e13570 Background: Comprehensive interdisciplinary coordinated care is essential for optimizing guideline-concordant treatment and achieving efficient, high-quality outcomes for patients with pancreatic cancer (PDAC). Although essential, the absence of comprehensive care models impedes efficiency, resource allocation, metric tracking, team engagement, and continuous quality improvement (CQI). Methods: From Feb-Aug 2023 our interdisciplinary (Inter-D) team conducted a 6-month strategic planning initiative to develop a robust, patient-centered pancreatic cancer program & operational roadmap. The initiative focused on: Key personnel, services and programs critical for evidence-based PDAC care. Processes, infrastructure and technology enhancements. Fostering a collaborative team culture. There were 3 phases: 1) Environmental analysis assessing strengths/gaps in the program; 2) Collaboration with leadership to align with institutional priorities; 3) Defining a mission vision, priorities & metrics. It resulted in a five-year plan and resource requirements, which has strategically guided clinical care delivery through 2025. Results: Implementing the plan’s 4 priority areas- increasing patient access, program growth, delivering 4-dimensional support, and ensuring CQI through outcome measurement- led to exceptional outcomes in the first year (FY24): Access: Implemented disease-specific hold slots for providers. Enhanced intake coordination and scheduling metrics to reduce new patient appointment referral to visit to 8.3 days. Growth: Organized an annual patient summit, PDAC symposium, clinician outreach programs and community engagement events, which correlated with a 30% increase in new patient volume. 4-Dimensional Care: Developed a comprehensive supportive care framework with RD assessments, genetic counseling, and streamlined transitions. Established an Inter-D clinic and weekly huddles for care continuity. Reduced referral-to-treatment time to 21.7 days and first visit to genetic test result to 17 days. Optimized pancreatic insufficiency management, cutting consultation-to-prescription time from 25 to 2.75 days. Continuous QI & Outcomes Measurement: Secured institutional support building comprehensive data plan to facilitate real-time assessment and tracking of all patients across regional centers. Implemented PDSA cycles to address high-priority areas, driving ongoing improvements. Conclusions: Strategic planning within disease-focused teams can transform cancer care delivery by increasing patient volume, improving measurable quality outcomes, fostering alignment with institutional goals, and establishing a clear roadmap for future growth. This approach is a replicable model for other disease teams seeking to enhance team-based care, efficiency, and improve patient outcomes.

504 Background: Electronic patient-reported outcomes (ePROs) are a component of high-quality pancreatic cancer care, but obstacles exist to implementation at scale to inform care across a complex health system. As part of the Canopy Cancer Collective initiative, the UCLA Agi Hirshberg Center for Pancreatic Diseases developed and implemented a model of ePRO-informed pancreatic cancer care, leveraging an oncology-specific care platform, Carevive. This study examines the feasibility of implementing ePROs in pancreatic cancer care, with attention to identifying key barriers and facilitators. Methods: Implementation was conducted from November 2024 to June 2025 incorporating the team’s Adaptive Interdisciplinary Model. Patients submitted baseline ePROs and could voluntarily enroll in the remote symptom monitoring (RSM) program. The baseline survey captured demographics as well as PROs focused on quality-of-life (QoL), symptoms, and overall health. The pre-implementation process involved identification of key stakeholders and formal SWOT analysis. In response to engagement challenges, a patient navigator with a defined clinic workflow was established to support patient enrollment and engagement. Continuous improvement efforts were followed to optimize implementation. Results: A total of 94 patients with pancreatic ductal adenocarcinoma with established and ongoing care at the center were identified. Of these, 59 patients (62.8%) submitted a baseline ePROs survey and 43 of them (72.9%) consented to enroll in the RSM program for ongoing monitoring. Of the 75 patients identified since January 2025, 51(68%) submitted a baseline survey; an increase from 42% prior to January 2025, exceeding the center’s 50% target completion rate. Optimization of the patient navigator’s clinic workflow is likely a contributing factor. Of all patients who submitted a baseline survey, the median age was 69, 57% were considered Intermediate Fit or Frail, and 74% indicated interest in trial participation. Fatigue, decreased appetite, anxiety, and insomnia were the most prevalent symptoms reported at baseline. Most patients indicated their QoL to be “6” and overall health to be a “5” on the EORTC-QLQ C30 (range: 1 (“Very poor”) to 7 (“Excellent”)). Conclusions: Routine collection of ePROs in a pancreatic cancer population is feasible and facilitated by the addition of a patient navigation workflow. The implementation enabled identification of symptom burden and QoL concerns. Facilitating factors included the following: engaged core team members, stakeholder support, a clearly defined conceptual model, use of an oncology-specific ePRO platform, utilization of a patient navigator role, and ongoing quality improvement efforts to optimize processes in real time. Next steps include measuring impact on patient experience and clinical outcomes of interest.

709 Background: The Canopy Cancer Collective, a Learning Health Network (LHN) comprised of 14 pancreatic cancer centers across the U.S., set ambitious goals in 2023 to improve screening rates across four key areas: clinical trial screening (from a baseline of 30% to 100%), assessment of enzyme replacement (37% to 100%), goals of care discussions (57% to 100%), and palliative care screening (30% to 100%). This study aimed to identify the barriers and facilitators influencing the implementation of these screening aims, with the goal of developing informed, actionable recommendations for future implementation efforts. Methods: Throughout 2023, data were gathered from monthly assessments completed by site coordinators and quality improvement coaches at each of the 14 centers. These assessments captured insights into planning, implementation, and challenges related to the screening aims. Additionally, a comprehensive site assessment conducted in October 2023 was analyzed. We employed content analysis to identify the key factors influencing the implementation process, with percentage improvements in screening aims documented. Results: A total of 128 assessments were reviewed. The most common barriers identified were insufficient personnel and time for screening implementation (n=7), delayed responses and lack of engagement from supporting teams (n=6), unanticipated delays and logistical barriers to the procedures (n=6), recruitment challenges (n=3), and changes in the staff or management (n=5). Facilitators that supported implementation included: identification and testing of patient-centered strategies for implementation of screening (n=11), team expansion (n=8), consistent data collection and sharing through the LHN database (n=7), launching of other initiatives tailored to institutional needs (n=5), and collaboration between teams within or across institutions (n=4). Among the barriers to form ideal interprofessional composition, resource shortages (n=7), provider shortages (n=6), and coordination difficulties (n=5) were included. By January 2024, the network’s screening rates had improved significantly: 92% for clinical trial, 87% for enzyme need and palliative care each, and 97% for goals of care. Conclusions: While common challenges such as staffing limitations and logistical barriers posed obstacles, facilitators like patient-centered strategies, team growth, and improved collaboration were key to the successful implementation of the screening aims. These findings offer actionable insights for enhancing future implementation efforts, with a focus on addressing resource limitations and fostering team engagement. Moving forward, we plan to assess the outcomes of these screening initiatives to examine their impact on patient care and evaluate the perceptions of site on utilization of implementation strategies to promote its adoption.

e23243 Background: Pancreatic adenocarcinoma is an aggressive cancer with a 13% five-year survival rate. To prolong survival, early implementation of treatment is necessary. Germline genetic testing is recommended by national guidelines regardless of stage, personal, and family history of cancer. It can impact treatment decision-making and clinical trial selection. Many institutions rely on genetic counselors (GCs) for evaluation and testing, and challenges in referral timelines and bandwidth can delay testing. There is a critical need in our interdisciplinary Pancreatic Cancer Clinic to expedite diagnosis and decrease unnecessary GC referrals. Methods: Using a plan-do-study-act (PDSA) model of quality improvement, baseline data for 20 referrals between August 2023 to December 2023 were obtained. The average time between referral placement and date of service by a GC and the time to result in reporting were recorded.The change consisted in shifting the responsibility for ordering germline tests to the lead oncologist, using an EMR-integrated order for the Tempus xG+ 88-gene blood panel. The order and lab collection occurred on the same day. Results were routed directly to the medical oncologist. For patients with negative results, patients were informed, and no further action was taken. When the result was positive for a pathogenic mutation or a variant of unknown significance (VUS), a referral was placed for GC. The goal of the study was to obtain genetic risk results faster to aid decision-making, decrease the time from referral to see GCs, and reduce the number of necessary referrals. Results: At baseline, the range from referral to GC appointment was 32-35 days, the reporting time of testing panels was 12-15 days, and the total time from referral to result was 45 to 50 days. The first PDSA cycle ran from 4/18/24-1/15/25, the selected panel was ordered and resulted for 51 patients. The average order-to-result time was 17.0 days . Of 51 tests ordered, 30 patients (59%) resulted as positive or VUS, which qualified for genetics referral placement. Of those 30, 28 (55% of total) who were local were referred to our Cancer Genetics Program. The average result to referral placement was 9 days. For 28 patients who were referred internally, the average referral placement to the first appointment offered was 16.7 days. Two patients had mutations that affected treatment decision making. In summary, germline testing led to 39% decrease in the number of referrals and reduced the time to see GCs by 18 days. Results reporting improved from an average of 45 days to 17 days. Conclusions: This medical oncologist-led germline testing workflow is considered efficient and an excellent option for any resource-limited program for optimal resource utilization and treatment decisions influenced by genetic risk. Future steps will focus on refining the testing process, order entry, and reporting.

45 Background: EPI is a prevalent, overlooked condition in PC impacting nutritional status, treatment tolerance & QOL. Evidence on pancreatic exocrine replacement therapy (PERT) in PC shows improvements in malabsorption, weight, QOL, sarcopenia, and survival increases. In the U.S, a lack of comprehensive guidelines on EPI/PERT in PC leaves a critical gap. Canopy engaged researchers to identify U.S. priorities in clinical practice to inform guideline development through expert consensus. Methods: A national Working Group (n = 12) convened. A mixed-methods approach and modified Delphi were used: Lit review; 6x focus groups (n=28; Patients/HCPs); 6 virtual meetings to develop consensus statements (CCS); 2 Delphi survey rounds deployed. Quant. ratings were analyzed for median & IQRs). Consensus was defined as ≥ 70% in agreement/strong agreement. CCS were validated for clinical feasibility & impact. Results: The15 CCS address critical domains in care & represent the first comprehensive recommendations standardizing EPI and PERT management in PC in the US. Conclusions: These statements offer practical guidance to improve EPI diagnosis & management in PC. Standardizing practice can reduce variability and improve outcomes. Wider adoption and iterative refinement of these recommendations through implementation is needed to validate clinical outcomes and further optimize care. Highlights from the 1st U.S. clinical consensus statements on EPI in panc cancer. Domain Statement Consensus Level Standards & Ethics EPI/PERT standards should be integrated into PC guidelines & MDC planning. 88% Screening & Clinical Criteria All PC patients should be screened for EPI & re-screened at intervals after. Given prevalence in PC, EPI in PC can be diagnosed through assessing symptoms/nutritional status, without PFTs (FE-1).EPI can be suspected when a patient presents with unintentional weight loss despite adequate intake, plus min. 1 additional EPI s/s, OR presentation w/ 2-3 EPI s/s without unintentional weight loss, despite adequate intake. 94% 88% 81% Therapeutic Principles Trialing PERT is considered safe & effective in symptomatic PC patients with OR without a clinical EPI Dx. 88% Access Practical considerations for Rx should include cost; pill burden; religious beliefs. 100% Dosing & Management Sugg. starting dose: 48,000 - 72,000 units/meal; 24,000-36,000 units/snack.Routine monitoring for dose adjustments should occur within 2 weeks after initiating PERT and with onset of any new/worsening s/s. 94% 94%

Background: Barriers exist to effectively integrate palliative care (PC) into care for individuals with chronic obstructive pulmonary disease (COPD). Objective: To test the acceptability of and satisfaction with a telehealth-facilitated integrated PC (TIPC) intervention and to examine its preliminary impact on quality of life (QOL) and symptoms. Methods: Nine patients with COPD received the TIPC intervention. Repeated measures data from the Functional Assessment of Chronic Illness Therapy-Palliative Care scale (FACIT-Pal) and the Clinical COPD Questionnaire (CCQ) were collected at baseline, three months, and six months. Intervention acceptability was measured using investigator-developed questions. Results: Analysis revealed significant changes over time in the FACIT-Pal and the CCQ (p values <0.05), reflecting improved health-related QOL and reduced COPD symptoms. There was a generally positive reception to the intervention. Discussion: Results suggest the TIPC intervention may be acceptable and may enhance QOL and reduce symptoms in individuals with COPD.

Background Chronic lung disease affects nearly 37 million Americans and often results in significant quality of life impairment and healthcare burden. Despite guidelines calling for palliative care (PC) integration into pulmonary care as a vital part of chronic lung disease management, existing PC models have limited access and lack scalability. Use of telehealth to provide PC offers a potential solution to these barriers. This study explored perceptions of patients with chronic lung disease regarding a telehealth integrated palliative care (TIPC) model, with plans to use findings to inform development of an intervention protocol for future testing.Methods For this qualitative study, we conducted semi-structured interviews between June 2021- December 2021 with patients with advanced chronic lung disease. Interviews explored experiences with chronic lung disease, understanding of PC, and perceived acceptability of the proposed model along with anticipated facilitators and barriers of the TIPC model. We analyzed findings with a content analysis approach.Results We completed 20 interviews, with two that included both a patient and caregiver together due to patient preference. Perceptions were primarily related to three categories: burden of chronic lung disease, pre-conceived understanding of PC, and perspective on the proposed TIPC model. Analysis revealed a high level of disease burden related to chronic lung disease and its impact on day-to-day functioning. Although PC was not well understood, the TIPC model using a shared care planning approach via telehealth was seen by most as an acceptable addition to their chronic lung disease care.Conclusions These findings emphasize the need for a patient-centered, shared care planning approach in chronic lung disease. The TIPC model may be one option that may be acceptable to individuals with chronic lung disease. Future work includes using findings to refine our TIPC model and conducting pilot testing to assess acceptability and utility of the model.

645 Background: Pancreas cancer (PC) is the third leading cause of cancer death in the United States. Canopy Cancer Collective (CCC) was founded in 2019 given the urgent need for improvements in survival and patient experience. Through interdisciplinary teams inclusive of patients, 14 care centers formed a learning health network (LHN) to share data and best practices to accelerate improvements in PC care delivery and outcomes. Methods: In October 2022, LHN representatives gathered to establish aims for the year. Through a consensus process, the LHN arrived at four aims to achieve by December 31, 2023. The aims are: Patients screened for 1) clinical trials will increase from 39% to 100%, 2) palliative care will increase from 30% to 100%, 3) enzyme need will increase from 37% to 100%, and 4) goals of care assessed will increase from 57% to 100% . CCC established measures to guide improvement toward the aims, which are tracked using a registry. Sites co-developed operational definitions for each measure and implemented new practices to identify and manage all patients with pancreas adenocarcinoma who enter their care. For each aim, each care center identified their current processes for screening, documented their desired future processes, tested changes to close gaps, and standardized successful changes. Many began with a subset of their population, or in a single clinic, and are working to expand to additional populations and settings. CCC facilitates best practice sharing among LHN peers and data sharing. Care centers have had access to the following supports: 1) quality improvement coaching, 2) topical workgroups, 3) peer workgroups, 4) network-wide webinars, 5) summaries of best practices to adapt locally, 6) data at site and network levels, and 7) a community platform for documentation and collaboration. Results: There are 2,443 patients in the CCC registry. All sites report data on patients discussed in pancreas clinic or tumor board and are working to include their full PC population. Data analyzed using Shewhart control charts (p-charts) show improvement at an aggregate level across all aims. A January 2021-December 2022 baseline includes 1,218 patients. Care centers began testing changes in January 2023, and 1,225 patients have been included since. The percent of patients screened for clinical trials, enzyme need, and palliative care has shifted above the upper control limits for at least six months. The percent of patients with goals of care assessed shifted above the upper control limit for five months. Just one data point outside the upper control limit (UCL) signifies non-random variation. Conclusions: These aims put our 14 care centers on a path to delivering measurably improved care for patients through better access to nutrition, clinical trials, and palliative and supportive care services. A LHN is a model of collaboration and community building that can successfully transform care delivery at scale for patients with PC.

272 Background: Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer death and presents with advanced incurable disease approximately 75% of the time, contributing to the lowest survival rate and worst multidimensional quality of life (QOL) compared to other adult solid tumors. Standardized screening for early integration of interdisciplinary care (IDC) services, advance care planning, and utilization of electronic patient-reported outcomes (ePROs) for improved QOL and symptom management are recommended, yet the literature is lacking in rigorously-conducted PDAC needs assessments, an important prerequisite to care model design. Methods: Between September 12, 2023 and May 7, 2024, 525 patients with gastrointestinal (GI) malignancies were sent a Supportive Care Questionnaire (SCQ), an ePRO survey assessing multi-dimensional IDC needs prior to first visit at an NCI-designated comprehensive cancer center in the Pacific Northwest. The SCQ includes validated surveys and a total of 12 domains chosen by the IDC service responsible for management of the given need(s), who also set trigger thresholds for referral to the IDC service. Rates of positive screens for each service were compared by cancer type (PDAC, Colorectal [CRC], gastroesophageal [GE]). Results: 340 (65%) SCQs were completed (57% via MyChart, 43% in person) similarly across disease groups; with an average of 10 mins to complete. Respondents were 49% female/59% male (Race: White (76.5%), Asian (10%), Black/African-American (4.5%), Other/Unknown (9%)/Ethnicity Non-Hispanic (90%, Hispanic 7.6%), Other/Declined/Unknown 2.4%), with primary language spoken being English (92%), Spanish (3.5%), simplified Chinese (1.5%) and Other (2.5%). Table 1 shows – by GI cancer type –the total number of responses and the proportion of patients who screened positive for one or more IDC services. Conclusions: Patients with PDAC had the greatest need for IDC services with most frequent positive screens indicating need for nutrition, social work, palliative care and patient navigation services when surveyed in our institution-wide program of SC screening for all new GI cancer patients. Results will inform further development of IDC services in PDAC and other GI cancers, including via staff prediction modeling. The SCQ is also being considered for SC screening and management across the Canopy Cancer Collective, a nationwide learning health network of pancreas cancer programs. PDAC CRC GE Surveyed 187 237 101 Completed 122 (65%) 153 (65%) 65 (64%) Positive Screen 68 (56%) 70 (46%) 26 (40%)

585 Background: Pancreatic cancer is the third leading cause of cancer death in the United States; it is a complex disease requiring coordinated patient care. Multidisciplinary tumor boards (MTB) are today's gold standard in pancreatic cancer but are frequently criticized for being time-intensive and inefficient. To address this issue, Cancer Collective and Hive Networks have developed a novel patient-information visualization tool designed to improve the communication and efficiency of multidisciplinary tumor board meetings. This pilot study investigated the patient-information visualization tool's usability, efficiency, and feasibility in pancreatic cancer tumor board meetings. Methods: A prospective multi-center pilot study was conducted at Northwell Health (a comprehensive community cancer program [NCCCP] in the Northeastern United States) and the University of California San Diego (an NCI-designated comprehensive cancer center in [NCCC] in the Southwestern United States. The feasibility of the tool was assessed by measuring the percentage of MTB cases discussed that used the patient-information visualization tool. The usability and efficiency of the tool were assessed via Likert scale questions. Acceptable usability and effectiveness were defined as a 70% score or higher. Additionally, MTB participants were queried for input on design improvements for future iterations and expected future directions of tool use. Results: The patient-information visualization tool was rolled out on 07/22/2022 at the NCCP and NCCC. From 07/22/2022-05/31/2023, 170 (92%) MTB cases were reviewed at the NCCP. From 07/22/2022-05/31/2023, 74 cases (100%) of MTB cases were reviewed using the patient-information visualization tool at the NCCP. The NCCP (n=9) mean scores for usability and efficiency were 4.31 (86%) and 4.17 (83%) respectively. The NCCC (n=6) mean scores for usability and efficiency were 4.04 (81%) and 3.96 (79%) respectively. Qualitative feedback, reported on survey open-ended questions, included suggested enhancements to improve the tool’s usability, such as leveraging data automation to reduce data entry burden, improving the user interface for ease of data visualization, and adding additional data elements (e.g., specific procedure and appointment details) to improve decision-making utility. Conclusions: Implementing the novel digital dashboard to visualize pancreatic cancer patient data was highly feasible, usable, and efficient. Future directions of tool use include refining based on qualitative feedback from end users and planning for data automation and interoperability with the EMR.

1520 Background: Improving lung cancer care among Veterans is a priority within the Veterans Affairs due to higher rates of lung cancer incidence, morbidity, and mortality among Veterans compared to non-veterans. Unaddressed symptom burden is common due to many factors including complex comorbidities, psychosocial challenges, smoking history and limited social support networks. Additionally, complications from social determinants of health can obstruct successful discussions of symptom-burden between Veterans and their clinical care teams which can limit compliance with recommended symptom management strategies. To overcome these barriers, we conducted a randomized controlled trial to test the effectiveness of a lay volunteer-led proactive symptom assessment and symptom intervention. The objective was to determine if the intervention improved clinician documentation from baseline to 6-months post-enrollment compared to usual care. Secondary outcomes included change in patient activation, health-related quality of life (HrQOL), and symptom-burden. Methods: Patients were randomized into the lay volunteer proactive symptom assessment intervention plus usual cancer care (intervention group) or usual cancer care alone (control group). We conducted electronic health record review to assess primary cancer-clinician symptom documentation of Veterans’ symptoms identified as moderate-to-severe at baseline and 6-months using the Edmonton Symptom Assessment Scale. Patient surveys with validated assessments were used to assess patient activation, HrQOL and symptom burden at baseline (time of enrollment) and 6-months post-enrollment. We used regression models to evaluate differences in our primary and secondary outcomes. Results: 60 Veterans were consented and randomized into the study (29 control; 31 intervention). There were no differences in demographic or clinical factors across groups. The median age was 70 years (range 56-85), 95% were male, 70% identified their race as White, 53% were married and 48% had a 2-year or 4-year college degree. The majority had at least 3 comorbidities (54%), diagnosed with stage 3 or 4 (62%) and received systemic treatment with chemotherapy and/or radiation (77%). At 6-months post-enrollment as compared to baseline, the intervention group had greater improvements in symptom documentation (56% from 12.5% vs. 29% from 43%, p = 0.01), greater improvements in patient activation (p<0.001), HrQOL (<0.001), and lower symptom burden (p<0.001) than the control group. Conclusions: Integration of proactive symptom assessment by lay volunteers has a significant and meaningful effect on symptom documentation, patient activation, quality of life, and reducing symptom burden among Veterans with lung cancer. Clinical trial information: NCT03216109.

BACKGROUND:Pain is a significant problem in patients with cancer. Breakthrough cancer pain contributes to the pain experience, but it is often underassessed and underrecognized. Shared decision-making (SDM), where patient preferences, goals, and concerns are discussed and integrated into a shared decision, can potentially foster earlier identification of pain, including breakthrough cancer pain, and improve pain management.OBJECTIVES:To explore the use of SDM to evaluate its impact on cancer pain management.METHODS:This prospective, multisite study engaged patients with advanced cancer to explore the use of SDM in managing cancer pain using a digital platform with an expanded pain assessment. Decision preferences were noted and incorporated into care. Outcomes included pain and patient-perceived pain care quality.RESULTS:51 patients with advanced cancer enrolled in the study. The mean pain score was 5 out of 10 throughout the three study time points. 88% of patients experienced breakthrough cancer pain of severe intensity at baseline and approximately 70% at visits two and three. The majority of breakthrough cancer pain episodes lasted longer than 30 minutes. The majority (86%) of participating patients desired shared decision-making or patient-driven decision-making. Most patients expressed satisfaction with the level of shared decision-making in managing their cancer pain. Breakthrough cancer pain remained significant for most patients.CONCLUSIONS:SDM incorporated into pain discussions has the potential to improve pain outcomes, but significant challenges remain in managing breakthrough cancer pain.

368 Background: Pancreas cancer (PC) survival is among the lowest of all malignancies. While limited advances in treatment are a major driver of this reality, ample opportunity exists to improve outcomes by reducing care variation, providingcoordinated, comprehensive care, and accelerating research. Learning health networks (LHNs) improve outcomes in pediatric diseases through such mechanisms, yet are not widely implemented in adult care. We aimed to develop, implement, and collect initial outcomes of the first oncology LHN, the Canopy Cancer Collective (CCC). Methods: In 2019, we established CCC to apply to PC the LHN model, including core tenets of continuous quality improvement (QI), data-sharing, empowered interdisciplinary teams and a stakeholder community including individuals with PC, and focus on community-defined improvable “outcomes that matter”. Six care centers were selected to join the LHN, and engaged in a collaborative design process to co-create a set of improvement aims and change ideas. Center team members received training in basic QI methods/tools guided by the IHI Model for Improvement and were coached to apply these to local improvement efforts. LHN infrastructure and technology enabled sharing of new ideas, best practices, and results amongst centers. Eight more centers joined in 2021, and an outcomes database built and implemented. Results generated by this database will inform center-specific and Network-wide improvement efforts and allow the LHN to undertake research. Results: Currently, 14 care centers are active participants in the CCC LHN. Five key outcomes have been defined as key targets, and centers have co-created and tested change ideas organized around key drivers of excellent PC care including proactive, timely care, aligned/prepared multidisciplinary teams, informed, activated patients, and accurate diagnosis and disease classification. 100% of care centers are trained in QI methods and actively testing change ideas. For example, in May 2022, 11 centers reporting on monthly QI activities met on average 4 times to advance QI projects, deploying a mean of 2.9 plan-do-study-act (PDSA) cycles (range, 0-5) focused on key drivers and outcomes, including reduced time to treatment, increased trial enrollment, assessment of patient experience, and improved data capture. Conclusions: Building a sustainable LHN for PC centers is feasible and has set the stage for improving patient and provider outcomes through iterative community-building, continuous improvement, and sharing of data and multidisciplinary best practices. Results lay the foundation for expansion not only in PC, but translation to other complex malignancies that will benefit from transformative, system-based approaches to outcome improvement.

Advanced practitioners are often in charge of planning and implementing care for cancer survivors, as noted by Carrie Tompkins Stricker, PhD, RN, ANP-BC, during JADPRO Live Virtual 2021. During a session at the conference, Dr. Stricker reviewed quality measures, best practices, and exciting innovations to draw on to improve survivorship care delivery.

PURPOSE: The Center for Medicare & Medicaid Innovation Oncology Care Model (OCM) requires documentation of a 13-point Institute of Medicine care management plan for Medicare patients. In addition, OCM includes evaluation of quality using key performance measures that align with the ASCO Quality Oncology Practice Initiative (QOPI). Both efforts are designed to improve patient-centered care and foster patients' engagement in their care plan. METHODS: A multicenter quality improvement project was conducted to develop a strategy to meet the OCM treatment planning (TP) requirement (Plan), pilot clinician education coupled with use of electronic TP in early-stage breast cancer (Do), evaluate the impact of TP on QOPI measures (Study), and develop recommendations for future implementation (Act). RESULTS: Thirty-three clinical providers and 171 women with breast cancer were included. Improved performance on several QOPI measures was observed for the intervention group compared with the historical control group. CONCLUSION: Meeting the OCM TP requirement through incorporating a technology solution provided an opportunity for quality improvement and preparation for full-scale TP within the OCM. TP delivery was associated with improved performance on select ASCO QOPI measures, which is likely to correspond with improved performance on quality measures within OCM.

INTRODUCTION Patient-reported outcome (PRO) measures used during cancer care delivery improve communication about symptoms between patients and clinicians and reduce service utilization for uncontrolled symptoms. However, uptake of PROs in routine cancer care has been slow. In this paper, we describe stakeholder engagement activities used to overcome barriers to implementing PROs. Implementation occurred in 2 study settings: PROs completed in the waiting room and reviewed during clinical visits to guide symptom management for multiple myeloma (visit-based PROs); and weekly PROs completed by cancer patients between chemotherapy visits to monitor symptoms at home (remote PROs). METHODS PRO implementation steps across studies included: (1) clinician and patient input on key symptoms, PRO measures, and identifying which PRO responses are clinically concerning to better target nursing actions; (2) developing PRO-based clinical decision support (CDS) for responding to concerning PROs; (3) training clinicians and clinical research assistants to interpret PROs and use software; and (4) describing implementation impact (frequency of concerning PRO responses and nursing actions). DISCUSSION Clinician and patient input was critical for identifying key symptoms, PRO measures, and clinically concerning response options. For the visit-based PRO observational study, all symptom scores appeared on a clinician dashboard, and those rated ≥1 by patients (on a 0-4 or 0-10 scale) had PRO-based CDS available for access. For the 2 remote PROs trials, stakeholders recommended that the 2 "worst" response options (eg, PRO responses of "often"/"always" or "severe"/"very severe") would trigger an automated email alert to a nurse along with PRO-based CDS. In each study, PRO-based CDS was tailored based on clinician input. Across studies, the most common nursing response to concerning PROs was counseling patients on (or providing care plans for) self-management of symptoms. In the trials, the percentage of weekly remote PROs generating an alert to a nurse ranged from 13% at an academic center to 36% in community oncology practices. KEY POINTS Across 3 prospective studies, PROs implemented into cancer care enabled tailored care based on issues identified on PROs. Stakeholder engagement was critical for successful implementation. This paper assists in addressing important PRO implementation challenges by describing a stakeholder-driven approach.

30 Background: Cancer pain prevalence is high (52%-77%) with breakthrough pain flares and end-of-dose failure adding to patient suffering and increased health care utilization. Shared decision-making (SDM), incorporating patient-stated preferences, goals, and concerns, can foster comprehensive pain assessment (CPA) and improve pain outcomes. Methods: This study will evaluate SDM and CPA in patients with cancer to manage chronic and breakthrough pain. Eligible patients have pain or are taking opioids to manage chronic cancer pain. Patients complete a tablet-based survey at enrollment to record baseline pain and activity levels, pain flare severity and length, end-of-dose pain, and SDM preferences. Results are presented on an electronic dashboard and the provider and patient collaboratively establish a pain care plan. The effectiveness of SDM on pain outcomes will be measured with the Pain Care Quality Survey. Results: Pain characterization is described for the first 43 patients enrolled, of which 42% (n=18) desire to share decision-making with the provider, while 35% (n=15) prefer to make the final decision after considering provider input. Patients are 57% (n=26) female with a mean age of 56 (range 20-93); baseline mean pain scores were 5.4, and overall distress scores were 5.43, (scale 0-10); 91% had a pain flare in the last seven days with mean severity of 5.53; 72% of flares lasted longer than 30 minutes. All patients had end-of-dose pain. Less than half (42%) have restricted activity and 23% manage self-care but cannot work. Participants reported incident pain associated with certain activity (63%) as well as insidious pain not associated with activity (65%). Enrolled patients selected 143 pain descriptors: burning (16), achy (24), sharp and stabbing (21), pins and needles (15), cramping (14) radiating (14), intermittent (19), and continuous (20). Conclusions: The majority (77%) of patients desire SDM. Although most patients were already taking opioids at presentation, they had moderate pain and distress, frequent flares and end of dose pain, and limitations on activity level due to the pain. Baseline pain characterization with a drill down CPA offers opportunity to use SDM to develop effective pain care plans and measure outcomes. Clinical trial information: NCT03304145.

Although recognized as best practice, regular integration of shared decision-making (SDM) approaches between patients and oncologists remains an elusive goal. It is clear that usable, feasible, and practical tools are needed to drive increased SDM in oncology. To address this goal, we convened a multidisciplinary collaborative inclusive of experts across the health-care delivery ecosystem to identify key principles in designing and testing processes to promote SDM in routine oncology practice. In this commentary, we describe 3 best practices for addressing challenges associated with implementing SDM that emerged from a multidisciplinary collaborative: (1) engagement of diverse stakeholders who have interest in SDM, (2) development and validation of an evidence-based SDM tool grounded within an established conceptual framework, and (3) development of the necessary roadmap and consideration of the infrastructure needed for engendering patient engagement in decision-making. We believe these 3 principles are critical to the success of creating SDM tools to be utilized both within and outside of clinical practice. We are optimistic that shared use across settings will support adoption of this tool and overcome barriers to implementing SDM within busy clinical workflows. Ultimately, we hope that this work will offer new perspectives on what is important to patients and provide an important impetus for leveraging patient preferences and values in decision-making.

158 Background: There is limited research on methods for alerting clinicians to concerning patient-reported outcome (PRO) responses and how often PROs trigger alerts to nurses during cancer care. Methods: In two randomized trials, adults with advanced cancer receiving chemotherapy were enrolled. Participants were randomized to usual care vs. weekly PROs completed between visits (with automated feedback to nurses). PRO responses in the intervention arm triggered automated email alerts to nurses for frequent, severe, or worsening symptoms in the last 7 days. Alert thresholds for PROs were chosen a priori but were unique to each study. The “Symptom Tracking and Reporting” (STAR) trial was conducted at one academic medical center. The “PROs to Enhance Cancer Treatment” (PRO-TECT [AFT-39]) cluster-randomized trial is being conducted in > 30 community practices. Results: In STAR, 766 patients participated (58% female, 38% ages ≥65, 17% minority, 28% ≤high school). 441 participants were randomized to the intervention arm, where 1,431/84,212 items (2%) triggered a concerning symptom alert, during 1,070/8,498 weeks (13%). Frequent alerts were for fatigue (62%), pain (32%), and appetite (16%). In PRO-TECT (AFT-39), 300 patients have been enrolled (58% female, 49% ages ≥65, 8% minority, 47% ≤high school) out of 1,000. 146 participants have been randomized to the intervention arm, where 1,422/24,739 items (6%) triggered an alert, during 824/2249 weeks (37%). Common alerts were for pain (48%), physical function (35%), and diarrhea (15%). PRO-TECT provided clinical decision support with alerts. Conclusions: In two randomized trials in advanced cancer, PROs collected during care delivery enabled tailored treatment based on issues identified on PROs. Pain, physical function, appetite, and diarrhea commonly triggered alerts for concerning symptoms. Early PRO-TECT results are showing a trend for higher weekly alert rates for concerning symptoms (37% vs. 13% in STAR), which may indicate that the PRO intervention will be even more effective in community practices. Results assist in addressing logistical considerations for implementing PROs into routine care. Clinical trial information: NCT03249090.