Innovation, education, and research: A multidisciplinary survivorship care model.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 10519-10519
Author(s):  
Hira Latif ◽  
Patrick Martone ◽  
James Edward Shaw ◽  
Eric Wisotzky ◽  
Asma Ali Dilawari
Keyword(s):  
Physical Function ◽  
Cardiovascular Health ◽  
The United States ◽  
Screening Tools ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Care Plans ◽  
Patient Reported

10519 Background: Advances in early detection, therapeutics, and an aging population are expected to lead to an increase in the number of cancer survivors in the United States to 20 million by year 2026. The Institute of Medicine and Commission on Cancer recommends delivery of survivorship care plans on completion of curative treatment. While models exist for high-quality survivorship care, institutions encounter barriers such as lack of resources and limited training in survivorship. Our institution piloted a unique model combining fellows’ education with guideline-driven recommendations from a multidisciplinary team to provide consolidated survivorship care. Methods: A survey for self-reported competence and experience was conducted amongst the hematology and oncology fellows at the MedStar Washington Hospital Center. A bimonthly clinic staffed by a medical oncologist, oncology fellow and a cancer rehabilitation fellow was initiated in September 2018. Didactic lectures, curriculum syllabus and recommended assessments were established. Screening tools for distress, patients’ confidence in knowledge about survivorship and physical function via PROMIS 20a were administered; clinical assessments including the “6-minute walk test” were used to assess cardiovascular health. Results: Most fellows had not encountered a survivor of lung (16%), GU (0%) and head and neck cancer (33%). Majority of the fellows had never delivered a survivorship care plan. Scores were low in competence and experience in survivorship. By December 2018, 15 patients with 17 diagnoses of cancer were referred to the clinic. 10 were survivors of hematologic malignancies while 7 were of solid tumors. The no-show rate was 40%. Fellows conducted the assessments and were supervised by an oncology attending. Of the 9 patients seen, 4 were referred for physical therapy; additional referrals for psychology and cardiology were frequent. Conclusions: A comprehensive multidisciplinary survivorship clinic focusing on fellows’ education is a feasible model for delivery of survivorship care and aims to bridge the gap in experience and competence of fellows. Future goals include re-assessment of patient-reported outcomes, physical function, and competence of fellows.

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.

Survivorship care plan visits: Mixed methods analysis of patient surveys.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 174-174
Author(s):  
Natalie Garces ◽  
Daisuke Goto ◽  
Carol J. Farhangfar ◽  
Tara Eaton
Keyword(s):  
Qualitative Analysis ◽  
Head And Neck ◽  
Subgroup Analysis ◽  
Statistical Significance ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Rank Test ◽  
Survivorship Care ◽  
Care Plans ◽  
Patient Reported

174 Background: Survivorship Care Plans (SCPs) are endorsed by cancer advocacy groups and required for accreditation, yet benefits are unclear. The purpose of this quality initiative was to assess the benefit of SCPs. Methods: From June 2015 to September 2017, survivors who had a SCP visit were surveyed to report their understanding of key survivorship topics pre/post visit; the most valuable information learned and plans to use the information. Descriptive statistics and qualitative analysis were performed. Subgroup analysis was performed for age, insurance, marital status, and race. Wilcoxon signed-rank test computed statistical significance. Results: Of 794 surveys, 657 (83%) were complete and evaluable. Surveys were collected from breast (436 [66%]), lung (45 [7%]), colorectal (33 [5%]), head and neck (25 [4%]), melanoma (24 [4%]), endometrial and ovarian (20 each [3%]), and other (54 (8%) cancer survivors. Statistically significant ( p<0.05) improvements in all questions (Table 1) were noted across nearly all disease sites. Exceptions were endometrial, head and neck, and melanoma, which already had > 75% answering “completely understand” for selected questions pre- SCP visit. Subgroup analysis found no significant differences. Self-management was a theme in the “other” insurance status subgroup (14) qualitative analysis. Four (36%) indicated an interest in information about programs to improve healthy behaviors. Conclusions: There was major positive impact of the SCP visit on patient-reported understanding of all survivorship topics. Providers may benefit from focusing SCP discussion on areas the survivor reports as “some” or “no” understanding pre- SCP visit. Providers should connect survivors to resources to support self-identified needs. [Table: see text]

Developing a culturally and linguistically responsive survivorship care plan for breast cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 146-146
Author(s):  
Kimlin Tan Ashing ◽  
Monica Rosales ◽  
Gingi Fulcher ◽  
Mayra Serrano ◽  
Jeffrey N. Weitzel ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Cultural Responsiveness ◽  
Advisory Council ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Preliminary Evaluation ◽  
Breast Cancers ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Care Plans

146 Background: African and Latina-American breast cancers patients (BCA) experience the greatest morbidity and mortality, suggesting a critical need for improved surveillance and quality care. The Institute of Medicine (IOM) and the Commission on Cancer (CoC) recommend that survivors receive personalized Treatment Summaries and Survivorship Care Plans (TSSCP) in order to facilitate best practice in clinical surveillance and follow-up care. This TSSCP template development study joined advocacy, scientific and medical communities to comprise a diverse advisory council (AC, N=38) to inform the development of the TSSCP-AA (African American) and TSSCP-S (Latino) templates targeting BCA. This abstract reports on the development, and presents the TSSCP-AA and TSSCP-S. Methods: The overall study was guided by the Shared Care and Psychooncology Models, and Contextual Model of Health Related Quality of Life. The AC provided input into the culturally relevant modifications of the American Society of Clinical Oncology (ASCO) TSSCP template to create the TSSCP-AA and TSSCP-S. Health care professionals enlisted from cancer centers and community hospitals (n=51) evaluated the TSSCP-AA and TSSCP-S templates on the following domains: content, clarity, utility, and cultural and socioecological responsiveness. Results: AC input revealed that the clinical (i.e., comorbidities) and cultural contexts (i.e., language, spirituality) must inform TS and SCP, respectively. Preliminary evaluation analyses documented that health professionals rated our TSSCP-AA and TSSCP-S templates as excellent to outstanding on content, clarity, utility, cultural responsiveness, and socioecological responsiveness (p<0.01). Conclusions: The evaluation results imply that the TSSCP-AA and TSSCP-S templates achieved cultural responsiveness with high acceptability and utility among professionals and survivors. We created both paper and electronic versions of theTSSCP-AA andTSSCP-S (English and bilingual English-Spanish formats) for providers to create individualized TSSCPs. Further, our TSSCP development approach can be adopted for TSSCP template development targeting ethnic/linguistic minority cancer survivors.

Survivor feedback on a late effects-oriented survivorship care plan for head and neck cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21596-e21596
Author(s):  
Talya Salz ◽  
Mary S. McCabe ◽  
Kevin C. Oeffinger ◽  
Rebecca B Schnall ◽  
Stacie Corcoran ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Late Effects ◽  
Clinic Visit ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Plans ◽  
Patient Reported

e21596 Background: Survivorship care plans (SCPs) typically include generic advice for the management of late effects (LEs) that can occur, rather than addressing LEs that the survivor actually has. We developed a platform called HN-STAR that uses electronic patient-reported outcomes (ePROs) and evidence-based LE management to generate a personalized SCP for survivors of head and neck cancer (HNC), a population vulnerable to various LEs. We assessed HNC survivors’ experiences with HN-STAR to ensure its acceptability and usefulness. Methods: Disease-free HNC survivors at two cancer hospitals used HN-STAR in conjunction with a routine survivorship visit. Prior to the visit, survivors used a validated ePRO measure (PRO-CTCAE) to report up to 22 physical LEs. Based on clinic visit discussions, HN-STAR generated an SCP that included a treatment summary and LE management plans. Survivors indicated their level of agreement to statements regarding the ease of use of the ePROs, content of the SCP, and intentions to adhere to LE management recommendations. Results: 47 survivors completed surveys (mean 5.4 years from treatment completion). Most were white (89%), male (85%), had an oropharynx tumor (58%), and received multimodality therapy (81%). More than half (51%) experienced at least 9 of the 22 LEs in the last 30 days (mean 8.2 per person). Most survivors reported that completing ePROs improved the discussions with their provider (98%), the quality of their care (96%), and their communication with their provider (98%). 91% agreed the SCP was the right length, and 98% agreed it was easy to follow. 98% intended to follow at least some of the recommendations for LEs management, and 98% reported feeling confident that they could follow the recommendations. The majority agreed that the SCP accurately summarized the clinic visit (98%), they would refer back to the SCP (98%), they trust the SCP (100%), and they plan to share the SCP with a primary care provider (87%). Conclusions: Among HNC survivors, an automatically generated SCP that was tailored to their LEs was acceptable, was trusted, and provided recommendations they intended to follow. Patient-centered SCPs that focus on existing LEs hold promise as a means to help survivors manage LEs.

Challenges in the implementation of survivorship care plans in an NCI-designated cancer center.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 68-68 ◽  
Author(s):  
Mary Mendelsohn ◽  
Joanne E. Mortimer ◽  
Leslie Popplewell ◽  
Lily L. Lai ◽  
Ellie Maghami ◽  
...  
Keyword(s):  
Cancer Registry ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Coordinator ◽  
Nurse Care ◽  
Care Plans ◽  
Patient Reported

68 Background: The development and initiation of Survivorship Care Plans (SCPs) across all disease sites was identified as a Strategic Initiative Goals for 2015 by the Clinical Cancer Committee. The 2012 Commission on Cancer requirements for certification provided an additional incentive to meet this goal. Establishing a process that includes the development and distribution of a SCP’s within the electronic medical record (EMR) is necessary to improve on the completion of SCP’s and to improve the utilization of surveillance tests in cancer survivors. We describe the process developed at a free-standing NCI cancer center to meet the standard of SCP provision to all cancer patients. Methods: A multi-disciplinary subcommittee of the Cancer Committee was designated to develop the overall strategic plan for the implementation of this standard. It met with disease teams to facilitate a treatment summary from Cancer Registry data, identify patient reported symptoms using a self report tablet (SupportScreen). Electronic care plans were created using survivorship research program templates and ASCO framework for each disease site team. The disease team Nurse Care Coordinator inputs information into the eSCP. Results: Templates have been established within the EMR in the documents section under survivorship care plan title. These can be initiated and modified when the Nurse Care Coordinator chooses to start them. The disease teams have established their time points for SCP presentation to their patients. Using the cancer registry to provide data related to staging, treatments and genetic testing has helped minimize development time. Individual survivor’s concerns will be reflected in patient reports and physician symptom documentation. This eSCP completion process is a pilot program within the breast cancer disease team and will be expanded to include patients with head & neck and hematologic malignancies with a goal of including all patients by mid 2016. Conclusions: The goal of improving survivorship care coordination and compliance with surveillance guidelines is challenging. Maximizing available interdisciplinary resources has helped to create a viable Survivorship Care plan at our institution.

scholarly journals Survivorship Programs and Care Plans in Practice: Variations on a Theme

2011 ◽  
Vol 7 (2) ◽  
pp. 70-75 ◽  
Author(s):  
Erin E. Hahn ◽  
Patricia A. Ganz
Keyword(s):  
Los Angeles ◽  
Cancer Survivorship ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Care Plans ◽  
Practice Variations ◽  
Variations On A Theme

This study looks at four Los Angeles–based cancer survivorship programs and finds that the Institute of Medicine–recommended survivorship care plan document can be successfully adapted for use in varied settings to inform and educate both patients and providers.

Evaluating survivorship cancer care through quality improvement programs.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 112-112
Author(s):  
Guadalupe R. Palos ◽  
Fran Zandstra ◽  
Ludivine Russell ◽  
Jacklyn J. Flores ◽  
Katherine R. Gilmore ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Compliance Rate ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Full Time ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Care Plans ◽  
Improvement Programs

112 Background: The Institute of Medicine noted cancer survivors’ care may be improved by providing each with a cancer survivorship care plan (CSCP). Recently, numerous versions of CSCPs have emerged; however, evidence-based processes to evaluate their use and quality in providing personalized survivorship care have yet to be implemented. Here, we describe our efforts to use the approach recommended by the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) to track and report the compliance rate for using electronic CSCPs in our survivorship clinics. Methods: The criteria used to conduct our audit evolved from the QOPI template, which included selection of survivors seen in 7 different out-patient survivorship clinics within a specific 6-month period, identification of denominators and numerators unique to each clinic, and determination of the number of records to audit based on the number of full-time providers in each clinic. Next, we established the target condition, method(s) used for data collection, appropriate measures, and other criteria used in the QOPI. All data were obtained from our CSCPs’ mined data, institutional electronic medical records, and scheduling systems. Results: From December 1, 2011, to May 31, 2012, we conducted an electronic medical records audit to determine the compliance rate for issuing survivorship care plans in 7 clinics. The survivorship clinics included breast, colorectal, endocrine (thyroid), genitourinary, gynecology, head/neck, and melanoma. A total of 3,274 electronic medical records were reviewed. 40 providers issued a total of 2,761 electronic CSCPs within 30 days of the arrived appointment. The compliance rate per clinic ranged from 64.5% to 94.7% (X=84.5%). Conclusions: We found the QOPI process to be user-friendly and applicable to our compliance monitoring effort. All data were extracted from electronic tools, thus ensuring the processes used were reliable, reproducible, and reasonably consistent across clinics. Further examination is warranted to determine characteristics of clinics with high- vs. low-compliance rates and their impact on survivors’ outcomes as related to specific CSCP recommendations.

Failing to Plan Is Planning to Fail: Improving the Quality of Care With Survivorship Care Plans

2006 ◽  
Vol 24 (32) ◽  
pp. 5112-5116 ◽  
Author(s):  
Craig C. Earle
Keyword(s):  
Care Plan ◽  
Survivorship Care Plan ◽  
Premature Menopause ◽  
Survivorship Care Plans ◽  
Primary Therapy ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Care Plans ◽  
Important Message ◽  
The Creation

The recent Institute of Medicine report “From Cancer Patient to Cancer Survivor: Lost in Transition” recommended the creation of survivorship care plans for patients as they complete primary therapy for cancer to ensure clarity for all involved about patients’ diagnoses, treatments received, and surveillance plans. Any previously existing follow-up guidelines for cancer survivors have been largely restricted to surveillance for recurrence of the primary disease. An important message of the Institute of Medicine report is that survivorship care plans must surpass this and address the chronic effects of cancer (pain, fatigue, premature menopause, depression/anxiety), monitoring for and preventing late effects like osteoporosis, heart disease, and second malignancies, and promoting healthy lifestyles. It should explicitly identify the providers responsible for each aspect of ongoing care and provide information on resources available for psychosocial and other practical issues that may arise as a result of the prior cancer diagnosis. Although having some sort of a plan is clearly necessary to achieve high quality care, there are practical barriers to formal off-treatment consultations and the creation of written documents that may become part of the medical record. This article reviews the elements of the proposed survivorship care plan and discusses areas of research and development needed to make them part of standard oncology practice.

Developing a culturally and linguistically responsive survivorship care plan for breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20651-e20651
Author(s):  
Kimlin Tan Ashing ◽  
Monica Rosales ◽  
Mayra Serrano ◽  
Gingi Fulcher ◽  
Isaac Benjamin Paz ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Cultural Responsiveness ◽  
Advisory Council ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Preliminary Evaluation ◽  
Breast Cancers ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Care Plans

e20651 Background: African and Latina-American breast cancers patients (BCA) experience the greatest morbidity and mortality, suggesting a critical need for improved surveillance and quality care. The Institute of Medicine (IOM) and the Commission on Cancer (CoC) recommend that survivors receive personalized Treatment Summaries and Survivorship Care Plans (TSSCP) in order to facilitate best practice in clinical surveillance and follow-up care. This TSSCP template development study joined advocacy, scientific and medical communities to comprise a diverse advisory council (AC, N=38) to inform the development of the TSSCP-AA (African American) and TSSCP-S (Latino) templates targeting BCA. This abstract reports on the development, and presents the TSSCP-AA and TSSCP-S. Methods: The overall study was guided by the Shared Care and Psychooncology Models, and Contextual Model of Health Related Quality of Life. The AC provided input into the culturally relevant modifications of the American Society of Cancer Oncology (ASCO) TSSCP template to create the TSSCP-AA and TSSCP-S. Health care professionals enlisted from cancer centers and community hospitals (n=51) evaluated the TSSCP-AA and TSSCP-S templates on the following domains: content, clarity, utility, and cultural and socioecological responsiveness. Results: AC input revealed that the clinical (i.e., comorbidities) and cultural contexts (i.e., language, spirituality) must inform TS and SCP, respectively. Preliminary evaluation analyses documented that health professionals rated our TSSCP-AA and TSSCP-S templates as excellent to outstanding on content, clarity, utility, cultural responsiveness, and socioecological responsiveness (p<0.01). Conclusions: The evaluation results imply that the TSSCP-AA and TSSCP-S templates achieved cultural responsiveness with high acceptability and utility among professionals and survivors. We created both paper and electronic versions of theTSSCP-AA andTSSCP-S (English and bilingual English-Spanish formats) for providers to create individualized TSSCPs. Further, our TSSCP development approach can be adopted for TSSCP template development targeting ethnic/linguistic minority cancer survivors.

Recall and uptake of survivorship care plan recommendations.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 67-67
Author(s):  
Andrew L. Salner ◽  
Deborah Walker ◽  
Amanda Seltzer ◽  
SarahLena Panzer ◽  
Carrie Stricker ◽  
...  
Keyword(s):  
Breast Cancer Survivors ◽  
Pilot Project ◽  
Planning System ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Plans ◽  
Patient Reported ◽  
Treatment Data

67 Background: Despite the growing delivery of survivorship care plans (SCPs), little research has examined survivors’ recall and adoption of SCP recommendations, including those based on patient-reported symptoms and concerns. Methods: 65 stage 0-III breast cancer survivors participated in this pilot project. Patients completed an electronic patient-reported outcomes (ePRO) survey prior to a visit with a nurse practitioner, who delivered a tailored SCP generated by the Carevive Care Planning System (CPS) using evidence-based algorithms driven by ePRO and diagnosis/treatment data. Approximately 6 weeks later, patients completed a survey to evaluate their recall and any corresponding action taken. Actual SCP recommendations were extracted from the Carevive CPS database and matched to follow-up surveys to determine recall accuracy. Results: Data were analyzed for 35 patients completing follow-up surveys to date. SCPs contained an average of 22.2 recommendations per patient, almost half (n = 10.7) for active symptoms/supportive care issues. Recommendations were broken down into 3 groups 1) Surveillance, 2) Prevention, and 3) Intervention; see table below for select results. Of note, lymphedema-related recommendations were recalled accurately more often (p = 0.005) by those with symptoms vs. those advised on prevention. Conclusions: Incorporating an ePRO survey into SCP delivery enables tailoring to patient needs and concerns, which may in turn enhance recall and follow through given saliency. Patients tended to recall more accurately SCP recommendations for active or more severe symptoms. Additional research is needed to maximize retention and follow through on SCP recommendations. [Table: see text]

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