scholarly journals Integrating primary care providers through the seasons of survivorship

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
G. Chaput ◽  
J. Sussman
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Care Delivery ◽  
Primary Care Providers ◽  
Survivorship Care ◽  
Care Providers ◽  
Long Term Effects ◽  
Primary Care Workforce ◽  
Clinical Environments ◽  
Oncology Providers

Traditionally, the role of primary care providers (pcps) across the cancer care trajectory has focused on prevention and early detection. In combination with screening initiatives, new and evolving treatment approaches have contributed to significant improvements in survival in a number of cancer types. For Canadian cancer survivors, the 5-year survival rate is now better than it was a decade ago, and the survivor population is expected to reach 2 million by 2031. Notwithstanding those improvements, many cancer survivors experience late and long-term effects, and comorbid conditions have been noted to be increasing in prevalence for this vulnerable population. In view of those observations, and considering the anticipated shortage of oncology providers, increasing reliance is being placed on the primary care workforce for the provision of survivorship care. Despite the willingness of pcps to engage in that role, further substantial efforts to elucidate the landscape of high-quality, sustainable, and comprehensive survivorship care delivery within primary care are required. The present article offers an overview of the integration of pcps into survivorship care provision. More specifically, it outlines known barriers and potential solutions in five categories:■ Survivorship care coordination■ Knowledge of survivorship■ pcp-led clinical environments■ Models of survivorship care■ Health policy and organizational advocacy

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.

Nurse navigation: The key to a seamless transition.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 84-84
Author(s):  
Joy M. Fulbright ◽  
Wendy McClellan ◽  
Gary C. Doolittle ◽  
Hope Krebill ◽  
Robin Ryan ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Cancer Survivorship ◽  
Childhood Cancer Survivors ◽  
Primary Care Providers ◽  
Survivorship Care ◽  
Care Providers ◽  
Nurse Navigator ◽  
Seamless Transition

84 Background: Children's Mercy (CM) established a cancer survivorship clinic that cares for approximately 180 survivors a year. A third of the survivors are 18 years or older requiring transition to adult care. The importance of transitioning childhood cancer survivors from pediatric oncology care to adult primary care has been acknowledged in literature, but obstacles remain. Barriers include patient and provider anxiety, difficulty navigating the complex health care system and lack of knowledge regarding late effects. CM and The University of Kansas Cancer Center (KUCC) collaborated to decrease barriers to transition for childhood cancer survivors. Methods: The work group met for 2 years to develop the clinic at KUCC. Models and delivery of survivorship care, including the breast cancer survivorship clinic at KUCC, were reviewed. A shared nurse navigator was identified as an essential component to a seamless transition. Philanthropic support was obtained and job description was developed. Contracts were negotiated to allow the navigator to be present at both institutions. Results: The Survivorship Transition Clinic (STC) at KUCC launched July 2014, with a navigator supporting patients at CM as they begin their transition. The same navigator then meets with the patient at KUCC STC as they initiate care. The navigator provides treatment summaries, patient education and navigates the referral services for survivors. Since clinic launch, 16 survivors out of 16 have successfully transitioned from pediatric to adult survivorship care. Positive feedback was received from patient satisfaction surveys that were administered. A common theme showed a relief from anxiety due to having a contact person to facilitate communication among providers in a complex healthcare system. Conclusions: The nurse navigator has minimized anxiety about transition for patients and parents as she establishes a relationship with patients at CM, and then is able to provide continuity as they transition to the STC at KUMC. The navigator also improves communication between pediatric providers, adult primary care providers and sub-specialists caring for the patients. Overall, our transition process has been effective and is now serving as a model across both institutions.

Oncologists' and primary care providers' awareness of late effects of cancer treatment: Implications for survivorship care.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6008-6008 ◽  
Author(s):  
Larissa Nekhlyudov ◽  
Noreen Aziz ◽  
Catherine C. Lerro ◽  
Katherine S. Virgo
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Cancer Treatment ◽  
Multinomial Logistic Regression ◽  
Primary Care Providers ◽  
Physician Attitudes ◽  
Premature Menopause ◽  
Care Providers ◽  
Long Term Effects ◽  
Chemotherapy Drugs

6008 Background: There is a growing population of cancer survivors, many of whom may experience late or long-term effects (LEs) of treatment. The goal of our study was to describe and compare primary care providers’ (PCP) and oncologists’ awareness of LEs. Methods: The Survey of Physician Attitudes Regarding the Care of Cancer Survivors was completed by a nationally representative sample of 1,072 PCPs and 1,130 oncologists (cooperation rate 65%). Respondents were asked to report for each of four standard chemotherapy drugs used to treat breast or colorectal cancer the five LEs they had observed and/or had seen reported in the literature. We described and compared the physicians’ responses and, using separate multinomial logistic regression models, determined predictors of their ability to identify the main LEs for all agents, adjusting for physician demographics and practice characteristics. Results: Almost all (95.3%) oncologists identified cardiac dysfunction as a LE of doxorubicin (Adriamycin), and peripheral neuropathy as LEs of both taxol (97.3%) and oxaliplatin (96.6%); while these LEs were identified by only 55.1%, 21.8% and 21.8% of PCPs, respectively. Most oncologists identified premature menopause (71.4%) and secondary malignancies (62.0%) as LEs of cytoxan, compared with only 14.8% and 17.2% of PCPs. Main LEs for all four chemotherapy drugs were identified by 65% (n=741) of oncologists and only 6% (n=60) of PCPs. In adjusted models, oncologists were more likely to identify the main LEs for all chemotherapy drugs if they spent 51-90% (OR 1.87, 95% CI 1.21-2.88) or >90% (OR 1.82, 95% CI 1.08-3.08) of their time on patient care, and less likely if they were not board certified (OR 0.58, 95% CI 0.37-0.89). African American PCPs were less likely to identify the main LEs for all chemotherapy drugs (OR 0.19, 95% CI 0.08-0.45). Conclusions: Oncologists often identified the main LEs of cancer drugs while PCPs did not. While not surprising, these findings emphasize that in the transition of patients from oncology to primary care settings, PCPs should be informed about the LEs of cancer treatment so that they may be better prepared to recognize and address these among survivors in their post-treatment care.

Survivorship workshop delivery to primary care providers.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 2-2
Author(s):  
Genevieve Chaput ◽  
Kristin Hendricks ◽  
Vinita D'Souza ◽  
Sarah Khan ◽  
Laura Naismith
Keyword(s):  
Primary Care ◽  
Late Effects ◽  
Cardiovascular Health ◽  
Care Delivery ◽  
Primary Care Providers ◽  
Survivorship Care ◽  
Care Providers ◽  
Data Ethics ◽  
Integral Role ◽  
Specific Outcome

2 Background: There are approximately 15 million cancer survivors (CS) in North America. In addition to higher risk of recurrence, over 50% of CS are afflicted with late effects. CS are burdened with more medical conditions than the general population. CS visit specialists during treatment, and 75% of them also see their primary care provider (PCP) during and after treatments. Despite their integral role in survivorship care, PCP lack survivorship knowledge and have low confidence regarding CS care, supporting the urgent need to educate them about CS issues and surveillance needs. This study aimed to assess the educational benefit of a survivorship workshop targeting PCP in Montreal, Canada. Methods: An accredited workshop based on NCCN’s 8 common survivor issues was developed and delivered to 155 PCP at 5 sites. Matched pre and post surveys were designed using Likert scale and short-answer questions, and were completed on a voluntary basis by PCP. Specific outcome measures were based on the first 3 levels of Kirkpatrick’s learning model: satisfaction, knowledge, and behaviour. Data analysis included an open-coding approach to identify major themes of qualitative data. Ethics approval was granted. Results: Response rate was 64%. 95% indicated high satisfaction and relevancy of content for primary care. Using t-tests to compare pre and post responses, results were statistically significant for both “list 2 standards of survivorship” and “name 2 late-effects of cancer treatment” survey items, indicating an increase in both standards and late effects identified post workshop. 99% expressed behavioural intent to incorporate survivorship information into practice. Conclusions: Much research has focused on identifying PCP barriers to optimal survivorship care delivery such as limited topic proficiency, yet further efforts are warranted to close that knowledge gap. Our findings revealed increased knowledge of CS issues and surveillance needs post workshop. 3 months survey data is being collected to evaluate for actual practice changes and willingness to manage specific CS issues (i.e. treating depression). A second workshop targeting cardiovascular health promotion interventions has been created: delivery is anticipated early 2016.

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.

Survivorship care plans for colorectal cancer survivors: What do primary care providers want and need?

2011 ◽  
Vol 29 (15_suppl) ◽  
pp. 9131-9131 ◽  
Author(s):  
T. Salz ◽  
K. C. Oeffinger ◽  
P. R. Lewis ◽  
R. Rhyne ◽  
R. L. Williams ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Survivors ◽  
Primary Care Providers ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Providers ◽  
Care Plans ◽  
Colorectal Cancer Survivors

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.

scholarly journals Complementary and Integrative Health Knowledge and Practice in Primary Care Settings: A Survey of Primary Care Providers in the Northwestern United States

2021 ◽  
Vol 10 ◽  
pp. 216495612110233
Author(s):  
Malaika R Schwartz ◽  
Allison M Cole ◽  
Gina A Keppel ◽  
Ryan Gilles ◽  
John Holmes ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Knowledge ◽  
Care Delivery ◽  
Primary Care Providers ◽  
The United States ◽  
Research Network ◽  
Care Providers ◽  
Integrative Health ◽  
And Training

Background The demand for complementary and integrative health (CIH) is increasing by patients who want to receive more CIH referrals, in-clinic services, and overall care delivery. To promote CIH within the context of primary care, it is critical that providers have sufficient knowledge of CIH, access to CIH-trained providers for referral purposes, and are comfortable either providing services or co-managing patients who favor a CIH approach to their healthcare. Objective The main objective was to gather primary care providers’ perspectives across the northwestern region of the United States on their CIH familiarity and knowledge, clinic barriers and opportunities, and education and training needs. Methods We conducted an online, quantitative survey through an email invitation to all primary care providers (n = 483) at 11 primary care organizations from the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region Practice and Research Network (WPRN). The survey questions covered talking about CIH with patients, co-managing care with CIH providers, familiarity with and training in CIH modalities, clinic barriers to CIH integration, and interest in learning more about CIH modalities. Results 218 primary care providers completed the survey (45% response rate). Familiarity with individual CIH methods ranged from 73% (chiropracty) to 8% (curanderismo). Most respondents discussed CIH with their patients (88%), and many thought that their patients could benefit from CIH (41%). The majority (89%) were willing to co-manage a patient with a CIH provider. Approximately one-third of respondents had some expertise in at least one CIH modality. Over 78% were interested in learning more about the safety and efficacy of at least one CIH modality. Conclusion Primary care providers in the Northwestern United States are generally familiar with CIH modalities, are interested in referring and co-managing care with CIH providers, and would like to have more learning opportunities to increase knowledge of CIH.

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