Multidisciplinary and multi-institutional cancer symptom management strategies in the Veterans Affairs: A mixed methods study.

Abstract

12076 Background: Effective symptom management in patients undergoing cancer treatment improves quality of life and overall survival. Yet, variability persists in how symptoms are assessed and managed across oncology settings. This mixed-methods study, conducted across 14 Veterans Affairs (VA) facilities in two regional Veterans Integrated Service Networks (VISN) 21 and 22, aimed to: 1) identify current symptom assessment strategies in use and 2) explore opportunities for standardizing, implementing, and scaling strategies to optimize care for Veterans undergoing cancer treatment. Methods: We conducted a comprehensive survey and semi-structured interviews to evaluate current symptom assessment and management practices, perspectives on standardized proactive strategies, and barriers and facilitators to implementation. The 10-question survey was distributed to 65 clinicians, nurses, social workers, navigators, pharmacists, behavioral medicine specialists, and ancillary care providers across 14 facilities in VISN 21 and 22, using an online staff directory. In addition, 25 facility-level oncology leaders and 10 Veterans receiving cancer care at these facilities were invited to participate in 30-minute semi-structured interviews. The interviews focused on attitudes, knowledge, and preferences regarding proactive symptom assessment, as well as interest in piloting potential interventions. Survey data were analyzed using descriptive statistics, and interview data were analyzed through thematic analysis. Results: A total of 40 participants (61.5% response rate) completed the survey, including 24 physicians (60%), 12 nurses/nurse practitioners (30%), 2 social workers (5%), and 2 pharmacists (5%). Of the 40 respondents, 36 (90%) reported assessing symptoms during clinical visits, with 12 (30%) utilizing only standardized psychological distress screening tools, such as the National Comprehensive Cancer Network Distress Thermometer. Infrastructure and resources varied widely across facilities with some facilities noting no palliative care providers, nurse practitioners, nurse navigators, or oncology nurses. Only 2 facilities integrated volunteers or lay peer support into cancer care. Among interviewees, 25 oncology leaders and 10 Veterans with cancer participated (100% response rate). Two key themes emerged: 1) urgent need for standardized, proactive symptom assessment and management; 2) importance of adaptable solutions, such as peer-led initiatives, tailored to facility and patient preferences rather than a one-size-fits-all approach. Conclusions: Proactive symptom assessment is underutilized across VISN 21 and 22 facilities. Standardized, adaptable strategies that combine high-touch and low-tech approaches, such as peer-led initiatives, are preferred and may provide a scalable solution to enhance cancer care for Veterans.