Gaps in care planning and delivery for patients with liver cancer: Baseline assessment for implementation of 4R Oncology model.

person George Therapondos Oschner Medical Center. Department of Gastroenterology and Multiorgan Transplant Institute, New Orleans, LA info_outline George Therapondos, Julia R. Trosman, Lingling Du, Jonathan Mizrahi, Tyler Allan Sandow, Ari Cohen, Juan Gimenez, Carol Palmer, Amanda Medina, Michelle O'Brien, Amie Tan, Christine B. Weldon

Authors person George Therapondos Oschner Medical Center. Department of Gastroenterology and Multiorgan Transplant Institute, New Orleans, LA info_outline George Therapondos, Julia R. Trosman, Lingling Du, Jonathan Mizrahi, Tyler Allan Sandow, Ari Cohen, Juan Gimenez, Carol Palmer, Amanda Medina, Michelle O'Brien, Amie Tan, Christine B. Weldon Organizations Oschner Medical Center. Department of Gastroenterology and Multiorgan Transplant Institute, New Orleans, LA, Center for Business Models on Healthcare, Glencoe, IL, Ochsner Medical Center, New Orleans, LA, Ochsner Health System, Jefferson, LA, Ochsner Health System, New Orleans, LA, Ochsner Health, New Orleans, LA, Genentech, South San Francisco, CA, Center for Business Models in Healthcare, Glencoe, IL Abstract Disclosures Research Funding Pharmaceutical/Biotech Company Genentech, A Member of the Roche Group Background: Liver cancer is a complex disease, requiring detailed care planning, patient engagement and delivery of comprehensive care, including supportive and health maintenance care. The 4R Oncology Model for patient facing care planning, patient self-management and team based delivery of complex care has the potential to address these needs. 4R (Right Info/Care/Patient/Time) significantly improves patient self-management and optimizes delivery of supportive and health maintenance care in breast and lung cancer (Trosman JCOOP 2021; Liu JCOOP 2022). The impact of 4R in liver cancer has not been examined. Ochsner Health’s multi-disciplinary live cancer team is implementing and evaluating 4R. Here we describe the baseline assessment of provider practices and patient experience of care planning and delivery of supportive and health maintenance care. Methods: Surveys of providers and patients on current care planning and delivery in liver cancer were conducted Oct 2022 – Jan 2023. We used 3 metrics of care planning and 3 metrics of care delivery (Table). Results: Survey response rates: providers 55% (33/60), patients 43% (27/63). Providers included physicians, advance practitioners, nurses and navigators from Hepatology, Transplant, Interventional Radiology and Medical Oncology. Patients were 56% female, 63% white, 37% black, 56% < 30k income. In care planning, patient experience was reported at a similar rate as provider practices for informed on goal of care, but significantly higher than providers for informed on next steps in care and receiving a detailed care plan (Table). In care delivery, patient experience and provider referral practices for social and supportive care were similarly low. Rates of patients’ receiving primary care and substance abuse assistance were significantly higher than respective rates of provider referrals. Among providers, 73% give patients a verbal care plan and 27% a hand written plan. The current process to create care plans is satisfactory to 54% of providers. Conclusions: We found substantial gaps in care planning and referrals to supportive and health maintenance care. Higher rates of patients reporting receipt of care planning and services suggest that many patients may resort to their own devices in these aspects of care. Ochsner Health aims to address these gaps by implementing the 4R Oncology model in liver cancer and will share results when available. % providers informing / referring patients % Patients receiving information / services P value Care planning Inform patients on goal of care 77 74 1.0 Inform patients on next steps to take in their care 47 74 0.03 Provide a detailed care plan 62 89 0.03 Care delivery Refer to social, supportive care during treatment 15 18 0.55 Refer to primary care, flu vaccine during treatment 15 78 0.0001 Refer to alcohol, substance use assistance during treatment 27 87 0.001