Power of an Effective Clinical Conversation: Improving Accrual Onto Clinical Trials

Author: Linda K. Parreco, RN, MS, Rhonda W. Dejoice, BA, Holly A. Massett, PhD, Rose Mary Padberg, RN, Ma, Sona S. Thakkar, MA

Journal of Oncology Practice. September 2012: JOP.2011.000478.

http://ascopubs.org/doi/full/10.1200/JOP.2011.000478

Abstract
Effective clinical conversations create the opportunity for patients to understand their options and to gain a better foundation for informed decision making about clinical trials.

The National Cancer Institute (NCI) is actively transforming clinical trials to revitalize the clinical trials system and improve patient accrual. For more than 30 years, NCI has provided information and communication resources about cancer clinical trials. The Institute supports a clinical trials Web site (www.cancer.gov/clinicaltrials) that receives nearly a half million page views a month. In addition, NCI's Cancer Information Service (800-4-CANCER, chat and e-mail) responds to 1,750 clinical trial inquiries every month. Although these numbers suggest that a high volume of clinical trial information is being exchanged between NCI, the public, and providers, most patients decide whether to participate in clinical trials during the patient-provider interaction.

Risk Factors and Patterns of Potentially Avoidable Readmission in Patients With Cancer

Author: Jacques D. Donzé, MD, MSc, Stuart Lipsitz, ScD, MSc, and Jeffrey L. Schnipper, MD, MPH

Journal of Oncology Practice. October 2016: JOP.2016.011445.

http://ascopubs.org/doi/full/10.1200/JOP.2016.011445

Purpose: Patients with cancer are particularly at risk for readmission within 30-days after discharge. To identify the patients who might benefit from more-intensive discharge interventions, we identified the risk factors associated with 30-day potentially avoidable readmissions.

Methods and Materials: We included all consecutive discharges from the oncology division of an academic tertiary medical center in Boston, Massachusetts, between July 1, 2009, and June 30, 2010. Potentially avoidable 30-day readmissions to the index hospital and two other hospitals within its network were identified. We performed a multivariable logistic regression in which the final model included variables found in bivariable testing to be significantly associated with the outcome.

Results: Among the 2,916 patients discharged during the study period, 1,086 (37.3%) were readmitted within 30 days. Of these, 341 (31.4% of all readmissions, 11.7% of all discharges) were identified as potentially avoidable. In the multivariable analysis, the following patient factors were associated with a significantly higher risk of a potentially avoidable readmission: total number of medications at discharge, liver disease, last sodium level, and last hemoglobin level before discharge. In addition, potentially avoidable readmissions occurred significantly earlier than unavoidable readmissions (median, 10 v 13 days; P < .001).

Conclusion: Almost 40% of patients with cancer had a 30-day readmission, and almost one third of these were deemed potentially avoidable, and several risk factors for this were identified. Interventions at discharge may be prioritized to patients with these risk factors.

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Hint: After her clinical training, she did a two year post-doctoral research fellowship at the Dana-Farber Cancer Institute under the direction of Dr. Margaret Shipp. During this time, she was a Clinical Instructor at the Harvard School of Medicine and completed an MSc in Epidemiology from the Harvard School of Public Health.

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