NP model of survivorship care: Lessons learned.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 26-26
Author(s):  
Gretchen Dawson ◽  
Stacy Wentworth
Keyword(s):  
Cancer Survivors ◽  
Nurse Practitioners ◽  
Primary Care Providers ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Survivorship Care ◽  
Care Providers ◽  
Term Care ◽  
Healthcare Needs

26 Background: The number of cancer survivors is expected to reach 20 million by 2026. As patient volumes increase, oncologists are tasked with seeing more patients, often allowing less time for survivorship-related concerns. In an effort to address this issue, nurse practitioners (NPs) are equipped to aid survivors by managing late/long-term side effects of treatment, monitor for recurrence, provide survivorship care plan (SCP), and promote overall health and wellness. Methods: When initiating a survivorship program, our community cancer center utilized survivorship nurse practitioners (SNP) to address increasing patient volumes and patients’ survivorship issues. By beginning with breast cancer survivors, we were able to meet patients prospectively at diagnosis to provide support and introduce survivorship. SNP later saw patients in designated Survivorship Clinic, after completing treatment and in long-term survivorship to address physical/psychosocial concerns, place appropriate referrals, and promote overall wellness. Collaboration with local Primary Care Providers (PCP) was integral for the long-term care of survivors. Results: In 9 months, prospective data collection surveys helped to better understand patients’ needs, allocation of appropriate resources, and measure patient empowerment. Collaboration with EMR team helped address patient volumes and workflow. Future collaboration of survivors’ healthcare needs with PCP was done by routing 162 completed SCPs to patient-designated PCP and mailing over 185 survivorship program introduction letters to community PCPs. Conclusions: Meeting patients prospectively aided in promoting the importance of survivorship helped provide evaluation of our survivorship program’s growth and development. However, patients introduced to survivorship at diagnosis required a formal referral at the completion of treatment, which disrupted workflow. Collaborating with EMR team to develop survivorship referrals, survivorship clinic templates, and SCP reports were important. Continued work with PCPs will be integral to future success. NPs provide survivorship-focused care in the oncology setting, while meeting continued demands of a growing cancer survivorship patient population.

With a little help from my friends: A multi-disciplinary approach to cancer survivorship.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24082-e24082
Author(s):  
Scott Capozza ◽  
Maura Harrigan ◽  
Javin Brita ◽  
Angela Khairallah ◽  
Tara B. Sanft
Keyword(s):  
Side Effects ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Health Care Providers ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Survivorship Care ◽  
Care Providers ◽  
Cancer Related Fatigue

e24082 Background: Long term cancer survivorship care is an integral part of the overall arc of oncology care. There is currently no standard of care for survivorship care beyond dissemination of a Survivorship Care Plan and data evaluating current models is limited. Furthermore, the most current Commission on Cancer recommendations suggest that a multi-disciplinary approach to cancer survivorship will best address the late and long-term side effects that survivors experience1. Methods: A multi-disciplinary adult cancer survivorship clinic at Yale Cancer Center and Yale New Haven Hospital was established in October 2006. This clinic is overseen by a medical oncologist and features the medical expertise of four distinct providers: an advance practice practitioner (such as an APRN or PA), a licensed clinical social worker, an oncology board-certified registered dietitian and an oncology board-certified physical therapist. Survivors meet with each provider for 30 minutes. A follow-up visit is scheduled 2-3 months later to assess the interventions discussed at the first visit and make modifications as necessary. This comprehensive approach allows the providers to address a wide array of late and long-term side effects from cancer treatment, including fear of recurrence, cancer related fatigue and weight management. Beginning with evidence-based research in their respective fields, each provider can create an individualized plan to address these concerns. Results: The National Comprehensive Cancer Network's Distress Thermometer demonstrated an almost 75% decrease in distress in cancer survivors pre- to post initial visit (n = 1,116 patients). Additionally, cancer-related fatigue, as measured by the MD Anderson Brief Fatigue Inventory, decreased by almost 50% from first to second visit (n = 313 patients). Conclusions: This poster is the first to demonstrate the feasibility of implementing a multi-disciplinary cancer survivorship clinic to address the late and long-term side effects of cancer survivors. Further research evaluating the correlation between improved access to long term survivorship care, as well as the health care providers required to provide optimal care in this setting, is needed. 1. American College of Surgeons Comminssion on Cancer, https://www.facs.org/-/media/files/quality-programs/cancer/coc/optimal_resources_for_cancer_care_2020_standards.ashx . Accessed February 10th, 2020.

scholarly journals Perspectives of Survivorship Care Plans Among Older Breast Cancer Survivors: A Pilot Study

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482091720
Author(s):  
Jessica L. Krok-Schoen ◽  
Michelle J. Naughton ◽  
Anne M. Noonan ◽  
Janell Pisegna ◽  
Jennifer DeSalvo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Pilot Study ◽  
Focus Groups ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Providers ◽  
Term Care

The Commission on Cancer’s standard 3.3 represents a paradigm shift in the care of cancer survivors, recommending that survivors receive a treatment summary and survivorship care plan (SCPs). A focus on older breast cancer survivors is needed, as they are the majority of the breast cancer population and their experiences and perspectives of SCPs is limited in the literature. This pilot study utilized a mixed methods approach (focus groups and self-report questionnaire data) to gather information on older (≥65 years) breast cancer survivors’ perspectives of their SCPs, cancer survivorship, and communication with their health-care providers. The questionnaire was completed individually by the participants prior to the focus group and contained items on basic demographics and their health status following cancer treatment. The focus groups indicated that only a minority of women actually developed a SCP. Those who developed a SCP in collaboration with their providers valued the personal care and attention received. However, some participants reported poor communication with their providers and within their health-care team, resulting in frustration and confusion. Participants’ suggestions for ideal SCPs included better education and personalization, particularly in appropriate nutrition and exercise, and managing side effects and comorbidities. Lastly, the women believed that additional long-term care resources, such as health coaches, were important in improving their survivorship. These findings provide insight into enhancing the content, communication, and application of SCPs to improve the survivorship experience of older breast cancer survivors.

Determinants of survivorship care plan implementation in U.S. cancer programs.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 78-78 ◽  
Author(s):  
Sarah Birken ◽  
Deborah Mayer ◽  
Bryan Weiner ◽  
Allison Mary Deal
Keyword(s):  
Cancer Survivors ◽  
Negative Relationship ◽  
Primary Care Providers ◽  
Care Quality ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Providers ◽  
Program Type ◽  
Adoption And Implementation

78 Background: The Institute of Medicine recommended and many professional societies require survivorship care plan (SCP) use to facilitate cancer survivors’ transition from treatment to follow-up care. Rates of SCP adoption (plans to use SCPs) and implementation (current use) in US cancer programs remain unclear. Our objectives were to (1) assess rates of SCP adoption and implementation and (2) determine what distinguishes cancer programs that have implemented SCPs from those that have not moved beyond adoption. Methods: We surveyed employees knowledgeable about SCP adoption and implementation in a nationally representative sample of 100 US cancer programs. Data were analyzed using descriptive and bivariate statistics. Results: The response rate was 80%. Ninety-six percent of programs adopted SCPs, but only 45% implemented SCPs. Among programs that implemented, SCP use remains inconsistent: Use is restricted primarily to breast (81.58%) and colorectal (55.26%) cancer survivors; in 58.33% of these programs, less than a quarter of providers has ever used SCPs; and SCPs are seldom delivered to survivors or their primary care providers. Employees in many programs indicated that SCPs were adopted because of the belief that SCPs would improve care quality and the release of professional society guidelines; however, neither of these factors influenced SCP implementation. Few quality markers (e.g., NCI-designated program type; Commission on Cancer membership) influenced SCP implementation. Determinants of SCP implementation included teaching hospital program type (p = .04) and NCCCP membership (p = .009). Freestanding facility type had a negative relationship with SCP implementation (p = .02). Conclusions: Given inconclusive evidence of SCPs’ effectiveness in improving care coordination and patient outcomes, many scholars have recently advocated for research to promote SCPs’ effectiveness. These efforts may be in vain if SCPs are not more routinely implemented. Efforts should be targeted at enabling programs to implement quality improvement tools. Future research should determine what promotes SCP implementation among teaching hospitals and NCCCP members, and what inhibits freestanding facilities from implementing SCPs.

scholarly journals The Impact of Nurse Practitioners on Hospitalizations and Discharges from Long-term Nursing Facilities: A Systematic Review

Healthcare ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 114 ◽  
Author(s):  
Michael Mileski ◽  
Upwinder Pannu ◽  
Bobbi Payne ◽  
Erica Sterling ◽  
Rebecca McClay
Keyword(s):  
Nurse Practitioners ◽  
Hospital Readmissions ◽  
Primary Care Providers ◽  
Scope Of Practice ◽  
Nursing Facilities ◽  
Care Providers ◽  
Term Care ◽  
Skilled Nursing ◽  
The Impact

The objective of this study was to increase the understanding of the role a nurse practitioner (NP) has in reducing the risk of hospitalizations and improving quality outcomes among nursing facility residents. This was explored by the research team conducting a systematic literature review via Cumulative Index of Nursing and Allied Health Literature, PubMed (MEDLINE), and Academic Search Ultimate. This is of concern because of the increased rate of hospital readmissions from skilled nursing facilities. The study found that utilization of NPs as primary care providers resulted in decreased unnecessary hospitalizations, increased access to healthcare, and improved health outcomes. NPs are fundamental in building relationships with residents and families and providing them information for decision making. The utilization of NPs in a long-term care setting should be encouraged to improve access to care, decrease hospitalizations, and enhance quality of care. States with reduced or restrictive scope of practice for NPs should revisit the regulations to provide unrestricted scope of practice for NPs.

Implementation of a novel primary care-centered clinic for survivorship care.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 41-41
Author(s):  
Archana Radhakrishnan ◽  
Youngjee Choi ◽  
Zackary Berger ◽  
Craig Evan Pollack ◽  
Sydney Morss Dy ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Cancer Patients ◽  
Cancer Care ◽  
Psychosocial Support ◽  
Primary Care Providers ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Survivorship Care ◽  
Care Providers

41 Background: Patients often face challenges in transitioning to the survivorship stage of cancer care and coordinating with primary care. Prior research has highlighted the uncertainty in who provides survivorship care, leaving patients “lost in transition”. Integrating primary care providers (PCP) into cancer care offers one potential solution. Expanding traditional PCP roles to participating throughout the cancer continuum and familiarizing PCPs with cancer patients’ needs can address this gap. We describe an innovative model of incorporating PCPs to delivering primary care to cancer survivors at a large academic institution. Methods: As one part of a plan to address an identified need for improving survivorship care for cancer patients at Johns Hopkins, PCPs and cancer survivorship care experts developed the Primary Care for Cancer Survivors clinic (PCCS) in 11/2015. The clinic receives referrals from the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center and patients are seen for either a one-time consultation or can transition their primary care to the clinic. We also are creating a database of internal and external referrals to meet the specific needs identified by patients. We descriptively analyzed the utilization of PCCS from 11/2015 through 9/2016. Results: A total of 35 patients have been seen at PCCS. The average age of patients was 56.8 (SD 12.4) and 32 were female and 3 were male. 24 patients identified as white, 8 black, 1 Asian, and 2 others. Most patients transitioned their PC to the clinic (n = 30). The majority of patients had breast (n = 19) and colorectal cancer (n = 5); 10 patients had metastatic disease (3 have deceased). Commonly, referrals were made to physical therapy, including pelvic rehabilitation and lymphedema management, and nutrition counseling. Conclusions: Patients with a wide variety of cancers and at all stages of disease were seen for survivorship care in the PCCS clinic. Integrating nutrition care, psychosocial support, exercise programs, and palliative care were key early factors in meeting patients’ needs. Continuing to assess and meet survivors’ individual needs and build referral networks are important next steps in the development of the clinic.

Implementation of survivorship care plans in the pediatric oncology clinic.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 55-55 ◽  
Author(s):  
Christine Moore Smith ◽  
Barron L. Patterson ◽  
Debra L. Friedman
Keyword(s):  
Pediatric Oncology ◽  
Standard Of Care ◽  
Primary Care Providers ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Survivorship Care ◽  
Care Providers ◽  
Care Plans

55 Background: Quality survivorship care and follow up have been well described in the pediatric oncology population to improve overall health of cancer survivors. Typically, a key component is the delivery of a survivorship care plan (SCP) in a dedicated survivorship program. Creation of an SCP in the immediate post-treatment period has not been commonly adopted. To address the Commission on Cancer's (CoC) requirement to provide SCPs within six months of ending therapy, our pediatric oncology clinic has used quality improvement (QI) methods to incorporate SCPs into clinic workflow with subsequent survivorship program referral. Our aim is to meet the CoC’s benchmark of 50% of eligible patients receiving SCPs by December 31, 2017. Our secondary goal is to improve the timeliness of delivery to patients, families, and primary care providers (PCP). Methods: Registry data from our cancer center was utilized to identify eligible patients. Upcoming appointments were then identified for a panel of eligible patients using the electronic medical record (EMR). Providers use a standardized SCP template which includes the components required by the CoC. The SCP is then reviewed with families, electronically sent to the PCP, and saved in the EMR. Evaluation of the process included subjective feedback from providers and Plan-Do-Study-Act cycles. Based on this feedback and cycles, iterations of the template have been progressively streamlined and the EMR panel has been updated. Results: Care plan creation and delivery is ongoing. At baseline, 28% of eligible patients had SCPs previously created in the survivorship program. After implementation of our QI methods, to date, we have increased the proportion of eligible patients with an SCP to 40.3%, approaching our goal of 50% by December 31, 2017. We have also decreased the time from end of therapy to delivery of a care plan from 22.9 months to 14 months. This is expected to further improve as the process continues. Conclusions: The QI process has been successful in implementing a new standard of care for delivery of SCPs. Ongoing use of QI methods will increase compliance with the CoC standards and result in improved survivorship care.

scholarly journals Building a survivorship care plan delivery process: Experience in an academic center.

2019 ◽  
Vol 5 (suppl) ◽  
pp. 69-69
Author(s):  
Zoneddy R. Dayao ◽  
Bernard Tawfik ◽  
Janet Abernathy ◽  
Charles Wiggins ◽  
Amy Gundelach ◽  
...  
Keyword(s):  
Cost Effective ◽  
Primary Care Providers ◽  
Comprehensive Cancer Center ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Multiple Time ◽  
Cancer Type ◽  
Survivorship Care ◽  
Care Providers ◽  
Care Plans

69 Background: The Institute of Medicine endorses delivery of survivorship care plans (SCPs) to the growing number of cancer survivors in order to improve the coordination of care between oncologists and primary care providers (PCPs). In response, the Commission on Cancer (COC) has increased the SCP delivery requirement to >50% of eligible patients, a goal that is difficult to meet given limited resources. Here we outline the initiatives taken to achieve this goal at the University of New Mexico Comprehensive Cancer Center (UNMCCC). Methods: Prior to 2017, SCPs were not routinely delivered. Beginning 2017, providers were tasked to complete and deliver printed SCPs , resulting in a 17% rate of SCP completion. However, there was general lack of provider support and enthusiasm as the process was time consuming with no method for identifying eligible patients and tracking SCP delivery. In 2018, designated staff was assigned to partially complete the SCPs to assist providers, resulting in an increase in SCP delivery rate to 41%. However, the same barriers existed. SCP softwares, although available, were expensive. A cost effective process therefore was needed. A committee was then formed to create a system-wide process utilizing the existing electronic health record (EHR) MOSAIQ. ASCO based SCPs were created. Once providers identify eligible patients, an SCP electronic order was initiated. Designated staff then partially completes the SCPs based on review of medical records. The EHR extracts data items including demographics, PCP information, cancer type and stage. The EHR is programmed to flag SCPs ready for delivery which the provider then edits and approves. This system tracks multiple time points including referral, completion and delivery of SCPs. This new process was implemented in April 2019. Quarterly reviews are set to assess metrics. Results: Utilizing existing EHR (MOSAIQ), a new SCP delivery process was created that allows tracking of assembly, completion and timing of delivery. Conclusions: To overcome existing barriers to SCP completion and delivery, a new cost effective process was created utilizing existing staff and EHR resources. Institutional support is key to the success of this initiative.

Primary care providers' awareness and utilization of survivorship care plans.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 94-94
Author(s):  
Alicia R. Rosales ◽  
Tina Schaal ◽  
Shelby Darland ◽  
Dan Sayam Zuckerman
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Care Coordination ◽  
Primary Care Providers ◽  
Comfort Level ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Providers ◽  
Care Plans

94 Background: The Commission on Cancer (CoC) standard 3.3 requires that all patients who complete cancer treatment receive a survivorship care plan (SCP). To aid in care coordination, the standard also requires that the SCP be provided to the patient’s primary care provider (PCP). St. Luke’s Mountain States Institute (MSTI) has been providing patients and PCPs with SCPs for more than 5 years. Other local accredited cancer centers also provide SCPs for their patients. Methods: In partnership with the local chapter of the American Cancer Society, MSTI created an online survey aimed at assessing the utilization of the SCP in primary care clinics and the PCP’s comfort level carrying out the recommended surveillance. The survey link was distributed through email to approximately 300 PCPs across a large geographical area in varying sized practices. Results: Sixty three responses were received in 3 weeks with 46 responses from physicians and 17 responses from advanced practice providers. All of the respondents said they care for cancer survivors in their practice but 54% have never received a SCP. Twenty nine reported having received a SCP and answered 8 questions related to how they use the SCP in practice. The majority refer to the SCP to monitor for recurrence and 52% use it as a tool for coordination of care. Forty eight percent use the SCP to manage co-morbid conditions. Ninety-five percent of all respondents indicated they feel comfortable carrying out a surveillance plan provided by the oncologist for patients 2 years out from treatment. Sixty-four percent indicated they would like additional education about caring for cancer survivors. A common theme in comments included the desire for improved communication between the oncologists and PCPs. Conclusions: This standard was created in part to improve care coordination between oncologists and PCPs. More than have of the PCPs in the MSTI service area have not seen a SCP for their patients. Most indicated they are comfortable providing surveillance if they have a clear follow-up care plan from the oncologist. More than half want additional information about caring for cancer survivors. Future exploration could include assessment of barriers to communication and utilizing the SCP in practice.

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