Presented at the 2013 AAPM Annual Meeting « Back

A Rapid-Cycle Quality Improvement Project for Symptom Control in Ethnic Chinese Cancer Patients

Lara K. Dhingra, PhD, ldhingra@chpnet.org¹, Kin Y. Lam, FACP1, William Cheung, MD², Theresa Shao, MD¹, Zujun Li, MD¹, Sandra Van De Maele, RN MSN APN-BC OCN¹, Victor Chang, MD³, Jack Chen, MBS¹, Vanessa A. Li, MA^1, Rhoda Wong, MSW¹, Huiyan Ye, MA⁴, Selina Chan⁵, Marilyn Bookbinder¹, Russell Portenoy, MD¹, (1) Beth Israel Medical Center, New York, New York, (2) New York, New York (3) VA New Jersey Health Care System, East Orange, New Jersey (4) Department of Pain Medicine and Palliative Care at Beth Israel Medical Center, Elmhurst, New York, (5) Beth Israel Medical Center, Flushing, New York

Introduction: Chinese Americans have high cancer rates and many are underserved immigrants with poorly controlled pain. Although quality improvement (QI) methodologies may improve patient outcomes, few pain management programs exist for this population. We aim to: test the effectiveness of a rapid-cycle QI intervention to enhance the processes and outcomes of pain management for underserved ethnic Chinese patients; determine whether a rapid-cycle QI intervention for pain can be generalized to other symptoms (fatigue, dyspnea) and identify sociodemographic and other barriers that are related to intervention uptake. Materials and Methods: In this ongoing community study, we are developing and testing a rapid-cycle QI model to improve pain among Chinese American cancer patients. The systems-based intervention, which is incorporated into repeated “plan-do-study-assess” QI cycles in collaboration with the oncology practices, includes: pain screening, follow-up and early pain treatment, referral, and clinician education. Ethnic Chinese patients and clinicians from four oncology practices are intervention targets. The Beth Israel Medical Center IRB approved the study. Results: Overall, 20.4% of patients (N=1,018) reported cancer-related pain (58.7% women; M age=60.4 years; 100% non-English speaking). The most prevalent cancers were breast (41.1%), head and neck (16.2%), and lung (13.5%); 38.0% were undergoing active treatment. Worst pain intensity was M=5.5 (SD=2.2), with 35.3% rating worst pain >7. Few (17.3%) reported using opioid or non-opioid analgesics for pain treatment. These data indicate that pain is prevalent among Chinese American cancer patients. Our community-based QI program may reduce disparities for this population and produce long-term changes in clinical pain management.

Funding: American Cancer Society 117416-RSGT-09-201-01-PC