Implementation of Standardized Assessment and Documentation to Monitor Oral Cancer Therapy Adherence

Abstract

Problem Statement: Medication nonadherence among breast cancer patients was identified as a problem by providers within Kapi'olani Medical Center for Women and Children, Women’s Cancer Center (WCC). Purpose: The purpose of this evidence-based quality improvement project was to create a standardized electronic health record (EHR) tool for providers to monitor adherence to oral cancer therapy in breast cancer patients, based on the American Society of Clinical Oncology (ASCO) standards, facilitating monitoring, and identifying barriers. Methods: A standardized oral cancer therapy adherence tool was created according to the ASCO standards, and this tool was built into the EHR, Epic. Providers caring for patients with breast cancer were educated on the use of the tool to monitor oral cancer therapy adherence and identify barriers. EHR data was gathered through benchmark reporting to measure provider usage of the tool. Results: A report covering the implementation period from 9/7/2022 to 1/7/2023, captured a total of 694 patients. Further analysis revealed that 99 patients completed the questionnaire within the specified four-month period, representing 14.3% of patients assessed for oral cancer therapy adherence. Barriers to medication adherence were monitored. The project was accepted as a quality improvement initiative by the Hawaii Pacific Health (HPH) Cancer Committee. Discussion: The low utilization of the questionnaire tool could be due to analysis error. The small sample size limits generalizability, and managerial support is needed for sustainability. This project demonstrates promising results in monitoring oral cancer therapy adherence using an EHR tool. It marks an initial step towards improving medication adherence through standardized assessment and documentation. The project revealed increasing utilization of the questionnaire over time, positive patient engagement with MyChart, and suggests future sustainability by involving patients in questionnaire completion.