Improving the survivorship care plan process across an academic and community cancer center.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 184-184
Author(s):  
Robert Stuver ◽  
Jennifer Faig ◽  
Gerry Abrahamian ◽  
Matthew M. Cadorette ◽  
William M. Decaneas ◽  
...  
Keyword(s):  
Care Plan ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Survivorship Care ◽  
Educational Module ◽  
Team Members ◽  
Improvement Plan ◽  
Management Personnel ◽  
Cancer Types ◽  
Disease Specific

184 Background: The goal of a survivorship care plan (SCP) is to improve provider coordination and engage patients in their care. Despite requirements from professional societies, implementation of SCPs is challenging. From April to July 2018, 36% of eligible patients received an SCP at our institution. We aimed to identify barriers to SCP completion and implement interventions to increase their delivery for all cancer types at our academic and community cancer sites. Methods: We created a survey to assess physician, nursing and trainee perceptions and identify barriers to SCP completion. The survey was sent to providers within our medical, surgical, and radiation oncology departments. Providers were asked to rate their satisfaction with our current SCP process and identify obstacles and solutions to achieve SCP completion. In response, we held meetings between oncology attendings, trainees, tumor registry staff, and health information management personnel to design an improvement plan. Results: Of 178 providers, 74 (41.6%) responded. Four percent were satisfied with our current process. The most frequently cited barriers were time (62.1%), lack of clarity regarding who completes the SCP (52%), and insufficient personnel (47.3%). The most frequently cited solutions were dedicated personnel (84.9%), disease-specific templates (61.6%), and education regarding SCPs (48.1%). Based on these results, we: (1) Streamlined our SCP process by entering a partially-templated SCP into an eligible patient’s electronic medical record by our tumor registrar; (2) Asked for disease-specific recommendations that can be included in the template; (3) Asked providers to identify additional team members who assist with SCP completion so that SCPs can be appropriately queued; and (4) Designed an online educational module. Conclusions: We identified multiple barriers to SCP completion at our institution. In response, we implemented a multifaceted improvement plan across our academic and community cancer sites. An analysis of its effects are forthcoming.

The Bon Secours St. Francis Cancer Survivorship Program: A model for community-based multidisciplinary survivorship care.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 45-45
Author(s):  
Kaitlin Bomar ◽  
Nicole Vickery ◽  
Meagan Duggan ◽  
Tina Redenz ◽  
Tracey Lukker ◽  
...  
Keyword(s):  
South Carolina ◽  
Cancer Survivors ◽  
Well Being ◽  
Academic Community ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Team Approach ◽  
Survivorship Care ◽  
Community Based

45 Background: In 1974, Giulio D' Angio,MD, stated “Cure Is Not Enough” and the concept of Survivorship was ignited. Multidisciplinary survivorship clinics have since become a mainstay of many pediatric cancer programs; few such clinics exist in adult cancer programs, especially in community practice. We report on the development of a survivorship care plan and a community-based clinic designed to provide guideline-driven after care for cancer survivors. Methods: An overview of the vision and mission of the Bone Secours St. Francis Cancer Center Survivorship Program is provided. Descriptive analysis of the components and metrics of success are provided, in the context of accrediting organizations requirements for current and future goals for survivorship care. Results: BSSF, which is a non-academic, community-based cancer program, and receives over 1300 referrals annually from a referral population of 1.32 million in 10 counties. St. Francis , accredited by both the Commission on Cancer and National Accreditation Program for Breast Centers, has been providing cancer‐related services to the Upstate South Carolina region for a decade. The survivorship program at St. Francis is a STAR‐certified program and is a patient‐centered service provided in a comprehensive and coordinated multidisciplinary team approach, including integrated psychologic care. A custom survivorship care plan was developed and efforts, including successes and barriers, to implementation of plans for all cancer survivors in accordance with CoC and NAPBC goals are addressed. Conclusions: The BSSF Cancer Center Survivorship Program has developed a practical, yet comprehensive SCP, which is risk-adapted and guideline-driven in order to provide customized survivorship education and monitoring. The MDC provides comprehensive evaluations and recommendations in order to maximize health and well-being of patients navigating life after cancer diagnosis and treatment. Our efforts have demonstrated that survivorship clinics of this nature can be established and successful in a non-academic community setting.

Is survivorship care plan discussion important to patients?

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 49-49
Author(s):  
Amy Eiko Leatherwood ◽  
Charles R. Thomas ◽  
Sara J Walker ◽  
Susan Hedlund
Keyword(s):  
Cancer Survivors ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Survivorship Care ◽  
Personalized Care ◽  
Quality Cancer Care ◽  
Liver Cancers ◽  
Need To Evaluate ◽  
Full Discussion

49 Background: The 2015 Commission on Cancer standard requires that cancer survivors receive a personalized survivorship care plan (SCP). There exists a gap in consistency of how and when this plan is delivered. There is a need to evaluate patient satisfaction with personalized care along with direct education regarding the SCP and follow up. The aim of the current study was to determine the 1) rate at which cancer survivors find in-person discussion of SCP helpful, and 2) the rate at which they find the in-person discussion more helpful than the alternatives. Methods: An anonymous questionnaire was routinely administered, for quality assurance purposes, to cancer patients who completed treatment in a radiation oncology setting at a NCI-Designated Cancer Center. The population consisted of survivors of breast, prostate, colon, anal, pancreatic, lung, and liver cancers. Patients were given the questionnaire at the conclusion of a survivorship visit with a nurse practitioner devoted to survivorship care. During the visit they received a SCP with full discussion and explanation of the content. The questionnaire asks two Yes/No questions: 1) Did you find the survivorship visit helpful and/or educational? 2) Was it more helpful to have the survivorship summary explained to you in person? Results: 71 survivorship visit patients were offered a questionnaire to complete at the end of their visit. 71 completed questionnaires were received from patients. Of these 71 questionnaires, 69/71 or 97% of responses were “yes” for question 1. For question 2, 68/71, or 96% of responses were “yes.” Conclusions: Our data show that the majority of patients are finding survivorship summaries to be a positive aspect of the care continuum. In addition, patients are also indicating that visits “in person,” with face-to-face explanation of survivorship summaries, are more helpful than receiving a summary without verbal involvement or explanation. These findings suggest that such in-person discussions could be considered important in quality cancer care. Future directions include investigating the effect of other individual, disease, or treatment characteristics on an individual’s preference for SCP delivery.

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.

Meeting requirements for survivorship visits: Interventions for patient identification.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 59-59
Author(s):  
Nancy K. Termer ◽  
Margie Richardson ◽  
M Jacob Adams ◽  
Alexander Alongi ◽  
Patricia Bellohusen ◽  
...  
Keyword(s):  
Care Plan ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Full Time ◽  
Survivorship Care ◽  
Time Data ◽  
Patient Identification ◽  
Identification Process ◽  
Data Analyst ◽  
Nurse Coordinator

59 Background: A major challenge in providing quality survivorship care to cancer patients is efficiently and effectively identifying and scheduling patients who need a Survivorship Visit (SV). While the Commission on Cancer (CoC) Standard 3.3 defines which patients require a Survivorship Care Plan (SCP), staff need to operationalize the definition and search the clinic’s patient records on a regular basis to accurately identify eligible patients. This is a challenge for a busy cancer center. Methods: In July 2017 the Judy DiMarzo Cancer Survivorship Program instituted a full time Data Analyst (DA) to assist in identifying survivors using the OncoLog Cancer Registry and the Electronic Medical Record (EMR). Previously the identification process was limited to the EMR, and the Survivorship Program Nurse Coordinator (NC) was a combined role overseeing metrics, identifying patients and assisting with SVs. Currently the DA has piloted a method extracting data monthly from OncoLog and the EMR to assess eligibility of Standard 3.3. The data is compiled and sent to the NC who assists the cancer-specific service lines responsible for the patients identified to ensure SVs occur in a timely manner. Results: Our pilot intervention resulted in a 283% increase in SVs per month, from an average of 30 SVs to 115 SVs per month. The overall achievement for the CoC SV delivery requirement increased from 16% prior to the intervention to 33% in just 3 months. GI increased from 5% to 20%. Lung increased from 16% to 39%. The average SV was 3 months after the end of treatment. Approximately 60 hours was dedicated to establishing this method and 35 hours per month in the eligibility, identification process. Conclusions: By adding a DA role, extracting data from Oncolog and the EMR, as well as increasing accountability at the service line level to improve identification and scheduling of eligible patients, the delivery of SCPs to eligible patients substantially increased. Nevertheless this process is time consuming and will likely not be sufficient to ensure that all eligible survivors receive appropriate care. Consequently, additional, systematic improvements in this process should be explored such as EMR methodologies to automate patient identification.

Enhancing provider engagement and accountability: A strategy for survivorship care plan implementation within a large hospital network.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 56-56
Author(s):  
Natalie Garces ◽  
Tara Eaton ◽  
Daisuke Goto
Keyword(s):  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Eligibility Criteria ◽  
Large Hospital ◽  
Plan Implementation ◽  
Hospital Networks ◽  
Cancer Types ◽  
Poster Presentations ◽  
To Receive

56 Background: Challenges to Survivorship Care Plan (SCP) implementation persist and guidelines to facilitate provider engagement and accountability are needed. In 2014, Levine Cancer Institute (LCI), part of one of the largest Commission on Cancer (COC) hospital networks, instituted a SCP delivery model. The patient’s LCI or LCI-affiliated physician or advanced care provider (ACP) is responsible to create and deliver the SCP. This presentation updates and extends prior work presented at the 2017 ASCO Cancer Survivorship Symposium to demonstrate the utility of enhanced provider engagement and accountability in SCP program expansion at LCI. Methods: The Survivorship Section partnered with the Cancer Committee to develop a system to enhance provider engagement and accountability. Strategies to improve engagement included: emailed SCP metrics (monthly goals and volume reports) and poster presentations to demonstrate SCP value to Tumor Site Section Leaders (TSSLs), administrators and providers. Strategies to promote accountability included: (1) partnered with TSSLs to clarify SCP eligibility criteria, set monthly goals and identify methods to optimize delivery; (2) discussed SCP metrics within each TSSL to highlight participation rates of providers or clinics; (3) presented Section- and clinic-specific SCP performance at quarterly Cancer Committee, National Accreditation Program for Breast Cancer leadership and Operational meetings; and (4) required all newly hired outpatient ACPs to receive SCP training and included SCP delivery in yearly ACP goals. Results: Since 2014, the total number of SCPs, participating providers, clinics and cancer types has grown 25-, 17-, 7- and 22-fold, respectively. Conclusions: LCI developed a multilayer partnership strategy that enhanced engagement and accountability at the leadership and provider level. This partnership significantly increased numbers of SCPs delivered over four years and allowed us to meet COC goals. [Table: see text]

Use of telemedicine to expand access to survivorship care.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 26-26 ◽  
Author(s):  
Kelli Kristine Cole-Vadjic ◽  
Jennie Robertson Crews
Keyword(s):  
Medical Oncology ◽  
Medical Center ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Small Island ◽  
Cancer Center ◽  
San Juan ◽  
Survivorship Care ◽  
Distress Screening ◽  
San Juan Islands

26 Background: PeaceHealth St Joseph Cancer Center (PHSJCC) provides medical and radiation oncology services in northwest Washington. PeaceIsland Medical Center (PIMC) is an affiliated medical center that provides medical oncology services in the nearby San Juan islands. Survivorship appointments for Survivorship Care Plan (SCP) delivery are available at PHSJCC but have not been available at PIMC. Telemedicine services were previously established for medical oncology appointments for patients at PIMC with a provider at PHSJCC. Methods: Since January of 2015, patients who are eligible for survivorship services are identified by their medical oncologist or nurse upon completion of chemotherapy at PIMC. They are scheduled for a 1 hour survivorship telemedicine appointment with the survivorship physician assistant (PA). The patients attend the appointment at PIMC with a nurse present there to assist with logistics and deliver survivorship appointment materials. The PA is at PHSJCC and conducts the appointment through visual and audio telemedicine equipment. During the telemedicine appointment the SCP is reviewed and delivered, educational materials are provided and discussed, and referrals are initiated as needed based on a standardized patient distress screening questionnaire. Patients who complete radiation therapy at PHSJCC but live in the San Juan islands are now also being identified and scheduled for survivorship telemedicine appointments at PIMC. Results: Patients who live in a small island community where survivorship services were not available are now able to receive a survivorship appointment with SCP delivery through telemedicine. Between January and July of 2015, 6 patients were identified for survivorship appointment eligibility upon completion of chemotherapy at PIMC. 3 of these patients have completed a survivorship telemedicine appointment, 2 are currently scheduled, and 1 declined to schedule. Although qualitative surveys have not yet been conducted, the patients who completed survivorship telemedicine appointments offered generally positive feedback about the experience. Conclusions: Telemedicine is an effective way to deliver SCPs in geographic areas where patients do not otherwise have access to survivorship care.

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.

A model of an advanced practice provider led melanoma survivorship clinic at a NCI-designated cancer center.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 41-41
Author(s):  
Ro Henderson ◽  
Gary C. Doolittle
Keyword(s):  
Adjuvant Treatment ◽  
Medical Oncology ◽  
Care Plan ◽  
Definitive Treatment ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Advanced Practice ◽  
Survivorship Care ◽  
Nccn Guidelines

41 Background: Melanoma cancer survivors present unique challenges for survivorship care due to their increasing numbers as well as the rapidly expanding options for adjuvant treatment including immunotherapy and targeted therapies for which the long term sequelae is relatively unknown. For this reason, the melanoma program at a NCI-designated cancer center elected to create an Advanced Practice Provider (APP) led dedicated Melanoma Survivorship Clinic. Methods: Patients are transferred to the APP led Melanoma Survivorship Clinic following the completion of definitive treatment for their cancer. The surgical and medical oncology specialists dedicated to the management of melanoma at this institution identify and include those requiring surgical intervention only as well as those who have received surgery followed by adjuvant treatment. Results: Patients meet with the APP who reviews the recommended stage specific National Comprehensive Cancer Network (NCCN) guidelines, completes and reviews the survivorship care plan (SCP). The SCP is provided to the patient and primary care provider. Patients continue to follow in the APP led clinic for at least the next 5 years to monitor for disease recurrence and the unique long term and late effects of new immune related and targeted agents. Surveillance includes history taking, physical examination including detailed skin examination, screening for genetic counseling, and Quality of Life tool. Imaging may be indicated if the patient develops symptoms that warrant or in those with higher risk disease . Five year risk of recurrence is calculated and reviewed using on-line tool. In addition, tools have been built in the electronic medical record to support documentation for melanoma survivorship patients as well as the SCP. Conclusions: Since its inception in March 2016, the APP led Melanoma Survivorship Clinic has been a successful collaboration between the APP, medical and surgical oncologists. There have been over 200 new survivorship patient referrals from surgical and medical oncology. Tools are continually modified and updated according to latest evidence, NCCN guidelines and SCP requirements.

QIM19-140: A New Standard of Care

2019 ◽  
Vol 17 (3.5) ◽  
pp. QIM19-140
Author(s):  
Bianshly Rivera Rivero ◽  
Melissa Kapsick ◽  
Smitha R. Pabbathi ◽  
Keyword(s):  
Cancer Registry ◽  
Task Force ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Patient Portal ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Specific Patient ◽  
Care Plans

Background: Nationally, many cancer survivors do not receive a survivorship care plan following completion of therapy. The American College of Surgeons’ Commission of Cancer’s Standard 3.3 requirement for accreditation placed this issue front and center for many of the participating cancer programs. The Commission on Cancer (CoC) survey found only one fifth of the cancer programs would be successful by 2015 and thus updated the standard in 2017. We describe a successful process created to deliver on this standard in an NCI designated cancer center to meet the needs of our patients. Methods: In early 2017, a multidisciplinary task force was created to initiate and implement survivorship care plans for newly diagnosed patients. Eligibility for care plans is determined by the CoC and the Moffitt cancer committee. The initiative included a cost-effective solution, “Journey Forward.” Moffitt Cancer Center was able to incorporate additional specific patient education and surveillance recommendations. A dedicated nursing team creating the care plans individually discussed with patients with the oversight of the Cancer Committee. Results: With collaboration from the cancer registry, nursing leadership and survivorship clinic, the diseases targeted initially were breast, gastrointestinal, genitourinary, head and neck, gynecology, non-small cell lung, thyroid, and lymphoma. Within 5 months of inception of the task force, 25% of survivorship care plans (SCP) were completed and by the end of the 2017 calendar year, we delivered 50% of analytic cases treated, amounting to approximately 2,500. The care plans were housed in the electronic medical record and available for patients via the patient portal. Conclusions: This initiative is made up of a multidisciplinary team from senior leadership, cancer committee members, the cancer registry, the survivorship clinic staff, nursing, social work, health information management, case management, and our information technology colleagues. A shared passion and vision lead the task force’s momentum. We all believed this was not just a mandate to comply with but a communication tool that is essential for our patients’ wellness long-term. Although there is minimal evidence to show the benefit of SCP with regard to outcomes, our team felt this document can indeed assist cancer patients’ transition into the next phase of their journey. Our project has improved the patient experience with positive feedback.

Psychosocial distress screening and the survivorship care plan in the community oncology setting.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 206-206
Author(s):  
Milana V. Dolezal ◽  
Mary Prishtina ◽  
Luanne Ridgley ◽  
Beverly Hart-Inkster ◽  
Kimberly Christensen ◽  
...  
Keyword(s):  
Psychosocial Distress ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Survivorship Care ◽  
Distress Screening ◽  
Care Plans ◽  
Oncology Nurse ◽  
Community Oncology ◽  
Nurse Navigator

206 Background: Alta Bates Summit Medical Center (ABSMC) is a Commission on Cancer (CoC) accredited comprehensive community oncology program in the San Francisco Bay Area with an annual adult cancer program of approximately 1700 patients. To satisfy CoC accreditation standards 3.2 (Psychosocial Distress Screening) and 3.3 (Survivorship) the cancer survivorship program has a collaborative nurse-led and primary oncologist-led model utilizing Journey Forward software for survivorship care plans (SCP) and the Distress Tool (DT). National standards include distress screening as an important assessment in cancer care, in order to provide interventions Methods: The self reporting DT was sent to adult cancer patients prior to a survivorship visit. Oncology nurse navigator and oncologist reviewed the DT and discussed concerns with the patient. Patients scoring 5 or greater on DT were referred to psychosocial services. Interventions based on patients’ needs include the Cancer Transitions Program(CTP), support groups and classes. Results: 100 patient charts were reviewed for DT and SCP. 95% of patients were female; 5% were male. Patients ranged in age from 22 to 92 years. 36 patients were enrolled in the 2015 CTP and 63% of those participants had completed SCP. Conclusions: The prevalence of psychosocial distress in our community oncology practice was lower than expected, in part due to the robust supportive care environment that patients actively partake in at the Cancer Center. Implementing the DT also improved patient and clinician communication resulting in more timely intervention. [Table: see text]

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