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Streck JM, Walter AW, Temel JS, Jawahri AE, Shin HJ, Regan S, Muzikansky A, Ponzani CJ, Ostroff JS, Park ER. Investigating documentation of alcohol and non-medical substance use in oncology treatment: an electronic health record review. Support Care Cancer 2022; 30:4275-4281. [PMID: 35088148 PMCID: PMC10201345 DOI: 10.1007/s00520-021-06688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/07/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Little is known about non-tobacco substance use (SU) and its treatment in cancer patients. National guidelines address tobacco only, and assessment of SU in cancer patients is not standardized. It is not clear how oncology clinicians assess, document, and follow-up on SU. METHODS We conducted an electronic health record review of patients enrolled in a smoking cessation trial at one large hospital site (N = 176). Chart review of oncology treatment notes assessed whether SU assessment was documented, the content of the documentation/assessment (e.g., frequency of use), and details about documentation (e.g., where/who documented). RESULTS Sixty-nine percent (121/176) of cancer patients had SU documented. Many patients (42%, 74/176) had only one substance documented; 66% (116/176) had alcohol use documented. For a substantial minority of patients (43/176; 24%), the provider did not specify the substance assessed (e.g., "drug use," "illicits"). SU was primarily documented by physicians (84%, 102/121), in routine progress notes (56%, 68/121), in the "social history" section of the note (84%, 102/121). Only 4 patients had a documented SU follow-up plan. When examining the subset of patients who reported problematic alcohol use (N = 27), the content of documentation was inconsistent (e.g., number of drinks/day vs. qualitative descriptors of use). CONCLUSIONS About 1/3 of oncology patients did not have SU assessment documented. SU other than alcohol use was infrequently documented, many clinicians documented SU but did not specify substance type, and few clinicians documented a follow-up plan for problematic SU. Oncology settings should utilize standardized assessment and referral for SU treatment.
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Affiliation(s)
- Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA.
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Health Promotion and Resiliency Intervention Research Program, The Mongan Institute, MGH, Boston, MA, USA.
| | - Angela W Walter
- Health Promotion and Resiliency Intervention Research Program, The Mongan Institute, MGH, Boston, MA, USA
- Department of Public Health, University of Massachusetts, Lowell, MA, USA
| | | | | | - Hyo Jin Shin
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA
| | - Susan Regan
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Colin J Ponzani
- Health Promotion and Resiliency Intervention Research Program, The Mongan Institute, MGH, Boston, MA, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Health Promotion and Resiliency Intervention Research Program, The Mongan Institute, MGH, Boston, MA, USA
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