PROACT: Implementing a PROACTive care pathway to empower and support breast cancer (BC) survivors.

Abstract

221 Background: Optimal comprehensive survivorship care, beyond screening of recurrences and new cancers, and including health promotion, management of physical as well as psychosocial needs and chronic conditions is insufficiently delivered. To increase patient (pt) empowerment and maximize the uptake of multidisciplinary strategies serving all survivorship needs, we implemented a proactive survivorship care pathway offered for pts with early BC at the end of their primary treatment phase (surgery, chemotherapy, radiotherapy). Methods: The pathway consisted of the following components: 1) receipt of a personalized survivorship care plan (SCP), 2) invitation to attend face-to-face group seminars focused on specific themes and a comprehensive survivorship consultation for multidisciplinary referrals (”the transition day”) 3) access to a mobile application (app) delivering personalized education according to symptoms reported and 4) decision aids for helping physicians to manage prevalent symptoms and side effects related to BC treatment. Administrative data were collected. A pre-specified post-experience survey was sent to all pts four weeks post pathway delivery to inform program implementation with a minimum requirement of 50 responses. BC physicians and members of the multidisciplinary implementation team (MIT) answered a dedicated survey. For the overall pathway and each of its components we descriptively evaluated the following domains: satisfaction (primary outcome), uptake, perceived usefulness, barriers for delivery, and suggestions for improvement. A 70% satisfaction rate would define a positive experience. Results: From October 2021 to April 2022, 241 SCP were delivered, and 98 pts attended the “transition day”. 62 pts replied to the survey, 42 (67%) had received the SCP, 34 (55%) attended the “transition day”, 36 (57%) accessed the app. Only 21 pts (34%) who answered the survey received the full pathway, 81% of whom were very or completely satisfied with it. Perceived usefulness of individual components and for pts that received the full pathway were, respectively: 64% and 90% for the SCP, 91% and 95% for the “transition day”, 72% and 90% for the app. Among 14 BC physicians, agreement regarding the usefulness of the components was: 93% for the SCP, 86% for the decision aids, 93% for the “transition day”, and 86% for the app. The MIT (n = 13) reported high engagement and satisfaction (100%). Main actionable points for improvement included: automated screening and SCP preparation, virtual “transition day”, increase physicians’ awareness. Conclusions: In this pilot phase, pts were satisfied with receiving a proactive survivorship care pathway and the majority reported that the components were useful for supporting their needs. This study informed improvements on program penetration. Evolution towards sustainability phase is ongoing including dissemination to other cancers and centers.

Investigating sexual health after breast cancer by longitudinal assessment of patient-reported outcomes

“… 53 Promoting periodic institutional educational activities with practical case discussions, identification of engaged health care professionals, development of symptom-management decision aids, and referral processes may help initiate this multidisciplinary dynamic. 54 (iii) Addressing modifiable risk factors for sexual concerns as appropriate, including the screening and management of emotional distress and weight balance, 55 and supporting patients with nonmodifiable risk factors such as the use of adjuvant therapies by offering them strategies to mitigate its treatment-related side-effects. (iv) Assess and reassess sexual health across the whole cancer care continuum at varied points of the patient journey to address any changes.…”

Cancer Care Delivery Innovations for Complex Health Care Systems

“…In the study of Franzoi et al, 1 "Implementing a PROACTive care pathway to empower and support survivors of breast cancer," researchers described implementation, survivors' and providers' experiences, satisfaction, and perceived usefulness of a proactive patient-centered survivorship care pathway consisting of four components: a personalized survivorship care plan (SCP), group support seminars and survivorship consultation at the end of treatment, access to a mobile application for management of symptoms, and decision aids for physicians to manage side effects and symptoms. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to guide a process evaluation of this program, the researchers found that 75% of survivors received a SCP, 52% attended seminars and consultation, 60% assessed the mobile support application, and 96% who participated in the full pathway experience reported being satisfied.…”