Providers screen cancer patients for quality of life concerns

Living with cancer isn't easy. The disease and treatment exact a tremendous toll on patients and their families.

For the past three years, 12 cancer centers in Chicago have been using a screening program that gives providers and patients resources aimed at better managing the disease and coping with the stress.

"We wanted to help people know about their resources and have access to resources that better their quality of lives," said Michael Hennessy, CEO of the Coleman Foundation. "We have a very bad case of Second City ideals—you have to go to the Mayo Clinic or Johns Hopkins if you have specific types of cancer. But we wanted to make sure that the best possible quality of care was all here in Chicago," he added.

FB01RDeveloped in 2015, the screening tool asks patients questions about an array of topics, including child-care issues, food insecurity, sleeping problems and depression. It was created by clinicians who are part of the collaborative, which includes roughly 170 doctors, nurses, advanced practitioners and social workers across the city. They relied on national, evidence-based guidelines from the American Society of Clinical Oncology and the National Comprehensive Cancer Network around support services for cancer patients.

Rush University Medical Center was an early adopter. Cancer patients fill out the survey when they visit their oncologist for the first time and then take it again whenever there are changes in their condition. Patients take the survey on average about twice per year, said James Gerhart, assistant professor of behavioral sciences at Rush.

Patients largely complete the survey on paper before their appointment and the results are logged into the electronic health record by a nurse or medical assistant while he or she discusses the responses with the patient. "We want the nurse to initiate the conversation," Gerhart said.

Since December, Rush has enabled some patients to fill out the survey on a tablet and the results are automatically uploaded into the medical center's EHR. Rush hopes by the end of the year all patients will fill out the survey electronically to reduce administrative burdens on clinicians.

The tool analyzes the responses and flags areas where follow-up is recommended. For example, if a patient responds to the survey that he is experiencing pain, the oncologist may bring up palliative care.

The tool also has support documents for clinicians to refer to if a patient answers "yes" to a certain concern. If a patient responded that she is worried about child care, the follow-up document advises the clinicians to not only ask what the specific concerns are, but offers suggestions for appropriate patient resources.

If a patient is struggling to discuss the cancer diagnosis with her child, the document links to patient handouts from the American Cancer Society and the National Institutes of Health about how family members can talk to children about the disease.

Rush has conducted about 8,000 screenings, which include patients who complete surveys more than once. Across all 12 sites that use the tool, including Loyola University Medical Center and Stroger Hospital of Cook County, more than 15,000 screenings have been conducted since 2015.

Gerhart said the collaborative has preliminary evidence that shows patients report less stress the more often they fill out the survey.

Providers have also reported that the patients who fill out the survey call the clinic less frequently with follow-up questions, said Christine Weldon, executive director of the Center for Business Models in Healthcare, a research firm that oversees the tool.

Although the tool is now largely used by providers in the Chicago area, one Quebec provider is using it. The survey, available in Spanish, Mandarin, French and Polish as well as English, is free of charge to cancer providers both nationally and in other countries.