Journal of Oncology Medicine & Practice

Improving Clinical Response to Cancer Symptom Screening: Leveraging Over Four Thousand Chart Audits for Actionable Person Centred Care

Abstract

Gillian Hurwitz, Lesley Moody, Zahra Ismail, Monika Duddy, Lisa Barbera

Introduction: Routine symptom screening for cancer patients using Patient Reported Outcome Measures (PROMs) is standard practice in Ontario to identify physical and emotional symptoms that can go undetected by clinicians. However, provider response to PROMs is essential to addressing symptom burden. To measure clinician response, a Regional Cancer Centre (RCC) chart audit process was developed to determine whether clinical teams acknowledged, assessed and/or addressed commonly experienced oncology symptoms outlined in the Edmonton Symptom Assessment System (ESAS).

Methods: Annually, RCCs received a chart audit tool with preset options. Sites audited charts for seven of the ESAS symptoms using a business intelligence tool to access patient charts based on sampling parameters. RCCs were required to audit charts of patients whose ESAS symptom scores were moderate to severe (4-10), with at least five charts in the moderate range (4-6).

Results: Overall, 4,679 charts from all 14 RCCs were examined in the FY 2016/17 and FY2017/18 audits (2,377 charts and 2,302 charts, respectively). Depression (45.5%) and anxiety (49.0%) were the least likely to be recorded in the patient’s chart, whereas pain (75.1%) was the most likely to be noted. Patients reporting depression and anxiety were the least likely to be offered assessments (49.8% and 51.1%, respectively) and interventions (47.0%, 46.5%, respectively). Patients reporting pain were the most likely to receive assessments (72.2%) and interventions (64.3%).

Conclusion: Chart audits help measure clinical response to PROMs, providing useful information on the gaps in care, including response to emotional symptoms and can inform local quality improvement initiatives.