Nurse practitioner-led breast cancer survivorship clinic

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20723-e20723
Author(s):  
A. Cureton ◽  
W. Pritham ◽  
M. Royce ◽  
K. Zahn

e20723 Background: The 2.5 million breast cancer survivors in the US demands increasing awareness of and need for healthcare organizations to address survivorship issues. Cancer survivorship care has become a specialty emphasizing health promotion, disease prevention, and patient satisfaction. It is a natural setting for advanced practice nurses to be leaders. This abstract presents a model for a nurse practitioner-led breast cancer survivorship clinic. Methods: Eligible patients are those previously diagnosed with invasive and/or in situ breast cancer and at least 5 years post-diagnosis without recurrence. Eligible survivors are identified annually through the University of New Mexico Tumor Registry. Clinic notes are reviewed to confirm the patient has not had a recurrence, new diagnosis, or death. Letters are sent to eligible survivors introducing the Breast Cancer Survivorship Clinic (Clinic) and inviting them to participate, and oncologists are encouraged to transfer eligible patients into the Clinic. Results: Eighty-six survivors are currently participating in the Clinic. Survivors are seen on an annual basis after mammogram. Each survivor receives a personalized Survivorship Care Plan at the first visit. The care plan was developed by a multi-disciplinary team of a breast oncologist, psychologist, social worker, nutritionist, and patient educator to provide input on the issues that survivors face. Components of Survivorship Care Plan: pathologic and genetic findings, summary of treatment, bloodwork, bone health, lymphedema, secondary malignancies, health maintenance recommendations, psychological assessment, nutrition/weight assessment. Conclusions: The establishment of the Clinic has several advantages: Breast cancer survivors are being followed in this specialty clinic after 5 years instead of being discharged from the Cancer Center. The Clinic has allowed oncologists more time for patients actively on therapy and more time to accommodate newly diagnosed patients. The Clinic addresses the unique issues faced by long term survivors, which could increase patient satisfaction. A multi-disciplinary team is key to developing a care plan for a survivorship clinic. However, the day-to-day operation of the clinic can be effectively led by a nurse practitioner. No significant financial relationships to disclose.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 60-60
Author(s):  
Shakuntala Shrestha ◽  
Pam Khosla ◽  
Janos Molnar ◽  
Maria Eugenia Corona ◽  
Sofia M Garcia

60 Background: To provide comprehensive services and meet Commission on Cancer (CoC) accreditation requirements, we developed and evaluated a customized breast cancer SCP template and delivery model. Objective: To implement and pilot test survivorship care plan (SCP) delivery for breast cancer survivors. Methods: Clinicians at a safety net hospital partnered with investigators at an academic institution to start a breast cancer survivorship care program. We developed an SCP template that is CoC-complaint and responsive to input gathered in 2 focus groups with breast cancer survivors (n = 12) and interviews with staff (n = 8). Oncologists and nurses identified and referred English-speaking women who had completed breast cancer treatment. Participants completed baseline measures prior to receiving individualized SCPs in a survivorship consultation visit with a dedicated APN. In response to high no-show rates, we expanded clinic scheduling to harmonize with participants' other medical appointments. Interim feasibility results for our ongoing study are presented here. Results: A total of 154 patients were screened to reach target enrollment (n= 80) within 20 months. Participant median age was 60 ± 11; 71% were African American, 14% Hispanic; 11% Non-Hispanic White and 92% had household incomes < $20,000. Average times were: 30 ± 13.4 minutes for abstracting patient clinical information in preparation for the survivorship visit; 25 ± 16 minutes for completing individual SCPs; 22±7.65 minutes to review / deliver the SCPs with patients. The difference in no-show rate between first 3-month recruitment period (clinic limited to one day/week) and next 17 months (clinic appointment expanded to accommodate patients' schedule) was statistically significant, p = 0.028. Conclusions: Tailoring SCP templates and delivery models to the needs of a safety net hospital aided the sustainability of a new survivorship clinic. Patient non-adherence to scheduled visits was significantly improved by expanding clinic hours. Significant clinician time was spent preparing SCPs and a level 4 visit (25 minutes) does not adequately reflect this effort. This study is funded by the American Cancer Society, Illinois Division (Grant# 254698).


2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e20610-e20610
Author(s):  
Wendy C. Budin ◽  
Deborah M. Axelrod ◽  
JoAnne M. Jaravata ◽  
Julia Anne Smith ◽  
Robin L. Kleinman ◽  
...  

2015 ◽  
Vol 11 (2) ◽  
pp. e222-e229 ◽  
Author(s):  
Steven C. Palmer ◽  
Carrie Tompkins Stricker ◽  
SarahLena L. Panzer ◽  
Sarah A. Arvey ◽  
K. Scott Baker ◽  
...  

This study demonstrates improvements in perceived knowledge and quality of survivorship care after receipt of a comprehensive survivorship care plan.


2011 ◽  
Vol 29 (15_suppl) ◽  
pp. 6117-6117 ◽  
Author(s):  
C. T. Stricker ◽  
L. A. Jacobs ◽  
A. DeMichele ◽  
A. Jones ◽  
B. C. Risendal ◽  
...  

2015 ◽  
Vol 25 (6) ◽  
pp. 729-731 ◽  
Author(s):  
Kimlin Tam Ashing ◽  
Lily Lai ◽  
Shirley Brown ◽  
Kommah McDowell ◽  
DeBorrah Carter ◽  
...  

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17542-e17542 ◽  
Author(s):  
P. De Fusco ◽  
R. Chlebowski

e17542 Background: Tremendous advances in detection and treatment have improved breast cancer survival rates. However, with nearly 22.4 million people worldwide living with cancer, optimal survivorship care has become a major focus of health care professionals (HCPs) and patient advocates. The Breast Cancer Survivorship Alliance (BCSA) is a group of HCPs and patient advocates dedicated to enhancing patient survivorship care and encouraging HCPs to look beyond the diagnosis and treatment of breast cancer. Methods: To identify educational needs in breast cancer survivorship, a 25-question survey was fielded at the 2007 San Antonio Breast Cancer Symposium. Electronic and print surveys were available at the Y-Me National Breast Cancer Organization and AstraZeneca booths. Results: Of the 516 respondents, 29% were from the United States, 63% were from the rest of the world, and 8% did not specify a location. A total of 73% were physicians, 7% were oncology nurses, nurse practitioners, or physician assistants, and 20% represented other aspects of breast cancer care (e.g., advocates and patients). The survey revealed a lack of consensus on the definition of cancer survivor, with only 26% of respondents selecting the definition established by the National Coalition for Cancer Survivorship (ie, from the moment of cancer diagnosis and for the balance of life). More than half (i.e., 51%) defined cancer survivor as a patient who has been disease-free for 5 years. Overall wellness promotion, adherence, and management of treatment-related side effects were ranked as the 3 most essential aspects of survivorship care. While most practices engage in posttreatment survivorship counseling, only 16% provide patients with an end-of-treatment summary or survivorship care plan. Most respondents indicated that their institution has a survivorship program in place (39%) or in development (30%). Conclusions: Although progress has been made in understanding and implementing survivorship care, additional education is needed to optimize care of breast cancer survivors. [Table: see text]


2011 ◽  
Vol 29 (15_suppl) ◽  
pp. 6082-6082 ◽  
Author(s):  
D. Coyle ◽  
E. Grunfeld ◽  
K. Coyle ◽  
J. A. Julian ◽  
G. R. Pond ◽  
...  

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 90-90 ◽  
Author(s):  
Kathy Trotter ◽  
Susan M. Schneider

90 Background: Group medical appointments have been shown to improve access, health outcomes and health care utilization rates, as well as self-management skills. A new model of breast cancer survivor care was designed and piloted at Duke Cancer Center. Survivors attended the clinic together in groups of six. An interdisciplinary group visit format in the initial part of the appointment provided surveillance, education and support, as well as formation of an individualized survivorship care plan. The first hour included review of their personal care plan and a 45-minute facilitated discussion. Afterwards, individual visits with the nurse practitioner, and dietitian, physical therapist, or social worker occurred. Methods: A 22-item Likert-type questionnaire sought opinions regarding logistics and the style and function of care delivered. 122 surveys were collected. Descriptive statistics (via SPSS v19) using ANOVA type regression were accomplished. Secondly, a retrospective two-group study of clinic financial data for follow-up patients was done. Revenues from the group medical visit by the NP were compared to those seen traditionally by the MD (N=300). Review of time to third available appointment for each clinician was also recorded. Results: 122 surveys were collected with a 86% response rate. Mean scores for all questions rated at least 4.4 of 5, with the highest score given for the confidence felt in the nurse practitioner (4.93) and the lowest for the acceptability of the wait time in the breast imaging area (4.4). Overall, 98% felt the program provided quality care and 97% were likely to recommend the clinic to other breast cancer survivors. What participants liked most about the program was sharing with other survivors. Cost benefit analysis revealed that revenues and direct costs were nearly equal between delivery models. Time to third available appointment for the primary referring oncologist, dropped from 29.4 to 26.7 days, while the NPs time remained stable at 8.7 days. Conclusions: The group visit model applied to survivor care appears feasible and highly satisfactory to participants.


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