Implementing the Survivorship Care Plan

2021 ◽  
pp. 760-766
Author(s):  
Erin E. Hahn ◽  
Patricia A. Ganz
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Cancer Survivorship ◽  
Care Plan ◽  
Care Planning ◽  
Survivorship Care ◽  
Treatment Summaries ◽  
Care Plans ◽  
American Society ◽  
Survivorship Care Planning

There are many challenges associated with ensuring quality care for cancer survivors. Cancer patients often require treatment by multiple specialists (surgeons, radiation oncologists, medical oncologists) due to the use of multimodal therapies. After treatment has ended, cancer patients may be at risk for serious long-term and late effects of their disease and treatment. Unfortunately, the oncology care system often fails to provide education and guidance to patients at the end of active cancer treatment, in contrast to the more standardized communication at the time of diagnosis and initial treatment planning. Delivering high-quality, coordinated care during the posttreatment phase is critical to ensure the best possible patient outcomes. One of the proposed first steps in accomplishing this is the widespread implementation of cancer treatment summaries and survivorship care planning, a key recommendation of the 2006 Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition. This has been embraced by a number of leading organizations, including the American Society of Clinical Oncology (ASCO) and the Commission on Cancer. Survivorship care has also become an international priority, with organizations such as the U.K. National Cancer Survivorship Initiative and Organization of European Cancer Institutes championing the importance of survivorship care. This chapter provides an overview of the development and use of treatment summaries and survivorship care planning and briefly reviews research on care plans and the health policy impact of survivorship care plans as they relate to quality improvement activities that are underway.

Implementing survivorship care planning in a large integrated cancer program.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 69-69
Author(s):  
Jamie Cairo ◽  
Carol Huibregtse ◽  
Adam Ferry ◽  
James L. Weese
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Care ◽  
Breast Cancer Survivors ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Care Planning ◽  
Survivorship Care ◽  
Care Plans ◽  
Survivorship Care Planning

69 Background: Aurora Health Care is comprised of 15 hospitals and 22 oncology clinics. Aurora Cancer Care (ACC), a Commission on Cancer (CoC) accredited program, diagnoses and treats 7,000 adult cancer patients annually, more than any other healthcare system in Wisconsin. The CoC’s Survivorship Standard 3.3 requires accredited cancer programs to provide cancer patients with survivorship counseling and a written care plan. ACC was challenged to develop a consistent model of survivorship care that can work at multiple sites across the system. Methods: Workflow planning and education began at all oncology clinics in fourth quarter of 2014. Thirteen disease specific survivorship care plan templates were built into the EMR with some-auto population functionality. A system wide delivery plan was launched in first quarter of 2015 with the goal of targeting 10% of eligible patients. Initial focus was on breast cancer patients with some sites also including other cancers. The model of survivorship care is an “embedded consultation” in medical or surgical oncology with an advanced practice provider (APP) completing the care plan and meeting with the patient at the end of first line treatment. Results: Initial required volumes were estimated based on 2013 registry data with a goal of completing approximately 700 care plans in 2015 to meet the 10% CoC standard. During Q1 & Q2 of 2015, 444 care plans were generated and given to patients, mostly for breast cancer survivors. The most significant barrier surrounded retrieving data from the EMR. Conclusions: Data from the first half of 2015 demonstrates success with the approach. Aurora Cancer Care will exceed the benchmark of 700 care plans. There has been a high level of engagement with the APPs who have taken ownership of survivorship care planning, contributing to the success of the program thus far. Because of difficulty retrieving data from the EMR, manual tracking was still required. Future modifications will address this and other barriers.

scholarly journals Long-Term Survivorship Care After Cancer Treatment - Summary of a 2017 National Cancer Policy Forum Workshop

2018 ◽  
Vol 110 (12) ◽  
pp. 1300-1310 ◽  
Author(s):  
Ronald M Kline ◽  
Neeraj K Arora ◽  
Cathy J Bradley ◽  
Eden R Brauer ◽  
Darci L Graves ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Cancer Treatment ◽  
Care Planning ◽  
Survivorship Care ◽  
Care Plans ◽  
Adult Cancer Survivors ◽  
After Cancer ◽  
Survivorship Care Planning ◽  
Policy Forum

Abstract The National Cancer Policy Forum of the National Academies of Sciences, Engineering and Medicine sponsored a workshop on July 24 and 25, 2017 on Long-Term Survivorship after Cancer Treatment. The workshop brought together diverse stakeholders (patients, advocates, academicians, clinicians, research funders, and policymakers) to review progress and ongoing challenges since the Institute of Medicine (IOM)’s seminal report on the subject of adult cancer survivors published in 2006. This commentary profiles the content of the meeting sessions and concludes with recommendations that stem from the workshop discussions. Although there has been progress over the past decade, many of the recommendations from the 2006 report have not been fully implemented. Obstacles related to the routine delivery of standardized physical and psychosocial care services to cancer survivors are substantial, with important gaps in care for patients and caregivers. Innovative care models for cancer survivors have emerged, and changes in accreditation requirements such as the Commission on Cancer’s (CoC) requirement for survivorship care planning have put cancer survivorship on the radar. The Center for Medicare & Medicaid Innovation’s Oncology Care Model (OCM), which requires psychosocial services and the creation of survivorship care plans for its beneficiary participants, has placed increased emphasis on this service. The OCM, in conjunction with the CoC requirement, is encouraging electronic health record vendors to incorporate survivorship care planning functionality into updated versions of their products. As new models of care emerge, coordination and communication among survivors and their clinicians will be required to implement patient- and community-centered strategies.

scholarly journals American Society of Clinical Oncology Clinical Expert Statement on Cancer Survivorship Care Planning

2014 ◽  
Vol 10 (6) ◽  
pp. 345-351 ◽  
Author(s):  
Deborah K. Mayer ◽  
Larissa Nekhlyudov ◽  
Claire F. Snyder ◽  
Janette K. Merrill ◽  
Dana S. Wollins ◽  
...  
Keyword(s):  
Clinical Oncology ◽  
Cancer Survivorship ◽  
Care Planning ◽  
Survivorship Care ◽  
Improved Outcomes ◽  
Implementation Studies ◽  
American Society ◽  
Survivorship Care Planning ◽  
Clinical Expert

Once SCPs are adopted on a wider scale, their value for improving the process of survivorship care planning should be evaluated, and other questions regarding improved outcomes can be addressed by research and implementation studies.

scholarly journals Survivorship care planning in neuro-oncology

2018 ◽  
Vol 5 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Heather E Leeper ◽  
Alvina A Acquaye ◽  
Susan Bell ◽  
Jennifer L Clarke ◽  
Deborah Forst ◽  
...  
Keyword(s):  
Critical Time ◽  
The United States ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care Plans ◽  
Care Planning ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Care Plans ◽  
Survivorship Care Planning

Abstract Cancer patient survivorship has become a significant topic within oncology care for both adult and pediatric patients. Starting in 2005, the Institute of Medicine recommended the use of survivorship care plans to assist patients transitioning from active treatment to the posttreatment phase of their cancer care, a critical time for many patients. Since 2014 there has been a mandate within the United States for adult cancer patients treated with curative intent to receive survivorship care plans comprised of a treatment summary and a follow-up plan to facilitate a better understanding among patients of what to expect after treatment. In addition to a general oncology survivorship care plan, specific care plans have been created for breast, lung, prostate, and colon cancers, as well as lymphoma. A survivorship care plan specific to adult neuro-oncology has been developed by a multidisciplinary and interprofessional committee, with approval from the Society for Neuro-Oncology Guidelines Committee. It has been published in compendium with this review of survivorship care planning and available as a fillable PDF on the Society of Neuro-Oncology Guidelines Endorsement web page (https://www.soc-neuro-onc.org/SNO/Resources/Survivorship_Care_Plan.aspx). Implementation of this survivorship care plan provides a unique opportunity to begin addressing the range of survivorship issues our neuro-oncology patients navigate from diagnosis to end of life.

Systematic development of a a breast cancer survivorship program at a small independent oncology practice.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 52-52 ◽  
Author(s):  
Cynthia Rogers ◽  
Shailesh R. Satpute
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Data Entry ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care Plans ◽  
Full Time ◽  
Survivorship Care ◽  
Breast Cancer Patients ◽  
Care Plans

52 Background: It is widely accepted that providing survivorship care plans leads to improvements in outcomes for cancer survivors. Treatment summaries are now part of ASCO and NCCN survivorship guidelines. We faced a unique challenge of implementing the survivorship care plan at the Jones Clinic as a small independent practice. The Jones Clinic consists of three full time physicians and two full time nurse practitioners. We see approximately 850 new patients per year. Methods: As a part of ASCO’s quality training program, we focused on the stage I – III (early stage) breast cancer patients who completed their initial therapy. We formed a team, identified the barriers, created a flow diagram of the process, assigned roles for each individual member and finally implemented the process. Results: The major issues identified were lack of provision in the electronic medical record (EMR) system for survivorship and lack of standardized data entry process. We created a system in the EMR for survivorship data entry and extraction of such data in a document. Since July 2015, one hundred percent of breast cancer patients completing adjuvant therapy at the Jones Clinic have received a survivorship treatment summary and a plan of care. The care plan is also shared with their primary care provider. Importantly, creating a survivorship document required less than 10 minutes of the provider’s time. Conclusions: We are now able to provide our patients with a survivorship care plan and address survivorship issues within thirty days of completion of therapy. Creating the care plan requires minimal time from the providers. Our new process meets ASCO guidelines for survivorship care plans and no additional staffing was needed. We now plan to provide a survivorship care plan to all oncology patients treated with curative intent.

Leveraging the electronic health record (EHR) to support survivorship care planning for bone marrow transplant (BMT) survivors.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 57-57
Author(s):  
Mandy Swiecichowski ◽  
Amye Tevaarwerk ◽  
Mark Juckett ◽  
James Edward Haine ◽  
Kirsten Norslien ◽  
...  
Keyword(s):  
Primary Care ◽  
Systems Engineering ◽  
Information Needs ◽  
Patient Data ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Care Planning ◽  
Survivorship Care ◽  
Roles And Responsibilities ◽  
Survivorship Care Planning

57 Background: BMT survivors are underrepresented in survivorship research, yet are at high risk for complications. Practice guidelines are vague, non-BMT clinicians are inadequately informed, and communication between BMT and non-BMT clinicians is inconsistent. Our objective is to develop EHR-integrated survivorship care planning that is user-centered, supports non-BMT clinician and survivor needs, but does not adversely impact clinical workflow. Methods: A multidisciplinary team of clinicians (primary care, oncology, BMT), engineers, and EHR analysts used a systems engineering approach to identify barriers and facilitators to BMT survivorship care planning. The team identified patient data categories to include in BMT survivorship care plan (SCP) templates, as well as examined tasks, technology, workflows and individual roles and responsibilities necessary to support care planning. Results: Facilitators include: potential for EHR to discretely capture individual diagnosis and treatment data to create accurate SCPs addressing survivor and primary care information needs. Barriers are: lack of EHR inter-operability which prevents sharing of patient data outside the BMT center’s EHR system, reliance on manual entry of critical data elements into the SCP (i.e. majority of the 88 patient data categories, identified by the team, are non-discrete in the EHR), inefficient or absent survivorship workflows, lack of resources (including time, dedicated clinical staff, space, SCP content), poorly defined roles and responsibilities for survivorship care provision, and lack of evidence-based BMT survivorship guidelines. Conclusions: Work system barriers impede use of the EHR to support survivorship care planning. Steps to overcome barriers: design discrete fields in the EHR to support patient-level data capture, re-engineer existing workflows to support survivorship care planning, obtain BMT program consensus on SCP content, and evaluate user-centeredness of SCPs. This research has the potential to improve feasibility and sustainability of survivorship care planning activities, resulting in improved communication and care coordination for BMT survivors.

scholarly journals Accuracy and Thoroughness of Treatment Summaries Provided as Part of Survivorship Care Plans Prepared by Two Cancer Centers

2017 ◽  
Vol 13 (5) ◽  
pp. e486-e495 ◽  
Author(s):  
Amye J. Tevaarwerk ◽  
William G. Hocking ◽  
Jamie L. Zeal ◽  
Mindy Gribble ◽  
Lori Seaborne ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Data Entry ◽  
Standard Of Care ◽  
Care Plan ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Cancer Centers ◽  
Treatment Summaries ◽  
Care Plans ◽  
Treatment Information

Purpose: Treatment summaries prepared as part of survivorship care planning should correctly and thoroughly report diagnosis and treatment information. Methods: As part of a clinical trial, summaries were prepared for patients with stage 0 to III breast cancer at two cancer centers. Summaries were prepared per the standard of care at each center via two methods: using the electronic health record (EHR) to create and facilitate autopopulation of content or using manual data entry into an external software program to create the summary. Each participant's clinical data were abstracted and cross-checked against each summary. Errors were defined as inaccurate information, and omissions were defined as missing information on the basis of the Institute of Medicine recommended elements. Results: One hundred twenty-one summaries were reviewed: 80 EHR based versus 41 software based. Twenty-four EHR-based summaries (30%) versus six software-based summaries (15%) contained one or more omissions. Omissions included failure to provide dates and specify all axillary surgeries for EHR-based summaries and failure to specify receptors for software-based summaries. Eight EHR-based summaries (10%) versus 19 software-based summaries (46%) contained one or more errors. Errors in EHR-based summaries were mostly discrepancies in dates, and errors in software-based summaries included incorrect stage, surgeries, chemotherapy, and receptors. Conclusion: A significant proportion of summaries contained at least one error or omission; some were potentially clinically significant. Mismatches between the clinical scenario and templates contributed to many of the errors and omissions. In an era of required care plan provision, quality measures should be considered and tracked to reduce rates, decrease inadvertent contributions from templates, and support audited data use.

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