A REDCap-Based Operational Tool to Guide Care Coordination in a Multidisciplinary Cutaneous Oncology Clinic

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TABLE OF CONTENTS

Overview
Abstract Operational Tool Development

Overview
Data Dictionary
OpTool Dashboard

Overview

We’re excited to share our recently published manuscript at JCO OP describing a REDCap-Based Operational Tool to Guide Care Coordination in a Multidisciplinary Cutaneous Oncology Clinic. In addition, we wanted to make available several tools that we hope you find helpful in the development of a multidisciplinary care of complex cancer patients.

Abstract

Important advances in the surgical, radiologic and medical management of cancer patients have greatly improved outcomes for a number of oncological diagnoses. Optimal integration and delivery of these various modalities requires thoughtful and effective communication across multiple levels of the care team. We describe the deployment and implementation of a web-based operational tool to facilitate provider coordination and tracking and visualization of the patient census, offering a new perspective on optimization of the multidisciplinary workflow. To help promote integration in multidisciplinary care, we have made the Data Dictionary for the operational tool and R code for the accompanying data visualization dashboard available.

Operational Tool Development

DATA DICTIONARY

To help promote integration in multidisciplinary care, we have made the data dictionary available.

Below is a preview of the Data Dictionary

Variable / Field Name Form Name Section Header Field Type Field Label Choices, Calculations, OR Slider Labels Field Note Text Validation Type OR Show Slider Number Text Validation Min Text Validation Max Identifier? Branching Logic (Show field only if…) Required Field? Custom Alignment Question Number (surveys only) Matrix Group Name Matrix Ranking? Field Annotation
record_id patient_information NA text Record ID NA NA NA NA NA NA NA NA NA NA NA NA NA
last_name patient_information NA text Last name NA NA alpha_only NA NA y NA NA NA NA NA NA NA
first_name patient_information NA text First name NA NA alpha_only NA NA y NA NA NA NA NA NA NA
mrn patient_information NA text MRN NA NA integer NA NA y NA NA NA NA NA NA NA
brth_dtc patient_information NA text Date of Birth NA NA date_mdy NA NA y NA NA NA NA NA NA NA
age patient_information NA calc Current Age rounddown(datediff(“today”, [brth_dtc], “y”,“mdy”)) NA NA NA NA NA NA NA NA NA NA NA NA
sex patient_information NA radio Gender of Patient 0, Female | 1, Male NA NA NA NA NA NA NA NA NA NA NA NA
referral patient_information NA text Referral Office NA NA NA NA NA NA NA NA NA NA NA NA NA
dx diagnosis NA checkbox Diagnosis (check all that apply) 1, Squamous Cell Carcinoma (1) | 2, Merkel Cell Carcinoma (2) | 3, Basal Cell Carcinoma (3) | 4, Sebaceous Carcinoma (4) | 5, Adnexal Tumor (5) | 6, Extramammary Paget’s Disease (6) | 7, Dermatofibrosarcoma Protuberans (7) | 8, Porocarcinoma (8) | 9, Melanoma (9) | 10, Cutaneous Leiomyosarcoma (10) | 11, Carcinoma of Unknown Primary (11) | 12, Lymphoepithelioma-like Carcinoma (12) | 99, Other (99) NA NA NA NA NA NA NA NA NA NA NA NA
dx_dtc diagnosis NA text Date of Diagnosis NA NA date_mdy NA NA NA NA NA NA NA NA NA NA
age_dx diagnosis NA calc Age at Time of Diagnosis rounddown(datediff([dx_dtc], [brth_dtc], “y”,“mdy”)) NA NA NA NA NA NA NA NA NA NA NA NA
tum_loc diagnosis Tumor Location dropdown Tumor Location (tum_loc) 1, Skin/Subcutaneous (1) | 2, Viscera (2) | 3, Lymphatic (3) | 4, CNS/Brain (4) | 5, Bone (5) | 6, Ocular (6) | 7, Mucosa (7) | 8, Nerve Involvement Only (no known cutaneous primary) | 98, Unknown/Not Reported (98) | 99, Other (99) NA autocomplete NA NA NA NA y NA NA NA NA NA
tum_loc_skin diagnosis NA dropdown Tumor/Lesion Location - Skin/Subcutaneous (tum_loc_skin) 1, Head/Neck (1) | 2, Chest (2) | 3, Abdomen (3) | 4, Back (4) | 5, Upper Extremity (5) | 6, Genitalia (6) | 7, Buttocks (7) | 8, Lower Extremity (8) | 98, Unknown/Not Reported (98) | 99, Other (99) NA autocomplete NA NA NA [tum_loc]=1 NA NA NA NA NA NA
tum_loc_skin_oth diagnosis NA text Tumor/Lesion Location - Skin/Subcutaneous - Other (tum_loc_skin_oth) NA NA NA NA NA NA [tum_loc_skin]=99 NA NA NA NA NA NA
tum_loc_laterality diagnosis NA dropdown Tumor Location - Laterality (tum_loc_laterality) 1, Right (1) | 2, Left (2) | 3, Midline (3) | 98, Unknown/Not Reported (98) | 99, Other (99) This is to designate right and left extremities, but also if a lesion is on the right side of the chest, for example or in the middle of the chest autocomplete NA NA NA [tum_loc]=1 NA NA NA NA NA NA
tum_loc_ant_post diagnosis NA dropdown Tumor Location - Anterior/Posterior/Medial/Lateral (tum_loc_ant_post) 1, Anterior (1) | 2, Posterior (2) | 3, Medial (3) | 4, Lateral (4) | 98, Unknown/Not Reported (98) | 99, Other (99) NA autocomplete NA NA NA [tum_loc]=1 NA NA NA NA NA NA
tum_loc_head diagnosis NA dropdown Tumor/Lesion Location - Head/Neck (tum_loc_head) 1, Scalp (1) | 2, Forehead (2) | 3, Orbital (3) | 4, Nose (4) | 5, Cheek (5) | 6, Lip (6) | 7, Chin (7) | 8, Neck (8) | 9, Ear (9) | 98, Unknown/Not Reported (98) | 99, Other (99) NA autocomplete NA NA NA [tum_loc_skin]=1 NA NA NA NA NA NA
tum_loc_orbit diagnosis NA checkbox Orbit locations 1, Upper Eyelid (1) |2, Lower Eyelid (2) |3, Conjunctiva (3) | 98, Unknown/Not Reported (98) | 99, Other (99) NA NA NA NA NA [tum_loc_head]=3 NA NA NA NA NA NA
tum_loc_head_oth diagnosis NA text Tumor/Lesion Location - Head/Neck - Other (tum_loc_head_oth) NA NA NA NA NA NA [tum_loc_head_oth]=99 NA NA NA NA NA NA
tum_loc_ue diagnosis NA dropdown Tumor Location - Upper Extremity (tum_loc_ue) 1, Shoulder (1) | 2, Upper Arm (2) | 3, Forearm (3) | 4, Hand and Fingers (4) | 98, Unknown/Not Reported (98) | 99, Other (99) NA autocomplete NA NA NA [tum_loc_skin]=5 NA NA NA NA NA NA
tum_loc_le diagnosis NA dropdown Tumor Location - Lower Extremity (tum_loc_le) 1, Upper leg (1) | 2, Knee (2) | 3, Lower leg (3) | 4, Foot and Toes (4) | 98, Unknown/Not Reported (98) | 99, Other (99) NA autocomplete NA NA NA [tum_loc_skin]=6 NA NA NA NA NA NA
stage_init_mdc_scc diagnosis NA radio Stage at initial MDC visit - cSCC (stage_init_mdc_scc) 1, Stage 1 | 2, Stage 2 | 3, Stage 3 (T3 or N1) | 4, Stage 4 (AnyT4 or N2 or N3 or M1) | 5, Unknown/Not Staged NA NA NA NA NA [dx(1)]=1 NA NA NA NA NA NA
stage_init_mdc diagnosis NA radio Stage at initial MDC visit - MCC (stage_init_mdc_mcc) 1, Clinical Stage 1 | 2, Clinical Stage 2 | 3, Clinical Stage 3 | 4, Clinical Stage 4 NA NA NA NA NA [dx(2)]=1 NA NA NA NA NA NA
stage_init_mdc_bcc diagnosis NA radio Stage at initial MDC visit - BCC (stage_init_mdc_bcc) 1, Stage 1 | 2, Stage 2 | 3, Stage 3 | 4, Stage 4 NA NA NA NA NA [dx(3)]=1 NA NA NA NA NA NA
stage_init_mdc_seb_ca diagnosis NA radio Stage at initial MDC visit - Sebaceous Carcinoma (stage_init_dx_seb_ca) 1, Stage 1 | 2, Stage 2 | 3, Stage 3 | 4, Stage 4 | 5, Unknown/Not Staged NA NA NA NA NA [dx(4)]=1 NA NA NA NA NA NA
stage_init_mdc_adnexal diagnosis NA radio Stage at initial MDC visit - Adnexal Tumor (stage_init_mdc_adnexal) 1, Stage 1 | 2, Stage 2 | 3, Stage 3 | 4, Stage 4 | 5, Unknown/Not Staged NA NA NA NA NA [dx(5)]=1 NA NA NA NA NA NA
stage_init_mdc_emp diagnosis NA radio Stage at initial MDC visit - Extramammary Paget’s disease (stage_init_mdc_emp) 1, Stage 1 | 2, Stage 2 | 3, Stage 3 | 4, Stage 4 | 5, Unknown/Not Staged NA NA NA NA NA [dx(6)]=1 NA NA NA NA NA NA
stg_notes diagnosis NA text Notes on Staging NA NA NA NA NA NA NA NA NA NA NA NA NA
rec_req_yn outside_clinic_notes NA radio Were the outside clinical notes requested? 0, No | 1, Yes NA NA NA NA NA NA NA NA NA NA NA NA
rec_req_who outside_clinic_notes NA radio Who requested the records? 0, Access Nurse | 1, Patient Service Coordinator | 2, Other NA NA NA NA NA NA NA NA NA NA NA NA
rec_received outside_clinic_notes NA radio Outside Clinic Notes Obtained? 0, No | 1, Yes NA NA NA NA NA NA NA NA NA NA NA NA
ph_num outside_clinic_notes NA text Phone number of the office for the clinical notes NA NA phone NA NA NA NA NA NA NA NA NA NA
fax_num outside_clinic_notes NA text Fax number of the office for the clinical notes NA NA phone NA NA NA NA NA NA NA NA NA NA
cd_req_yn initial_imaging_requests NA radio CD of Imaging Requested? 0, No | 1, Yes NA NA NA NA NA NA NA NA NA NA NA NA
cd_req_who initial_imaging_requests NA radio Who requested the Imaging? 0, Access Nurse | 1, Patient Service Coordinator | 2, Other NA NA NA NA NA NA NA NA NA NA NA NA
cd_received initial_imaging_requests NA radio CD of Imaging Obtained? 0, No | 1, Yes NA NA NA NA NA NA NA NA NA NA NA NA
ph_num_1 initial_imaging_requests NA text Phone number of the office for the Imaging NA NA phone NA NA NA NA NA NA NA NA NA NA
fax_num_1 initial_imaging_requests NA text Fax number of the office for the Imaging NA NA phone NA NA NA NA NA NA NA NA NA NA
path_req_yn initial_pathology_requests NA radio Were the outside pathology slides requested? 0, No | 1, Yes NA NA NA NA NA NA NA NA NA NA NA NA
path_req_who initial_pathology_requests NA radio Who requested the pathology slides? 0, Access Nurse | 1, Patient Service Coordinator | 2, Other NA NA NA NA NA NA NA NA NA NA NA NA
path_received initial_pathology_requests NA radio Outside Pathology Slides Obtained? 0, No | 1, Yes NA NA NA NA NA NA NA NA NA NA NA NA
ph_num_2 initial_pathology_requests NA text Phone number of the office for the Pathology NA NA NA NA NA NA NA NA NA NA NA NA NA
fax_num_2 initial_pathology_requests NA text Fax number of the office for the Pathology NA NA NA NA NA NA NA NA NA NA NA NA NA
md_visit providers_during_initial_consultation NA checkbox Which of the following providers is the patient scheduled with? 1, Provider 1 | 2, Provider 2 | 3, Provider 3 | 4, Provider 4 | 5, Provider 5 NA NA NA NA NA NA NA NA NA NA NA NA
am_pm providers_during_initial_consultation NA radio Was patient initially seen the AM or PM MDC (or both) 1, AM (1) | 2, PM (2) NA NA NA NA NA NA NA NA NA NA NA NA
visit_dtc providers_during_initial_consultation NA text Date of Initial Consultation in MDC NA NA date_mdy NA NA NA NA NA NA NA NA NA NA
patient_service_coordinator_to_do follow_up_for_patient_service_coordinator NA text Follow up for Patient Service Coordinator (i.e. the “To Do”) NA NA NA NA NA NA NA NA NA NA NA NA NA
patient_service_coordinator_notes follow_up_for_patient_service_coordinator NA text Notes on the follow up: (i.e. anything more to add) (optional) NA NA NA NA NA NA NA NA NA NA NA NA NA
appto_do follow_up_for_advanced_practice_provider NA text Follow up for Advanced Practice Provider (i.e. the “To Do”) NA NA NA NA NA NA NA NA NA NA NA NA NA
app_notes follow_up_for_advanced_practice_provider NA text Notes on the follow up (optional) NA NA NA NA NA NA NA NA NA NA NA NA NA
provider_1 follow_up_for_provider_1 NA text Follow up for Provider 1 (i.e. the “To Do”) NA NA NA NA NA NA NA NA NA NA NA NA NA
note_provider_1 follow_up_for_provider_1 NA text Notes on the follow up: NA NA NA NA NA NA NA NA NA NA NA NA NA
provider_2_to_do follow_up_for_provider_2 NA text Follow up for Provider 2 (i.e. the “To Do”) NA NA NA NA NA NA NA NA NA NA NA NA NA
note_provider_2 follow_up_for_provider_2 NA text Notes on the follow up (optional) NA NA NA NA NA NA NA NA NA NA NA NA NA
tx_received treatment NA checkbox What type of treatment did the patient receive as a result of the MDC (check all that apply) 1, Surgical Therapy (1) | 2, Systemic Therapy (e.g. Immunotherapy/Chemotherapy (2) | 3, Radiotherapy (3) | 4, Intralesional Therapy (4) | 5, Topical Therapy (5) | 98, Unknown/Not Reported (98) | 99, Other (99) NA NA NA NA NA NA NA NA NA NA NA NA
syst_rx_type treatment NA checkbox What type of systemic therapy did the patient receive (check all that apply)? 1, Cemiplimab (1) | 2, Pembrolizumab (2) | 3, Avelumab (3) | 4, Nivolumab (4) | 5, Cisplatin (5) | 6, Carboplatin (6) | 7, Cetuximab (7) | 98, Unknown/Not Reported (98) | 99, Other (99) NA NA NA NA NA [tx_received(2)]=1 NA NA NA NA NA NA
tx_cancer_center treatment NA checkbox Did the patient receive systemic therapy at the Home Cancer Center? 0, No (0) | 1, Yes (1) | 98, Unknown/Not Reported (98) NA NA NA NA NA [tx_received(2)]=1 NA NA NA NA NA NA
exenteration_yn treatment NA radio Did the patient undergo a orbital exenteration? 0, No (0) | 1, Yes (1) NA NA NA NA NA [tx_received(1)][current-instance] = 1 AND [tum_loc_skin]=3 NA NA NA NA NA NA
ss_dtc patient_status NA text Date of Subject Status NA NA date_mdy NA NA NA NA NA NA NA NA NA NA
ss patient_status NA radio Subject status 0, Alive (0) | 1, Dead (1) | 99, Unknown/Not Reported (99) NA NA NA NA NA NA NA NA NA NA NA NA
death_dtc patient_status NA text Date of Death NA NA date_mdy NA NA NA [ss]=1 NA NA NA NA NA NA
ss_overview patient_status A brief synopsis of the patient text An [age] [sex] with [dx] NA NA NA NA NA NA NA NA NA NA NA NA NA
ss_other patient_status NA text Additional Notes NA NA NA NA NA NA NA NA NA NA NA NA NA
fu patient_status Patient’s Next Scheduled Visit with MDC Providers text When is the patient’s Next Scheduled Visit? NA NA NA NA NA NA NA NA NA NA NA NA NA
os patient_status NA calc Overal Survival rounddown(datediff([ss_dtc][last-instance],[dx_dtc], “d”,“mdy”)) NA NA NA NA NA NA NA NA NA NA NA NA
os_2 patient_status NA calc Overal Survival if Deceased rounddown(datediff([death_dtc][last-instance],[dx_dtc], “d”,“mdy”)) NA NA NA NA NA [ss]=1 NA NA NA NA NA NA
clinical_trial clinical_trials NA checkbox <div class=“rich-text-field-label”><p>Clinical Trial</p></div> 1, Adjuvant Checkpoint Inhibitor in MCC| 2, Adjuvant Checkpoint Inhibitor in CSCC | 3, Neoadjuvant Checkpoint Inhibitor for MCC | 4, Neoadjuvant Checkpoint Inhibitor for SCC | 5, Checkpoint Inhibitor Plus Oncolytic Virus in NMSC NA NA NA NA NA NA NA NA NA NA NA NA
date_enrolled clinical_trials NA text Date Enrolled NA NA date_mdy NA NA NA NA NA NA NA NA NA NA


To download the Data Dictionary please click here. Once you have the Data Dictionary downloaded, you can directly import that csv file in a New Project in REDCap. For more information on REDCap please click here

OPTOOL DASHBOARD

In addition to facilitating communication between the multi-disciplinary care team, the REDCap-Based Operational Tool, when coupled with a statistical programming language, such as R, can provide a dynamic platform for data visualization and data analysis.

Here is an example of a Dashboard we’ve created using the packages RMarkdown and Flexdashboard

NMSC MDC Dashboard


Of note, the data set here is completely simulated. Any relation to actual patients is purely coincidental

The R Code used to generate this Dashboard can be found here

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