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399 Advanced Practice Provider Perspectives on Advanced Care Planning
- Christopher Johnson, Alexis Colley, Jeanette Broering, Tasce Bongiovanni, Sanziana Roman, Elizabeth Wick
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- Journal:
- Journal of Clinical and Translational Science / Volume 6 / Issue s1 / April 2022
- Published online by Cambridge University Press:
- 19 April 2022, pp. 75-76
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- Article
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OBJECTIVES/GOALS: Perioperative surgical care is team-based with close partnership between surgeons, residents, advanced practice professionals (APPs), and others. The objective is to develop an understanding of the current state and implementation needs required for APPs to engage surgical patients in advanced care planning (ACP) to promote goal concordant care. METHODS/STUDY POPULATION: We will conduct a mixed methods evaluation of ACP knowledge, attitudes, and beliefs amongst surgical APPs to identify barriers and facilitators of APPs engaging in a team-based approach to engaging surgical patients in ACP. We will conduct an online survey and qualitative interviews in the following 4 domains: 1) knowledge, skills, and attitudes about engaging in ACP with a patient or their surrogate decision maker during their perioperative care; 2) prior ACP-specific education; 3) experiences conducting ACP discussions with patients; and 4) perceived training needs to increase ACP uptake and documentation. The findings will provide the foundations to design team-based interventions focused on addressing the barriers and inform training and coaching needs to develop expertise and comfort in the ACP process. RESULTS/ANTICIPATED RESULTS: We expect variability in the knowledge, skills, attitudes, and experiences with the ACP process. We anticipate gaining a better understanding of the educational materials best suited to support APPs as they begin engaging patients in ACP. Possible barriers to APP-led ACP discussions include inconsistent role delineation, uncertainty about the value of pre-operative vs. post-operative ACP discussions, lack of experience engaging in ACP discussion, and lack of familiarity with electronic health records ACP tools. Possible facilitators of APP-led ACP discussions may be related to past work experience settings, exposure to ACP in educational preparation, hands-on observation of value of ACP in surgical patients and influences from attending and residents. DISCUSSION/SIGNIFICANCE: While current ACP research in surgery focuses on physician-led patient engagement in ACP discussions, there is a paucity of research focusing on how to develop a team-based approach to ACP discussions in surgery. This study will provide information necessary for the development of interventions that increase team-based ACP for surgical patients.
2314 (In)Adequacy of prophylactic central lymph node dissection for papillary thyroid cancer in the United States: An analysis of 18,755 patients
- Keven Seung Yong Ji, Taofik Oyekunle, Julie A. Sosa, Sanziana A. Roman
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- Journal:
- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, p. 77
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- Article
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OBJECTIVES/SPECIFIC AIMS: The incidence of papillary thyroid cancer (PTC) has sharply increased in recent decades. Though thyroid resection is the best treatment modality, there is significant variation in practice involving use of prophylactic central lymph node dissection (PCLND) at time of thyroidectomy. Recently, a threshold number for lymph node (LN) yield was determined to assure adequacy of lymphadenectomy in evaluating occult nodal disease via PCLND for pathologic T3, clinical N0, M0 PTC patients, for whom guidelines recommend PCLND. This study assesses the prevalence of adequate prophylactic LN dissection (APLND) and determines its association with patient, and disease characteristics. METHODS/STUDY POPULATION: Adult patients receiving surgery for pT3 cN0 M0 PTC >1 cm were identified from the National Cancer Data Base, 2004–2015. APLND for pT3 stage was defined as removing 8 or more LNs, based on recent literature. Univariate and multivariate logistic regression models were employed to determine factors associated with APLND and inadequate prophylactic LN dissection (IPLND). RESULTS/ANTICIPATED RESULTS: In total, 18,755 patients were included: 2905 (10.1%) had APLND; 15,849 (89.9%) had IPLND. Rate of APLND increased from 4.9% to 17.9% over the decade. Patients receiving APLND were younger than those receiving IPLND (47 vs. 52 years, respectively, p<0.001). The proportion of cases found to be LN positive in the APLND group was 64.5%, while that in the IPLND group was 18.2% (p<0.001). After adjustment, Whites were more likely than Blacks to receive APLND [OR 1.86 (95% CI 1.51–2.30), p<0.001]. The adjusted OR of receiving APLND was higher at academic centers [1.76 (1.29–2.41), p<0.001] and at integrated centers [1.77 (1.25–2.51), p<0.001], compared with community facilities. After adjustment, patients with multifocal tumors were more likely to receive APLND than those with unifocal tumors [1.28 (1.17–1.41), p<0.001]. Unplanned 30-day readmission rate was higher in the APLND group (2.4%) compared to the IPLND group (1.7%, p<0.001); this remained significant after adjustment [OR for APLND 1.80 (1.31–2.47), p<0.001]. There was no significant difference in the likelihood of receiving radioactive iodine between patients who underwent APLND Versus IPLND [1.00 (0.90–1.00), p=0.6]. DISCUSSION/SIGNIFICANCE OF IMPACT: APLND is associated with a higher likelihood of finding metastatic LNs, and an increased risk of unplanned short-term readmissions. The rate of APLND has increased over time, but still only a minority of thyroid cancer patients undergo adequate prophylactic surgery. Disparities exist based on patient, facility, and disease characteristics. Further work is needed to study the association between adequacy of dissection and disease recurrence.