Objective As part of ongoing implementation of electronic patient-reported outcome tools at the Dana-Farber Cancer Institute, here we describe the development of the electronic New Patient Intake Questionnaire. Materials and Methods The original New Patient Intake Questionnaire includes a review of symptoms, oncology history, family history, health behaviors, health and social status, health literacy and numeracy, which was modified for integration into the EHR using content determination, build and configuration, implementation, analytics, and interventions. The engagement of key stakeholders, including patients, clinical staff, and providers, throughout the development and deployment of the electronic Questionnaire was crucial to producing a successful tool. Continual modifications based on input of stakeholders (such as mode of tool deployment) were made to ensure the utility and usability of the tool for both patients and providers. Results Implementation of the EHR-integrated electronic New Patient Intake Questionnaire improved collection of the PRD by increasing questionnaire accessibility for patients, while also providing all available data to clinicians and researchers. Careful consideration of the content and configuration of the questionnaire allowed for a successful, institute-wide implementation of the tool. Discussion This effort demonstrates the feasibility of implementation of a system-wide electronic questionnaire, emphasizing the importance of iterative refinement to create a tool that is both patient-centric and usable for clinicians. Conclusions The electronic New Patient Intake Questionnaire allows for systematic collection of the PRD, which should benefit cancer care outcomes through innovative care delivery and healthcare interventions.

Background We evaluated the time to progression and survival outcomes of second-line therapy for metastatic colorectal cancer among adults aged 70 years and older compared to younger adults following progression on first-line clinical trials. Methods Associations between clinical and disease characteristics, time to initial progression and rate of receipt of second-line therapy were evaluated. Time to progression and overall survival were compared between older and younger adults in first- and second-line trials by Cox regression, adjusting for age, sex, Eastern Cooperative Oncology Group Performance Status (ECOG PS), number of metastatic sites and presence of metastasis in the lung, liver or peritoneum. All statistical tests were 2-sided. Results Older adults comprised 16.4% of patients on first-line trials (870 total older adults age >70 years; 4,419 total younger adults age ≤70 years, on first-line trials). Older adults and those with ECOG PS > 0 were less likely to receive second-line therapy than younger adults. Odds of receiving second-line therapy decreased by 11% for each additional decade of life in multivariable analysis (odds ratio = 1.11, 95% confidence interval = 1.02, 1.21, P = .01. Older and younger adults enrolled in second-line trials experienced similar median time to progression and median overall survival (median time to progression = 5.1 vs. 5.2 months, respectively; median overall survival = 11.6 vs. 12.4 months, respectively). Conclusions Older adults were less likely to receive second-line therapy for metastatic colorectal cancer, though we did not observe a statistical difference in survival outcomes vs. younger adults following second-line therapy. Further study should examine factors impacting decisions to treat older adults with second-line therapy. Inclusion of geriatric assessment may provide better criteria regarding the risks and benefits of second-line therapy.

6535 Background: Addressing unmet SDoH needs may reduce interruptions to cancer care caused by ED visits and hospitalizations (EDH). We aimed to determine feasibility of systematic screening for unmet patient-reported SDoH needs within a large tertiary academic comprehensive cancer center and association of unmet needs with EDH. Methods: We conducted a cross-sectional analysis of SDoH needs among new oncology patient (pts) consults from 5/15-9/21 at Dana-Farber Cancer Institute (DCFI). Pts completed an intake questionnaire including demographics, disease, and SDoH needs of financial distress, health literacy/numeracy, social isolation on a dichotomous or 5-point Likert scale. We ran bivariate and multivariable models on the association between demographics, SDoH and EDH within 30 days of consult using robust generalized estimating equations controlling for clustering by consult provider. Results: 125,997 unique new consults were seen from 5/15 – 9/21 of which 20,913 completed the intake questionnaire and were alive at 30 days after consult. Respondents were age 40-64 (50%), female (60%), non-Hispanic (84%), White (90%) and English speaking (97%), and 7% had an EDH within 30 days of consult. The most reported SDoH need was limited health numeracy (26%). In bivariate analysis, factors associated with ED visits were: non-English language, lung or GU/GYN cancer, living > 25 mi from DFCI and limited health literacy and numeracy (all p < 0.05). Demographics associated with hospitalizations included: White race and English as a primary language (EPL) (both p < 0.05). Multivariable analysis showed female gender (OR 1.53, p < 0.01), lung (OR 3.22*) and GU/GYN (OR 2.21*) (p < 0.05 for both) cancer, and living > 25 mi from DFCI (OR 2.50, p < 0.0001) were associated with increased likelihood of ED visit while EPL (OR 1.80, p < 0.05) and GU/GYN (OR 1.65, p < 0.01*) cancer were associated with increased likelihood of hospitalization. Conclusions: It is feasible to systematically screen for unmet SDoH which are associated with increased frequency of ED visits. Differences in characteristics associated with ED vs. hospitalization could indicate possible bias or suggest SDoH needs as a reason for avoidance of costly medical care. Further study will expand SDoH screening and measure impact of resource matching to reduce disruptions to cancer care. [Table: see text]

IMPORTANCE Often electronic tools are built with English proficient (EP) patients in mind. Cancer patients with limited English proficiency (LEP) experience gaps in care and are at risk for excess toxic effects if they are unable to effectively communicate with their care team. OBJECTIVE To evaluate whether electronic patient-reported outcome tools (ePROs) built to improve health outcomes for EP patients might also be acceptable for LEP patients in the context of oral cancer-directed therapies (OCDT). DESIGN, SETTING, AND PARTICIPANTS This qualitative study was conducted at a single NationalCancer Institute-designated comprehensive cancer center. In 2019, English-speaking and Spanishspeaking LEP patients with cancer receiving oral chemotherapies were recruited to participate in a qualitative focus group examining patient attitudes toward ePROs and electronic tools that are used to manage adherence and symptoms related to oral therapies. Six focus groups were held for EP patients and 1 for Spanish-speaking LEP patients. LEP was defined as patients who self-identified as needing an interpreter to navigate the health care system. Data analysis was performed April through June of 2019.EXPOSURES Enrolled patients participated in a focus group lasting approximately 90 minutes. MAIN OUTCOMES AND MEASURESThe perspectives of patients with cancer treated with oral chemotherapies on integrating ePROs into their care management. RESULTS Among the 46 participants included in the study, 46 (100%) were White, 10 (22%) were Latinx Spanish-speaking, 43 (93%) were female, and 37 (80%) were aged at least 50 years or older.Among the 6 focus groups with 6 to 8 EP patients (ranging from 6 to 8 participants) and 1 focus group with 10 Spanish-speaking LEP patients, this qualitative study found that EP and LEP patients had different levels of acceptability of using technology and ePRO tools to manage their OCDT. EP patients felt generally positive toward OCDT and were not generally interested in using electronic tools to manage their care. LEP patients generally disliked OCDT and welcomed the use of technology for health management, particularly when addressing gaps in symptom management by their oncology clinicians. CONCLUSIONS AND RELEVANCEAlthough most electronic interventions target EP patients, these findings reveal the willingness of LEP patients to participate in technology-based interventions. Expanding ePROs to LEP patients may help to manage gaps in communication about treatment and potential adverse events because of the willingness of LEP patients to use ePRO tools to manage (continued) Key Points Question Should electronic patientreported outcome tools (ePROs), built for patients who are English proficient (EP), be implemented for Spanishspeaking patients with limited English proficiency (LEP), particularly in the context of oral cancer-directed therapies (OCDT)? Findings This qualitative study of 46 participants found that EP and LEP patients have different levels of acceptability of using technology and ePRO tools to manag...

Schools of Public Health have a commitment to engage in practice-based research and be involved in collaborative partnerships. In 2016 the faculty, staff, and students from the University of Nebraska Medical Center College of Public Health and the Nebraska Department of Health and Human Services, Division of Behavioral Health collaborated to develop and administer a comprehensive assessment of the mental health and substance use disorder services provided by the Division of Behavioral Health. The purpose of this paper is to describe the process used to develop the trusting and mutually beneficial partnership and the data tools that were created and used to assess and determine the behavioral health needs. It is unrealistic to think that practitioners could undertake a project of this magnitude on their own. It is essential to have identified processes and systems in place for others to follow.