Population-based standardized symptom screening: Cancer Care Ontario’s Edmonton Symptom Assessment System and performance status initiatives.

56 Background: The goal of the collaborative is to improve the quality and consistency of physical and emotional symptom management across the cancer journey. Objectives are: (a) promote the adoption of electronic symptom assessment using a standardized tool and (b) increase the clinical use of evidence based guidelines to effectively manage patient identified symptoms. Methods: The actions taken for this initiative are to manage cancer symptoms through a patient reported measurement tool; improve the quality of symptom management through the uptake of symptom management guides and algorithms for care; and drive improvement through the adoption of an electronic symptom assessment platform The following aims were established for this work: (1) Aim for symptom screening and assessment (70% of ambulatory cancer clinic patients are screened for symptom severity using ESAS at least once/month) (2) aim for symptom management (evidence from chart audits show intervention as per evidence based guidelines for patients reported symptom scores) (3) aim for patient satisfaction (90% of target population indicates that their health care team took their scores into consideration when developing a care plan) and (4) aim for evidence of use (90% of patients state that their doctor or nurse spoke with them about their symptom screen). Results: 60% of cancer patients are screened each month representing over 28,000 people. Six of fourteen cancer regions are above the provincial target of 70%, with some close to 90%. 92% of patients felt ESAS was important to complete to help health care providers know how they are feeling. Conclusions: Cancer Care Ontario has been able to drive improvements in symptom management through the implementation of system wide electronic symptom assessment. For other jurisdictions interested in adopting this approach, the following areas are critical for success. (a.) Leadership at all levels of the system; (b.) clinical tools at the point of care; (c) engagement of patients in the design of care; (d) communications support to spread information to all stakeholders; and (e) using to data to drive performance improvement and accountability.

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Integration of system-level patient-reported outcome measurement into everyday clinical care: Lessons learned from the cancer care Ontario experience.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.159 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 159-159

Author(s):

Sean Molloy ◽

Jose Pereira ◽

Esther Green ◽

Deborah Jane Dudgeon ◽

Doris Howell ◽

...

Keyword(s):

Health Care ◽

Cancer Care ◽

Symptom Management ◽

Symptom Assessment ◽

System Level ◽

Evidence Based ◽

Care Providers ◽

Symptom Screening ◽

Patient Reported ◽

Evidence Based Guidelines

159 Background: The goal of the collaborative is to improve the quality and consistency of physical and emotional symptom management across the cancer journey. Objectives are to promote the adoption of electronic symptom assessment using a standardized tool and to increase the clinical use of evidence based guidelines to effectively manage patient identified symptoms. Methods: The actions taken for this initiative are (a) manage cancer symptoms through a patient reported measurement tool; (b) improve the quality of symptom management through the uptake of symptom management guides and algorithms for care; and (c) drive improvement through the adoption of an electronic symptom assessment platform. The following aims were established for this work: (1) aim for symptom screening and assessment (70% of ambulatory cancer clinic patients are screened for symptom severity using ESAS at least once/month); (2) aim for symptom management (evidence from chart audits show intervention as per evidence based guidelines for patients reported symptom scores); (3) aim for patient satisfaction (90% of target population indicates that their health care team took their scores into consideration when developing a care plan); and (4)aim for evidence of use (90% of patients state that their doctor or nurse spoke with them about their symptom screen). Results: 60% of cancer patients are screened each month representing over 28,000 people. Six of fourteen cancer regions are above the provincial target of 70%, with some close to 90%. 92% of patients felt ESAS was important to complete to help health care providers know how they are feeling. Conclusions: Cancer Care Ontario has been able to drive improvements in symptom management through the implementation of system wide electronic symptom assessment. For other jurisdictions interested in adopting this approach, the following areas are critical for success: a) leadership at all levels of the system; b) clinical tools at the point of care; c) engagement of patients in the design of care; d) communications support to spread information to all stakeholders; and e) using to data to drive performance improvement and accountability.

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Measuring patient-reported outcomes to improve cancer care in Canada: an analysis of provincial survey data

Current Oncology ◽

10.3747/co.25.3995 ◽

2018 ◽

Vol 25 (2) ◽

pp. 176 ◽

Cited By ~ 10

Author(s):

K. Tran ◽

S. Zomer ◽

J. Chadder ◽

C. Earle ◽

S. Fung ◽

...

Keyword(s):

Cancer Treatment ◽

Cancer Care ◽

Patient Reported Outcomes ◽

Symptom Burden ◽

Symptom Assessment ◽

Physical Symptoms ◽

Assessment System ◽

System Level ◽

Care Providers ◽

Patient Reported

Patient-reported outcomes measures (proms) are an important component of the shift from disease-centred to person-centred care. In oncology, proms describe the effects of cancer and its treatment from the patient perspective and ideally enable patients to communicate to their providers the physical symptoms and psychosocial concerns that are most relevant to them. The Edmonton Symptom Assessment System–revised (esas-r) is a commonly used and validated tool in Canada to assess symptoms related to cancer. Here, we describe the extent to which patient reported outcome programs have been implemented in Canada and the severity of symptoms causing distress for patients with cancer.As of April 2017, 8 of 10 provinces had implemented the esas-r to assess patient-reported outcomes. Data capture methods, the proportion of cancer treatment sites that have implemented the esas-r, and the time and frequency of screening vary from province to province. From October 2016 to March 2017 in the 8 reporting provinces, 88.0% of cancer patients were screened for symptoms. Of patients who reported having symptoms, 44.3% reported depression, with 15.5% reporting moderate-to-high levels; 50.0% reported pain, with 18.6% reporting moderate-to-high levels; 56.2% reported anxiety, with 20.4% reporting moderate-to-high levels; and 75.1% reported fatigue, with 34.4% reporting moderate-to-high levels.There are some notable areas in which the implementation of proms could be improved in Canada. Findings point to a need to increase the number of cancer treatment sites that screen all patients for symptoms; to standardize when and how frequently patients are screened across the country; to screen patients for symptoms during all phases of their cancer journey, not just during treatment; and to assess whether giving cancer care providers real-time patient-reported outcomes data has led to appropriate interventions that reduce the symptom burden and improve patient outcomes. Continued measurement and reporting at the system level will allow for a better understanding of progress in proms activity over time and of the areas in which targeted quality improvement efforts could ensure that patient symptoms and concerns are being addressed.

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Prescreening of Patient-reported Symptoms using the Edmonton Symptom Assessment System (ESAS) in Outpatient Palliative Cancer Care

10.21203/rs.2.16484/v1 ◽

2019 ◽

Author(s):

Garden Lee ◽

Han Sang Kim ◽

Si Won Lee ◽

Eun Hwa Kim ◽

Bori Lee ◽

...

Keyword(s):

Palliative Care ◽

Cancer Care ◽

Severe Symptom ◽

Symptom Burden ◽

Symptom Assessment ◽

Assessment System ◽

Advanced Cancer Patients ◽

Edmonton Symptom Assessment System ◽

Patient Reported

Abstract Background: Although early palliative care is associated with a better quality of life and improved outcomes in end-of-life cancer care, the criteria of palliative care referral are still elusive. Methods: We collected patient-reported symptoms using the Edmonton Symptom Assessment System (ESAS) at the baseline, first, and second follow-up visit. The ESAS evaluates ten symptoms: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, appetite, and wellbeing. A total of 71 patients were evaluable, with a median age of 65 years, male (62%), and the Eastern Cooperative Oncology Group (ECOG) performance status distribution of 1/2/3 (28%/39%/33%), respectively. Results: Twenty (28%) patients had moderate/severe symptom burden with the mean ESAS ≥5. Interestingly, most of the patients with moderate/severe symptom burdens (ESAS ≥5) had globally elevated symptom expression. While the mean ESAS score was maintained in patients with mild symptom burden (ESAS<5; 2.7 at the baseline; 3.4 at the first follow-up; 3.0 at the second follow-up; P =0.117), there was significant symptom improvement in patients with moderate/severe symptom burden (ESAS≥5; 6.5 at the baseline; 4.5 at the first follow-up; 3.6 at the second follow-up; P <0.001). Conclusions: Advanced cancer patients with ESAS ≥5 may benefit from outpatient palliative cancer care. Prescreening of patient-reported symptoms using ESAS can be useful for identifying unmet palliative care needs in advanced cancer patients.

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Implementing a Patient-Reported Outcome Measure for Hemodialysis Patients in Routine Clinical Care

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.01840220 ◽

2020 ◽

Vol 15 (9) ◽

pp. 1299-1309 ◽

Cited By ~ 1

Author(s):

Jenna M. Evans ◽

Alysha Glazer ◽

Rebecca Lum ◽

Esti Heale ◽

Marnie MacKinnon ◽

...

Keyword(s):

Outcome Measure ◽

Symptom Burden ◽

Symptom Assessment ◽

Patient Reported Outcome ◽

Assessment System ◽

Edmonton Symptom Assessment System ◽

Patient Reported Outcome Measure ◽

Symptom Screening ◽

Patient Reported ◽

Patient Provider Communication

Background and objectivesThe Edmonton Symptom Assessment System Revised: Renal is a patient-reported outcome measure used to assess physical and psychosocial symptom burden in patients treated with maintenance dialysis. Studies of patient-reported outcome measures suggest the need for deeper understanding of how to optimize their implementation and use. This study examines patient and provider perspectives of the implementation process and the influence of the Edmonton Symptom Assessment System Revised: Renal on symptom management, patient-provider communication, and interdisciplinary communication.Design, setting, participants, & measurements Eight in-facility hemodialysis programs in Ontario, Canada, assessed patients using the Edmonton Symptom Assessment System Revised: Renal every 4–6 weeks for 1 year. Screening and completion rates were tracked, and pre- and postimplementation surveys and midimplementation interviews were conducted with patients and providers. A chart audit was conducted 12 months postimplementation.ResultsIn total, 1459 patients completed the Edmonton Symptom Assessment System Revised: Renal; 58% of eligible patients completed the preimplementation survey (n=718), and 56% of patients who completed the Edmonton Symptom Assessment System Revised: Renal at least once completed the postimplementation survey (n=569). Provider survey response rates were 71% (n=514) and 54% (n=319), respectively. Nine patients/caregivers from three sites and 48 providers from all sites participated in interviews. A total of 1207 charts were audited. Seven of eight sites had mean screening rates over 80%, suggesting that routine use of the Edmonton Symptom Assessment System Revised: Renal in clinical practice is feasible. However, the multiple data sources painted an inconsistent picture of the value and effect of the Edmonton Symptom Assessment System Revised: Renal. The Edmonton Symptom Assessment System Revised: Renal standardized symptom screening processes across providers and sites; improved patient and provider symptom awareness, particularly for psychosocial symptoms; and empowered patients to raise issues with providers. Yet, there was little, if any, statistically significant improvement in the metrics used to assess symptom management, patient-provider communication, and interdisciplinary communication.ConclusionsThe Edmonton Symptom Assessment System Revised: Renal patient-reported outcome measure may be useful to standardize symptom screening, enhance awareness of psychosocial symptoms among patients and providers, and empower patients rather than to reduce symptom burden.

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Health care providers’ use and knowledge of the Edmonton Symptom Assessment System (ESAS): is there a need to improve information and training?

Supportive Care in Cancer ◽

10.1007/s00520-013-1955-8 ◽

2013 ◽

Vol 22 (1) ◽

pp. 201-208 ◽

Cited By ~ 11

Author(s):

Daniela Carli Buttenschoen ◽

Jarad Stephan ◽

Sharon Watanabe ◽

Cheryl Nekolaichuk

Keyword(s):

Health Care ◽

Health Care Providers ◽

Symptom Assessment ◽

Assessment System ◽

Care Providers ◽

Edmonton Symptom Assessment System ◽

And Training

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The Department of Health and Human Services (DHHS) Sickle Cell Disease (SCD) Initiative: Increasing Access and Improving Care

Blood ◽

10.1182/blood.v118.21.4834.4834 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4834-4834

Author(s):

Susan B. Shurin ◽

Hani Atrash ◽

Coleen Boyle ◽

R. Lorraine Brown ◽

Janet L. Collins ◽

...

Keyword(s):

Health Care ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Health Care Providers ◽

The United States ◽

Evidence Based ◽

Care Providers ◽

Cell Disease ◽

Evidence Based Guidelines ◽

Support Research

Abstract Abstract 4834 Over the past half century, the course of sickle cell disease has been transformed in the United States through the conduct of rigorous biomedical research and broad application of the results. Universal newborn screening with comprehensive medical care has dramatically reduced death and disability in childhood, and increased the numbers of patients surviving into adulthood. However, access to health care has not kept up with the changing demographics of those affected by sickle cell disease. Health care often becomes fragmented when patients transition from pediatric to adult health care providers. Access to comprehensive care has impeded both conduct of clinical and implementation of research results. To address these needs in this changing environment, HHS Secretary Kathleen Sebelius has charged six agencies of HHS – NIH, CDC, HRSA, FDA, AHRQ and CMS – and the Offices of Minority Health and Planning and Evaluation, to improve the health of people with SCD. The agencies are coordinating their programs and collaborating with the Office of the Secretary, to achieve the following goals:create a comprehensive database of individuals with SCD to facilitate the monitoring of health outcomes and clinical research;improve the care of adults and children through development and dissemination of evidence-based guidelines, which are anticipated in Spring, 2012, with broad implementation plans;identify measures of quality of care for individuals with SCD and incorporate them into quality improvement programs at HHS;increase the availability of medical homes to improve patient access to quality primary and specialty care;provide State Medicaid officials, health care providers, patients, families and advocacy groups with information about resources related to SCD care and treatment;work with the pharmaceutical industry and academic investigators to increase the development of effective treatments for patients with SCD;support research to improve health care for people with SCD;support research to understand the clinical implications of SC trait;engage national and community-based SCD advocacy organizations and experts in ongoing discussions to ensure that issues of importance to persons affected are addressed. Organizational and strategic actions are being taken at each agency to enhance implementation of research advances; provide evidence-based guidelines to families, health care providers, and payers; facilitate new drug development; and provide public health data to impact both the health care delivery and research agendas. The enthusiastic support of the American Society of Hematology and its members is essential for long-term success of this endeavor. Disclosures: No relevant conflicts of interest to declare.

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Pre‐screening of patient‐reported symptoms using the Edmonton Symptom Assessment System in outpatient palliative cancer care

European Journal of Cancer Care ◽

10.1111/ecc.13305 ◽

2020 ◽

Vol 29 (6) ◽

Author(s):

Garden Lee ◽

Han Sang Kim ◽

Si Won Lee ◽

Yu Rang Park ◽

Eun Hwa Kim ◽

...

Keyword(s):

Cancer Care ◽

Symptom Assessment ◽

Assessment System ◽

Edmonton Symptom Assessment System ◽

Patient Reported

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Critical Care Clinicians’ Knowledge of Evidence-Based Guidelines for Preventing Ventilator-Associated Pneumonia

American Journal of Critical Care ◽

10.4037/ajcc2009131 ◽

2010 ◽

Vol 19 (3) ◽

pp. 272-276 ◽

Cited By ~ 21

Author(s):

Mohamad F. El-Khatib ◽

Salah Zeineldine ◽

Chakib Ayoub ◽

Ahmad Husari ◽

Pierre K. Bou-Khalil

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Evidence Based ◽

Ventilator Associated Pneumonia ◽

Care Providers ◽

Care Experience ◽

Respiratory Therapists ◽

Evidence Based Guidelines

Background Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different initiatives for the prevention of ventilator-associated pneumonia have been developed and recommended.Objective To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-based guidelines for preventing ventilator-associated pneumonia.Methods Ten physicians, 41 nurses, and 18 respiratory therapists working in the intensive care unit of a major tertiary care university hospital center completed an anonymous questionnaire on 9 nonpharmacological guidelines for prevention of ventilator-associated pneumonia.Results The mean (SD) total scores of physicians, nurses, and respiratory therapists were 80.2% (11.4%), 78.1% (10.6%), and 80.5% (6%), respectively, with no significant differences between them. Furthermore, within each category of health care professionals, the scores of professionals with less than 5 years of intensive care experience did not differ significantly from the scores of professionals with more than 5 years of intensive care experience.Conclusions A health care delivery model that includes physicians, nurses, and respiratory therapists in the intensive care unit can result in an adequate level of knowledge on evidence-based nonpharmacological guidelines for the prevention of ventilator-associated pneumonia.

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Standardized symptom screening: Cancer Care Ontario's expanded prostate cancer index composite for clinical practice (EPIC-CP) provincial implementation approach.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.100 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 100-100 ◽

Cited By ~ 1

Author(s):

Farzana Haji ◽

Lisa Catherine Barbera ◽

Colleen Bedford ◽

Brett Nichols ◽

Michael Donald Brundage

Keyword(s):

Prostate Cancer ◽

Cancer Care ◽

Symptom Management ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Provider Education ◽

Symptom Screening ◽

Communication Processes ◽

Implementation Approach ◽

Patient Reported

100 Background: Cancer Care Ontario endorses patient reported outcome measures to improve outcomes and experience for nearly 14 million Ontarians. The EPIC-CP tool, validated to screen/monitor symptoms and side-effects in men with localized prostate cancer, was selected to improve patient and provider experience, and facilitate symptom management. Two pilots tested EPIC-CPs feasibility and acceptability. Subsequent recommendations include: province-wide implementation, improving technological privacy, patient and provider education and communication processes. This abstract will describe the provincial strategy for implementation of EPIC-CP. Methods: The implementation approach involved stakeholder-driven practices based on Kotter’s organizational process framework. Clinical, technical, administrative and patient stakeholder representatives from 14 cancer centres formed working groups to create a climate for change, to engage centres to strategize locally, to implement and sustain change and to address the challenges identified by the EPIC-CP pilot. Results: The final pilot ended in June 2015, and executive endorsement for EPIC-CP provincial implementation in March 2016. A schedule for multi-site phased implementation was informed by stakeholder consultations and began in Oct 2016. Technological privacy improvements were informed by 95 representatives creating a multidisciplinary team tasked with provincial oversight, development of EMR guidelines and IT solutions. Five patient and five clinical educational guides were designed to assist in symptom management, each focusing on one domain of EPIC-CP. Creation of the guides drew on the clinical and scientific expertise among 12 clinicians of varying disciplines in collaboration with four patients. This team assisted in enhancing communication processes by designing 21 training materials, including FAQs and narrated guides, accessible on a central communications hub. Conclusions: Results indicate that this framework-based, stakeholder-driven approach was successful and could be applied to other wide-scale implementations of symptom management tools.

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