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K.S. Roark
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ORAL 08 - Smoking Cessation, Tobacco Control and Lung Cancer (ID 94)
- Event: WCLC 2015
- Type: Oral Session
- Track: Prevention and Tobacco Control
- Presentations: 1
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ORAL08.02 - Interest in Smoking Cessation Treatment among Patients in a Community-Based Multidisciplinary Thoracic Oncology Program (ID 2886)
10:56 - 11:07 | Author(s): K.S. Roark
- Abstract
- Presentation
Background:
Cigarette smoking is the major cause of lung cancer. Many adults smoke at the time of a lung cancer diagnosis and continue to smoke during treatment although doing so adversely affects treatment response, quality of life, and survival time. While authoritative bodies recommend that tobacco use be addressed in lung cancer care, few patients receive effective treatment. The coordinated multidisciplinary model of care delivery, in which patients, their caregivers, and key specialists concurrently develop evidence-based care, offers an ideal setting to integrate high quality cessation treatment. To assess the need for and acceptability of cessation services, we surveyed patients about their smoking status, interest in quitting, and willingness to participate in a clinic-based cessation program.
Methods:
The study was conducted in the Multidisciplinary Thoracic Oncology Program at Baptist Cancer Center, Memphis TN. One-hundred eight consecutive new patients, seen between 7/31/13 and 9/24/14, completed a social history questionnaire. From this history, we extracted data related to sociodemographic characteristics (age, gender, race, marital status), smoking status, age of smoking initiation, and tobacco dependence (using the Heaviness of Smoking Index, consisting of cigarettes smoked per day and time of first cigarette of the day). Current smokers reported their level of interest in quitting, and how likely they would be to participate in a cessation program (‘I would not participate’; ‘I might participate but am not sure’; ‘I would participate’). Chi square tests were used to compare characteristics of those who would participate in the stop-smoking program vs. those who would not or were unsure whether they would participate.
Results:
Average age of patients was 65 years (range: 29-91), 41% were men, 58% were white, 39% black, and 15% had graduated college. Patients’ cancer stage broke down to stage I (16%), stage II (9%), stage III (18%), stage IV (28%), and undetermined (29%). 84% of patients had ever smoked cigarettes, 35% currently smoked, and 11% had quit smoking within the past year. Among current smokers, 71% (n=27) were “very interested” in quitting smoking in the next month and of these, 74% reported that they would be willing to participate in a smoking cessation program in the clinic. Willingness to participate in a cessation program was associated with greater interest in quitting (χ[2][1]= 13.3, p=.0003), but was not associated with sociodemographic characteristics, cancer stage, or smoking-related characteristics (amount smoked, age at smoking initiation, or dependence).
Conclusion:
Nearly half (46%) of patients in a community-based multidisciplinary thoracic oncology program were current cigarette smokers or had quit within the previous year, indicating a considerable need for cessation and relapse-prevention support. Encouragingly, a majority of current smokers were highly motivated to make a quit attempt in the next month, and most indicated that they would take advantage of a clinic-based cessation program. Willingness to participate in a cessation program was similar across a broad range of sociodemographic, cancer stage, and nicotine dependence levels. There is considerable need for, and interest in, smoking cessation services in the setting of community-based multidisciplinary lung cancer care.
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ORAL 27 - Care (ID 123)
- Event: WCLC 2015
- Type: Oral Session
- Track: Advocacy
- Presentations: 1
- Moderators:M.N. Mountain, J. Freeman-Daily
- Coordinates: 9/08/2015, 10:45 - 12:15, 708+710+712
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ORAL27.01 - Bridging the Quality Chasm in Lung Cancer Care: Stakeholder Perspectives on Multidisciplinary Care in a Community Hospital Setting (ID 848)
10:45 - 10:56 | Author(s): K.S. Roark
- Abstract
- Presentation
Background:
The prevailing patient care model for lung cancer involves serial referrals among multiple clinical specialists. This practice may cause delays in diagnosis and treatment, patient/caregiver confusion and anxiety, poor communication among physicians, and diminished opportunities for patients to receive evidence-based care. The multidisciplinary care model may rectify these problems with the serial model, and thereby improve the quality and outcomes of care. However, the value of the multidisciplinary care model has not been objectively established. We collected the perspectives of key stakeholders on the 2 models of care. We sought to: examine the perceived strengths and weaknesses of each model; uncover potential barriers to establishing an effective multidisciplinary care program; and establish meaningful benchmarks with which to measure care delivery in both models. This work preceded a prospective comparative effectiveness study of the 2 models of care.
Methods:
We conducted 21 focus groups, involving 106 subjects (22 patients, 24 caregivers, 9 nurses, 8 hospital administrators, 4 executives of health insurance companies, and 39 physicians). The physicians included groups of medical and radiation oncologists, hospitalists, pulmonologists, thoracic surgeons, and primary care physicians. Patients had received care for a confirmed or suspected lung cancer in the Baptist Memorial Health Care System within the preceding 6 months. Disease stage ranged from early, with curative-intent treatment, to advanced-stage with palliative-intent care. Providers may or may not have had personal experience of the multidisciplinary model. We used verbatim transcripts of the audio recordings and field notes to analyze the content of each focus group session using Dedoose Software. We identified recurring themes and variants within and across the various stakeholder groups.
Results:
Several overlapping themes emerged. There was a perception that the multidisciplinary care improved physician collaboration, care coordination, accuracy of diagnosis, concordance with treatment recommendations, timeliness of care, efficiency of care-delivery, and patient satisfaction. Potential obstacles to successful implementation of the multidisciplinary care model included problems with physician reimbursement, the duration of the patient-physician interaction, and acceptability/integration of the model within the current health care infrastructure. These concerns were especially prevalent among physicians. Overcoming these barriers would require physician and patient education, efficient use of electronic medical records, and improving general awareness about the multidisciplinary care model. Identified evaluative benchmarks included measures of patient/caregiver experience and satisfaction, survival rates, timeliness of care, the quality of patient-physician communication, consistency of recommendations among physicians, and the adequacy of consultation times.
Conclusion:
The stakeholders in lung cancer care had broadly overlapping beliefs about optimal care delivery for lung cancer. However, they also had different expectations, and motivations. These competing factors have the potential to influence perceptions about the quality, efficiency, and effectiveness of lung cancer care delivery. Patients, caregivers, clinicians, administrators, and third-party payers were in favor of the multidisciplinary model for lung cancer care. However, key barriers must be addressed for optimal implementation. Meaningful stakeholder input is essential to improving the quality of lung cancer care.
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P1.10 - Poster Session/ Advocacy (ID 228)
- Event: WCLC 2015
- Type: Poster
- Track: Advocacy
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.10-002 - Lung Cancer Patients' Perspectives on Multi-Disciplinary Care in a Community Setting (ID 2183)
09:30 - 09:30 | Author(s): K.S. Roark
- Abstract
Background:
Lung cancer causes 27% of all cancer deaths in the United States, with very modest improvement in patient survival in the past 30 years. In addition to cancer biology, adverse patient factors such as cumulative age- and tobacco-related co-morbidities, and care-delivery factors such as the need for multiple physician involvement, contribute to the paucity of progress. The standard serial model of care, involving sequential referrals to specific care providers, if not carefully coordinated, may delay care and enable discordance between patient needs and provider priorities. The multidisciplinary model, widely touted as potentially superior, has never been rigorously evaluated. Leading up to a comparative effectiveness study of the serial and multidisciplinary care models, we closely examined patient experiences with lung cancer care delivery.
Methods:
We conducted a qualitative study, in 5 focus groups of 22 patients (10 males/12 females; 15 White/7 Black) receiving care within the previous 6 months for confirmed or suspected lung cancer at a community-based hospital, the Baptist Memorial Health Care System. Stage distribution was: 6 stage I lung cancer, 2 stage II, 3 stage III, 3 stage IV, 5 undetermined; 3 patients had a non-lung primary malignant lung lesion. A standardized script was used to ensure consistency of questions across all focus groups. Saturation of emergent themes determined the number of focus groups conducted. We used verbatim transcripts and field notes to analyze the content of each focus group, and Dedoose Software to identify recurring themes and variants.
Results:
Patients perceived that the multidisciplinary care approach enabled more timely care-delivery, better physical collaboration, improved patient-physician communication, and reduced redundant testing. Use of a nurse navigator in this model also helped decrease confusion, stress, and anxiety associated with care-coordination. There was a perception of the multidisciplinary model as providing a ‘one-stop shop’, a central point of contact that reduces the amount of travel and coordination required between multiple specialists. Among those patients who had prior encounters with serial care, some had experienced insensitive disclosure of diagnosis, poor physician communication, redundant testing, delays in diagnosis and treatment, misdiagnosis, and mistreatment. Patients involved in serial care were also more likely to seek a second opinion after initial diagnosis. The multidisciplinary care model was believed to provide multiple opinions in one visit.
Conclusion:
Lung cancer patients strongly preferred the multidisciplinary model of care, perceiving it to be more patient-centered and efficient than serial care. These data provide useful information on important patient-centered benchmarks that should be incorporated into rigorous comparisons of the effectiveness of these two care delivery models. Additional work is needed to examine barriers to program development through meaningful input from other key stakeholders, such as healthcare providers, institutional administrators, third party payers, and healthcare policymakers.
