of respondents reported low item ratings and the self rating ECOG and/or NYHA performance scales. Significant differences were also found when comparing the FACT-BMT Scores, subscales and total scores with demographic attributes such as, marital status, living situation, health insurance, employment status, and income. Twenty-five per cent (n=21) of respondents described new problems with sleep and 54% (n= 41) of respondents reported that a structured exercise program would have been beneficial for recovery. There were 21 respondents who participated in this survey (2006) and two prior surveys (1997 and 1999). Content and themes of their unsolicited and solicited written responses of their self reported lived experiences over time will be presented. Conclusions: Overall, participants reported good quality of life. Based on demographics, there were subgroups identified potentially needing assessments and interventions focused on physical, social, emotional, and functional well being. This could be accomplished through a more focused pre-admission and follow-up needs assessment to identify patients who would potentially benefit from additional resources for psychosocial support, sleep and exercise/activity issues.
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