Practitioners Describe Barriers to Patient-Centered Care in DLBCL

Barriers within oncology systems can impede patient-centered care coordination and delivery in those with relapsed/refractory diffuse large B-cell lymphoma (DLBCL). A study presented at the 2020 ASH Annual Meeting identified factors that impede individualized care in this patient population.

Between December 2019 and January 2020, 33 hematology/oncology healthcare professionals (HCPs) from two community oncology systems completed team-based surveys designed to assess barriers to quality care for patients with relapsed/refractory DLBCL; 52% of respondents (n=17) were medical oncologists/hematologists. The researchers also retrospectively audited electronic medical records (EMRs) of 75 patients with relapsed/refractory DLBCL to compare documented practice patterns with self-reported survey results.

Thirty-one of the participants engaged in audit feedback sessions, 55% of whom (n=17) were medical oncologists/hematologists. Action plans were developed based on survey insights and EMR findings. Additional surveys were completed before and after the audit feedback sessions, measuring changes in participants’ beliefs and confidence in care delivery.

Using a five-point Likert scale (0, extremely unlikely; 5, extremely likely), HCPs indicated a high likelihood of using prognostic scores (mean score, 3.8) and cell of origin (mean score, 3.9) to inform DLBCL treatment decisions. However, despite documentation of individual prognostic factors, only 30% of EMRs included the calculated International Prognostic Index (IPI) risk score and only 8% included cell of origin. No EMRs included an age-adjusted IPI, stage-modified IPI, or National Comprehensive Cancer Network IPI score.

Nearly half of HCPs (47%) reported that they engage in shared decision-making in up to 50% of their patients, with 63% noting that they ask the patient what role he or she would like to play in the shared decision-making process. However, fewer HCPs integrated other shared decision-making tools, such as using visual aids to communicate treatment benefits and risks (59%), referring patients to online education resources (53%), including the patient’s spouse and/or family members in decisions (47%), and discussing financial toxicity (38%).

The top HCP responses to the single aspect of care for relapsed/refractory DLBCL in greatest need for improvement in their systems were care coordination (34%), adverse event recognition and management (20%), individualizing treatment (16%), and prognostic scoring (14%). As part of their action plans, HCPs prioritized three practice behaviors to address with their clinical teams: (1) individualizing treatment decisions based on patient- and disease-related factors (40%); (2) improving communication during care transitions (40%); and (3) providing adequate patient education about treatment options and potential side effects (20%).

After audit feedback sessions, HCPs reported a shift in beliefs about collaborative care. Post-sessions, 54% of HCPs reported incorporating shared decision-making techniques into practice compared with 39% pre-sessions. Post-sessions, 54% of HCPs reported aligning treatment decisions with evidence-based guidelines compared with 29% pre-sessions.

“After participating in this quality improvement initiative, HCPs demonstrated improved commitment to team-based collaboration and increased confidence in delivering patient-centered care,” the researchers concluded.

Reference

Hagemeister FBB, Jacobson A, Carter JD, et al. Real-World Gaps in Chart Documentation and Patient-Centered Care Inform Team-Based Action Plans for Relapsed/Refractory DLBCL: Results from a Quality Improvement Study. Abstract 2517. Presented at the 62nd American Society of Hematology Annual Meeting & Exposition, December 2-11, 2020.