Meeting Abstract

JL508. Diversity Awareness and Documentation Practices Among Oncology Advanced Practice Providers: A Prospective Quality Improvement Project

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ABSTRACT

Abstracts From 
JADPRO Live at APSHO 2017
Marriott Marquis, Houston, Texas • November 2–5, 2017

The posters for the abstracts below can be found at:
eventscribe.com/2017/posters/JADPROLIVE/home.asp

Background: Health-care providers have the challenge of caring for widely diverse populations. The United States currently has the most polyracial, polyethnic, and polyreligious population in history (Andrews & Boyle, 2002). The 2002 Institute of Medicine (IOM) landmark report titled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care confirmed that disparities in health care exist and are associated with worse outcomes. Findings also suggest that bias, prejudice and stereotyping by the health care provider may contribute to disparities. The IOM called for efforts to address these disparities, including increasing awareness among health care providers (Institute of Medicine [IOM], 2003).

Objective: To assess the cultural self-awareness of oncology advanced practice providers (APPs) who practice in a community- based outpatient cancer center. To investigate the extent to which oncology APPs include cultural care into patient assessments.

Methods: APPs working in an academic community-based hospital outpatient oncology clinic completed a questionnaire titled, the “Looking Glass Examination.” This tool evaluates cultural self-awareness and examines the intrinsic attitudes that providers may have when caring for patients of diverse backgrounds (Yeo et al, 2011). A prospective, quality improvement chart review was performed to analyze the extent to which cultural themes were addressed during oncology clinic visits.  A list of cultural keywords and phrases was used as a guide for chart review. Ten percent, 164 patients, of the 2015 cancer population at the institution were examined, which included a stratified sample of the top five disease groups:  breast, lung, gastrointestinal, genitourinary, hematologic, and gynecologic cancers (Duke Cancer Institute, 2016). 

Results: Responses from the questionnaire were analyzed. There was a 92% response rate. Forty-five percent of APPs demonstrate above average cultural awareness. Upon chart review, of the 28 cultural keyword items, an average of 4.88 items were addressed each visit, including age and gender. Multiple cultural items, including literacy, language, use of herbal treatments, insurance status, and belief about disease were addressed less than 5% of the time.

Conclusions: Oncology APPs show high cultural self-awareness. We predict the cultural documentation will be low. Limitations to this study include potential bias of the APP after completing the questionnaire and inter-reviewer variability.  There may be cultural aspects addressed during the clinic visit that were not documented.

Recommendations: Cultural assessment should be a standard part of oncology patient assessments. An open-ended cultural questionnaire would help APPs better assess the cultural needs of their patients. A cultural review of systems dot phrase was created for use in the EMR. This can be shared and applied across the health system to better serve our patients. 

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