Case Studies in IO: A Closer Look at Care Delivery Survey

In collaboration with the Association of Community Cancer Centers and Emory University Winship Cancer Institute. Hosted by Northeast Georgia Medical Center.

Date: Wednesday, August 14, 2019

Time: 7:00 - 8:30 AM

Location: Northeast Georgia Medical Center

Presenter:
Rathi Pillai, MD
Assistant Professor

Department of Hematology and Oncology
Winship Cancer Institute
Emory University

*CME/CNE credit is available - 1.5 AMA PRA Category 1 Credit(s)™, ANCC credit: 1.5 contact hours

Please take a moment to complete this questionnaire. Completion of this form is mandatory for CME/CNE credit.

Background information:

This program is being held as a part of The Immunotherapy Collaborative of Oncology Networked Communities (IC-ONC), a global information network in which multidisciplinary healthcare providers, responsible for treating patients with cancer, are connected via education.By completing this registration form, you will become a member of its Observatory, an open information resource that healthcare providers may access and query to better understand the use of immunotherapy and to drive best practice in the management of patients via education. You will also have complimentary access to many other useful educational activities and resources from over 14 educational partners.

In the coming years, IC-ONC’s Observatory will continue to grow as new members join and as we expand our programming and research.

For more information please visit: www.ic-onc.org.

Question Title

1. Contact Information

Name:

Credentials

Email Address:

City:

State:

Country

Question Title

2. What is your job/role?

Hematologist-Oncologist

Nurse

Nurse Practitioner

Oncologist

Oncology Nurse

Oncology Pharmacist

Pathologist

Pharmacist

Physician Assistant

Primary Care Physician

Radiologist

Other

Please specify

Question Title

3. What is your practice type?

Academic

Community/private/skilled nursing facility (SNF)

Hospital

Health maintenance organization (HMO)/Managed care organization (MCO)

Laboratory/research

Pharmacy (retail, outpatient, specialty, etc.)

Other (please specify)

Question Title

4. On a scale of 1 - 5 ( 1 - not confident, 5 - very confident), what is your confidence level regarding your knowledge of immunotherapy/immune checkpoint inhibitors (ICI)?

Clear

i We adjusted the number you entered based on the slider’s scale.

Question Title

5. Where do you typically obtain your oncology related Continuing Professional Development (CPD)? (Select all that apply)

Certified conferences, rounds, journal clubs or small-group activities

Non-certified rounds, journal clubs, small-group activities or conferences

Fellowships, formal courses, personal learning projects, 'trainee'ships

Reading, podcasts, audio, video, internet searching

Learning stimulated by participation in activities such as setting practice standards; patient safety; continuous quality improvement; curriculum development; guideline development; assessment tools and strategy development; examination board membership; or peer review

Non-certified self-assessment programs that provide data with feedback to individual physicians regarding their current knowledge base, enabling the identification of needs and development of future learning opportunities relevant to their practice

Accredited performance assessment (simulation activities, chart audit and feedback, multi-source feedback, direct observation feedback on teaching, annual performance review, practice assessments)

Question Title

6. Who in your practice administers the immunotherapy/ICI therapy? (Select all that apply)

Oncologist

Hematologist-Oncologist

Oncology Nurse

Oncology Pharmacist

Primary Care Physician

Nurse Practitioner

Nurse

Physician Assistant

Other (please specify):

Question Title

7. Who within your practice is involved in day-to-day management of patients receiving immunotherapy/ICI therapy? (Select all that apply)

Oncologist

Hematologist-Oncologist

Oncology Nurse

Oncology Pharmacist

Pathologist

Primary Care Physician

Nurse Practitioner

Nurse

Physician Assistant

Pharmacist

Radiologist

Other (please specify):

Question Title

8. Who on the multidisciplinary team is responsible for educating patients about immunotherapy/ICI in the treatment of their cancer? (Select all that apply)

Oncologist

Hematologist-Oncologist

Oncology Nurse

Oncology Pharmacist

Nurse Practitioner

Nurse

Physician Assistant

Pharmacist

Primary Care Physician

Emergency Physician

Other (please specify):

Question Title

9. Who on the multidisciplinary team manages immune-related adverse events associated with immunotherapy/ICI? (Select all that apply)

Oncologist

Hematologist-Oncologist

Oncology Nurse

Oncology Pharmacist

Nurse Practitioner

Nurse

Physician Assistant

Pharmacist

Primary Care Physician

Emergency Physician

Other (please specify):

Question Title

10. Do you currently care for/interact with patients on immunotherapy including Immune Checkpoint Inhibitors (ICI)?

Yes