Early results showed that a new care delivery model improved breast cancer care, according to a poster presentation at this year’s Oncology Nursing Society (ONS) Annual Congress.

The 4R Care Sequence® is a one-page, multimodality, personalized care project plan that is used by the care team to plan and deliver care. The 4 Rs in the title represent the right information, care, patient and time. It incorporates recommendations for patient-centric care pathway plans from the Institute of Medicine, Medicare’s OCM and NCCN guidelines, which include multi-modality planning from diagnosis to survivorship that specifies the clinical team, identification of therapy and side-effects and supportive care.

“The 4R model provides a roadmap for the patient and also for the patient’s care team,” said Janeen Bazan, RN, OCN, BSN, lead author of the poster and an oncology nurse navigator from Advocate Sherman Hospital, during the presentation. “It’s very helpful in time management for the patient.”

To understand how the 4R Care Sequence® plans impacted care, researchers surveyed 77 patients with stage 0-3 breast cancer from September 2019 to August 2020 at Advocate Sherman Hospital. Of the patients, 28 received 4R Care Sequences® and 49 received a baseline control model.

A survey given to all patients asked whether or not the patients’ care provider instructed them to do certain activities. The researchers found that all patients who received the 4R Care Sequences® were more likely to have been counseled in 8 areas:

Getting an immunization (flu, pneumonia, shingles) before starting cancer treatment (52% of baseline cohort, 70% of 4R cohort)

Seeing a dentist before starting cancer treatment (13% of baseline cohort, 33% of 4R cohort)

Getting a genetic counseling appointment before surgical decision (39% of baseline cohort, 44% of 4R cohort)

Managing weight if over or under weight (16% of baseline cohort, 26% of 4R cohort)

Getting a nutritionist consult about how to eat during cancer treatment (15% of baseline cohort, 26% of 4R cohort)

Getting emotional support (46% of baseline cohort, 52% of 4R cohort)

Keeping up appointments with primary care for routine care (67% of baseline cohort, 75% of 4R cohort)

Caring for a chronic disease (43% of baseline cohort, 46% of 4R cohort)

Early results showed that the use of the 4R Care Sequences® improved the referrals of recommended breast cancer care. Due to the small sample size, Bazan reported that the results are not statistically significant, however, the trend is still encouraging. The researchers’ plan to continue using 4R Care Sequences, collecting patient surveys and assessing their impact.

“I’m very excited to look at our next data and share with other programs, and hopefully bring in other cancer types,” Bazan said.

Bazan J. Early results: Impact of 4R (Right Info / Care / Patient / Time) care sequence plans, provided to patients by oncology nurses, on timing and sequence of guideline recommended care. Presented at: Oncology Nursing Society 46th Annual Congress; April 20, 22, 27, and 29, 2021. ePoster 1567. 

https://ons.confex.com/ons/2021/qi/eposterview.cgi?eposterid=1567

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Early research showed an improvement in provider recommendations of care for patients with breast cancer based on eight guideline metrics.

A New Care Delivery Model May Positively Impact Care Referrals for Patients with Breast Cancer

Although nursing and pharmacy staff responded positively to a new Chemotherapy Education Policy mandating pre-treatment patient education and defining standards for the process, it failed to meet its goals of increasing the quality of that education and decreasing the instances of patients receiving education on the day of their first dose, according to a poster presentation at this year’s Oncology Nursing Society Annual Congress.

The researchers aimed to standardize and increase the quality of the pre-treatment chemotherapy education process and to decrease the amount of patients receiving “same day chemo teaches,” or learning about their treatment on the day of their first dose, to reduce patient anxiety and increase understanding.

“At our National Comprehensive Cancer Network (NCCN)-designated ambulatory oncology center, patients are educated about their treatment by both nurses and pharmacists,” said Martha Read, MSN, RN, OCN, of the Seattle Cancer Care Alliance, during the presentation. “There was a lack of consistency in the educational content covered, the materials that were given to the patient and when the education took place.”

To reach these goals, a chemotherapy education committee comprised of providers, pharmacists, nurses, supportive care and patient education services developed a policy to standardize the education process, with identified benchmarks. These changes defined standards for educational materials and acceptable online resources, educational content (common side effects, treatment schedule, supportive care, when to contact team), documentation and education scheduling of pre-treatment and a 3-day post-treatment follow up call from the clinic nurse.

After implementing the new education policy, the percentage of patients receiving chemotherapy education on the same day as their first day of treatment dropped from 33% to 28%. While the number went down, and nursing and pharmacy staff responded positively to the changes, Read explained, post-intervention, “same day chemo” teaches still happened between 41-48% of the time.

“Our next steps are to identify the barriers to providing pre-treatment chemotherapy education prior to the first day of treatment,” said Read. “And also, to provide additional education to reinforce the standards that were set in our policy.”

The researchers also plan to evaluate the implementation of the three-day follow up call obtaining patient feedback on the education experience.

Read M. Improving Chemotherapy Patient Education through Standardization: Does a Policy Help? Presented at: Oncology Nursing Society 46th Annual Congress; April 20, 22, 27, and 29, 2021. ePoster 1536. https://ons.confex.com/ons/2021/cp/eposterview.cgi?eposterid=1536

While staff at a NCCN-designated oncology center responded positively to a new Chemotherapy Education Policy, its implementation did not increase the quality of education or decrease the incidence of “same day chemo teaches,” according to data presented at the ONS Annual Congress.

Jamie Cesanek

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A New Care Delivery Model May Positively Impact Care Referrals for Patients with Breast Cancer

Chemotherapy Education Policy Fails to Increase Education and Decrease ‘Same Day Chemo’ Teaching