Utilizing Telecommunication to Provide Patient Centered Care for Adults Newly Diagnosed with GI Cancer: A Quality Improvement Project

INTRODUCTION: A confirmed diagnosis of GI Cancer causes anxiety and stress as patients become overwhelmed with questions, worries and fears. At diagnosis, patients are not yet formally connected to the support services available to those actively receiving chemotherapy, creating a “gap period”. To help reduce anxiety, as well as, foster therapeutic relationships and improve overall patient experiences, a structured telephone communication by the gastrointestinal cancer oncology nurse practitioner (GI NP) was proposed. AVAILABLE KNOWLEDGE: Reduction of anxiety has been shown to enhance the quality of life, increase compliance with a prescribed treatment plan and foster the ability to sign informed consent. Nurses play an important role in reducing anxiety by creating an environment in which patients are able to develop trusting relationships to communicate their concerns. A navigation program helps to reduce the gap in oncology care between diagnosis and the start of treatment and connect patient to services which can provide support, education and guidance to the newly diagnosed GI oncology patient. METHODS: The self-reported PROMIS Anxiety Scale short form and the NCCN Distress Thermometer were used to measure anxiety and distress pre and post-intervention along with the Patient Satisfaction with Cancer Care (PSCC) satisfaction tool post-intervention to gauge patient satisfaction. A Paired t-test was utilized to evaluate the effect of the intervention on the PROMIS anxiety scores and the NCCN distress scores. INTERVENTION: Telephone communications were made to patients by the GI NP within 48 hours of the diagnostic visit. Weekly communications were then scheduled as needed until the patient’s treatment began, as requested by the patient, or as determined necessary by any issues or concerns that arose. A final visit was made at the start of care. RESULTS: In this quality improvement study, 16 patients were evaluated over 3 months. Anxiety scores demonstrated a statistically significant reduction from pre to post intervention m=4.375, 95% CI [SD 7.92, p .043). There was no significant difference in distress scores. Patient satisfaction responses (n=8) indicated very high levels of satisfaction with the telephone communications. CONCLUSIONS: Although this QI study was small, results indicate a significant improvement in anxiety levels with telephone communications during the gap period between diagnosis and the start of care. This demonstrates an important role for navigators in increasing the outreach to patients at this time. Our feedback indicated patients felt more connected to the clinic and more trusting of their relationship with their providers at the initiation of treatment. Ideally, this project should be continued on a much larger scale for more valid results