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I'd now like to welcome Dr. Kincannon, who will talk to us more about activating early reporting and communication between members of the care team. Thank you, Doctor Weber. And as Doctor Weber mentioned, my name is Doctor Kyle Cuncannon, and I'll be talking about in this section, activating early reporting and care team communication. Clinician perspective, establishing clear reporting thresholds. We want to define immediate call now, red flags on every patient card, new or worsening confusion or behavioral changes, seizure or loss of consciousness, jaundice, fever with abdominal pain would be examples. Define graded call soon items. This could be progressive neuropathy, affecting activities of daily living, persistent vomiting or diarrhea, new palpitations or syncope. And then document thresholds in the chart, give patient card and preferred language, and confirm via a teach pack. Clinician perspective here, the multidisciplinary communication pathway. We have the patient and care provider, sorry, the patient and care partner, nurse triage scripted with brief assessments, oncology clinician deciding whether the whole dose change or if an urgent visit is required, and then we have rapid specialty consults. These could be neurology, hematology, cardiology, ophthalmology, pharmacy, social work, as indicated. Clinician perspective, practical tools to reduce reactive management. We want to provide the patient and care partner with a bilingual one-page escalation card. Use a printed nurse triage script, scheduled proactive calls, for example, on day 3 of week 2, and electronic health record alerts for abnormal test results. Use Teachback to confirm understanding and record the caregiver contract and preferred language. Routine pharmacy med review at initiation on any new symptom call to identify drug-drug interactions. For the patient care partner perspective, how to report changes, scripts, and safety steps. Teach the care partner a simple color script. This is Maria's husband. Today she did X, an example, and now Y or symptom is occurring. Nurse will ask onset, level of alertness, breathing, and medication changes. Explain to care partner immediate safety steps at home, for example, stop driving until cleared, secure hazardous appliances, ensure medication and easy use organizer, and keep emergency contact list visible. Next polling question, for a patient with limited internet access, which combination best supports early reporting? A relying on family to call if hospitalized, B bilingual printed escalation card and scheduled nurse phone check-ins, C, enrollment in electronic PRO portal, or D, waiting for next clinical visit to report symptoms. Thank you all for your responses. Here the correct answer is B, bilingual printed escalation card and scheduled nurse phone check-ins. For our next section here, facilitating preference informed decision making over time, we'll proceed here. The clinician perspective, revisit benefit risk framing over time. Reframe outcomes relative to the patient goals at each visit. Benefits can include tumor control, CNS protection, symptom relief with the risks of cognitive adverse events, hepatotoxicity, neuropathy, or a quality of life impact. Use simple language, expected benefit magnitude, likely timelines, most relevant risks, and then compare options. Continue, reduce, rechallenge or switch against the patient's priorities. Document the rationale and patient preference in the chart to guide future decisions. Clinician perspective here, Process for adapting recommendations as care evolves. Steps at decision points, toxicity progression or life changes. You want to reassess patient priorities and function, present options with pros, cons tailored to those priorities, use a brief decision aid or visual risk benefit table, agree on a time-limited plan and monitoring schedule, and then document the shared decision and contingency plans. Polling question, which single question best elicits a patient's current treatment priority? A, do you prefer pills or infusions? B. What matters most to you now, Staying mentally sharp, avoiding hospital stays, or living as long as possible? C. Can you afford your medications? Or D, do you have a care partner at home? Thank you all for your responses. The correct answer was B. What matters most to you now? Staying mentally sharp, avoiding hospital stays, or living as long as possible. No patient care partner perspectives, eliciting and documenting changing values and tolerance for risk. Ask open concrete questions over time. For example, what is most important to you now? Would you trade some length of response for fewer cognitive side effects? We want to use simple scales, prioritize cognition versus tumor control, encourage patient care partner to flag changes in tolerance, they have increased fatigue, caregiver burden, that might shift choices. Reconfirm decisions after acute events, such as a hospitalization or family changes. Another polling question, if Maria's cognitive symptoms improve, but neuropathy worsens and limits work, what is the most preference informed next step? Is it automatically continue current dose because cancer response matters most? Stop treatment permanently. reassess patient priorities and consider dose reduction or switching agent based on what the patient values most. Or D, refer to palliative care. Thank you all for your responses. The correct answer here is C, reassess patient priorities and consider dose reduction or switching agent based on what the patient values most. All right, how can care teams best equip care partners to objectively track and report subtle personality, word finding, or mood changes that patients may not recognize themselves? Um, so I think the The first point here is to set expectations, right, make patients and their caregivers aware that there are neurocognitive side effects and that we want them to be on the lookout for those things. I think, you know, Especially with sort of more, you know, say minor side effects. You know, they might not be on the forefront of patients' or caregivers' minds unless we prompt them. So I think, you know, setting that expectation up front to be on the lookout for these things and then kind of prompting during future interactions is, is really helpful, you know, if you ever Other thing that can be, I think that we've talked about that can be helpful is kind of having a symptom diary, you know, where patients kind of record or caregivers record symptoms on a on a day to day basis, you know, when you're only seeing somebody every few weeks, maybe even every few months, you know, it's hard to remember everything that's been going on, especially if it, you know, Isn't majorly affecting your day to day life and so I think encouraging patients and caregivers to kind of keep a diary of those things can be very helpful. Where can we find standardized tools for monitoring patient collateral symptoms and educate families to the management of symptoms. Looks like we got Kyle back, so I'll let you take that one. Yeah, I think, uh, great question. Sorry for being cut off here, the internet cut off briefly. Um, yeah, you know, a lot of the tools that I lean on were actually provided by our nursing staff. So I think the intake forms and the standardized, um, patient assessment forms that we have in many clinics, um, these are treatment assessments and symptom assessments that are not specific necessarily to one. Particular type of medicine, but that can be applied across the whole clinic panel. So these things that are standardized and they may need to be adapted for a given treatment, for example, if someone's on a 3rd-generation inhibitor, having a symptom assessment before every clinic visit that focuses on neurocognitive challenges or other things they may be experiencing is, I think, uh, an important way to do that. So, making Not only sure that it's standardized with your visits, so it's happening at a regular cadence, but also