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• 11946

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  P2.24 - Poster Session 2 - Supportive Care (ID 157)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11968

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    P2.24-022 - Implementing Dyspnea Management: A quality improvement project for patients with lung cancer in Ontario, Canada (ID 1439)

    09:30 - 09:30  |  Author(s): C. Kiteley
    • Abstract

    Background
    Dyspnea is a distressing symptom that occurs in up to 75% of patients with lung cancer as measured by the Edmonton Symptom Assessment System (ESAS). Appropriate dyspnea management (DM) can improve the patient’s quality of life, performance status and emotional well-being. However DM is not uniform or standard across Regional Cancer Centers (RCC). A quality improvement intiative on DM was implemented through the Disease Pathway Management (DPM) of Cancer Care Ontario (CCO). DPM is a unifying approach to quality improvement that integrates program activity across the cancer continuum in order to advance system-wide improvements. This initiative provided advice on various delivery models and strategies for DM.

    Methods
    Seven RCCs received funding from CCO to undertake one year pilot projects in DM. These projects had to have potential for significant impact, be innovative and be cost effective. Each RCC project was required to address the physical and psychological aspects of dyspnea that affect the patient, their families and/or caregivers. The precise methodology was left to each RCC to develop and initiate within the specified criteria. Approaches included educational sessions for patients and family members, individual counseling and treatment plans, and symptom management clinics. Four measures were tracked: ESAS for patient-reported symptom severity, Palliative Performance Status (PPS) for evaluation of functional status, European Organization for Research and Treatment Quality of Life Questionnaire (EORTC-QOL) to measure quality of life and a Patient Survey to evaluate the patient’s knowledge of dyspnea, preparedness for self-management and overall satisfaction with the DM initiative.

    Results
    188 patients were evaluable. 45% of patients with an initial severe dyspnea score on ESAS reported a shift to either a moderate or mild score by the last visit. 32% of patients with an initial moderate dyspnea score on ESAS reported a shift to a mild score. Patient satisfaction was high, with feelings of empowerment to carry on daily activities as a result of the interventions offered; caregivers reported a better understanding of dyspnea and better ability to support their loved ones; clinicians noted a difference in patients attending the dyspnea care initiative and valued the helpful resource for their patients. Challenges encountered during the project were lower than expected recruitment due to lack of clinical engagement from busy clinicians, multiple additional visits that sometimes conflicted with other scheduled patient visits to the RCC, and declining performance status of the patients precluding in-person attendance for training in DM techniques.

    Conclusion
    DM can be effectively implemented and tailored to local needs of a RCC or program. Key factors for success included a clinical champion and a multidisciplinary team approach in order to build the necessary knowledge and expertise for DM. The lessons learned as a result of these pilot projects have led to a new initiative to improve the quality and consistency of DM across the province of Ontario. This new initiative will incorporate novel approaches for knowledge transference with the possibility of engaging healthcare providers beyond the RCC.