Implementing an electronic health record workflow to identify parents with cancer and implications for supportive oncology care.
Parents with cancer face unique psychosocial challenges as they navigate treatment while caring for dependent children, yet parenthood status is rarely captured in oncology workflows. This initiative evaluated the feasibility and outcomes of a new electronic health record (EHR)-based workflow to systematically identify parents with cancer and then connect them to family-focused assessment and supportive care.
A two-phase quality improvement initiative was conducted at an NCI-designated comprehensive cancer center. Phase 1 included process mapping, analysis of tumor registry and distress screening data, and development of an EHR screening item assessing parenting status. Phase 2 implemented the item ("Patient is a parent/caregiver with child/ren < 22 years of age?") into oncology workflows, linking identified parents to a new supportive care program, Family Circle, which includes psychosocial assessment, navigation, and family-centered support. Training for oncology clinicians included in-service education. Analyses examined prevalence estimates and associations between parenting, distress, anxiety, and depression and reports of quality improvement metrics.
Among N = 2,172 screened patients, 20.6% identified as parents; the age-adjusted prevalence of parenting with children under 21 was 16.9%, consistent with national estimates. Parents reported significantly higher distress (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.11-1.64, p = 0.003) and anxiety (OR = 1.28, 95% CI = 1.06-1.52, p = 0.009) than matched non-parents. Parents with younger children exhibited greater anxiety than those with older children (F = 4.32, df = 2, 393, p = .01). During implementation, N = 431 parents were identified in 6 months (79.4% through the EHR item).
Embedding parenting status screening into the EHR is feasible, accurate, and critical for linking parents with cancer to supportive care. Wider implementation of such workflows may enhance psychosocial oncology practice and improve cancer parenting outcomes.
A two-phase quality improvement initiative was conducted at an NCI-designated comprehensive cancer center. Phase 1 included process mapping, analysis of tumor registry and distress screening data, and development of an EHR screening item assessing parenting status. Phase 2 implemented the item ("Patient is a parent/caregiver with child/ren < 22 years of age?") into oncology workflows, linking identified parents to a new supportive care program, Family Circle, which includes psychosocial assessment, navigation, and family-centered support. Training for oncology clinicians included in-service education. Analyses examined prevalence estimates and associations between parenting, distress, anxiety, and depression and reports of quality improvement metrics.
Among N = 2,172 screened patients, 20.6% identified as parents; the age-adjusted prevalence of parenting with children under 21 was 16.9%, consistent with national estimates. Parents reported significantly higher distress (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.11-1.64, p = 0.003) and anxiety (OR = 1.28, 95% CI = 1.06-1.52, p = 0.009) than matched non-parents. Parents with younger children exhibited greater anxiety than those with older children (F = 4.32, df = 2, 393, p = .01). During implementation, N = 431 parents were identified in 6 months (79.4% through the EHR item).
Embedding parenting status screening into the EHR is feasible, accurate, and critical for linking parents with cancer to supportive care. Wider implementation of such workflows may enhance psychosocial oncology practice and improve cancer parenting outcomes.
Authors
Tercyak Tercyak, Sleiman Sleiman, Akand Akand, Statman Statman, Adams Adams, Biel Biel, Davis Davis, Zhang Zhang, Ahn Ahn, Marshall Marshall, Gaines Gaines, Sharkey Sharkey
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