Purpose/Objectives To evaluate the process of survivorship care plan (SCP) completion and to survey oncology staff and primary care physicians (PCPs) regarding challenges of implementing SCPs. Design Descriptive pilot study. Setting Two facilities in Vermont, an urban academic medical center and a rural community academic cancer center. Sample 17 oncology clinical staff created SCPs, 39 PCPs completed surveys, and 58 patients (breast or colorectal cancer) participated in a telephone survey. Methods Using Journey Forward tools, SCPs were created and presented to patients. PCPs received the SCP with a survey assessing its usefulness and barriers to delivery. Oncology staff were interviewed to assess perceived challenges and benefits of SCPs. Qualitative and quantitative data were used to identify challenges to the development and implementation process as well as patient perceptions of the SCP visit. Main Research Variables SCP, healthcare provider perception of barriers to completion and implementation, and patient perception of SCP visit. Findings Oncology staff cited the time required to obtain information for SCPs as a challenge. Completing SCPs 3–6 months after treatment ended was optimal. All participants felt advanced practice professionals should complete and review SCPs with patients. The most common challenge for PCPs to implement SCP recommendations was insufficient knowledge of cancer survivor issues. Most patients found the care plan visit very useful, particularly within six months of diagnosis. Conclusions Creation time may be a barrier to widespread SCP implementation. Cancer survivors find SCPs useful, but PCPs feel insufficient knowledge of cancer survivor issues is a barrier to providing best follow-up care. Incorporating SCPs in electronic medical records may facilitate patient identification, appropriate staff scheduling, and timely SCP creation. Implications for Nursing Oncology nurse practitioners are well positioned to create and deliver SCPs, transitioning patients from oncology care to a PCP in a shared-care model of optimal wellness. Institution support for the time needed for SCP creation and review is imperative for sustaining this initiative. Knowledge Translation Accessing complete medical records is an obstacle for completing SCPs. A 3–6 month window to develop and deliver SCPs may be ideal. PCPs perceive insufficient knowledge of cancer survivor issues as a barrier to providing appropriate follow-up care.
Cancer survivors face several challenges following the completion of active treatment, including uncertainty about late effects of treatment and confusion about coordination of follow-up care. The authors evaluated patient satisfaction with personalized survivorship care plans designed to clarify those issues. The authors enrolled 48 patients with breast cancer and 10 patients with colorectal cancer who had completed treatment in the previous two months from an urban academic medical center and a rural community hospital. Patient satisfaction with the care plan was assessed by telephone interview. Overall, about 80% of patients were very or completely satisfied with the care plan, and 90% or more agreed that it was useful, it was easy to understand, and the length was appropriate. Most patients reported that the care plan was very or critically important to understanding an array of survivorship issues. However, only about half felt that it helped them better understand the roles of primary care providers and oncologists in survivorship care. The results provide evidence that patients with cancer find high value in personalized survivorship care plans, but the plans do not eliminate confusion regarding the coordination of follow-up care. Future efforts to improve care plans should focus on better descriptions of how survivorship care will be coordinated.About 12.5 million people in the United States were living with a personal history of cancer in 2009, including more than 2.5 million women with breast cancer and more than 1 million men and women with colorectal cancer (Howlader et al., 2012). An extensive body of research provides evidence that cancer survivors frequently experience late effects fromNo financial relationships relevant to the content of this article have been disclosed by the independent peer reviewers or editorial staff.Sprague can be reached at brian.sprague@uvm.edu, with copy to editor at CJONEditor@ons.org. (Ganz, 2000;Harrington, Hansen, Moskowitz, Todd, & Feuerstein, 2010;Hewitt, Greenfield, & Stovall, 2005;Stein, Syrjala, & Andrykowski, 2008;Strieker & Jacobs, 2008). A landmark report by the Institute of Medicine (Hewitt et al., 2005) recognized that the system of delivering care to the growing number of cancer survivors was inadequate. Specifically, it suggested that the transition of medical care following cancer treatment often is not well coordinated, and many cancer survivors and providers are unaware of late effects and heightened health risks related to the cancer and its treatment. A key recommendation of the report was that patients with cancer completing primary treatment should be provided with a survivorship care plan that includes a comprehensive treatment and care summary and follow-up plan. HHS Public AccessAlthough the Commission on Cancer (2012) added the provision of a survivorship care plan to its cancer program standards, sparse evidence exists regarding the effectiveness and optimal content of care plans (Salz, Oeffinger, McCabe, Layne, & Bach, 2012). Two sma...
Objective Survivorship care plans (SCP), which describe a cancer survivor’s diagnosis, treatment and follow-up, are recommended. The study objective was to evaluate primary care providers’ (PCP) responses to SCPs developed for breast and colorectal cancer survivors in their practice and to determine whether PCP response to the SCPs varied according to characteristics of the practitioner and their practice. Method SCPs were created using the Journey Forward® Care Plan for breast and colorectal cancer patients in rural and urban settings. The SCP and a survey were sent to PCPs. Participants Primary care physicians. Main Measures Attitudes regarding survivorship care plans. Results Thirty-nine (70.9% response rate) surveys were completed. Most felt the SCP was useful (90%), that it enhanced understanding (75%) and that detail was sufficient (>80%). However, 15% disagreed that the care plan helped them understand their role, a perception especially prevalent among PCPs in the rural setting. Among PCPs with ≤ 18 years in practice, 95% agreed that the SCP would improve communication with patients, contrasted with 60% of those with >21 years in practice. The most common barrier to providing follow-up care was limited access to survivors. Conclusions While SCPs appear to improve PCPs understanding of a cancer diagnosis and treatment, clear delineation of each provider’s role in follow-up care is needed. Additional detail on which tests are needed and education on late and long term effects of cancer may improve coordination of care.
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