Radiation Therapy Oncology Group RTOG Semi-Annual Meeting

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Urban Latino African American Cancer (ULAAC) Disparities Project. Michael L. Steinberg, MD, FACRPrincipal InvestigatorDavid Huang, MDCo-InvestigatorNicole Harada, CCRC, CCRPClinical Trials Coordinator/Data Manager. Part Updates. Authoritative Navigation Clinical TrialsTelesynergy/TelemedicineQuality AssurancePublications, Articles, and PresentationsWork in Progress.

Presentation Transcript

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Radiation Therapy Oncology Group (RTOG) Semi-Annual Meeting Tampa, Florida February 3, 2007

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Urban Latino African American Cancer (ULAAC) Disparities Project Michael L. Steinberg, MD, FACR Principal Investigator David Huang, MD Co-Investigator Nicole Harada, CCRC, CCRP Clinical Trials Coordinator/Data Manager

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Component Updates Administrative Navigation Clinical Trials Telesynergy/Telemedicine Quality Assurance Publications, Articles, and Presentations Work in Progress

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Administrative Component

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Our Partners Centinela Freeman Regional Medical Center Michael L. Steinberg, MD, FACR, Principal Investigator David Khan, MD, Co-Investigator David Huang, MD, Co-Investigator RAND Corporation Allen Fremont, MD, PhD Nell Forge, PhD , Co-Investigator USC Norris Comprehensive Cancer Center Oscar Streeter, MD , Co-Investigator UCSF Comprehensive Cancer Center Mack Roach, MD , Co-Investigator

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Infrastructure Project Staff: Debbie Karaman, MPH, Community Health Educator Erika Cobb, Program Administrative Assistant Herschel Knapp, PhD, MSSW Nicole Harada, Clinical Trials Coordinator Susan Richardson, RN, Oncology Nurse Keith Andre, MA, Project Administrator

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Community Liaison Community Advisory Board Meets two times each year Investigators' Meeting Meets two times each year Medical Advisory Board Meets 6 times each year

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Navigation Component

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Our Patients

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Cancer Disparities Research Partnership (CDRP) Patient Navigation Model Patient Navigation Rehabilitation Outreach Cancer Diagnosis Resolution Abnormal Finding Abnormal Results Diagnosis Treatment Conclude Navigation Freeman, et.al., Cancer Practice , 1995. Determination Treatment Abnormal outcomes Conclude Navigation

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Patient Navigator Training Program The 9-hour guide instructional class underscores: Investigating and executing assets for patients in an auspicious manner Listening empathetically and non-judgmentally Completing suitable records of all communications for the benefit of patient Empowering patients to self-advocate in the social insurance domain

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Training Program

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Active Navigators

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Reasons for Navigator Attrition

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Gender of Active Navigators

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Ethnicity of Active Navigators

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Cancer Survivor Status of Active Patient Navigators

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Patient Data

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Patients Offered Navigation By Project Year

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Ethnicity of Patients Offered Navigation

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Percentage of every Ethnicity Accepting Navigation * Small example estimate

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Percentage of Patients Accepting Navigation By Ethnicity

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Measuring the Effectiveness of Barrier Solution Identification Patient-particular obstructions to care are distinguished amid the patient admission directed by a pilot Records are kept up and evaluated to decide number of days to hindrance arrangement recognizable proof Barrier arrangement incorporates doling out a pilot (psychosocial boundaries) and distinguishing group assets (useful boundaries)

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Premise Barriers to care improve the probability that the patient won't have the capacity to agree to treatment and follow-up regimens Barriers to care improve the probability that the patient won't partake in a clinical trial Addressing hindrances to care will improve consistence and probability of clinical trials support

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6 Most Common Barriers

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Barriers to Care: Chart Audit

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Mean Number of Days to Barrier Solution Identification

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Percentage of Barriers Solutions Identified in One Day

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Clinical Trials

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Trials Open for Accrual

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Trials Closed to Accrual

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Patients Accrued to Trial

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Accrual to Trial by Ethnicity

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Clinical Trial Accrual/Navigation

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Telesynergy Telemedicine

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Telesynergy Usage Tumor Boards Meetings with accomplices and tutoring foundations Meetings with CDRP destinations

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Quality Assurance

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Instruments *Patient Satisfaction Survey *Cancer Post Treatment Survey *Clinical Trial Questionnaire Rand Process Instrument – In Process

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1. The patient guide was affable. 2. The patient pilot was delicate. 3. The patient pilot was conscious. 4. The patient pilot was benevolent. 5. The patient pilot was careful. 6. I esteemed working with the guide. 7. The instruction materials I got were useful. 8. Bolster administrations referrals addressed my issues. 9. I got money related data (if necessary). 10. I would prescribe this administration to others. Reaction: 5 point Likert Scale Strongly Agree = 5, Strongly Disagree = 1 N/An alternative offered on each question Patient Satisfaction Survey

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Sample technique Each month, 10% of patients are haphazardly chosen for phone pilot benefit fulfillment review.

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Q: Does the pilot's growth history anticipate understanding fulfillment? As it were: Do you need to have had growth keeping in mind the end goal to give viable tumor route?

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Navigators without a hx. of CA beat guides w/CA hx. on 60% of patient fulfillment measurements.

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Statistically Significant Differences Individual ANOVA test uncovered a factually noteworthy distinction on question 7 (as it were).

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Overall patient fulfillment surpasses 90% with pilot benefits paying little mind to guide's growth history ( p = .953). Note: 5-point Likert scale scores introduced as fulfillment rates

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Final Question on Survey Would you get a kick out of the chance to proceed with the Patient Navigator Program?  I might want to keep working with my pilot.  I might want to have an alternate pilot appointed to me.  I might want to end getting route.

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94.7% of patients overviewed continueed route. Pilot's CA hx. does not anticipate tolerant fulfillment ( X 2 : p = .329.)

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Provisional Findings Overall, there is no measurably noteworthy distinction in patient fulfillment when contrasting pilots who have had tumor with guides who have not had disease. As such: All assistance are great hands and 95% of patients were fulfilled and wished to proceed with route

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Further investigation pending gathering n Correlative examinations to investigate guide/persistent measurements: Navigator attributes : age, sexual orientation, training, race/ethnicity,marital status, number of patients Patient post-tx measurements : explored versus not-explored, age, sexual orientation, race/ethnicity, instruction, religion, conjugal status, pay, geology, treatment fulfillment, prosperity measurements: physical, social, enthusiastic, practical, otherworldly).

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Cancer Post-Treatment Survey Reason(s) for declining route Demographics Treatment fulfillment scale FACIT ( F unctional A ssessment of C hronic I llness T herapy) instrument Compares patients who acknowledged/rejected route administrations at four levels:

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Sample attributes 107 patients were offered route 45 (42.1%) acknowledged route 62 (57.9%) denied route

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Reasons for denying route 85% I am an autonomous individual 68% I have a strong family 47% I am a private individual 44% I have steady friend(s) 42% I am a profound/religious individual 23% Navigation appeared to be pointless 13% I was hazy on what the guide would do 8% The part of the pilot appeared to be meddling to me

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Demographics No noteworthy contrasts ( p > .05) Race Education Religion Marital status Living conditions Income

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Treatment Satisfaction No huge contrasts ( p > .05) on 8 of 9 measurements utilizing a 1 – 4 Likert scale (1 = never, 4 = continually): During my growth treatment, I had great correspondence with my care suppliers. Acknowledged route: 2.85 Refused navigation: 2.54 } ( p = .037)

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FACIT instrument Patient self-assessment multi-scale instrument Measures 5 territories of prosperity utilizing 5 point Likert scales (1 = not under any condition, 5 = in particular) Physical 7 questions Social/Family 7 questions Emotional 6 questions Functional 7 questions Spiritual 12 questions

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FACIT Scores No huge contrasts ( p > .05) on 3 of 5 scales: Physical Social/Family Spiritual

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FACIT Scores Emotional Well-Being Accepted route: 20.65 Refused navigation: 17.91 Functional Well-Being Accepted route: 21.85 Refused navigation: 17.13 } ( p = .025) } ( p = .012)

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Do Navigators Make a Difference in Acceptance of Clinical Trials? Challenges: Small n the truth of the quantity of patients qualified for clinical trial in a group doctor's facility procedure change required to guaranteed the early nearness of a guide in CT examinations

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Do Navigators Make a Difference in Acceptance of Clinical Trials? Preparatory impressions propose that early consideration of a pilot in dialogs with patients about clinical trials is related with an expansion rate of investment

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Do Navigators Make a Difference in Acceptance of Clinical Trials? Of patients qualified for a trial who have a pilot show at CT talks 80% acknowledge 20% decay n = 5 Only 1*/9 pts who declined had guide input * impression of non scope by protection (oversaw mind)

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"Will get nearer take after up" as essential explanation behind patient tolerating CT (navigator perception) Patients who acknowledged CT with a pilot exhibit at CT examinations gave as expressed purpose behind acknowledgment Of qualified patients who don't have a guide display at CT