ABSTRACT
Introduction Early palliative care, delivered in oncology palliative care clinics (OPCCs) typically involves in-person visits, but virtual care visits were adopted during the COVID-19 pandemic. This study aimed to explore patients' experiences of virtual visits to an OPCC at a tertiary cancer centre in Toronto, Canada during the pandemic. Methods One-on-one telephone interviews were conducted with patients who had a) at least one in-person visit to the OPCC prior to the pandemic, with subsequent virtual follow-up, or b) virtual visits only. Purposive sampling was used to ensure representation based on sex, age, distance from the cancer centre, and mode of virtual visits (telephone vs. video). Interviews were recorded and professionally transcribed;thematic analysis was used. Results Twenty-six patients were interviewed (17 had an in-person visit, 9 virtual only). Patients reported overall satisfaction with virtual care, appreciating that it reduced care disruption during the pandemic. An initial in-person visit was felt to assist with rapport-building with the team. Many participants wished to continue with virtual care beyond the pandemic, especially during periods of relative health stability. At transition points in care, or when advance care planning discussions were anticipated, inperson visits were preferred. Conclusions Virtual visits to the OPCC during the COVID-19 pandemic were feasible and appreciated by patients. The role of virtual care for select scenarios beyond the pandemic should be further explored.
ABSTRACT
Background/aims: Early palliative care, delivered in oncology palliative care clinics (OPCCs) typically involves in-person visits. The COVID-19 pandemic necessitated rapid changes in the delivery of ambulatory care, and the adoption of virtual care where feasible. Aim: To determine the experiences of patients who switched from inperson to virtual visits to an OPCC at a tertiary cancer centre in Toronto, Canada during the COVID-19 pandemic. Methods: One-on-one telephone interviews were conducted with patients who had at least one in-person visit to the OPCC prior to the COVID-19 pandemic, and whose subsequent follow-up was switched to virtual visits. Purposive sampling was used to ensure representation based on sex, age, distance from their home to the cancer centre, and mode of virtual visits (telephone versus video). Interviews were recorded and professionally transcribed;thematic analysis was used. Results: Sixteen patients were interviewed, lasting between 20-60 minutes. Patients reported overall ease with the transition to virtual care, and appreciated that virtual care allowed for continuity of care without disruption during the pandemic. Previous in-person visits to the OPCC were felt to be advantageous in terms of rapport-building with the team, especially for the initial visit;non-verbal communication was highlighted. Many participants expressed a desire to have the option for virtual care beyond the pandemic, especially during periods of relative health stability. Conclusions: Virtual visits to the OPCC during the COVID-19 pandemic were feasible and appreciated by patients. The role of virtual care for select clinical scenarios beyond the pandemic should be further explored.
ABSTRACT
Background: Adverse drug events are common in ambulatory oncology where care spans multiple providers and medication documentation is often poor. We undertook a QI project with the aim of having 30% of patients have a best possible medication history (BPMH) or medication reconciliation (MedRec) documented within 30 days of starting systemic therapy. Methods: An Electronic Medical record-Integrated Tool (EMITT) was developed to facilitate documentation. 2 Plan-Do-Study-Act (PDSA) cycles have been completed to date;PDSA 1 consisted of piloting EMITT in 3 clinics run by physician champions. PDSA 2 which consisted of expanding pharmacy support and addition of a 4 clinic was impacted by care changes related to COVID. The proportion of patients with BPMH/MedRec documented in EMITT was calculated monthly for each period (PDSA 1, PDSA 2 pre-COVID and PDSA 2 post-COVID). The balancing measure of time to complete an entry was evaluated through a time motion study. Results: Between 9/9/2019 and 31/5/2020, 9.4% (233/2488) of patients had BPMH/MedRec completed;Table shows proportion of patients by month. BPMH and MedRec were most frequently performed by pharmacists followed by pharmacy students and nurses. On average, it took 5.5 minutes to complete an entry (n = 10;median number of medications per patient = 12.3). Conclusions:BPMH was documented more often than MedRec. While some usage was sustained, the changes to care as a result of COVID-19 negatively impacted ambulatory medication reconciliation. Future PDSA cycles will involve engaging patients in MedRec and extending EMITT to all ambulatory cancer clinics where medication management is a major component of care.