Bio


Dr. Tyler Johnson--a clinical associate professor of medicine and oncology at Stanford University Medical School--is a physician, author, educator, and humanitarian. A medical oncologist, Dr. Johnson sees patients with all types of gastrointestinal malignancies and particularly focuses on patients with neuroendocrine tumors, colon cancer, and pancreas cancer.

Dr. Johnson served for many years as a leader of the Stanford Hospital in-patient oncology services and helped launch the hospital's first direct care inpatient service, med 12. He is also responsible for helping respond to the surge of patients that came with the pandemic and its aftermath.

Dr. Johnson views the practice of medicine largely as an educational endeavor. He directs the Stanford University Hematology/Oncology Fellowship Program and spends significant time teaching trainees at levels. To that end, for many years he has taught medical students, residents, and fellows—including hosting them as temporary and longer-term apprentices in his oncology clinic and working with them on the inpatient housestaff oncology service. He emphasizes diversity and inclusion in his mentoring efforts and has worked to promote the professional development of medical trainees across the training spectrum--from undergraduates to oncology fellows.

The winner of multiple Stanford Medicine teaching awards, Dr. Johnson has established himself as a regional and increasingly as a national leader and innovator in the education of oncology fellows, including by developing novel teaching methods that have been presented across the country, including at national meetings. He also works as one of the principal faculty members of the Stanford Educators-4-CARE program.

Dr. Johnson and his co-host, Henry Bair, became concerned about the loss of a shared sense of meaning in the medical profession and, together, have taught multiple classes in the Medical School and, in the spring of 2022, founded The Doctor's Art podcast. Since then, the podcast has become one of the most listened to medical podcasts in the world and has won multiple national awards, making it one of the most lauded and most popular medical podcasts.

Finally, Dr. Johnson is an author with a growing reputation for insightful analysis of the intersection of medicine, ethics, and spirituality. His writings has been featured by Religion News Service, the Salt Lake Tribune, BYU Studies, Dialogue, and The San Jose Mercury News, where he is a regular contributor. He serves on the editorial boards of both BYU Studies and Wayfare and has written extensively on modernity loss of faith and meaning and the role of spirituality in constructing a purposeful and fulfilling life.

Clinical Focus


  • Oncology, specializing in the care of tumors of the gastrointestinal tract
  • Medical Oncology

Academic Appointments


Administrative Appointments


  • Assistant Director of Inpatient Oncology Service, Stanford University Hospital (2016 - Present)

Honors & Awards


  • Stanford Internal Medicine Residency Chief REsident, Stanford Internal Medicine Residency Program (2012-2013)
  • Heritage Scholar (4 year full tuition scholarship), Brigham Young University (1999-2005)
  • National Merit Scholar, National Merit Scholarship Corporation (1999)

Boards, Advisory Committees, Professional Organizations


  • Editorial Board Member, BYU Studies (2020 - Present)
  • Board Member, ASCO Education Board (2021 - Present)

Professional Education


  • Board Certification: American Board of Internal Medicine, Medical Oncology (2024)
  • Medical Education: University of Pennsylvania School of Medicine (2009) PA
  • Fellowship: Stanford University Hematology and Oncology Fellowship (2016) CA
  • Residency: Stanford University Internal Medicine Residency (2013) CA

Community and International Work


  • HIV/TB care in South Africa

    Topic

    Serving patients with HIV and TB in South Africa

    Populations Served

    Indigent patients

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • Healthcare in Argentina, Buenos Aires, Argentina

    Topic

    Providing Healthcare

    Populations Served

    BMT patients

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

Clinical Trials


  • ALTUS: Performance of a Multi- Target Hepatocellular Carcinoma (HCC) Test in Subjects With Increased Risk Recruiting

    The primary objective is to assess overall sensitivity and specificity of Oncoguard™ Liver for hepatocellular cancer (HCC) detection in a surveillance population.

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  • A Study of RO6958688 in Participants With Locally Advanced and/or Metastatic Carcinoembryonic Antigen Positive Solid Tumors Not Recruiting

    Study BP29541 is a first-in-human, open-label, multi-center, dose-escalation Phase I clinical study of single-agent RO6958688 in participants with locally advanced and/or metastatic carcinoembryonic antigen (CEA) positive solid tumors who have progressed on standard treatment, are intolerant to standard of care (SOC), and/or are non-amenable to SOC. The study will be conducted in two parts. Part I of the study will investigate the safety and pharmacokinetics of a single dose of RO6958688 in single participant cohorts with dosing starting from a minimal anticipated biological effect level dose of 0.05 milligrams (mg) and up to a maximum dose of 2.5 mg. Part II will establish the appropriate therapeutic dose based on safety, pharmacokinetics, and the maximum tolerated dose (MTD) of RO6958688 for the once per week (QW) regimen, every three weeks (Q3W) regimen, and for the step up dosing regimen.

    Stanford is currently not accepting patients for this trial. For more information, please contact Cancer Clinical Trials Office (CCTO), 650-498-7061.

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  • A Study of the Safety, Pharmacokinetics, and Therapeutic Activity of RO6958688 in Combination With Atezolizumab in Participants With Locally Advanced and/or Metastatic Carcinoembryonic Antigen (CEA)-Positive Solid Tumors Not Recruiting

    This is an open-label, multicenter, dose-escalation and expansion Phase Ib clinical study of RO6958688 in combination with atezolizumab. Part I of the study is subdivided into parts IA and IB. Part IA is dose escalation with a starting dose of 5 mg of RO6958688 given QW (once a week) and a fixed, flat dose of 1200 mg given Q3W (every 3 weeks) of atezolizumab, to evaluate the safety and determine the MTD of RO6958688 in combination with atezolizumab. Part IB is a dose/schedule finding part that will explore different administration schedules of RO6958688 in combination with atezolizumab (1200 mg Q3W) to establish the appropriate dose/schedule of RO6958688 in combination with atezolizumab.

    Stanford is currently not accepting patients for this trial. For more information, please contact Cancer Clinical Trials Office (CCTO), 650-498-7061.

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  • Assessment of a Serious Illness Conversation Guide (SICG) in Advanced Gastro-Intestinal Cancers Not Recruiting

    The purpose of the study is to determine whether standardized implementation of a scripted template for discussing important issues that arise near the end of life improves the care of those who have advanced cancer.

    Stanford is currently not accepting patients for this trial. For more information, please contact Daniel Holguin, 650-736-3379.

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  • Dose Escalation Study of CLR 131 in Children, Adolescents, and Young Adults With Relapsed or Refractory Malignant Tumors Including But Not Limited to Neuroblastoma, Rhabdomyosarcoma, Ewings Sarcoma, and Osteosarcoma Not Recruiting

    The study evaluates CLR 131 in children, adolescents, and young adults with relapsed or refractory malignant solid tumors and lymphoma and recurrent or refractory malignant brain tumors for which there are no standard treatment options with curative potential.

    Stanford is currently not accepting patients for this trial. For more information, please contact Nancy Sweeters, 650-721-4074.

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  • Study of Magrolimab (Hu5F9-G4) in Combination With Cetuximab in Participants With Solid Tumors and Advanced Colorectal Cancer Not Recruiting

    The primary objectives of this study are: (Phase 1b) to investigate the safety and tolerability and to determine the recommended Phase 2 dose (RP2D) for magrolimab in combination with cetuximab; and (Phase 2) to evaluate overall response rate (ORR) of magrolimab in combination with cetuximab in participants with Kirsten rat sarcoma 2 viral oncogene homolog (KRAS) mutant and KRAS wild-type colorectal cancer (CRC).

    Stanford is currently not accepting patients for this trial. For more information, please contact Cancer Clinical Trials Office (CCTO), 650-498-7061.

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  • Study of Personalized Immunotherapy in Adults With Metastatic Colorectal Cancer Not Recruiting

    This study will evaluate the safety and tolerability of a personalized live, attenuated, double-deleted Listeria monocytogenes (pLADD) treatment in adults with metastatic colorectal cancer.

    Stanford is currently not accepting patients for this trial. For more information, please contact Flordeliza Mendoza, CCRC, 650-724-2056.

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All Publications


  • Optimizing hematology/oncology (H/O) curricula for internal medicine (IM) residents: A two-institution Delphi survey. Silverstein, J., Huppert, L., Schwede, M., Goglin, S., Johnson, T., Babik, J., Brondfield, S. LIPPINCOTT WILLIAMS & WILKINS. 2024
  • Phase II trial of organ preservation program using short-course radiation and FOLFOXIRI for rectal cancer (SHORT-FOX). Pollom, E. L., Fisher, G. A., Shelton, A., Johnson, T., Chen, C., Jackson, S., Shaheen, S., Holden, T., Bien, J., King, D., Morris, A. M., Kin, C., Dawes, A., Kirilcuk, N., Gahagan, J., Vitzthum, L., Sheth, V., Brown, E., Pratapneni, A., Chang, D. LIPPINCOTT WILLIAMS & WILKINS. 2024
  • Web-Based Scaffolds: The Feasibility of a Constructivist Approach to Oncology Fellow Learning. JMIR cancer Brondfield, S., Schwede, M., Johnson, T. P., Arora, S. 2024; 10: e52501

    Abstract

    In this 2-institution feasibility pilot, oncology fellows used and updated freely available web-based learning tools (scaffolds) in a constructivist fashion.

    View details for DOI 10.2196/52501

    View details for PubMedID 38393780

  • Implementing a Family-Centered Rounds Intervention Using Novel Mentor-Trios. Pediatrics Khan, A., Patel, S. J., Anderson, M., Baird, J. D., Johnson, T. M., Liss, I., Graham, D. A., Calaman, S., Fegley, A. E., Goldstein, J., O'Toole, J. K., Rosenbluth, G., Alminde, C., Bass, E. J., Bismilla, Z., Caruth, M., Coghlan-McDonald, S., Cray, S., Destino, L. A., Dreyer, B. P., Everhart, J. L., Good, B. P., Guiot, A. B., Haskell, H., Hepps, J. H., Knighton, A. J., Kocolas, I., Kuzma, N. C., Lewis, K., Litterer, K. P., Kruvand, E., Markle, P., Micalizzi, D. A., Patel, A., Rogers, J. E., Subramony, A., Vara, T., Yin, H. S., Sectish, T. C., Srivastava, R., Starmer, A. J., West, D. C., Spector, N. D., Landrigan, C. P., Patient and Family Centered I-PASS SCORE Study Group 2024

    Abstract

    BACKGROUND AND OBJECTIVES: Patient and Family Centered I-PASS (PFC I-PASS) emphasizes family and nurse engagement, health literacy, and structured communication on family-centered rounds organized around the I-PASS framework (Illness severity-Patient summary-Action items-Situational awareness-Synthesis by receiver). We assessed adherence, safety, and experience after implementing PFC I-PASS using a novel "Mentor-Trio" implementation approach with multidisciplinary parent-nurse-physician teams coaching sites.METHODS: Hybrid Type II effectiveness-implementation study from 2/29/19-3/13/22 with ≥3 months of baseline and 12 months of postimplementation data collection/site across 21 US community and tertiary pediatric teaching hospitals. We conducted rounds observations and surveyed nurses, physicians, and Arabic/Chinese/English/Spanish-speaking patients/parents.RESULTS: We conducted 4557 rounds observations and received 2285 patient/family, 1240 resident, 819 nurse, and 378 attending surveys. Adherence to all I-PASS components, bedside rounding, written rounds summaries, family and nurse engagement, and plain language improved post-implementation (13.0%-60.8% absolute increase by item), all P < .05. Except for written summary, improvements sustained 12 months post-implementation. Resident-reported harms/1000-resident-days were unchanged overall but decreased in larger hospitals (116.9 to 86.3 to 72.3 pre versus early- versus late-implementation, P = .006), hospitals with greater nurse engagement on rounds (110.6 to 73.3 to 65.3, P < .001), and greater adherence to I-PASS structure (95.3 to 73.6 to 72.3, P < .05). Twelve of 12 measures of staff safety climate improved (eg, "excellent"/"very good" safety grade improved from 80.4% to 86.3% to 88.0%), all P < .05. Patient/family experience and teaching were unchanged.CONCLUSIONS: Hospitals successfully used Mentor-Trios to implement PFC I-PASS. Family/nurse engagement, safety climate, and harms improved in larger hospitals and hospitals with better nurse engagement and intervention adherence. Patient/family experience and teaching were not affected.

    View details for DOI 10.1542/peds.2023-062666

    View details for PubMedID 38164122

  • Developing an Inpatient Relationship Centered Communication Curriculum (I-RCCC) rounding framework for surgical teams. BMC medical education Nassar, A. K., Weimer-Elder, B., Yang, R., Kline, M., Dang, B. K., Spain, D. A., Knowlton, L. M., Valdez, A. B., Korndorffer, J. R., Johnson, T. 2023; 23 (1): 137

    Abstract

    Morning rounds by an acute care surgery (ACS) service at a level one trauma center are uniquely demanding, given the fast pace, high acuity, and increased patient volume. These demands notwithstanding, communication remains integral to the success of surgical teams. Yet there are limited published curricula that address trauma inpatient communication needs. Observations at our institution confirmed that the surgical team lacked a shared mental model for communication. We hypothesized that creating a relationship-centered rounding conceptual framework model would enhance the provider-patient experience.A mixed-methods approach was used for this study. A multi-pronged needs assessment was conducted. Provider communion items for Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys were used to measure patients' expressed needs. Faculty with experience in relationship-centered communication observed morning rounds and documented demonstrated behaviors. A five-hour workshop was designed based on the identified needs. A pre-and post-course Assessment and course evaluation were conducted. Provider-related patient satisfaction items were measured six months before the course and six months after the workshop.Needs assessment revealed a lack of a shared communication framework and a lack of leadership skills for senior trauma residents. Barriers included: time constraints, patient load, and interruptions during rounds. The curriculum was very well received. The self-reflected behaviors that demonstrated the most dramatic change between the pre and post-workshop surveys were: I listened without interrupting; I spoke clearly and at a moderate pace; I repeated key points; and I checked that the patient understood. All these changed from being performed by 50% of respondents "about half of the time" to 100% of them "always". Press Ganey top box likelihood to recommend (LTR) and provider-related top box items showed a trend towards improvement after implementing the training with a percentage difference of up to 20%.The Inpatient Relationship Centered Communication Curriculum (I-RCCC) targeting senior residents and Nurse Practitioners (NP) was feasible, practical, and well-received by participants. There was a trend of an increase in LTRs and provider-specific patient satisfaction items. This curriculum will be refined based on the study results and potentially scalable to other surgical specialties.

    View details for DOI 10.1186/s12909-023-04105-7

    View details for PubMedID 36859253

  • Utilizing co-production to improve patient-centeredness and engagement in healthcare delivery: Lessons from the Patient and Family-Centered I-PASSstudies. Journal of hospital medicine O'Toole, J. K., Calaman, S., Anderson, M., Baird, J., Fegley, A., Goldstein, J., Johnson, T., Khan, A., Patel, S. J., Rosenbluth, G., Sectish, T. C., West, D. C., Landrigan, C. P., Spector, N. D., Patient and Family-Centered I-PASS Education Executive and SCORE Program Education and Training Committees 2023

    View details for DOI 10.1002/jhm.13055

    View details for PubMedID 36717094

  • Mismatch Repair and Microsatellite Instability Testing for Immune Checkpoint Inhibitor Therapy: ASCO Endorsement of College of American Pathologists Guideline. Journal of clinical oncology : official journal of the American Society of Clinical Oncology Vikas, P., Messersmith, H., Compton, C., Sholl, L., Broaddus, R. R., Davis, A., Estevez-Diz, M., Garje, R., Konstantinopoulos, P. A., Leiser, A., Mills, A. M., Norquist, B., Overman, M. J., Sohal, D., Turkington, R. C., Johnson, T. 2023: JCO2202462

    Abstract

    The College of American Pathologists (CAP) has developed a guideline on testing for mismatch repair (MMR) and microsatellite instability (MSI) for patients considered for immune checkpoint inhibitor therapy. ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations.The CAP guideline was reviewed for developmental rigor by methodologists. An ASCO Endorsement Panel subsequently reviewed the content and the recommendations.The ASCO Endorsement Panel determined that the recommendations from the CAP guideline, published on August 3, 2022, are clear, thorough, and based on the most relevant scientific evidence. ASCO endorses Mismatch Repair and Microsatellite Instability Testing for Immune Checkpoint Inhibitor Therapy: Guideline From the College of American Pathologists in Collaboration With the Association for Molecular Pathology and Fight Colorectal Cancer.Within the guideline, MMR immunohistochemistry (IHC), MSI polymerase chain reaction, and MSI next-generation sequencing are all recommended testing options for colorectal cancer, MMR-IHC and MSI-polymerase chain reaction for gastroesophageal and small bowel cancer, and only MMR-IHC for endometrial cancer. No recommendation in favor of any testing method over another could be made for any other cancer. Tumor mutational burden was not recommended as a surrogate for DNA MMR deficiency. If MMR deficiency consistent with Lynch syndrome is detected, it should be communicated to the treating physician.Additional information is available at www.asco.org/molecular-testing-and-biomarkers-guidelines.

    View details for DOI 10.1200/JCO.22.02462

    View details for PubMedID 36603179

  • Embracing Our Highest Worship Some Thoughts on Our Approach to the Temple BYU STUDIES QUARTERLY Johnson, T. 2023; 62 (2): 73-97
  • Family, nurse, and physician beliefs on family-centered rounds: A 21-site study JOURNAL OF HOSPITAL MEDICINE Patel, S. J., Khan, A., Bass, E. J., Graham, D., Baird, J., Anderson, M., Calaman, S., Cray, S., Destino, L., Fegley, A., Goldstein, J., Johnson, T., Kocolas, I., Lewis, K. D., Liss, I., Markle, P., O'Toole, J. K., Rosenbluth, G., Srivastava, R., Vara, T., Landrigan, C. P., Spector, N. D., Knighton, A. J. 2022

    Abstract

    Variation exists in family-centered rounds (FCR).We sought to understand patient/family and clinician FCR beliefs/attitudes and practices to support implementation efforts.Patients/families and clinicians at 21 geographically diverse US community/academic pediatric teaching hospitals participated in a prospective cohort dissemination and implementation study.We inquired about rounding beliefs/attitudes, practices, and demographics using a 26-question survey coproduced with family/nurse/attending-physician collaborators, informed by prior research and the Consolidated Framework for Implementation Research.Out of 2578 individuals, 1647 (64%) responded to the survey; of these, 1313 respondents participated in FCR and were included in analyses (616 patients/families, 243 nurses, 285 resident physicians, and 169 attending physicians). Beliefs/attitudes regarding the importance of FCR elements varied by role, with resident physicians rating the importance of several FCR elements lower than others. For example, on adjusted multivariable analysis, attending physicians (odds ratio [OR] 3.0, 95% confidence interval [95% CI] 1.2-7.8) and nurses (OR 3.1, 95% CI 1.3-7.4) were much more likely than resident physicians to report family participation on rounds as very/extremely important. Clinician support for key FCR elements was higher than self-reported practice (e.g., 88% believed family participation was important on rounds; 68% reported it often/always occurred). In practice, key elements of FCR were reported to often/always occur only 23%-70% of the time.Support for nurse and family participation in FCR is high among clinicians but varies by role. Physicians, particularly resident physicians, endorse several FCR elements as less important than nurses and patients/families. The gap between attitudes and practice and between clinician types suggests that attitudinal, structural, and cultural barriers impede FCR.

    View details for DOI 10.1002/jhm.12962

    View details for Web of Science ID 000855975200001

    View details for PubMedID 36131598

  • Implementation and efficacy of a fellow-led, case-based noon lecture series. Dickerson, J., Myall, N., Roy, M., Johnson, T. LIPPINCOTT WILLIAMS & WILKINS. 2022
  • Online scaffolds: A constructivist approach to oncology fellow learning. Brondfield, S., Schwede, M., Johnson, T., Arora, S. LIPPINCOTT WILLIAMS & WILKINS. 2022
  • Phase II trial of organ preservation program using short-course radiation and folfoxiri for rectal cancer (SHORT-FOX) Pollom, E. L., Shelton, A., Fisher, G. A., Bien, J., King, D., Johnson, T., Chen, C., Shaheen, S., Chong, C., Vitzthum, L., Kirilcuk, N., Morris, A. M., Kin, C., Dawes, A., Sheth, V., Sundaram, V., Brown, E., Chang, D. LIPPINCOTT WILLIAMS & WILKINS. 2022
  • Education research - Understanding the factors involved in inpatient communication for orthopedic trainees. Annals of medicine and surgery (2012) Daniel, D., Avedian, R., Johnson, T., Michaud, J. B., Weimer-Elder, B., Kline, M., Nassar, A. K. 2021; 72: 103079

    Abstract

    Background: "Interpersonal and Communication Skills" (ICS) is a core competency set forth by the ACGME. No structured curriculum exists to train orthopedics residents in ICS.Methods: Twenty-four out of thirty-five orthopedics residents completed the survey (69%). The survey had the following domains: [1] Demographics, [2] Communication Needs/Goals, and [3] Communication Barriers.Results: Eighty-three percent of respondents wanted to improve their communication skills and their patient's experience. Interns-PGY4s wanted to improve on similar specific communication skills. All residents desired training in conflict management.Conclusion: There is a need among orthopedics residents for a communication skills curriculum early in residency training, specifically in conflict management.

    View details for DOI 10.1016/j.amsu.2021.103079

    View details for PubMedID 34876980

  • When it's needed most: a blueprint for resident creative writing workshops during inpatient rotations. BMC medical education Edwards, L. M., Kim, Y., Stevenson, M., Johnson, T., Sharp, N., Reisman, A., Srinivasan, M. 2021; 21 (1): 535

    Abstract

    BACKGROUND: Narrative Medicine may mitigate physician burnout by increasing empathy and self-compassion, and by encouraging physicians to deeply connect with patient stories/experiences. However, Narrative Medicine has been difficult to implement on hectic inpatient teaching services that are often the most emotionally taxing for residents.OBJECTIVE: To evaluate programmatic and learner outcomes of a novel narrative medicine curriculum implementation during inpatient medicine rotations for medical residents. Programmatic outcomes included implementation lessons. Learner outcomes included preliminary understanding of impact on feelings ofburnout. Additionally, we developed a generalizable narrative medicine framework for program implementation across institutions.METHODS: We developed and implemented a monthly 45-min Narrative Medicine workshop on Stanford's busiest and emotionally-demanding inpatient rotation (medical oncology). Using the Physician Wellbeing Inventory (PWBI, range 1-7; 3-4=high burnout risk; ≥4, high burnout), we anonymously assessed resident burnout during pre-implementation control year (2017-2018, weeks 1and 4), and implementation year (2018-2019, weeks 1 and 4). We interviewed program directors and facilitators regarding curriculum implementation challenges/facilitators.RESULTS: Residents highly rated the narrative medicine curriculum, and the residency program renewed the course for 3 additional years. We identified success factors for programmatic success including time neutrality, control of session, learning climate, building trust, staff partnership, and facilitators training. During control year, resident burnout was initially high (n=16; mean PBWI=3.0, SD: 1.1) and increased by the final week (n=15; PBWI=3.4, SD: 1.6). During implementation year, resident burnout was initially similar (n=13; PBWI=3.1, SD: 1.9) but did not rise as much by rotation end (n=24; PBWI=3.3, SD: 1.6). Implementation was underpowered to detect small effect sizes. Based on our our experience and literature review, we propose an educational competency framework potentially helpful to facilitate inpatient narrative medicine workshops, as a blueprint for other institutions.CONCLUSIONS: Inpatient Narrative Medicine is feasible to implement during a challenging inpatient rotation and may have important short-term effects in mitigating burnout rise, with more study needed. We share teaching tools and propose a competency framework which may be useful to support development of inpatient narrative medicine curricula across institutions.

    View details for DOI 10.1186/s12909-021-02935-x

    View details for PubMedID 34670565

  • Implementation of a cloud-based electronic patient-reported outcome (ePRO) platform in patients with advanced cancer. Journal of patient-reported outcomes Generalova, O., Roy, M., Hall, E., Shah, S. A., Cunanan, K., Fardeen, T., Velazquez, B., Chu, G., Bruzzone, B., Cabot, A., Fisher, G. A., Srinivas, S., Fan, A. C., Haraldsdottir, S., Wakelee, H. A., Neal, J. W., Padda, S. K., Johnson, T., Heestand, G. M., Hsieh, R. W., Ramchandran, K. 2021; 5 (1): 91

    Abstract

    BACKGROUND: Patient reported outcomes (PROs) have been associated with improved symptom management and quality of life in patients with cancer. However, the implementation of PROs in an academic clinical practice has not been thoroughly described. Here we report on the execution, feasibility and healthcare utilization outcomes of an electronic PRO (ePRO) application for cancer patients at an academic medical center.METHODS: We conducted a randomized trial comparing an experimental ePRO arm to standard of care in patients with advanced cancer in the thoracic, gastrointestinal, and genitourinary oncology groups at Stanford Cancer Center from March 2018 to November 2019. We describe the pre-implementation, implementation, and post-implementation phases of the ePRO arm, technological barriers, electronic health record (EHR) integration, clinician burden, and patient data privacy and security. Feasibility was pre-specified to be at least 70% completion of all questionnaires. Acceptability was based on patient and clinician feedback. Ambulatory healthcare utilization was assessed by reviewing numbers of phone messages, electronic portal messages, and referrals for supportive care.RESULTS: Of 617 ePRO questionnaires sent to 72 patients, 445 (72%) were completed. Most clinicians (87.5%) and patients (93%) felt neutral or positive about the ePRO tool's ease of use. Exposure to ePRO did not cause a measurable change in ambulatory healthcare utilization, with a median of less than two phone messages and supportive care referrals, and 5-6 portal messages.CONCLUSIONS: Web-based ePRO tools for patients with advanced cancer are feasible and acceptable without increasing clinical burden. Key lessons include the importance of pilot testing, engagement of stakeholders at all levels, and the need for customization by disease group. Future directions for this work include completion of EHR integration, expansion to other centers, and development of integrated workflows for routine clinical practice.

    View details for DOI 10.1186/s41687-021-00358-2

    View details for PubMedID 34524558

  • Teacher's Plea BYU STUDIES QUARTERLY Johnson, T. 2021; 60 (2): 81-118
  • Metastatic Pancreatic Cancer: ASCO Guideline Update. Journal of clinical oncology : official journal of the American Society of Clinical Oncology Sohal, D. P., Kennedy, E. B., Cinar, P., Conroy, T., Copur, M. S., Crane, C. H., Garrido-Laguna, I., Lau, M. W., Johnson, T., Krishnamurthi, S., Moravek, C., O'Reilly, E. M., Philip, P. A., Pant, S., Shah, M. A., Sahai, V., Uronis, H. E., Zaidi, N., Laheru, D. 2020: JCO2001364

    Abstract

    PURPOSE: The aim of this work was to provide an update to the ASCO guideline on metastatic pancreatic cancer pertaining to recommendations for therapy options after first-line treatment.METHODS: ASCO convened an Expert Panel and conducted a systematic review to update guideline recommendations for second-line therapy for metastatic pancreatic cancer.RESULTS: One randomized controlled trial of olaparib versus placebo, one report on phase I and II studies of larotrectinib, and one report on phase I and II studies of entrectinib met the inclusion criteria and inform the guideline update.RECOMMENDATIONS: New or updated recommendations for germline and somatic testing for microsatellite instability high/mismatch repair deficiency, BRCA mutations, and TRK alterations are provided for all treatment-eligible patients to select patients for recommended therapies, including pembrolizumab, olaparib, larotrectinib, or entrectinib, or potential clinical trials. The Expert Panel continues to endorse the remaining recommendations for second-line chemotherapy, as well as other recommendations related to treatment, follow-up, and palliative care from the 2018 version of this guideline. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.

    View details for DOI 10.1200/JCO.20.01364

    View details for PubMedID 32755482

  • NARRATIVE ONCOLOGY: AN INTERVENTION TO PROMOTE RESIDENT WELLBEING AND PATIENT-CENTERED CARE ON AN EMOTIONALLY EXHAUSTING INPATIENT ROTATION Stevenson, M., Edwards, L., Kim, Y., Kim, C., Johnson, T., Garvert, D. SPRINGER. 2020: S754
  • Feasibility and design of a cloud-based digital platform in patients with advanced cancer. Roy, M., Hall, E., Velazquez, B., Shah, S., Fardeen, T., Cunanan, K., San Pedro-Salcedo, M., Wakelee, H. A., Neal, J. W., Padda, S., Das, M., Fan, A. C., Srinivas, S., Fisher, G. A., Haraldsdottir, S., Johnson, T., Chu, G., McMillan, A., Ramchandran, K. AMER SOC CLINICAL ONCOLOGY. 2019
  • In Support of a Complex IDEA-A New Meta-analysis Supporting the Findings of the International Duration Evaluation of Adjuvant Therapy Collaboration. JAMA network open Johnson, T. 2019; 2 (5): e194161

    View details for DOI 10.1001/jamanetworkopen.2019.4161

    View details for PubMedID 31099858

  • Thrombophilia testing in the inpatient setting: impact of an educational intervention. BMC medical informatics and decision making Kwang, H. n., Mou, E. n., Richman, I. n., Kumar, A. n., Berube, C. n., Kaimal, R. n., Ahuja, N. n., Harman, S. n., Johnson, T. n., Shah, N. n., Witteles, R. n., Harrington, R. n., Shieh, L. n., Hom, J. n. 2019; 19 (1): 167

    Abstract

    Thrombophilia testing is frequently ordered in the inpatient setting despite its limited impact on clinical decision-making and unreliable results in the setting of acute thrombosis or ongoing anticoagulation. We sought to determine the effect of an educational intervention in reducing inappropriate thrombophilia testing for hospitalized patients.During the 2014 academic year, we implemented an educational intervention with a phase implementation design for Internal Medicine interns at Stanford University Hospital. The educational session covering epidemiology, appropriate thrombophilia evaluation and clinical rationale behind these recommendations. Their ordering behavior was compared with a contemporaneous control (non-medicine and private services) and a historical control (interns from prior academic year). From the analyzed data, we determined the proportion of inappropriate thrombophilia testing of each group. Logistic generalized estimating equations were used to estimate odds ratios for inappropriate thrombophilia testing associated with the intervention.Of 2151 orders included, 934 were deemed inappropriate (43.4%). The two intervention groups placed 147 orders. A pooled analysis of ordering practices by intervention groups revealed a trend toward reduction of inappropriate ordering (p = 0.053). By the end of the study, the intervention groups had significantly lower rates of inappropriate testing compared to historical or contemporaneous controls.A brief educational intervention was associated with a trend toward reduction in inappropriate thrombophilia testing. These findings suggest that focused education on thrombophilia testing can positively impact inpatient ordering practices.

    View details for DOI 10.1186/s12911-019-0889-6

    View details for PubMedID 31429747

  • Reclaiming Reality Doctoring and Discipleship in a Hyperconnected Age BYU STUDIES QUARTERLY Johnson, T. 2018; 57 (3): 7–38
  • A high value care curriculum for interns: a description of curricular design, implementation and housestaff feedback POSTGRADUATE MEDICAL JOURNAL Hom, J., Kumar, A., Evans, K. H., Svec, D., Richman, I., Fang, D., Smeraglio, A., Holubar, M., Johnson, T., Shah, N., Renault, C., Ahuja, N., Witteles, R., Harman, S., Shieh, L. 2017; 93 (1106): 725–29
  • A high value care curriculum for interns: a description of curricular design, implementation and housestaff feedback. Postgraduate medical journal Hom, J. n., Kumar, A. n., Evans, K. H., Svec, D. n., Richman, I. n., Fang, D. n., Smeraglio, A. n., Holubar, M. n., Johnson, T. n., Shah, N. n., Renault, C. n., Ahuja, N. n., Witteles, R. n., Harman, S. n., Shieh, L. n. 2017

    Abstract

    Most residency programmes do not have a formal high value care curriculum. Our goal was to design and implement a multidisciplinary high value care curriculum specifically targeted at interns.Our curriculum was designed with multidisciplinary input from attendings, fellows and residents at Stanford. Curricular topics were inspired by the American Board of Internal Medicine's Choosing Wisely campaign, Alliance for Academic Internal Medicine, American College of Physicians and Society of Hospital Medicine. Our topics were as follows: introduction to value-based care; telemetry utilisation; lab ordering; optimal approach to thrombophilia work-ups and fresh frozen plasma use; optimal approach to palliative care referrals; antibiotic stewardship; and optimal approach to imaging for low back pain. Our curriculum was implemented at the Stanford Internal Medicine residency programme over the course of two academic years (2014 and 2015), during which 100 interns participated in our high value care curriculum. After each high value care session, interns were offered the opportunity to complete surveys regarding feedback on the curriculum, self-reported improvements in knowledge, skills and attitudinal module objectives, and quiz-based knowledge assessments.The overall survey response rate was 67.1%. Overall, the material was rated as highly useful on a 5-point Likert scale (mean 4.4, SD 0.6). On average, interns reported a significant improvement in their self-rated knowledge, skills and attitudes after the six seminars (mean improvement 1.6 points, SD 0.4 (95% CI 1.5 to 1.7), p<0.001).We successfully implemented a novel high value care curriculum that specifically targets intern physicians.

    View details for PubMedID 28663352

  • Prevalence and Financial Impact of Inappropriate Thrombophilia Testing in the Inpatient Hospital Setting: A Retrospective Analysis Mou, E., Kwang, H., Hom, J., Shieh, L., Ahuja, N., Harman, S., Johnson, T., Kumar, A., Shah, N., Witteles, R., Berube, C. AMER SOC HEMATOLOGY. 2016
  • Bruton's tyrosine kinase inhibitors in chronic lymphocytic leukemia and lymphoma. Clinical advances in hematology & oncology : H&O Varma, G., Johnson, T. P., Advani, R. H. 2016; 14 (7): 543-554

    Abstract

    The development of Bruton's tyrosine kinase (BTK) inhibitors and their introduction into clinical practice represent a major advance in the treatment of chronic lymphocytic leukemia (CLL) and other B-cell lymphomas. Although ibrutinib is the only BTK inhibitor that has been approved by the US Food and Drug Administration, several others are under investigation. Ibrutinib is currently approved for use in relapsed/refractory CLL, CLL with 17p deletion (del[17p]), relapsed or refractory mantle cell lymphoma, and Waldenström macroglobulinemia. Although it is clear that ibrutinib has altered treatment paradigms and outcomes in these diseases, several questions remain regarding (1) its role in frontline vs salvage therapy; (2) its use as a single agent vs in combination with biologic agents, other small molecules, or traditional chemoimmunotherapy; (3) the optimal duration of treatment; and (4) the treatment of patients who cannot tolerate or have disease resistant to ibrutinib. Because sparse clinical data are available on other BTK inhibitors, it is unclear at present whether their clinical efficacy and toxicity will differ from those of ibrutinib.

    View details for PubMedID 27379948

  • Empathy and the Atonement BYU STUDIES QUARTERLY Johnson, T. 2016; 55 (4): 105-122
  • Throughput. Annals of internal medicine Johnson, T. 2011; 155 (2): 133-?