Patient Consult: Direct Interface of Physicist with the Patient in the Course of Treatment

Transcription

1 Patient Cnsult: Direct Interface f Physicist with the Patient in the Curse f Treatment Tdd Atwd, PhD Radiatin Medicine & Applied Sciences The Evlving Clinical Medical Physicist Hw have we traditinally impacted patient care? Implementing vendr-prvided technlgies Perfrming equipment/patient-specific quality assurance Is this path sustainable? Technlgies and cmmercial prducts becming mre rbust and autmated 1 Quality assurance and cmmissining becming well characterized and autmated 2,3 Our prfessin must change Need t utilize ur unique skillsets t have a meaningful impact Need t be willing t expand the scpe f ur prfessin 1 Laberta, V. Benefits f Autmatin in Radiatin Onclgy. Onclgy Times Yaddanapudi, S. et al. Rapid Acceptance Testing f Mdern Linac Using On bard MV and kv Imaging Systems. Medical Physics Zwan, B. et al. Cmmissining and QA fr VMAT Delivery Systems: An Efficient Time reslved System Using Real time EPID Imaging. Medical Physics T. Atwd AAPM 2017 Learning frm Radiatin Onclgists Faced a dilemma f clinical practice in latter half f last century Often viewed merely as technicians that treated referrals Began t participate in tumr bards, multidisciplinary clinics, etc. Transfrmed frm raditherapist t radiatin nclgist T. Atwd AAPM

2 Gals % US Adults % US Adults 8/2/2017 Learning frm Patients Access t the internet is increasing Adults nline: 52% (2000) t 88% (2015) Pew Research Center (2015) Adults Online and Trust in Physicians Trust in physicians is decreasing Great cnfidence : 73% (1966) t 34% (2012) Harris ( ) Year T. Atwd AAPM 2017 Learning frm Radiatin Onclgy Patients Access t the internet is increasing Adults nline: 52% (2000) t 88% (2015) Pew Research Center (2015) Adults Online and Trust in Physicians Trust in physicians is decreasing Great cnfidence : 73% (1966) t 34% (2012) Harris ( ) Online patient infrmatin is t cmplex fr general ppulatin Rsenburg, S. et al. Pract Radiat Oncl (2017) Patient-related distress can negatively impact utcmes fllwing RT Habbush, Y. et al. Adv Radiat Oncl (2017) Year T. Atwd AAPM 2017 Physics Direct Patient Care Initiative Establish an independent prfessinal relatinship with patients Meet with the patient at regularly scheduled appintments Take wnership f all technical aspects related t treatment Allw physicians t fcus n ther aspects f patient care Lay grundwrk fr future innvatins and patient respnsibilities T. Atwd AAPM

3 T. Atwd AAPM 2017 T. Atwd AAPM 2017 T. Atwd AAPM

4 T. Atwd AAPM 2017 T. Atwd AAPM 2017 T. Atwd AAPM

5 T. Atwd AAPM 2017 T. Atwd AAPM 2017 T. Atwd AAPM

6 T. Atwd AAPM 2017 T. Atwd AAPM 2017 Initial Observatins Medical physicists easily integrated int care team Wide variety f patient types Anxius, distrusting, scared and cnfused abut radiatin Calm, thankful, fascinated by the therapy Mst patients want t be included in the prcess Want their questins heard and answered Want t be a part f the decisin-making Want persnalized infrmatin (t review and share) Rewarding experience as a medical physicist T. Atwd AAPM

7 Initial Observatins Unexpected Experiences Requested by returning patients (nt just fr RT) Thank yu ntes frm patients after treatment Prmpted new physician-physicist interactins Learning Experiences Deferring medical questins devalues the interactin Prly chsen wrds can instantly derail a sessin Frmal cmmunicatin training is a necessity T. Atwd AAPM 2017 T. Atwd WIMP 2017 Randmized Clinical Trial Phase 1 Assess patient anxiety and satisfactin Grup 1: Physics direct patient care grup Grup 2: Standard practice grup Questinnaire given at 3 time pints After the simulatin appintment After the first treatment After the last treatment T. Atwd AAPM

8 Randmized Clinical Trial Six questins related t patient anxiety (Validated State-Trait Anxiety Inventry) Fur questins related t patient satisfactin and technical understanding (Mdified frm validated questinnaires) T. Atwd AAPM 2017 Randmized Clinical Trial Start with a lead-in phase Enrll 30 patients Test verall prcess (cnsent, questinnaires, etc.) Evaluate results frm the physics direct patient care grup Test randmizatin prcess Preliminary results 15 patients cmpleted 10 currently n study All frm physics direct patient care grup T. Atwd AAPM 2017 Patient Anxiety (15 patients, scale: 1 = Nt at all, 4 = Very much) I feel cnfident Last Tx First Tx Simulatin 4.0 (+/- 0.0) 3.9 (+/- 0.3) 3.6 (+/- 1.0) I am relaxed Last Tx First Tx Simulatin 3.4 (+/- 1.1) 3.9 (+/- 0.3) 3.7 (+/- 0.7) I feel calm Last Tx First Tx Simulatin 4.0 (+/- 0.7) 3.9 (+/- 0.4) 3.9 (+/- 0.3) T. Atwd AAPM

9 Patient Satisfactin (15 patients, scale: 1 = Nt at all, 4 = Very much) Hw satisfied are yu with yur verall radiatin nclgy experience? Last Tx First Tx Simulatin 4.0 (+/- 0.0) 3.8 (+/- 0.6) 3.7 (+/- 0.7) D yu feel that adequate Last Tx time was devted t explaining the technical First Tx aspects f yur treatment? Simulatin 3.9 (+/- 0.4) 3.9 (+/- 0.4) 3.8 (+/- 0.6) Hw satisfied are yu with yur understanding f the technical aspects f yur treatment? Last Tx First Tx Simulatin 3.3 (+/- 0.8) 3.7 (+/- 0.7) 3.8 (+/- 0.5) T. Atwd AAPM 2017 Next Steps Mve t randmizatin n clinical trial Phase 2: evaluate physician time savings Begin t braden the scpe f the prject T. Atwd AAPM 2017 Establishing independent prfessinal relatinships with patients is expected f a clinical medical physicist. But this is just the beginning Next we cmbine ur technical expertise with direct patient care t establish new clinical respnsibilities and expand the scpe f ur prfessin. Managing knwledge-based systems/data The pssibilities are endless, but it all begins here. T. Atwd AAPM

10 Thank Yu Cllabratrs: Derek Brwn, PhD AJ Mundt, MD Tdd Pawlicki, PhD Jim Murphy, MD Kevin Mre, PhD 10