Purpose: Survivorship care plans for cancer survivors may facilitate provider-to-provider communication. Primary care provider (PCP) perspectives on care plan provision and use are limited, especially when care plans are generated by an electronic health record (EHR) system. We sought to examine PCPs' perspectives regarding EHR-generated care plans.Methods: PCPs (N ϭ 160) who were members of the Wisconsin Research and Education Network listserv received a sample 10-page plan (WREN cohort). PCPs (n ϭ 81) who had or were currently seeing survivors enrolled onto one of our survivorship clinical trials received a copy of the survivor's personalized care plan (University of Wisconsin [UW] cohort). Both cohorts received a survey after reviewing the plan. All plans were generated within an EHR.Results: Forty-six and 26 PCPs participated in the WREN and UW cohorts, respectively. PCPs regarded EHR-generated plans as useful in coordinating care (88%), understanding treatments (94%), understanding treatment adverse effects (89%), and supporting clinical decisions (82%). Few felt using EHR-generated plans would disrupt clinic workflow (14%) or take too much time (11%). Most (89%) preferred receiving the plan via EHR. PCPs reported consistent provision (81%) and standard location in the medical record (89%) as key factors facilitating their use of survivorship care plans. Important facilitators of care plan use included a more abbreviated plan, ideally one to three pages (32%), and/or a plan specifically tailored to PCP use (57%). Conclusion:Plans were viewed as useful for coordinating care and making clinical decisions. However, PCPs desired shorter, clinician-oriented plans, accessible within an EHR and delivered and located in a standardized manner.
Survivorship care plans (SCPs) have been recommended as tools to improve care coordination and outcomes for cancer survivors. SCPs are increasingly being provided to survivors and their primary care providers. However, most primary care providers remain unaware of SCPs, limiting their potential benefit. Best practices for educating primary care providers regarding SCP existence and content are needed. We developed an education program to inform primary care providers of the existence, content, and potential uses for SCPs. The education program consisted of a 15-min presentation highlighting SCP basics presented at mandatory primary care faculty meetings. An anonymous survey was electronically administered via email (n = 287 addresses) to evaluate experience with and basic knowledge of SCPs pre- and post-education. A total of 101 primary care advanced practice providers (APPs) and physicians (35% response rate) completed the baseline survey with only 23% reporting prior receipt of a SCP. Only 9% could identify the SCP location within the electronic health record (EHR). Following the education program, primary care physicians and APPs demonstrated a significant improvement in SCP knowledge, including improvement in their ability to locate one within the EHR (9 vs 59%, p < 0.0001). A brief educational program containing information about SCP existence, content, and location in the EHR increased primary care physician and APP knowledge in these areas, which are prerequisites for using SCP in clinical practice.
Every cancer survivor and his/her primary care provider should receive an individualized survivorship care plan (SCP) following curative treatment. Little is known regarding point-of-care utilization at primary care visits. We assessed SCP utilization in the clinical context of primary care visits. Primary care physicians and advanced practice providers (APPs) who had seen survivors following provision of an SCP were identified. Eligible primary care physicians and APPs were sent an online survey, evaluating SCP utilization and influence on decision-making at the point-of-care, accompanied by copies of the survivor's SCP and the clinic note. Eighty-eight primary care physicians and APPs were surveyed November 2016, with 40 (45%) responding. Most respondents (60%) reported discussing cancer or related issues during the visit. Information needed included treatment (66%) and follow-up visits, and the cancer team was responsible for (58%) vs primary care (58%). Respondents acquired this information by asking the patient (79%), checking oncology notes (75%), the SCP (17%), or online resources (8%). Barriers to SCP use included being unaware of the SCP (73%), difficulty locating it (30%), and finding needed information faster via another mechanism (15%). Despite largely not using the SCP for the visit (90%), most respondents (61%) believed one would be quite or very helpful for future visits. Most primary care visits included discussion of cancer or cancer-related issues. SCPs may provide the information necessary to deliver optimal survivor care but efforts are needed to reduce barriers and design SCPs for primary care use.
Purpose: Efforts to inform survivors about long-term risks and planned follow-up after cancer treatment have increased. Survivorship Care Plans (SCPs) and care planning sessions have been recommended since 2005, yet the benefits of both SCP provision and care planning are only now being assessed. The impact of SCPs separate from care planning sessions is unclear, however SCPs alone require less time and cost to provide than SCPs combined with care planning sessions. We hypothesized that SCPs alone might enhance patient knowledge. In a randomized trial, we assessed change in patient knowledge of diagnosis, treatment, late/chronic side effects and followup care pre and post receipt of SCP. Methods: Patients who completed primary treatment within the past 2 years for Stage 0-3 breast cancer were consented, enrolled, and randomized to immediate (intervention) versus delayed receipt (control) of an individualized SCP without care planning. All participants completed the Wisconsin Survey of DiagnOsis and Management in Breast cancer (WiSDOM-B), a test of knowledge about one’s own breast cancer diagnosis, treatment and late effects scored out of 40 points. The survey was completed at both baseline and at four weeks (prior to delayed receipt); the primary outcome was change in score. The study was designed with 90% power to detect a between-group difference of 4 points (out of 40 possible). Results: Between November 2013 and March 2014, we recruited 64 women aged 36-78 with Stage 0-3 breast cancer. Most participants were Stage 1-2 (n=50, 79%) with n=7 (10.9%) in Stage 3. Most had received chemotherapy (62.5%), endocrine therapy (89.1%), or radiation (76.6%). At baseline, the average WiSDOM-B score was 28.3 out of 40 (70.8%), range 15.5-38.5. There was no evidence of change in score from baseline to four weeks for either the immediate SCP group (+0.41, 95% CI [-0.97,+1.79]) or delayed receipt control group (+0.95, 95% CI [-0.48,2.38]). Observed variation was consistent with sample size assumptions, and the observed treatment difference (-0.55, 95% CI [-2.53,1.44], p=n.s.) ruled out the prespecified clinically significant effect size of +4.0 (+10%). Overall, participants scored better on questions testing knowledge of diagnosis (side, year of diagnosis, lymph node test results, receptor status, and stage) and surgical side effects than on questions testing knowledge of other treatment (chemotherapy, radiation or endocrine therapy) side effects. Participant satisfaction with knowledge and care team communication was collected pre and post SCP, as well as feedback on SCP content and use of the SCP. These and analyses of selected questions shown to change post SCP by Nissen et al will also be presented. Conclusion: In a controlled, randomized clinical trial, receipt of a SCP without care planning sessions did not appear to significantly increase survivor knowledge about cancer diagnosis, treatment and followup as assessed by the WiSDOM-B survey. Efforts to improve survivor knowledge should investigate the impact of care planning sessions or other interactive health information tools. A second study of patients (n=64) randomized to immediate or delayed receipt of SCPs, in conjunction with care planning sessions, is currently enrolling. Citation Format: Amye J Tevaarwerk, Kevin A Buhr, Kari B Wisinski, Mark Burkard, Mindy Gribble, Willam Hocking, Wenjun Sun, SarahMaria Donohue, Jamie Zeal, Abigail Terhaar, Douglas A Wiegman, Mary E Sesto. Randomized clinical trial assessing the impact of survivorship care plans on survivor knowledge [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-15.
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