Barriers and Facilitators to Implementing Cancer Survivorship Care Plans

Abstract

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.

Assessment of the feasibility and acceptability, and pre-test of the utility of an individualized survivorship care plan (ISCP) for women with endometrial cancers during the transition of the end of active treatment to cancer survivorship

“…The time required to find information and complete the ISCP was, however, comparable to that reported in many studies (Curcio, Lambe, Schneider, & Khan, 2012;Dulko et al, 2013;Stricker et al, 2011). The length of the meeting during which the ISCP was provided was also similar to that of other studies (Curcio et al, 2012;Stricker et al, 2011), although one study reported a shorter time (between 15 and 30 minutes; Salz et al, 2014).…”

“…Studies have documented the development of an ISCP for women with breast cancer (Clausen et al, 2012;Dulko et al, 2013;Smith, Singh-Carlson, Downie, Payeur, & Wai, 2011), for survivors of colorectal cancer (Baravelli et al, 2009;Salz et al, 2012), and for other types of cancer (Mayer, Gerstel, Leak, & Smith, 2012) based on existing ISCPs. Some recommend personalizing the ISCP to better meet the complex needs of survivors (Haq et al, 2013).…”

Views of Family Physicians about Survivorship Care Plans to Provide Breast Cancer Follow-Up Care: Exploration of Results from a Randomized Controlled Trial

“…Several studies have focused on what scps should entail [8][9][10][11][12][13] , their rationale and strategies for their implementation 14,15 , or obstacles to their completion 10,[15][16][17][18][19][20] . Other studies have described the perspectives of patients about, and patient and health care provider support for or satisfaction with, scps [21][22][23][24][25][26][27][28][29][30][31] .…”

Development and validation of an individualized survivorship care plan (ISCP) for women with endometrial cancer during the transition of the end of active treatment to the cancer survivorship

“…In fact, the difficulty of clarifying the roles and responsibilities of each team member in terms of filling out and delivering the IFCP has been raised, as have the lack of time for customized development and implementation, and the lack of resources (staff and financial) (Brennan et al, 2014;Dulko et al, 2013).…”

“…The use of an electronic format is recommended, as is giving a paper copy to the survivor at the last treatment. As discussed in other studies (Baravelli et al, 2009;Dulko et al, 2013), the nurse would be the professional appointed to complete and deliver the IFCP near the end of treatment or shortly thereafter (Mayer, Gerstel, Leak, & Smith, 2012). An end-oftreatment meeting would normalize the transition to survivorship at the end of active treatment, introduce the IFCP as an information and coordination tool, respond to questions raised, direct to resources where necessary, and encourage the transition to the family physician (Jefford et al, 2011).…”