Background: Survivors of cancer often describe a sense of abandonment post treatment, with heightened uncertainty, and limited knowledge of what lies ahead. This study examined the efficacy of a survivorship care planning intervention to help physicians address survivorship issues through communication skills training plus a new consultation focused on the use of a survivorship care plan for patients with Hodgkin’s lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL). Methods: This cluster randomized, four-site trial examined the efficacy of a Survivorship Planning Consultation (SPC; physicians received communication skills training and applied these skills in a survivorship-focused office visit using a survivorship care plan) with patients who achieved complete remission after completion of first-line therapy versus a control arm in which physicians were trained to and subsequently provided a time-controlled, manualized Wellness Rehabilitation Consultation (WRC) focused only on discussion of healthy nutrition and exercise as rehabilitation post-chemotherapy. The primary outcomes for patients were changes in knowledge about lymphoma and adherence to physicians’ recommendations for vaccinations and cancer screenings. Results: Forty-two physicians and 198 patients participated across the four sites. Patients whose physicians were in the SPC arm had greater knowledge about their lymphoma (p = 0.01) and had greater adherence to physician recommendations for influenza vaccinations (p = 0.02) and colonoscopy (p = 0.02) than patients whose physicians were in the WRC arm. Conclusions: A dedicated consultation using a survivorship care plan and supported by communication skills training may enhance patient knowledge and adherence to some health promotion recommendations.
IntroductionSurvivors of cancer often describe a sense of abandonment post-treatment, with heightened worry, uncertainty, fear of recurrence and limited understanding of what lies ahead. This study examines the efficacy of a communication skills training (CST) intervention to help physicians address survivorship issues and introduce a new consultation focused on the use of a survivorship care plan for patients with Hodgkin's lymphoma and diffuse large B-cell lymphoma.Methods and analysisSpecifically, this randomised, 4-site trial will test the efficacy of a survivorship planning consultation (physicians receive CST and apply these skills in a new survivorship-focused office visit using a survivorship plan) with patients who have achieved complete remission after completion of first-line therapy versus a control arm in which physicians are trained to subsequently provide a time-controlled, manualised wellness rehabilitation consultation focused only on discussion of healthy nutrition and exercise as rehabilitation postchemotherapy. The primary outcome for physicians will be uptake and usage of communication skills and maintenance of these skills over time. The primary outcome for patients is changes in knowledge about lymphoma and adherence to physicians’ recommendations (eg, pneumococcus and influenza vaccinations); secondary outcomes will include perceptions of the doctor–patient relationship, decreased levels of cancer worry and depression, quality of life changes, satisfaction with care and usage of healthcare. This study will also examine the moderators and mediators of change within our theoretical model derived from Leventhal's Common-Sense Model of health beliefs.Ethics and disseminationThis study was approved by the Institutional Review Boards at Memorial Sloan Kettering Cancer Centers and all other participating sites. This work is funded by the National Cancer Institute (R01 CA 151899 awarded to DWK and SH as coprincipal investigators). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute (NCI) or the National Institutes of Health (NIH). The study findings will be disseminated to the research and medical communities through publication in peer-reviewed journals and through presentations at local, national and international conferences.Trial registration numberNCT01483664.
Cancer survivors often experience both short- and long-term challenges as a result of their cancer treatment. Many patients report feeling “lost in transition” following cancer treatment. The oncologist plays a key role in helping the patient to transition to survivorship. The purpose of this paper is to provide a descriptive understanding of the clinical care delivered during follow-up visits for lymphoma patients transitioning from active therapy into survivorship. We used thematic text analysis to identify themes in transcripts of audio recordings of 21 physicians and their patients in follow-up visits within 3 years of completing lymphoma treatment. Conversations between oncologists and patients during follow-up visits addressed a variety of themes, including specific health concerns, follow-up care, health promotion, prior treatment and test results, overall health status, emotional communication and affective tone, post-treatment rehabilitation, discussions occurring in the patient’s physical examination, and social issues. However, the frequency with which these themes were discussed varied. In addition, there did not appear to be a consistent framework for these visits. The varied nature of the follow-up visits analyzed in this study suggests the need for increased structure in survivorship-care consultations.
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