Dimick J

Background: The Comprehensive Cancer Program held a community Colorectal Cancer Awareness Fair on March 5, 2019 at the VAMC. The goal was to increase awareness of Colorectal Cancer and to engage veterans in educational opportunities about Colorectal Cancer.

Methods: The VAMC purchased an in atable “Megacolon” for veterans to walk through guided by nurses from the GI department. Cubicles were set-up for nursing education sessions, a provider station, a scheduling station, and a colonoscope table. A video loop “Before and After Colonoscopy” by Mechanisms in Medicine, Inc. (Thornhill, Ontario, Canada) played continuously in the waiting area by the provider and nurse’s cubicles. Providers in the GI department offered 2 educational presentations: “How to Stop Colon Cancer Before It Starts” by Carol Macaron, MD; and “Colonoscopy: The Good, Bad, and Ugly” by Edith Ho, MD. Additional education information was provided at staffed tables from VA General Surgery, GI, MOVE! Nutrition & Food Services, and Smoking Cessation. Also, in attendance were Crohn’s and Colitis Foundation, and the American Cancer Society. External Affairs advertised the fair on Facebook and Twitter. Medical Media created publicity posters and event flyers.

Results: The event was attended by 244 people—68 veterans, 170 employees, and 6 guests. Six colonoscopies were scheduled onsite. At least 7 veterans had questions regarding their colonoscopy surveillance in which reminder dates were given.

Background: The Comprehensive Cancer Program held a community Colorectal Cancer Awareness Fair on March 5, 2019 at the VAMC. The goal was to increase awareness of Colorectal Cancer and to engage veterans in educational opportunities about Colorectal Cancer.

Methods: The VAMC purchased an in atable “Megacolon” for veterans to walk through guided by nurses from the GI department. Cubicles were set-up for nursing education sessions, a provider station, a scheduling station, and a colonoscope table. A video loop “Before and After Colonoscopy” by Mechanisms in Medicine, Inc. (Thornhill, Ontario, Canada) played continuously in the waiting area by the provider and nurse’s cubicles. Providers in the GI department offered 2 educational presentations: “How to Stop Colon Cancer Before It Starts” by Carol Macaron, MD; and “Colonoscopy: The Good, Bad, and Ugly” by Edith Ho, MD. Additional education information was provided at staffed tables from VA General Surgery, GI, MOVE! Nutrition & Food Services, and Smoking Cessation. Also, in attendance were Crohn’s and Colitis Foundation, and the American Cancer Society. External Affairs advertised the fair on Facebook and Twitter. Medical Media created publicity posters and event flyers.

Results: The event was attended by 244 people—68 veterans, 170 employees, and 6 guests. Six colonoscopies were scheduled onsite. At least 7 veterans had questions regarding their colonoscopy surveillance in which reminder dates were given.

Background: The Comprehensive Cancer Program held a community Colorectal Cancer Awareness Fair on March 5, 2019 at the VAMC. The goal was to increase awareness of Colorectal Cancer and to engage veterans in educational opportunities about Colorectal Cancer.

Methods: The VAMC purchased an in atable “Megacolon” for veterans to walk through guided by nurses from the GI department. Cubicles were set-up for nursing education sessions, a provider station, a scheduling station, and a colonoscope table. A video loop “Before and After Colonoscopy” by Mechanisms in Medicine, Inc. (Thornhill, Ontario, Canada) played continuously in the waiting area by the provider and nurse’s cubicles. Providers in the GI department offered 2 educational presentations: “How to Stop Colon Cancer Before It Starts” by Carol Macaron, MD; and “Colonoscopy: The Good, Bad, and Ugly” by Edith Ho, MD. Additional education information was provided at staffed tables from VA General Surgery, GI, MOVE! Nutrition & Food Services, and Smoking Cessation. Also, in attendance were Crohn’s and Colitis Foundation, and the American Cancer Society. External Affairs advertised the fair on Facebook and Twitter. Medical Media created publicity posters and event flyers.

Results: The event was attended by 244 people—68 veterans, 170 employees, and 6 guests. Six colonoscopies were scheduled onsite. At least 7 veterans had questions regarding their colonoscopy surveillance in which reminder dates were given.

Purpose: To address concerns of the cancer committee (CC) and facility regarding the transition use of the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) to the Veteran Symptom Assessment Screen (VSAS).

Background: The Cleveland VA Medical Center (CVAMC) had used the NCCN DT since 2012. In March 2016, in conjunction with the Durham VAMC, the CVAMC began to pilot the VSAS screening tool to replace the NCCN DT. This initiative was an attempt to use one tool that could be used across all VAs to satisfy both The American College of Surgeon’s (ACOS) Commission of Cancer (CoC) accreditation as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification. The CVAMC locally added social elements of transportation, housing and insurance to the VSAS tool.

Methods: In March 2016 the Ear Nose and Throat (ENT) clinic continued to use the NCCN DT while the Oncology Clinics (OC) began to initiate the VSAS. In the CVAMC OC, Veterans that scored a 4 or greater on the VSAS tool in depression, anxiety, or distress or answered yes to transportation, housing, or insurance concerns had a Distress Screening Outpatient Consult entered into CPRS by the intake RN/LPN in clinic. The consultation was then signed off by the provider in clinic delivering care to Veteran that day. The consult was received, reviewed and completed by the oncology social worker (OSW) or the oncology behavioral health (OBH).

Results: In 2016 there were 162 NCCN DT distress screenings that were completed. 38% scored a 4 or above and required referral to OBH/OSW. Only 53% had complete documentation in CPRS. In contrast the VSAS in 2016 had 107 screenings that were completed. 31% required referral to OBH/OSW. 97% had complete documentation in CPRS.

Conclusions/Implications: This pilot project at the CVAMC allowed clear comparison between NCCN DT and VSAS tools. At our institution, the completion rate of the VSAS, referral and documentation process clearly was more effective than the NCCN DT process. Due to these outcomes the CC and facility made the decision to transition our distress screening process to the VSAS from the NCCN DT.

Purpose: To address concerns of the cancer committee (CC) and facility regarding the transition use of the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) to the Veteran Symptom Assessment Screen (VSAS).

Background: The Cleveland VA Medical Center (CVAMC) had used the NCCN DT since 2012. In March 2016, in conjunction with the Durham VAMC, the CVAMC began to pilot the VSAS screening tool to replace the NCCN DT. This initiative was an attempt to use one tool that could be used across all VAs to satisfy both The American College of Surgeon’s (ACOS) Commission of Cancer (CoC) accreditation as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification. The CVAMC locally added social elements of transportation, housing and insurance to the VSAS tool.

Methods: In March 2016 the Ear Nose and Throat (ENT) clinic continued to use the NCCN DT while the Oncology Clinics (OC) began to initiate the VSAS. In the CVAMC OC, Veterans that scored a 4 or greater on the VSAS tool in depression, anxiety, or distress or answered yes to transportation, housing, or insurance concerns had a Distress Screening Outpatient Consult entered into CPRS by the intake RN/LPN in clinic. The consultation was then signed off by the provider in clinic delivering care to Veteran that day. The consult was received, reviewed and completed by the oncology social worker (OSW) or the oncology behavioral health (OBH).

Results: In 2016 there were 162 NCCN DT distress screenings that were completed. 38% scored a 4 or above and required referral to OBH/OSW. Only 53% had complete documentation in CPRS. In contrast the VSAS in 2016 had 107 screenings that were completed. 31% required referral to OBH/OSW. 97% had complete documentation in CPRS.

Conclusions/Implications: This pilot project at the CVAMC allowed clear comparison between NCCN DT and VSAS tools. At our institution, the completion rate of the VSAS, referral and documentation process clearly was more effective than the NCCN DT process. Due to these outcomes the CC and facility made the decision to transition our distress screening process to the VSAS from the NCCN DT.

Purpose: To address concerns of the cancer committee (CC) and facility regarding the transition use of the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) to the Veteran Symptom Assessment Screen (VSAS).

Background: The Cleveland VA Medical Center (CVAMC) had used the NCCN DT since 2012. In March 2016, in conjunction with the Durham VAMC, the CVAMC began to pilot the VSAS screening tool to replace the NCCN DT. This initiative was an attempt to use one tool that could be used across all VAs to satisfy both The American College of Surgeon’s (ACOS) Commission of Cancer (CoC) accreditation as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification. The CVAMC locally added social elements of transportation, housing and insurance to the VSAS tool.

Methods: In March 2016 the Ear Nose and Throat (ENT) clinic continued to use the NCCN DT while the Oncology Clinics (OC) began to initiate the VSAS. In the CVAMC OC, Veterans that scored a 4 or greater on the VSAS tool in depression, anxiety, or distress or answered yes to transportation, housing, or insurance concerns had a Distress Screening Outpatient Consult entered into CPRS by the intake RN/LPN in clinic. The consultation was then signed off by the provider in clinic delivering care to Veteran that day. The consult was received, reviewed and completed by the oncology social worker (OSW) or the oncology behavioral health (OBH).

Results: In 2016 there were 162 NCCN DT distress screenings that were completed. 38% scored a 4 or above and required referral to OBH/OSW. Only 53% had complete documentation in CPRS. In contrast the VSAS in 2016 had 107 screenings that were completed. 31% required referral to OBH/OSW. 97% had complete documentation in CPRS.

Conclusions/Implications: This pilot project at the CVAMC allowed clear comparison between NCCN DT and VSAS tools. At our institution, the completion rate of the VSAS, referral and documentation process clearly was more effective than the NCCN DT process. Due to these outcomes the CC and facility made the decision to transition our distress screening process to the VSAS from the NCCN DT.

Purpose: A diagnosis of cancer, its treatment, and surveillance are fraught with distress. Despite recommendations from The National Comprehensive Cancer Network (NCCN) 2013 Guidelines, many cancer centers struggle to implement distress screening and to identify “appropriate intervals” for screening. A grant from the VA Office of Academic Affairs supported the development of a Center of Excellence (CoE) specialty cancer care clinic for breast, melanoma, and lymphoma, at a large academic VAMC to deliver patient-centered care and train learners in interprofessional practice. The CoE team has made distress screening a priority for this clinic.

Methods: Veterans are screened at every visit in the CoE clinic to determine the incidence, trends, and components of distress and provide same-day intervention for those scoring > 4 on the Distress Thermometer (DT). The distress screening has been rolled out to the lung cancer clinic and ear, nose, and throat (ENT) cancer clinics. Veterans are screened at check in. A nurse reviews the screenings prior to the veteran entering the exam room. Veterans with distress scores > 4 are offered same-day appointments with the appropriate provider(s) accompanied by student learners. The social worker assesses practical and family concerns; the psychologist addresses veterans’ emotional concerns; physical problems are handled by the nurse practitioner or medical oncologist. Veterans commonly need intervention from all of the providers. Trainees observe the interventions with the veterans, as each discipline addresses the distress. The distress screening process in the Lung Cancer Clinic and ENT clinic is different, as the psychologist and social work staff are not always present in these clinics throughout the day. The veterans who scored > 4 are offered a same-day visit or they can choose to have a follow-up telephone call from a social worker or psychologist.

Results: During the first 15 months of the CoE cancer clinic, 192 of 525 screenings (37%) yielded scores > 4, consistent with previous research (Holland & Alici, 2010). Of the veterans who had moderate to severe distress > 4, 65 (34%) had practical problem concerns and 44 (23%) cited family problems. The remaining components of distress revealed 136 (71%) emotional problems, 16 (9%) spiritual needs, and 176 (92%) physical. Some veterans had problems in multiple domains. The lung cancer clinic has completed 169 screens over the past 5 months, 96 (31%) were scores of > 4. Of these veterans, 32 (19%) uncovered practical problems, 15 uncovered (10%) family problems, and 64 (40%) were distressed due to emotional concerns. The largest sources of distress were physical problems; 120 (74%) of participating veterans uncovered physical issues. The ENT clinic has just begun screening the veterans for distress. The projected date for data analysis for the ENT clinic is August 2014.

Conclusions: VA grant funding supported an oncology team and its trainees to work together in an interprofessional specialty clinic. The team found that same-day intervention for veterans scoring > 4 is feasible, because the nurse can immediately alert the appropriate provider(s). One of the goals of the CoE clinic is to demonstrate sustainability of the intervention across the VA ’s cancer care program. The distress screening has been implemented successfully in the lung cancer and ENT clinics with minimal disruption to the flow of these established clinics. There are plans to implement this process in all cancer care clinics at the medical center.

Purpose: A diagnosis of cancer, its treatment, and surveillance are fraught with distress. Despite recommendations from The National Comprehensive Cancer Network (NCCN) 2013 Guidelines, many cancer centers struggle to implement distress screening and to identify “appropriate intervals” for screening. A grant from the VA Office of Academic Affairs supported the development of a Center of Excellence (CoE) specialty cancer care clinic for breast, melanoma, and lymphoma, at a large academic VAMC to deliver patient-centered care and train learners in interprofessional practice. The CoE team has made distress screening a priority for this clinic.

Methods: Veterans are screened at every visit in the CoE clinic to determine the incidence, trends, and components of distress and provide same-day intervention for those scoring > 4 on the Distress Thermometer (DT). The distress screening has been rolled out to the lung cancer clinic and ear, nose, and throat (ENT) cancer clinics. Veterans are screened at check in. A nurse reviews the screenings prior to the veteran entering the exam room. Veterans with distress scores > 4 are offered same-day appointments with the appropriate provider(s) accompanied by student learners. The social worker assesses practical and family concerns; the psychologist addresses veterans’ emotional concerns; physical problems are handled by the nurse practitioner or medical oncologist. Veterans commonly need intervention from all of the providers. Trainees observe the interventions with the veterans, as each discipline addresses the distress. The distress screening process in the Lung Cancer Clinic and ENT clinic is different, as the psychologist and social work staff are not always present in these clinics throughout the day. The veterans who scored > 4 are offered a same-day visit or they can choose to have a follow-up telephone call from a social worker or psychologist.

Results: During the first 15 months of the CoE cancer clinic, 192 of 525 screenings (37%) yielded scores > 4, consistent with previous research (Holland & Alici, 2010). Of the veterans who had moderate to severe distress > 4, 65 (34%) had practical problem concerns and 44 (23%) cited family problems. The remaining components of distress revealed 136 (71%) emotional problems, 16 (9%) spiritual needs, and 176 (92%) physical. Some veterans had problems in multiple domains. The lung cancer clinic has completed 169 screens over the past 5 months, 96 (31%) were scores of > 4. Of these veterans, 32 (19%) uncovered practical problems, 15 uncovered (10%) family problems, and 64 (40%) were distressed due to emotional concerns. The largest sources of distress were physical problems; 120 (74%) of participating veterans uncovered physical issues. The ENT clinic has just begun screening the veterans for distress. The projected date for data analysis for the ENT clinic is August 2014.

Conclusions: VA grant funding supported an oncology team and its trainees to work together in an interprofessional specialty clinic. The team found that same-day intervention for veterans scoring > 4 is feasible, because the nurse can immediately alert the appropriate provider(s). One of the goals of the CoE clinic is to demonstrate sustainability of the intervention across the VA ’s cancer care program. The distress screening has been implemented successfully in the lung cancer and ENT clinics with minimal disruption to the flow of these established clinics. There are plans to implement this process in all cancer care clinics at the medical center.

Purpose: A diagnosis of cancer, its treatment, and surveillance are fraught with distress. Despite recommendations from The National Comprehensive Cancer Network (NCCN) 2013 Guidelines, many cancer centers struggle to implement distress screening and to identify “appropriate intervals” for screening. A grant from the VA Office of Academic Affairs supported the development of a Center of Excellence (CoE) specialty cancer care clinic for breast, melanoma, and lymphoma, at a large academic VAMC to deliver patient-centered care and train learners in interprofessional practice. The CoE team has made distress screening a priority for this clinic.

Methods: Veterans are screened at every visit in the CoE clinic to determine the incidence, trends, and components of distress and provide same-day intervention for those scoring > 4 on the Distress Thermometer (DT). The distress screening has been rolled out to the lung cancer clinic and ear, nose, and throat (ENT) cancer clinics. Veterans are screened at check in. A nurse reviews the screenings prior to the veteran entering the exam room. Veterans with distress scores > 4 are offered same-day appointments with the appropriate provider(s) accompanied by student learners. The social worker assesses practical and family concerns; the psychologist addresses veterans’ emotional concerns; physical problems are handled by the nurse practitioner or medical oncologist. Veterans commonly need intervention from all of the providers. Trainees observe the interventions with the veterans, as each discipline addresses the distress. The distress screening process in the Lung Cancer Clinic and ENT clinic is different, as the psychologist and social work staff are not always present in these clinics throughout the day. The veterans who scored > 4 are offered a same-day visit or they can choose to have a follow-up telephone call from a social worker or psychologist.

Results: During the first 15 months of the CoE cancer clinic, 192 of 525 screenings (37%) yielded scores > 4, consistent with previous research (Holland & Alici, 2010). Of the veterans who had moderate to severe distress > 4, 65 (34%) had practical problem concerns and 44 (23%) cited family problems. The remaining components of distress revealed 136 (71%) emotional problems, 16 (9%) spiritual needs, and 176 (92%) physical. Some veterans had problems in multiple domains. The lung cancer clinic has completed 169 screens over the past 5 months, 96 (31%) were scores of > 4. Of these veterans, 32 (19%) uncovered practical problems, 15 uncovered (10%) family problems, and 64 (40%) were distressed due to emotional concerns. The largest sources of distress were physical problems; 120 (74%) of participating veterans uncovered physical issues. The ENT clinic has just begun screening the veterans for distress. The projected date for data analysis for the ENT clinic is August 2014.

Conclusions: VA grant funding supported an oncology team and its trainees to work together in an interprofessional specialty clinic. The team found that same-day intervention for veterans scoring > 4 is feasible, because the nurse can immediately alert the appropriate provider(s). One of the goals of the CoE clinic is to demonstrate sustainability of the intervention across the VA ’s cancer care program. The distress screening has been implemented successfully in the lung cancer and ENT clinics with minimal disruption to the flow of these established clinics. There are plans to implement this process in all cancer care clinics at the medical center.