scholarly journals Survivorship Care Planning: Why Is It Taking So Long?

2017 ◽  
Vol 15 (9) ◽  
pp. 1165-1169 ◽  
Author(s):  
Sarah A. Birken ◽  
Deborah K. Mayer
Keyword(s):  
Care Planning ◽  
Survivorship Care ◽  
Survivorship Care Planning

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

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.

scholarly journals The Role of the Advanced Practice Nurse in Survivorship Care Planning

2015 ◽  
Vol 6 (1) ◽  
Author(s):  
Virginia Sun, RN, PhD ◽  
Jill M. Olausson, RN, MSN, CDE ◽  
Rebecca Fujinami, RN, CCM, OCN® ◽  
Carrie Chong, RN, MN, NP ◽  
Rachel Dunham, RN, MSN, NP ◽  
...  
Keyword(s):  
Practice Nurse ◽  
Advanced Practice ◽  
Care Planning ◽  
Advanced Practice Nurse ◽  
Survivorship Care ◽  
Survivorship Care Planning

scholarly journals Feasibility of a Mobile Phone App and Telephone Coaching Survivorship Care Planning Program Among Spanish-Speaking Breast Cancer Survivors (Preprint)

2019 ◽  
Author(s):  
Anna María Nápoles ◽  
Jasmine Santoyo-Olsson ◽  
Liliana Chacón ◽  
Anita L Stewart ◽  
Niharika Dixit ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Survivors ◽  
Well Being ◽  
Care Planning ◽  
Survivorship Care ◽  
Spanish Speaking ◽  
Health Distress ◽  
Follow Up Care ◽  
Survivorship Care Planning

BACKGROUND Spanish-speaking Latina breast cancer survivors experience disparities in knowledge of breast cancer survivorship care, psychosocial health, lifestyle risk factors, and symptoms compared with their white counterparts. Survivorship care planning programs (SCPPs) could help these women receive optimal follow-up care and manage their condition. OBJECTIVE This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a culturally and linguistically suitable SCPP called the Nuevo Amanecer (New Dawn) Survivorship Care Planning Program for Spanish-speaking breast cancer patients in public hospital settings, approaching the end of active treatment. METHODS The 2-month intervention was delivered via a written bilingual survivorship care plan and booklet, Spanish-language mobile phone app with integrated activity tracker, and telephone coaching. This single-arm feasibility study used mixed methods to evaluate the intervention. Acceptability and feasibility were examined via tracking of implementation processes, debriefing interviews, and postintervention satisfaction surveys. Preliminary efficacy was assessed via baseline and 2-month interviews using structured surveys and pre- and postintervention average daily steps count based on activity tracker data. Primary outcomes were self-reported fatigue, health distress, knowledge of cancer survivorship care, and self-efficacy for managing cancer follow-up health care and self-care. Secondary outcomes were emotional well-being, depressive and somatic symptoms, and average daily steps. RESULTS All women (n=23) were foreign-born with limited English proficiency; 13 (57%) had an elementary school education or less, 16 (70%) were of Mexican origin, and all had public health insurance. Coaching calls lasted on average 15 min each (SD 3.4). A total of 19 of 23 participants (83%) completed all 5 coaching calls. The majority (n=17; 81%) rated the overall quality of the app as “very good” or “excellent” (all rated it as at least “good”). Women checked their daily steps graph on the app between 4.2 to 5.9 times per week. Compared with baseline, postintervention fatigue (B=–.26; P=.02; Cohen d=0.4) and health distress levels (B=–.36; P=.01; Cohen d=0.3) were significantly lower and knowledge of recommended follow-up care and resources (B=.41; P=.03; Cohen d=0.5) and emotional well-being improved significantly (B=1.42; P=.02; Cohen d=0.3); self-efficacy for managing cancer follow-up care did not change. Average daily steps increased significantly from 6157 to 7469 (B=1311.8; P=.02; Cohen d=0.5). CONCLUSIONS We found preliminary evidence of program feasibility, acceptability, and efficacy, with significant 2-month improvements in fatigue, health distress, and emotional well-being and increased knowledge of recommended follow-up care and average daily steps. Tailored mobile phone and health coaching SCPPs could help to ensure equitable access to these services and improve symptoms and physical activity levels among Spanish-speaking Latina breast cancer survivors.

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