Staging the development and implementation of a Coordinated Cancer Care Model using risk-based survivorship care: A deliberative discussion among multiple stakeholders.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18027-e18027
Author(s):  
Dominique Tremblay ◽  
Karine Bilodeau ◽  
Catherine Prady ◽  
Nassera Touati
Keyword(s):  
Risk Assessment ◽  
Empirical Studies ◽  
Primary Care Providers ◽  
Cancer Risk Assessment ◽  
Care Plan ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Care Providers ◽  
Care Model ◽  
Deliberative Discussion

e18027 Background: Risk-based survivorship care has become one of the best practices care recommended by the Institute of Medicine. It involves coordinated follow-up services based on the risk of long-term and late effects, cancer recurrence and an individualised care plan. Risk-based care requires specific knowledge about cancer histology, treatments, and potential consequences of cancer and its treatment to guide surveillance, screening and counseling. Diagnostic and treatment details and their associated health risks may not be known by survivors or their multiple care providers. Implementing risk-based survivorship care is often challenging for providers. This presentation report on a deliberative workshop on the development and planning of a risk-based survivorship care model. Methods: The deliberative workshop is part of a larger study in two regional cancer networks in Quebec, selected for there differences (geographic location, population size, academic mandate). A total of 25 key informants (researchers, managers, family physicians, oncologists, cancer survivors, nurses, social workers) participated into the workshop on October 2nd, 2018. Deliberative discussion between local stakeholders followed by videoconference, getting together stakeholders from both networks was drawn from Gupta et al 3 steps: 1) identify the problem; 2) develop the innovation; 3) design the pilot test. Results: Although the context of the network was different, main issues were similar: 1) there is no common understanding of the concept “risk-based survivorship care”, either for survivors, primary care providers and cancer specialist; 2) “silo functioning” within and between teams is a main barriers to ensure care coordination based on risk assessment; 3) organizational assets should be formalized to insure safe coordination of survivorship care based on cancer risk assessment. Conclusions: Given the recognized importance of risk-based survivorship care and implementation challenges, deliberative discussions may provide a useful lens to inform translation of this model into real practices and guide empirical studies.

Survivorship care plans: Is there buy-in from oncology providers?

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 8-8
Author(s):  
Talya Salz ◽  
Erin Onstad ◽  
Mary S. McCabe ◽  
Shrujal S. Baxi ◽  
Richard L. Deming ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Survivorship Care Plans ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Care Providers ◽  
Care Plans ◽  
Ongoing Care ◽  
Oncology Providers ◽  
To Receive

8 Background: The Institute of Medicine advised that cancer survivors and their primary care providers receive survivorship care plans (SCPs) to summarize cancer treatment and plan ongoing care. However, the use of SCPs remains limited. Methods: Oncology providers at 14 National Cancer Institute Community Cancer Centers Program (NCCCP) hospitals completed a survey regarding their perceptions of SCPs, including barriers to implementation, strategies for implementation, the role of oncology providers, and the importance of topics in SCPs (diagnosis, treatment, recommended ongoing care, and the aspects of ongoing care that the oncology practice will provide). Results: Among 245 providers (70% response rate), a minority reported ever providing an SCP or any of its components to patients. The most widely reported barriers were personnel to creating SCPs and time (69% and 64% of respondents, respectively). The most widely endorsed strategy among those using SCPs was the use of a template with pre-specified fields; 94% of those who used templates found them helpful. For each topic of an SCP, while 87%-89% of oncology providers felt it was very important for primary care providers to receive the information, only 58%-65% of respondents felt it was very important for patients to receive the information. Further, 33%-38% of respondents had mixed feelings about whether it was oncology providers’ responsibility to provide SCPs. Conclusions: Practices need additional resources to overcome barriers to implementing SCPs. We found resistance toward SCPs, particularly the perceived value for the survivor and the idea that oncology providers are responsible for SCP dissemination.

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.

Survivors' narratives of the value of cancer survivorship care plans and clinical services.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 57-57
Author(s):  
Guadalupe R. Palos ◽  
Megan Hebdon ◽  
Sara McComb ◽  
Richard W Wagner ◽  
Maria Alma Rodriguez
Keyword(s):  
Primary Care ◽  
Clinical Data ◽  
Primary Care Providers ◽  
Care Plan ◽  
Care Practice ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Providers ◽  
Care Plans ◽  
Head Neck

57 Background: Providers in primary care practice can benefit from having a better understanding of cancer survivors’ perceptions of the value of survivorship treatment summaries and care plans. Our objective was to qualitatively explore survivors’ perceptions of care received in dedicated outpatient clinics for survivors of breast, genitourinary (GU), and head/neck cancers. Methods: This study was conducted from August 8, 2014 to October 2, 2014 in 3 clinics, selected on variation in infrastructure, patient populations, and disease site. A convenience sample of survivors scheduled for an appointment in these clinics was eligible. Semi-structured interviews were conducted by research staff trained in qualitative methodology. Demographic and clinical data were collected. Groups explored a) experience with care/services, b) value of care plan, service coordination and clinic operations and c) gaps/strengths in transition to clinics. Descriptive statistics were used to summarize and analyze demographic and clinical data. Discussions were transcribed verbatim with confirmation of themes among a team of researchers. Results: A total of 36 survivors, X= 62.3 (SD = 10.9) years, were interviewed. Of these 27.8% breast survivors, 38.9% head/neck, and 33.3% GU, with X= 8.33 (SD = 5.83) years since their cancer diagnosis. Of these, 80.5% were Caucasian, 8.3% Hispanic/Latino, and 5.6% Asian/Pacific Islander, and 5.6% African-American. 61.1% were male and 78.6% married or living with someone. Survivors cited concerns about inconsistency in methods used to distribute care plans to survivors, inadequate communication about the purpose of the care plan, and vague recall of receiving care plans. Survivors reported the value of receiving survivorship care were “having an awareness of what’s up the road, establishing a constant relationship with their provider and addressing gaps in care”. Conclusions: The value of offering survivorship care is supported by the narratives of these survivors. Additional training and education on effective communication about survivorship care plans may be useful to oncology specialists and primary care providers.

scholarly journals Breast Cancer Risk Assessment and Chemoprevention Use Among Veterans Affairs Primary Care Providers: A National Online Survey

2019 ◽  
Vol 185 (3-4) ◽  
pp. 512-518
Author(s):  
Balmatee Bidassie ◽  
Amanda Kovach ◽  
Marissa A Vallette ◽  
Joseph Merriman ◽  
Yeun-Hee Anna Park ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
Primary Care ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Primary Care Providers ◽  
Comfort Level ◽  
Cancer Risk Assessment ◽  
Care Providers ◽  
Breast Cancer Risk Assessment

Abstract Introduction Breast cancer is the most common cancer diagnosed among women and the second most common cause of cancer death among women. There are ways to reduce a woman’s risk of breast cancer; however, most eligible women in the United States are neither offered personalized screening nor chemoprevention. Surveys have found that primary care providers are largely unaware of breast cancer risk assessment models or chemoprevention. This survey aims to investigate Veterans Health Administration primary care providers’ comfort level, practice patterns, and knowledge of breast cancer risk assessment and chemoprevention. Materials and Methods An online, Research Electronic Data Capture-generated survey was distributed to VHA providers in internal medicine, family medicine, and obstetrics/gynecology. Survey domains were provider demographics, women’s health experience, comfort level, practice patterns, barriers to using risk models and chemoprevention, and knowledge of chemoprevention. Results Of the 167 respondents, 33.1% used the Gail model monthly or more often and only 2.4% prescribed chemoprevention in the past 2 years. Most VHA primary care providers did not answer chemoprevention knowledge questions correctly. Designated women’s health providers were more comfortable with risk assessment (P < 0.018) and chemoprevention (P < 0.011) and used both breast cancer risk models (P < 0.0045) and chemoprevention more often (P < 0.153). Reported barriers to chemoprevention were lack of education and provider time. Conclusions VHA providers and women Veterans would benefit from a system to ensure that women at increased risk of breast cancer are identified with risk modeling and that risk reduction options, such as chemoprevention, are offered when appropriate. VHA providers requested risk reduction education, which could improve primary care provider comfort level with chemoprevention.

Perspectives Among Primary Care Providers and Hematologist/Oncologists in the Coordination of Care for Patients with Hematologic Malignancies

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3156-3156
Author(s):  
Haleh Kadkhoda ◽  
Clare Karten ◽  
Kevin C. Oeffinger ◽  
Kanti R. Rai ◽  
S. Frieda Pearce ◽  
...  
Keyword(s):  
Primary Care ◽  
Hematologic Malignancies ◽  
Primary Care Providers ◽  
Shared Care ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Providers ◽  
Roles And Responsibilities

Abstract Abstract 3156 Introduction Clinicians have different expectations and perceptions regarding the role of primary care providers (PCPs) and hematologist/ oncologists (Hem/Oncs) in the provision of follow-up and survivorship care for patients with hematologic malignancies, and for the cancer survivor in general [Cheung JCO 2009]. The continuing decline in the number of specialists will require PCP involvement in the care of the patients with hematologic malignancies in particular, as well as cancer survivors in general. An outcomes study investigated barriers to shared care/ co-management of patients with hematologic malignancies and current practices of PCPs and Hem/Oncs regarding communication, provider roles and responsibilities and resources needed to implement effective cancer survivorship care plans. Methods: Internet polling surveys within an educational activity developed by the Leukemia & Lymphoma Society (LLS) and Medscape LLC with outcomes assessment by CE Outcomes, LLC. The activity learning objectives centered on roles and communication touch points for PCPs and Hem/Oncs, strategies and tools for optimal patient care, and recommendations for care of survivors with hematologic malignancies. Case-based education was delivered by an expert panel of hematologist/oncologist and primary-care physicians to illustrate critical communication points between Hem/Onc and PCP. The activity addressed regional variations in care, fragmentation of care, and helped define healthcare provider roles in the shared–care model. Electronic health records (EHR) and a treatment summary form were discussed as methods for effectively communicating a survivorship care plan among healthcare providers. More than 4, 000 physicians participated in the activity; 170 specialists and 587 PCPs were respondents to the survey. Polling questions and outcomes survey addressed barriers and current practices in shared care of patients with hematologic malignancies. Responses of PCPs and Hem/Oncs were aggregated and compared to identify gaps in continuity of care between specialties. Results: A summary of interactivity responses of PCPs (N=587) and Hem/Oncs (N=170) shows the most significant barrier to co-management of patients with hematologic malignancies was “lack of defined roles and responsibilities for PCPs vs specialists” (51.5% Hem/Onc vs 53.2% PCP). Confusion over roles is evident as 55.6% of Hem/Onc respondents expect the oncology specialist to follow the patient during the “watch and wait' period, while 45.8% of PCPs expect the PCP to follow the patient, and 35.4% expect the PCP and specialist to follow the patient together. More than half of PCPs and specialists report that they should co-manage follow up for cancer recurrence. The majority of PCPs and specialists report that standardized communication tools are from “very to extremely important” yet only approximately one third of PCPs and specialists are currently using EHR resources, with a third in the process of implementing EHR in their practices. Conclusions: Barriers to the provision of shared care and co-management of the cancer survivor can be addressed by more clearly defining individual clinician roles and responsibilities. Bridging gaps in the survivorship care plan requires improved communication between Hem/Oncs and PCPs to coordinate “watch and wait” care and follow-up screening, and effective methods to transfer patient records and history including Treatment Summary Forms and EHR. Disclosures: No relevant conflicts of interest to declare.

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