Improving Oral Oncolytic Compliance with Technology

This blog post is the final of a five-part series highlighting the achievements of the 2022 ACCC Innovator Award winners before their in-depth sessions at the ACCC 39th National Oncology Conference. You can learn more about the innovations being recognized this year and the people who pioneered them by joining ACCC in West Palm Beach, Fla., on October 12-14, 2022.

“From our perspective, this project was about improving an existing process that despite our best efforts can still prove challenging, even in well-established cancer programs,” said Morgan Nestingen, MSN, APRN, AGCNS-BC, NEA-BC, OCN, ONN-CG, director of nursing for Patient Intake and Navigation Services at Baptist Health South Florida, Miami Cancer Institute. 

Timely treatment education, consent gathering, and adherence tracking can present logistical challenges for many cancer programs and practices, particularly when an oral oncolytic is prescribed. These challenges are due in part to older solutions that are no longer benefiting all patients equally. Problems like this have persisted in oncology despite healthcare’s fast-paced innovations and there is no one-size-fits-all fix. 

For example, insurance coverage limitations may require patients to fill oral oncolytic prescriptions at specialty pharmacies, leading to communication gaps between patients and their care team. Once at home, patients may deviate from the prescribing provider’s instructions to try to reduce treatment-related symptoms, stretch out their costly prescriptions, or discontinue treatment altogether. Given these persistent challenges, oncology programs and practices must work harder to track oral oncolytic prescriptions and adapt their established workflows to ensure safe treatment adherence. 

Additionally, unique challenges cropped up with the rapid adoption of telehealth driven by the COVID-19 pandemic. Because patients are spending less time in the cancer clinic, education and treatment compliance is difficult to track when these tasks are shared across by clinic, nursing, and pharmacy staff, who may not all be included in a patient’s virtual appointment. Though education, consent, and treatment adherence can be considered minor workflow-related issues when compared to clinical concerns (e.g., symptom management, treatment toxicities, etc.), optimizing these services can lead to an improved patient experience and employee satisfaction.

Finding Gaps in Care

Miami Cancer Institute completed an initial audit to identify gaps in its care delivery. One such gap included the oncology service line’s dependence on a specialty education team to provide oral oncolytic treatment education. While high-quality education and consent were consistently provided, it occurred too late in the care continuum for patients prescribed oral oncolytics. Once patients left the cancer institute with an oral oncolytic prescription, staff did not always have the means to provide timely follow up. “There was always the danger that the patient would take that paper prescription, go fill it at their specialty pharmacy, and start taking it prior to their education visit,” said Nestingen. “For us, the opportunity was to do these steps all in real-time with existing staffing resources.”

Therefore, Miami Cancer Institute leadership determined that they needed a same-day solution. “This was an in-the-moment solution. While we have the patient here, what are all the actions we need to take before that person leaves?” asked Nestingen. A streamlined process would allow the cancer care team to complete all pre-treatment tasks during the patient’s appointment and would mean no follow up would be needed when patients return to their communities to live, work, and continue their anti-cancer treatment at home. 

Technology and Staffing Solutions

To better address these concerns, Miami Cancer Institute’s team took an interdisciplinary approach, including members from pharmacy, informatics, technology and digital (e.g., information technology), executive leadership, clinic leadership, and nursing, as well as physician and advanced practice provider teams. 

The team turned to technology solutions that were already being used by Baptist Health South Florida and that were well understood by their healthcare teams and patients. Access Passport was already available in Miami Cancer Institute’s electronic health record, as it was being used for other consenting processes; its benefits for their oral oncolytic workflow were not yet realized. The team provided tablets to clinic staff to initiate electronic consent and trained them on how to use Zoom and DocuSign to perform education and consent during virtual patient appointments. By using these technologies, Miami Cancer Institute staff are providing high-quality cancer care without having to dip deeper into its operating budget.

The team also leveraged existing staff resources to assist busy Miami Cancer Institute clinics by instituting on-call nursing support. A designated nurse carries a mobile phone and receives calls from clinics in need of urgent, real-time assistance with oral oncolytic education and support.

Realizing Success

Nestingen said that the team’s success rested on coming to consensus on one creative and adaptable goal: Before any patient starts their medication, there will be real documentation and completion of meaningfully informed consent and treatment education on the same day as their medical appointment—whether that visit is in person or virtual. Further success from this project is realized through continued data tracking and auditing to ensure staff members are following updated procedures and that gaps in care are being addressed.

To learn more about Miami Cancer Institute’s innovation, including the technology and tools it has utilized to improve care delivery, register to attend the National Oncology Conference. Nestigen is excited to learn from and join her colleagues this fall, stating, “ACCC is a group of folks who are highly committed to cancer care. There are boundless expertise, connections, resources, and toolkits available online. The difference between that and a living, breathing conference is really the immersion and connection—learning better, the ability to connect with others, and conversations that are more natural and not limited to what we can put on a discussion thread.”