implementation sCienCe/Knowledge translation

561 | Does the Distress Assessment and Response Tool (DART) Save Lives? Evaluating the Impact of DART on Cancer-related Survival at the Princess Margaret Cancer Center

Bryan Gascon1_{, Yvonne Leung}2,3_{, Osvaldo Espin-Garcia}4_,

Gary Rodin1,3_{, Madeline Li}1,3

1_{Department of Supportive Care, Princess Margaret Cancer Centers,}

University Health Network, Toronto, Canada; 2_{de Souza Institute,}

University Health Network, Toronto, Canada; 3_{Department of}

Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; 4_{Department of Biostatistics, Princess Margaret Cancer}

Center, University Health Network, Toronto, Canada

Background/rationale or Objectives/purpose: Symptom management is

an integral component of cancer care, but evidence demonstrating clin- ical benefits of symptom screening is limited. The Distress Assessment and Response Tool (DART) at the Princess Margaret Cancer Centre (PM) integrates electronic symptom screening with triaged interprofes- sional clinical assessment. DART has been administered routinely in all clinics at PM since 2010. The impacts of DART on clinician response and cancer-related survival were evaluated.

Methodology or Methods: The study population consisted of can-

cer patients who attended PM between 2010–2014. Data on clinician response to DART-identified symptoms, sociodemographic, medical, and cause-of-death were extracted from hospital and provincial cancer registries. Propensity for DART completion, accounting for age, sex, marital status, income, cancer type and stage, were incorporated into inverse probability treatment weighting (IPTW) analyses to estimate the effect of DART completion on overall cancer-related survival.

Impact on practice or Results: A total of 1,329 charts were reviewed

for randomly selected patients who scored ≥ 4 on select physical and emotional DART symptoms between 2011–2014. Pooled clinician as- sessment and intervention rates were 65% and 48%, respectively. Over the study period, 43% (n = 20,792) of patients completed DART at least once. Over the same period, there were 13,142 cancer-related deaths amongst all PM patients. After propensity score analysis, DART non-completion was associated with lower cancer-related survival (HR 4.0; 95% CI 3.9–4.1) than those who completed DART.

Discussion or Conclusions: DART completion was associated with

better overall survival in a large heterogeneous cohort of cancer pa- tients. Further exploration is required to determine the contribution of clinician response rates to the potential mechanisms underlying this association.

656 | Development and piloting of a patient centered, risk-stratified supportive care clinical pathway for Head & Neck cancer patients in a Chilean cancer center

Loreto Fernandez Gonzalez1_{, Loreto Moreira}2_{, Cesar Casanova}2,3_,

Piero Bettoli2

1_{Social and Behavioral Health Sciences, Dalla Lana School of}

Public Health, University of Toronto, Toronto, Canada; 2_Instituto

Oncológico Fundación Arturo Lopez Perez, Santiago, Chile;

3_{Universidad Mayor, Santiago, Chile}

Background/rationale or Objectives/purpose: Unmet supportive care

needs for head and neck cancer (HNC) patients are well documented. Clinical pathways (CP) intend to standardize personalized multidis- ciplinary care, optimize resources, and ensure continuity of care. We developed and piloted a HNC-CP, focused on high-risk patients early identification for supportive care.

Methodology or Methods: CP was designed as a quality improve-

ment initiative in a private non-profit cancer center in Santiago, Chile. Process included 1) literature review 2) assessment of patients records to identify supportive care needs 3) development of a risk profile according to treatment plan and impact on QoL 4) institutional resources assess- ment. Piloting began on October 2017. Implementation evaluation was conducted following Proctor et al. in July 2018.

Impact on practice or Results: CP consists on a single-visit com-

prehensive assessment (CA) by psychologist, nutrition specialist and speech-language pathologist. All patients should have at least a pre and posttreatment CA. High-risk profile was defined as combination of nu- tritional/functional low status, socioeconomic vulnerability and multi- modal treatment. High-risk patients are followed up during and after treatment. The CP was piloted with 33 patients. 33% had severe mal- nutrition at first CA, 24% presented significant psychosocial and eco- nomic stressors. 21% met high-risk criteria. Regarding implementation, acceptability and appropriateness were high, with disparate physicians’ adoption, along with institutional barriers for joint multidisciplinary assessment.

Discussion or Conclusions: CP is a useful device for identifying and

managing high-risk HNC patients in a developing country. Patients deal with needs and toxicities requiring ongoing supportive care. Despite high acceptability and appropriateness, HNC supportive care faces implemen- tation difficulties related to physician referrals and institutional barriers.

536 | How to do PROs in cancer care? - Tailoring process of implementation strategies for PRO assessments in cancer routine care

Mirja Gianna Goerlach, Theresa Schrage, Holger Schulz, Christiane Bleich

University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

Background/rationale or Objectives/purpose: The successful imple-

mentation of patient-reported outcomes (PROs) in clinical routine faces many challenges, first and foremost the lack of consideration thereof in the patient care process. The aim of this study is to design suitable implementation strategies for improving the effectiveness of PRO as- sessment in inpatient and outpatient cancer routine care.

Methodology or Methods: Interviews with oncological patients

(N = 28) and medical staff (N = 4) as well as focus groups with medical staff (N = 18) across five different oncological clinics were conducted. On the basis of these, qualitative content anal- ysis revealed relevant barriers and facilitators for implementation of PROs in cancer care. These were subsequently presented in an expert discussion culminating in the development of strategies and a model of implementation following the principles of the Medical Research Council and the RE-AIM Framework.

Impact on practice or Results: Four PRO implementation strategies

were developed to fit the demands of the five different oncological clinics.

Those were: 1) a concise questionnaire, 2) electronic input into a soft- ware with direct interface to patients’ records, 3) software and process training for medical staff and 4) guidance on pathways for further care.

Discussion or Conclusions: Key to improving the effectiveness of

PRO assessment in the time-critical clinical environment is the utili- zation of easy-to-use, electronic PRO questionnaires directly linked to patients’ records thereby improving consideration of PROs in patient care. In order to validate the effectiveness of this implementation pro- cess further, an evaluation of implementation following a stepped wedge design will be conducted.

395 | Using Survivorship Care Plans as a Transition Tool from the Cancer Centre to Primary Care

Brittany Mutsaers1_{, Carrie Liska}2_{, Justin Presseau}3,4,1_{, Gail Laroque}2_,

Cheryl Harris5_{, Kednapa Thavorn}5_{, Marie-Hélène Chomienne}6_,

Sophie Lebel1

1_{School of Psychology, University of Ottawa, Ottawa, Canada;} 2_{Wellness Beyond Cancer Program, The Ottawa Hospital, Ottawa,}

Canada; 3_{Clinical Epidemiology Program, Ottawa Hospital Research}

Institute, Ottawa, Canada; 4_{School of Epidemiology and Public}

Health, University of Ottawa, Ottawa, Canada; 5_{Ottawa Hospital}

Research Institute, Ottawa, Canada; 6_{C.T; Lamont Primary Health}

Care Research Centre, University of Ottawa, Ottawa, Canada

Background/rationale or Objectives/purpose: Survivorship Care Plans

(SCPs) are intended as a tool for cancer survivors and primary care provid- ers (PCPs) to facilitate survivors’ transition from active cancer treatment to follow-up in primary care. Barriers to the uptake of SCPs in real-world settings may contribute to the mixed research findings on the outcomes of SCP use. The objectives of this study are to: a) identify barriers and enablers perceived to influence SCP use among cancer survivors and PCPs in urban, rural, and remote settings; and b) develop recommendations for addressing identified barriers and maximizing enablers to SCP use.

Methodology or Methods: We aim to recruit forty PCPs and cancer

survivors to participate in semi-structured interviews developed using the Theoretical Domains Framework (TDF) to systematically identify barriers and enablers to SCP use. Participants will be recruited through the Wellness Beyond Cancer Program at The Ottawa Hospital, Cana- da. Content and thematic analysis will be conducted. The results will be used to develop recommendations for implementing SCPs into practice.

Impact on practice or Results: Coordinating follow-up care between

cancer specialists and PCPs is important for ensuring that cancer survi- vors receive adequate follow-up care. While SCPs are recommended to facilitate this transition, guidance on the optimal use of SCPs in practice is needed.

Discussion or Conclusions: Preliminary results will be present-

ed. Overall, developing recommendations for implementing SCPs in diverse settings is important for evaluating the impact of SCPs on pa- tient outcomes. Adequate evaluation will then help decision makers determine if benefits gained from SCPs justify the additional time and resources required.

328 | What Canadian Association of Psychosocial Oncology (CAPO) members want from the Research Advisory Committee? A survey of members’ research needs and priorities

Sophie Lebel

University of Ottawa, Ottawa, Canada

Background/rationale or Objectives/purpose: Objectives: The Cana-

dian Association of Psychosocial Oncology (CAPO) seeks to foster interdisciplinary excellence in psychosocial oncology research, edu- cation and clinical practice. The CAPO Research Advisory Commit- tee specifically works to support excellence in psychosocial oncology research by encouraging research in diverse areas. To guide its future

efforts, the Research Advisory Committee is documenting the current research needs of CAPO members and their perspectives on the Com- mittee’s main responsibilities.

Methodology or Methods: Methods: Current and past CAPO mem-

bers will be asked to complete a brief online survey in May 2019 via personalized emails, the CAPO weekly newsletter, and the CAPO web- site. In addition to descriptive information about their professional roles and current involvement in research, members will be asked about: a) the kinds of training they need to support their research efforts, b) the best medium to receive this support, c) responsibilities of the CAPO Re- search Advisory Committee towards CAPO members, and d) whether they support the creation of a national Psychosocial Oncology Research Network to facilitate multi-centre studies and collaborations. Data will be analyzed using content analysis and descriptive statistics.

Impact on practice or Results: Results: Final survey results will be

presented at the annual meeting.

Discussion or Conclusions: Conclusion and clinical implications: The

results of this survey will inform CAPO and other Psychosocial Oncolo- gy Societies about ways they can meet the needs of their members. In the context of an increasingly competitive research environment, research committees play an important role in supporting the efforts of their members and building the evidence-base for practice.

96 | Implementation & Upscaling: Enhancing national implementation of evidence-based innovations to improve quality of life of cancer patients in the Netherlands

Chantal Lammens, Vanessa Bouwman, Myrle Stouten Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands

Background/rationale or Objectives/purpose: Too many evi-

dence-based interventions (EBI’s) have been developed in the field of psycho-oncology of which the availability doesn’t reach beyond the re- search phase and site. EBI’s are not automatically adopted and implement- ed, let alone available on a nationwide level . A diversity of barriers and en- ablers can be defined . Implementation and upscaling is often seen as the responsibility ‘of the field’, but what is practically needed, how to arrange this on a structural basis and who can be held accountable?

Methodology or Methods: Starting with a proof of principle, five di-

verse EBI’s were selected. Tailor-made nationwide implementation plans were developed, carried out and monitored. With lessons learned from this proof of principle, an ‘Upscaling guide’ is developed. This guide can be used for current and yet to develop EBI’s, to optimize their upscaling process and enhancing nationwide implementation/upscaling and avail- ability in the Netherlands

Impact on practice or Results: The upscaling guide, includes an

‘upscaling-model’ and pre-conditions for upscaling, such as reimburse- ment, education of (end)users, time, disentangle intervention and re- search. These pre-conditions need to be addressed to enhance successful upscaling of EBI’s in the field of psycho-oncology in the Netherlands.

Discussion or Conclusions: Important lessons learned from

this proof of principle is that successful implementation/upscaling of an EBI starts before the intervention itself is (fully) developed. It takes co-cre- ation and teamwork from the start, in which it is essential to bring peo- ple with different areas of expertise together: expertise in (mental) health- care, research, but also regarding reimbursement and (local and/or national) law & regulations. Upscaling takes time, tenacity and continui- ty. Those who are able to build a network, can go further

95 | ‘Psychosocial training and research needs in oncology health care professionals working in hospitals.’

Veronique Gerits1_{, Ellen Daly}1_{, Angelique Verzelen}1_{, Sabien Bauwens}1,2_,

Eva Jacobs1,3_{, Wim Distelmans}2,1_{, Lieve Vanderlinden}4

1_{Cédric Hèle Institute, Mechelen, Belgium;} 2_{Universitair Ziekenhuis}

Brussel, Brussel, Belgium; 3_{Forum Palliatieve Zorg, Wemmel, Belgium;} 4_{Kom op tegen Kanker, Brussel, Belgium}

Background/rationale or Objectives/purpose: The Cédric Hèle institute

(CHi) - Flemish institute of Psychosocial Oncology - conducted an ex- ploratory research to gain insight in (1) the needs and bottlenecks ex- perienced by oncology health care professionals concerning education in psychosocial oncology; (2) relevant research themes in psychosocial oncology; (3) the needs and bottlenecks experienced by oncology health care professionals concerning the implementation of scientific research and (4) how to bridge the gap between research and clinical practice.

Methodology or Methods: CHi performed an online questionnaire that

was sent by e-mail to all members of the online CHi- community working in hospitals. 1045 e-mails were sent with a 19% (n = 201) response rate. The questionnaire consisted of 3 parts. Training and research needs were explored in part one and two. Professional data were collected in part 3. Each part of the questionnaire consisted of open and closed questions.

The results of the closed questions will be analysed and presented in pie and bar charts. For the qualitative data, thematic analysis will be used to draw conclusions.

Impact on practice or Results: The data collection was completed in

February 2019. Results will be available by June 2019.

Discussion or Conclusions: CHi will use the results of this study to

keep their current training offer up to date and adapted to the needs of oncology health care professionals.

The insights of this study will lead to a better knowledge and im- plementation of good practices in order to continue to bridge the gap between psychosocial oncology research and clinical practice in hospital settings.

l. palliative Care

742 | Dying with Dignity in final days-Patients and Family members preferences

Saranya Sundarraju1_{, Veenavani Nallepalli}2_{, Karthikeyan Perumal}3_,

Prasanna Govindarajan4_{, Krishna kumar Rathnam}5_{, Vigneshwaran K}5 1_{Annamalai University, Chidambaram, India;} 2_{Sri Balaji college of}

Physiotherapy,BIHER, Chennai, India; 3_{Kamakshi memorial Hospital,}

Chennai, India; 4_{UNIVERSAL Hospital, Salem, India;} 5_Madurai

meenakshi hosptal and research center, Madurai, India

Background/rationale or Objectives/purpose: As comfort measures in-

tensify, so should the support provided to the dying patient’s family. Af- ter the patient’s death, palliative care focuses primarily on bereavement and support of the family. Lack of effective, patient- family communi- cation can increase the psycho social distress leading to poor Quality of death, where the dying patients’ true feelings, concerns and needs (Psycho-Social-Spiritual) are unaddressed.To develop a study which purports a meaningful conversation for terminal ill cancer patients and their family members,to squeeze out the final drops of life like their medical preferences, medical choices, desires and patients favorite place to spend their final days that will adhere to the rights of the patient to painless death. This study will be a torch bearer in Indian health care system that contributes to formulate common guidelines among all health care system to promote dignity among dying patients

Methodology or Methods: A convergent parallel mixed methods

design involving both Qualitative and Quantitative methods.Patient Dignity inventory (PDI) chochinov et al 2005 is used to measure the level of dignity of patient. Qualitative Data were analyzed using content analysis and Quantitative analysis are analyzed using appropriate statis- tical packages. A total of 60 palliative care patients and their care takers were recruited from five inpatient palliative care units in five districts of Tamil Nadu including both urban and rural patients from Chennai, Pondicherry, Tiruvarur, Trichy and Madurai.

Impact on practice or Results: From the results of the study it is in-

ferred that the level of dignity of patients dying in palliative care was found to be very poor. The Qualitative analysis results gave raise to some of the important emergent themes like enhanced respect of self in decision making, promotion of effective interaction about their needs, unfinished business and patient preferences of staying at home during death, pro- moting legacy and willingness to die without any life stabilizing devices

Discussion or Conclusions: This study will help promote the impor-

tance of the concept of dignity among health care professionals, nurses and other workers in the field of palliative care who emphasise the im- portance of managing symptoms alone. The study also claims address- ing psycho social and spiritual needs are equally important along with treating physical symptom. As the study discusses the aspects of death it is culturally sensitive.

724 | New Frontiers for AYA Oncology: Developing an Integrated AYA Clinic between Palliative Care and Psychiatry at Princess Margaret Cancer Centre

Pamela Mosher1,2_{, Ahmed Al-Awamer}1

1_{Princess Margaret Cancer Centre, Toronto, Canada;} 2_{Sick Kids}

Hospital, Toronto, Canada

Background/rationale or Objectives/purpose: Identify AYA patients’

unique palliative care needs.

Describe the challenges of integrating palliative care in the AYA population

Outline an approach to communicating with AYA about palliative care issues

Background: Early adolescence and young adulthood is a time of de- veloping personal identity, relationships, careers and financial inde- pendence. Individuals in this age group may have limited exposure to adverse life experiences. Despite strong calls for early integration of palliative and psychosocial care in the Adolescent and Young Adult (AYA) cancer population, significant gaps still exist in the delivery of palliative and psychological care for this group. Little is known about AYA patients’ end of life preferences or their psychological experiences while receiving palliative care. To address some of these unknowns, our interdisciplinary team developed a new integrated palliative and psy- chosocial clinic for AYA patients.

Methodology or Methods: Over 100 AYA patients and families have

been assessed by an attending palliative care physician and a psychia- trist together in our new clinic. Trainees from multiple disciplines rotate in the clinic. We have identified important AYA clinical needs, interven- tions, and barriers to care.

Impact on practice or Results: Early access to consolidated palliative

and psychosocial care is helpful for patients, families and oncology teams.

Discussion or Conclusions: We will present our experience in work-

ing with this complex patient population and several lessons learned. More research and clinical models are needed to provide integrated sup- port to AYA’s requiring palliative care. Using age-appropriate interven- tions and advance care planning tools may be helpful for palliative care clinicians to address AYA patients’ needs.

692 | Palliative care transitions from acute care to community-based care: A systematic review

Stephanie Saunders1_{, Tieghan Killackey}2_{, Allison Kurahashi}1_,