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Although metastatic breast cancer (MBC) survival is improving, symptoms remain a significant burden. Returning to a cancer center for symptom management can be challenging. Technology-enabled supportive care platforms are worth exploration. Seventeen patients with MBC were randomized to immediate or delayed start for a 3-month intervention that included daily tablet-based guideline-concordant self-care for pain, distress, fatigue, and sleep disturbance, as well as weekly calls with a patient navigator. The primary outcome was patient acceptability. We also assessed feasibility, patient satisfaction, and cost and compared between group differences for symptoms. RM-ANOVA examined between group differences over time. Hedges’ d effect sizes quantified magnitude of differences in change between immediate and delayed start. Sixty-eight percent of patients approached accepted the tablet-based intervention. Patients interacted with the tablet 48% of possible days. Patient satisfaction ranged from 83 for walking to 49% for the psychological interventions. The cost of delivering Nurse AMIE for 3 months was $570.23. Small nonsignificant improvements were found for fatigue (d=0.24). Nonsignificant, but potentially clinically meaningful, moderate reductions were found for sleep (d=0.65) and distress (d=0.74). A tablet-based supportive care platform that offers guideline-concordant self-care for pain, fatigue, sleep, and distress was observed to be highly acceptable and feasible for patients with metastatic breast cancer. Patient satisfaction scores and initial evaluation of efficacy are promising, and the platform warrants further investigation. Technology-based self-care is a promising option to address symptoms in patients with metastatic breast cancer.

Women with metastatic breast cancer desire interventions that would allow them to self‐manage symptoms, but which do not require additional clinic appointments. We used a community based participatory research approach to develop a tablet based supportive care intervention called Nurse AMIE to address this need. The intervention modules are drawn from published evidence based clinical guidelines from ASCO and NCCN, including physical activity, soothing music, mindfulness meditation, guided imagery, cognitive behavioral therapy, and psychoeducation. Preliminary results include 61% and 55% acceptability from clinicians and patients, respectively, as well as 86% feasibility, defined as using the tablet for at least 30 of the 90‐day intervention. These preliminary results warrant additional research, particularly given the potential for this intervention to address needs of rural and medically underserved patients.

Prior research has used focus group methodology to investigate cultural factors impacting the breast cancer experience of women of various ethnicities including African-Americans; however, this work has not specifically addressed treatment decision-making. This study identifies key issues faced by African-American women diagnosed with breast cancer regarding treatment decisions. We used an interpretive-descriptive study design based on qualitative data from three focus groups (n = 14) representing a population of African-American women in central Pennsylvania. Participants were asked to think back to when they were diagnosed with breast cancer and their visit with the breast surgeon. Questions were asked about the actual visit, treatment choices offered, sources of information, and whether the women felt prepared for the surgery and subsequent treatments. The prompts triggered memories and encouraged open discussion. The most important themes identified were fear across the breast cancer disease trajectory, a preference for visual information for understanding the diagnosis and surgical treatment, and support systems relying on family and friends, rather than the formal health-care system. Our results have implications for practice strategies and development of educational interventions that will help breast cancer patients better understand their diagnosis and treatment options, encourage their participation in treatment decision-making, and provide psychosocial support for those at high risk for emotional distress.

This pilot study assessed the levels of patient emotional distress and impact on clinic throughput time. From April through August 2012, 149 breast cancer patients at the Penn State Hershey Breast Center were screened with the emotions thermometer (ET), a patient-rated visual 0–10 scale that measures distress, anxiety, depression, anger, burden, and need for help. Also, patients indicated their most pressing cancer-related concerns. Clinic visit time was computed and compared with a control group. Using a previously validated cut point ≥4 for any thermometer, we found emotional difficulty in the following proportions: distress 22 %, anxiety 28 %, depression 18 %, anger 14 %, burden 16 %, and need for help 10 %; 35 % scored above the cut point on at least 1 thermometer. We found higher levels of distress in all domains associated with younger age at diagnosis. More extensive surgery (bilateral mastectomy vs unilateral mastectomy vs. lumpectomy) was correlated with higher levels of psychosocial distress. Most often cited concerns, experienced by >20 %, included eating/weight, worry about cancer, sleep problems, fatigue, anxiety, and pain. Mean clinic visit time for evaluable patients screened using the ET (n = 109) was 43.9 min (SD 18.6), compared with 42.6 min (SD 16.2) for the control group (n = 50). Utilizing the ET, more than one-third of women screened met criteria for psychological distress. Younger age at diagnosis and more extensive surgery were risk factors. The ET is a simple validated screening tool that identifies patients in need of further psychological evaluation without impacting clinic throughput time.

The purpose of this study was to assess national practices of surgeons who treat breast cancer in order to identify opportunities to improve patient education.In June 2012, the membership of the American Society of Breast Surgeons (ASBrS) (n = 2,818) was surveyed via email questionnaire to evaluate their current practice of shared decision making and informed consent for breast cancer patients.A total of 737 members (26 %) responded, including 384 breast surgeons and 306 general surgeons, 13 midlevel providers, and 25 other specialists. It was found that 90 % of surgeons spent more than 30 min meeting with a new cancer patient, and of these, 30 % spent more than an hour. Surgeons who spent more than 1 h face-to-face with a new cancer patient reported higher levels of overall patient knowledge compared with those who spent less (mean = 3.80 vs. 3.64 of 5; p = 0.001). Also, 89 % of respondents reported using educational tools, of whom more than 90 % used written tools. In addition, 65 % of members stated an interest in a free online educational tool if available and indicated a preference for a flexible tool that could be used by the patient alone or with a nurse.While practice patterns may vary, our results reveal that one-third of surgeons spend at least 1 h in consultation with a new breast cancer patient. More time spent translated to a higher perceived patient understanding of their disease and treatment options. Although the majority of surgeons currently use written materials, there was clear support for a free online educational tool.

Appalachia is characterized by a high prevalence of individual-level risks for breast cancer, including physical inactivity and postmenopausal obesity. The availability of local, evidence-based programs to improve physical fitness is limited. We adapted an evidence-based intervention, StrongWomen, to improve physical fitness and increase breast cancer knowledge among women 40 years and older in Appalachian Pennsylvania. Utilizing a multi-site, community-based design, we tested the adapted 12-week, supervised program—New STEPS (Strength Through Education, Physical fitness and Support)—among 139 women. The completion rate was 67.6 %. Pre/post scores improved for each of six fitness assessments (P < 0.01). We found differences in overall fitness by study site (P < 0.001), but no differences by age (P = 0.13) or by previous breast cancer diagnosis (P = 0.73). New STEPS is an adapted, evidence-based program that can improve physical fitness and breast cancer awareness among women in Appalachian Pennsylvania. New STEPS may help fill a void in local fitness programs for Appalachian women at risk for breast cancer or breast cancer recurrence.

43 Background: Early integration of specialty Palliative Care (PC) in cancer patients improves quality of life and lowers medical costs. Engaging cancer patients early remains challenging. A checklist approach that evaluates type of malignancy, comorbidities, functional status, uncontrolled symptoms, readmission rates, and psychosocial/spiritual distress may prompt consultation to the PC team. We evaluated a palliative care screening tool’s (PCST) effect on promoting early PC consultation for oncology inpatients. Methods: A modified version of the Center to Advance Palliative Care screening tool was utilized by our hospital as part of the admission assessment. Registered nurses completed the PCST within 24 hours of admission for all adults. A PCST score of 3 or higher prompted staff to suggest a PC consult. A retrospective chart review of oncology patients who received a PC consult was performed to assess whether the screening tool score within 24 hours of admission impacted timing of a consult order. Effective tool utilization was considered to be a consult order within 36 hours of a high risk screen score. Results: From January through March 2014, 215 cancer patients screened with the PCST were found to have a score of 3 or higher. Seventy seven percent scored a 3 or higher, and PC consultation occurred in 16% of that patient cohort. Twenty three percent of PC consults occurred in patients scoring less than 3. The average number of days from admission to PC consult was 6 days. Conclusions: Using a PCST did not trigger PC consultation for inpatient cancer patients. Thirty four percent of the screened patients died during that admission, indicating a dramatic change in status from admission or ineffective prognostication, both barriers to early integration of PC. Our work suggests that a screening tool alone, even in a center with a well-embedded PC program, is not a sufficient means of effectively integrating PC into a patient’s hospital stay. Further work to identify patient characteristics that lead to consultation in both high and low risk patients is necessary.