The Integration of Survivorship Care Planning at a Comprehensive Cancer Center

Background: Cancer patients infrequently engage in advance care planning processes. Establishing preferences for future medical treatment without advance care planning may not be patient-centered, as it fails to consider important factors that influence these important decisions. Objective: The purpose of this study was to assess the influence of patient intrapersonal factors including race, religion, level of depression, and cancer stage on overall preferences for future medical treatment, including the presence of a (DNR), power of attorney, and advance directive. Design: A retrospective chart review design was used. Patients were included who were diagnosed with cancer at The Ohio State University James Comprehensive Cancer Center from 01/2015 to 08/2019. Results: A total of 3,463 patients were included. Median age was 59 years (IQR: 49, 67) and the majority of the patients was female (88.7%). Compared with no religious preference, patients who identified as religious had 61% higher odds (95%CI: 1.08-2.40) of having a DNR and approximately 30% higher odds of having a power of attorney (95%CI: 1.08-1.62) or advance directive (95%CI: 1.02-1.64). Patients with clinically relevant depression had more than twice the odds of having a DNR versus patients with no/lower levels of clinical depression (OR: 2.08; 95%CI: 1.40-3.10). White patients had higher odds of having a power of attorney (OR: 1.57; 95%CI: 1.16-2.13) and an advance directive (OR: 3.10; 95% CI: 1.95-4.93) than African-American/Black patients. Conclusions: Understanding the factors that affect preferences for future medical treatment is necessary for medical professionals to provide proper care and support to patients diagnosed with cancer and their families.

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Survivorship Care Planning: Why Is It Taking So Long?

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2017.0148 ◽

2017 ◽

Vol 15 (9) ◽

pp. 1165-1169 ◽

Cited By ~ 12

Author(s):

Sarah A. Birken ◽

Deborah K. Mayer

Keyword(s):

Care Planning ◽

Survivorship Care ◽

Survivorship Care Planning

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Using practice algorithms to deliver cancer survivorship care.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e19625 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e19625-e19625

Author(s):

Guadalupe R. Palos ◽

Fran Zandstra ◽

Ludivine Russell ◽

Jacklyn J Flores ◽

Yvette DeJesus ◽

...

Keyword(s):

Clinical Practice ◽

Cancer Survivors ◽

Psychosocial Functioning ◽

Phase 1 ◽

Comprehensive Cancer Center ◽

Cancer Site ◽

Cancer Center ◽

Survivorship Care ◽

Disease Specific

e19625 Background: Clinical practice algorithms provide a framework to guide providers’ practice in delivering care to long-term cancer survivors. Here we describe how algorithms were developed in a comprehensive cancer center and types of metrics used to evaluate their feasibility. Methods: Survivorship practice algorithms were based on a multidisciplinary care approach successfully used to build screening and treatment algorithms. This model consisted of four phases: development, adoption, implementation, and evaluation of algorithms. Phase 1, expert clinicians and researchers identified and agreed upon a specific cancer site. Group-consensus and literature reviews/syntheses were used to determine eligibility criteria to transition patients to survivorship care. Phase 2, reviews and approval processes were conducted by credentialing and regulatory committees to ensure adoption of the algorithms into clinical practice. Phase 3, pilot programs were conducted to implement the algorithm(s) in disease-specific survivorship clinics. Phase 4, metrics to evaluate progress included the number of algorithms and providers’ use of and adherence to the algorithms. Results: Between 09/2008 – 12/2011, nine multidisciplinary disease-specific survivorship clinics were operationalized. Thirty-seven practice algorithms were developed to provide survivorship care based on each survivor’s specific needs. The algorithms’ framework included: 1) surveillance for recurrent or new primary malignancies; 2) primary and secondary cancer prevention recommendations; 3) management of toxicities and latent treatment effects; and 4) assessment of psychosocial functioning. Conclusions: Practice algorithms provide an organized plan to deliver comprehensive and holistic care to long-term survivors. Given the projected increase in cancer survivors, further research is needed to determine how practice algorithms impact providers’ practice and survivors’ outcomes.

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The effects of global and targeted advance care planning efforts at a national comprehensive cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.79 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 79-79 ◽

Cited By ~ 2

Author(s):

Finly Zachariah ◽

Lindsay Emanuel ◽

Gayle Ito-Hammerling ◽

Judy Wong-Toh ◽

Denise Morse ◽

...

Keyword(s):

Advance Directives ◽

Advance Care Planning ◽

Capture Rate ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Central Component ◽

Care Planning ◽

Advance Care ◽

Patient Centric ◽

Capture Rates

79 Background: Advance Care Planning is a central component of patient centered care and helps assure treatment aligns with a patient’s goals, values, and priorities. Various studies demonstrate advance care planning decreases stress and anxiety, increases satisfaction, improves awareness and implementation of a patient’s end of life wishes, and reduces costs in select populations. At City of Hope (COH) National Medical Center, we made concerted efforts over the last four years to improve the overall number of advance directives(ADs), and have additionally focused on improving AD capture rates in clinically relevant populations (patients undergoing surgery, those with metastatic disease, and those undergoing hematologic transplant). Methods: The Department of Supportive Care Medicine with executive team endorsement and in collaboration with medical oncology, hematology, anesthesia, surgery, nursing, marketing, and informatics created a patient-centric advance care planning program. We developed disease specific workflows, created multi-lingual AD workshops in the Sheri & Les Biller Patient and Family Resource Center, changed policy to provide complimentary patient/caregiver and staff notarizations for ADs, leveraged the electronic medical record (assured providers were able to document discussions, know when ADs were absent, and easily retrieve ADs when present), deploy AD specific screening questions, and most recently created a culturally sensitive branding campaign coined “Plan Today for Tomorrow.” Results: The rate of advance directive capture for all patients new to COH has continuously improved from 12% in 2012 to 22% in 2016. In transplant patients, AD capture rate increased to 63%. In a pilot for bladder cancer patients undergoing cystectomy, ADs were increased to 68%, and in the pre-anesthesia testing clinic, ADs were increased to 35%. Conclusions: We have made significant strides in the capture of advance directives at City of Hope with markedly higher capture rates in selectively targeted, clinically relevant populations. We anticipate improved patient centric care as a result, with the unintended consequence of cost savings and decreased resource utilization.

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Analysis of financial sustainability of survivorship clinics led by advanced practice providers.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.11560 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 11560-11560

Author(s):

Maria Alma Rodriguez ◽

Guadalupe R. Palos ◽

Katherine Ramsey Gilmore ◽

Paula A. Lewis-Patterson ◽

Patricia Chapman ◽

...

Keyword(s):

Physician Assistants ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Advanced Practice ◽

Survivorship Care ◽

Manage Care ◽

Recovery Percentage ◽

Long Term Survivors ◽

Delivery Models

11560 Background: Disease specific Survivorship Care Clinics (SCs) have been established within a comprehensive cancer center. Clinics are staffed by Advanced Practice Providers (APPs), Physician Assistants and Advanced Practice Registered Nurses, with experience in the management of each disease type. To determine the sustainability of this model of survivorship care, we analyzed the professional fees’ revenue generated by APPs’ billings for 6 clinics and then compared the APPs’ salaries across all clinics. Methods: A retrospective analysis was conducted of 6 survivorship clinic’s patient volumes and clinic days supported by APPs from 9/1/16-4/30/17. The full FTE salary of the APPs, including benefits were prorated to the time dedicated to each of the SCs. Institutional financial data was used to align professional fees to actual reimbursements received. Salary recovery percentage was calculated as the ratio of reimbursement received to prorated FTE salary. Results: Table shows variation in APPs’ salary commensurate to FTE proportion. Results also indicate there was an average of 99% professional fee recovery. Clinics with an FTE proportion > 0.5 had recovery higher than the anticipated prorated salary, suggesting there is a threshold to maximize efficacy and sustainability. Conclusions: APPs professional fees for care provided to cancer survivors are reimbursable, across disease types or payers, and proportionally supports their salaries. Our findings suggest delivery models based on APPs to manage care of long-term survivors can be self-supporting.[Table: see text]

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Leveraging the electronic health record (EHR) to support survivorship care planning for bone marrow transplant (BMT) survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.7_suppl.57 ◽

2018 ◽

Vol 36 (7_suppl) ◽

pp. 57-57

Author(s):

Mandy Swiecichowski ◽

Amye Tevaarwerk ◽

Mark Juckett ◽

James Edward Haine ◽

Kirsten Norslien ◽

...

Keyword(s):

Primary Care ◽

Systems Engineering ◽

Information Needs ◽

Patient Data ◽

Care Plan ◽

Survivorship Care Plan ◽

Care Planning ◽

Survivorship Care ◽

Roles And Responsibilities ◽

Survivorship Care Planning

57 Background: BMT survivors are underrepresented in survivorship research, yet are at high risk for complications. Practice guidelines are vague, non-BMT clinicians are inadequately informed, and communication between BMT and non-BMT clinicians is inconsistent. Our objective is to develop EHR-integrated survivorship care planning that is user-centered, supports non-BMT clinician and survivor needs, but does not adversely impact clinical workflow. Methods: A multidisciplinary team of clinicians (primary care, oncology, BMT), engineers, and EHR analysts used a systems engineering approach to identify barriers and facilitators to BMT survivorship care planning. The team identified patient data categories to include in BMT survivorship care plan (SCP) templates, as well as examined tasks, technology, workflows and individual roles and responsibilities necessary to support care planning. Results: Facilitators include: potential for EHR to discretely capture individual diagnosis and treatment data to create accurate SCPs addressing survivor and primary care information needs. Barriers are: lack of EHR inter-operability which prevents sharing of patient data outside the BMT center’s EHR system, reliance on manual entry of critical data elements into the SCP (i.e. majority of the 88 patient data categories, identified by the team, are non-discrete in the EHR), inefficient or absent survivorship workflows, lack of resources (including time, dedicated clinical staff, space, SCP content), poorly defined roles and responsibilities for survivorship care provision, and lack of evidence-based BMT survivorship guidelines. Conclusions: Work system barriers impede use of the EHR to support survivorship care planning. Steps to overcome barriers: design discrete fields in the EHR to support patient-level data capture, re-engineer existing workflows to support survivorship care planning, obtain BMT program consensus on SCP content, and evaluate user-centeredness of SCPs. This research has the potential to improve feasibility and sustainability of survivorship care planning activities, resulting in improved communication and care coordination for BMT survivors.

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