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.

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.

Who is receiving survivorship care plans? Findings from the 2012 Livestrong survey.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9608-9608
Author(s):  
Ruth Rechis ◽  
Carla Bann ◽  
Stephanie Nutt ◽  
Linda Squiers ◽  
Naveen Rao
Keyword(s):  
Medical Center ◽  
Care Plan ◽  
Cancer Center ◽  
Survivorship Care Plans ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Long Term Effects ◽  
Care Plans ◽  
Key Stakeholders

9608 Background: There are more than 14 million cancer survivors in the US – a number that is on the rise. Care coordination resources will be essential to provide support to this growing population. Key stakeholders, including the Commission on Cancer (CoC) and the Institute of Medicine, have proposed survivorship care plans (SCPs) as a way to extend support. However, limited research has been conducted to date on SCPs. Methods: In 2012, the LIVESTRONG Foundation (LIVESTRONG) administered a survey to understand the role of a treatment summary (TS) and SCPs and how they fit into survivors’ care. Logistic regression models were conducted to identify factors associated with receiving SCPs or TS. Results: 5,303 survivors responded to these questions (Table). While 92% of these respondents received information about where to return to for cancer check-ups, only 51% reported receiving a TS and 17% reported receiving a SCP. Survivors who were more likely to receive SCPs if they had a navigator (p<.001) and if they were male, Black, had finished treatment within the past year, or received care at a university-based medical center or community cancer center (p < 0.05). Also, those receiving a SCP were significantly more likely to have had a detailed discussion with a provider regarding long-term side effects, emotional needs, and lifestyle recommendations. Specifically, 60% of those with a SCP discussed long-term effects compared to 39% who did not. Conclusions: Results here indicate that few survivors receive SCPs but survivors reported benefits from receiving them. Currently many workflow barriers impede delivering SCPs, and LIVESTRONG is working with key stakeholders including the CoC to automate the LIVESTRONG Care Plan powered by Penn Medicine’s OncoLink through a registry and EMR system to understand how to address this issue. [Table: see text]

Systematic development of a a breast cancer survivorship program at a small independent oncology practice.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 52-52 ◽  
Author(s):  
Cynthia Rogers ◽  
Shailesh R. Satpute
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Data Entry ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care Plans ◽  
Full Time ◽  
Survivorship Care ◽  
Breast Cancer Patients ◽  
Care Plans

52 Background: It is widely accepted that providing survivorship care plans leads to improvements in outcomes for cancer survivors. Treatment summaries are now part of ASCO and NCCN survivorship guidelines. We faced a unique challenge of implementing the survivorship care plan at the Jones Clinic as a small independent practice. The Jones Clinic consists of three full time physicians and two full time nurse practitioners. We see approximately 850 new patients per year. Methods: As a part of ASCO’s quality training program, we focused on the stage I – III (early stage) breast cancer patients who completed their initial therapy. We formed a team, identified the barriers, created a flow diagram of the process, assigned roles for each individual member and finally implemented the process. Results: The major issues identified were lack of provision in the electronic medical record (EMR) system for survivorship and lack of standardized data entry process. We created a system in the EMR for survivorship data entry and extraction of such data in a document. Since July 2015, one hundred percent of breast cancer patients completing adjuvant therapy at the Jones Clinic have received a survivorship treatment summary and a plan of care. The care plan is also shared with their primary care provider. Importantly, creating a survivorship document required less than 10 minutes of the provider’s time. Conclusions: We are now able to provide our patients with a survivorship care plan and address survivorship issues within thirty days of completion of therapy. Creating the care plan requires minimal time from the providers. Our new process meets ASCO guidelines for survivorship care plans and no additional staffing was needed. We now plan to provide a survivorship care plan to all oncology patients treated with curative intent.

Perceived value of cancer survivorship care among Asians and Native Hawaiian/Pacific Islanders.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e22522-e22522
Author(s):  
Jared David Acoba ◽  
Sharon Tamashiro ◽  
Marci Chock
Keyword(s):  
Cancer Survivors ◽  
Racial Differences ◽  
Cancer Survivorship ◽  
Native Hawaiian ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Plans

e22522 Background: Numerous studies have evaluated the impact of cancer survivorship care. However, no study to date has focused on Asian or Native Hawaiian/Pacific Islander (NH/PI) cancer survivors. It has been well documented that Asian and NH/PI patients often suffer from inferior cancer outcomes compared to White patients, and differences in their experience with cancer survivorship care could contribute to this disparity. Methods: Surveys were sent to 1410 cancer survivors who were treated at a community cancer center with curative intent and who had received survivorship care plans between Jan 2014 and June 2018. The 26-item questionnaire evaluated patients’ perception of various aspects of their survivorship care plan and follow-up physician visits. All responses were anonymous. Results: Of the 360 patients who responded, 24% were White, 54% Asian, and 13% NH/PI. Compared to Whites, Asian and NH/PI patients were younger (p = 0.004), less educated (p = 0.004), and reported a lower income (p < 0.0005). Among all patients, 62% reported that the survivorship care plan was “very helpful” and 86% rated their satisfaction with physician follow-up visits as “very good” to “excellent.” There were no racial differences in satisfaction with either survivorship care plan or physician follow-up. In a multivariate binary logistic regression, Asians and NH/PI patients were significantly more likely to rate ongoing survivorship care as helpful compared to Whites, OR 4.08 (95%CI, 2.13-7.82). Conclusions: There were no racial differences in patient satisfaction with their survivorship care plans and follow-up care. However, Asian and NH/PI patients valued ongoing cancer survivorship care follow-up significantly more than White patients. Whether more extensive survivorship care would lead to improved outcomes among Asian and NH/PI cancer patients should be investigated further.

Evaluation of electronic care plan usage and usefulness among breast cancer survivors.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 83-83 ◽  
Author(s):  
Mary Sesto ◽  
William Gray Hocking ◽  
Douglas Wiegmann ◽  
Thomas Y Yen ◽  
Mindy Gribble ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Objective Evaluation ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Patient Portal ◽  
Survivorship Care ◽  
Care Plans ◽  
Treatment Summary

83 Background: Survivorship care plans (SCP) are recommended to improve communication between breast cancer survivors (BCS), primary care, and oncology. Objective evaluation of survivor access of specific care plan content is challenging as commonly-used formats (e.g., paper or electronic file) prevent tracking of usage. This project aimed to evaluate the usage and usefulness of an electronic survivorship care plan (eSCP) that could track access and pages visited. Methods: We recruited 128 BCS from outpatient oncology clinics. 121 BCS received eSCP access via an online secure patient portal; seven received paper copies and are not included in this analysis. The research team customized the portal to track eSCP usage and page visits during the study period (at least 12 weeks of eSCP access). The eSCP consisted of four internal pages (Guide, Treatment Summary, Followup Plan, and Glossary) plus 21 external hyperlinks to survivorship resources. eSCP usefulness and understandability were evaluated using 10-item Likert scales: 1 (not at all useful/very hard to understand to 10 very useful/very easy to understand). Results: 90 out of 121 (74.38%) participants accessed the eSCP. The majority accessed the eSCP within two days of receiving access (N = 70/90, 77.8%) and visited 1 to 3 times (N = 81/90, 90%). Treatment Summary was the most frequently visited internal page (158 visits by 69 participants). Other page usage: Followup Plan (124 visits by 65 participants), Guide (113 visits by 62 participants), and Glossary (46 visits by 31 participants). 34 participants (37.78%) accessed external pages from the eSCP. Participants perceived the overall care plan as useful (8.78, 95% CI [8.38, 9.19]) and easy to understand (8.81, 95% CI [8.47, 9.16]). Conclusions: We found high usage rates among BCS provided an eSCP and the majority perceived the eSCP as useful and easy to understand. Based on favorable assessment and use, it is reasonable for eSCPs to serve as a tool to facilitate communication and care coordination for survivors, especially as access to and use of mobile device technology and electronic patient health portals increase. Minority and rural survivors access and use of such features may require further research.

Survivorship care plan assessment checklist (SCPAC): A tool to evaluate breast cancer survivorship care plans.

2011 ◽  
Vol 29 (15_suppl) ◽  
pp. 6117-6117 ◽  
Author(s):  
C. T. Stricker ◽  
L. A. Jacobs ◽  
A. DeMichele ◽  
A. Jones ◽  
B. C. Risendal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivorship ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Breast Cancer Survivorship ◽  
Care Plans

Colorectal cancer survivors' needs and preferences for survivorship information.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6073-6073
Author(s):  
Talya Salz ◽  
Mary S. McCabe ◽  
Victoria Susana Blinder ◽  
Elena B. Elkin ◽  
Margaret Kemeny ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
New York ◽  
Diagnosis And Treatment ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Plans ◽  
Treatment History ◽  
Completion Date

6073 Background: We assessed colorectal cancer (CRC) survivors’ needs and preferences for information to guide development of a survivorship care plan. Methods: We conducted a survey of survivors treated for stage I-III CRC at two hospitals in New York City. Participants completed treatment 6-24 months before the interview and had not received a survivorship care plan. We evaluated whether survivors knew their basic treatment history, whether they understood ongoing risks, and their preferences for receiving survivorship information. Results: 175 CRC survivors completed the survey between June 2010 and November 2011. Survivors generally remembered basic information about their diagnosis and treatment: 88% accurately reported the location of their cancer; 95-100% accurately reported whether they had surgery, chemotherapy, or radiation; and 90-95% correctly reported the completion date (within 6 months) for each treatment. Survivors knew less about the risks of local and distant recurrences (69% and 77% correct, respectively) and of getting another CRC compared to unaffected individuals (40% correct). More than three quarters of participants received information about their cancer, their treatment history, ongoing oncology visits, and testing to be done by the oncologist (77-86% across categories). Across these categories of information, 93-99% of those who received information found it useful. Most survivors did not receive information about symptoms to report to their doctors, returning to work, financial issues, or legal issues (59-95% across categories); but those who received this information found it useful (67%-100% across categories). Conclusions: Even without receiving survivorship care plans, CRC survivors generally understood their cancer diagnosis and treatment. However, many lacked knowledge of ongoing risks, prevention, and nonmedical survivorship issues. Most survivors found the survivorship information they received useful. The greatest benefit of survivorship care plans to survivors may not be summarizing past care as much as helping survivors understand their risks and plan for the future.

Who is receiving survivorship care plans? Findings from the 2012 LIVESTRONG survey.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 26-26
Author(s):  
Ruth Rechis ◽  
Stephanie Nutt ◽  
Carla Bann ◽  
Linda Squiers ◽  
Naveen Rao
Keyword(s):  
Medical Center ◽  
Care Plan ◽  
Cancer Center ◽  
Survivorship Care Plans ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Long Term Effects ◽  
Care Plans ◽  
Key Stakeholders

26 Background: There are more than 14 million cancer survivors in the US – a number that is on the rise. Care coordination resources will be essential to provide support to this growing population. Key stakeholders, including the Commission on Cancer (CoC) and the Institute of Medicine, have proposed survivorship care plans (SCPs) as a way to extend support. However, limited research has been conducted to date on SCPs. Methods: In 2012, the LIVESTRONG Foundation (LIVESTRONG) administered a survey to understand the role of a treatment summary (TS) and SCPs and how they fit into survivors’ care. Logistic regression models were conducted to identify factors associated with receiving SCPs or TS. Results: 5,303 survivors responded to these questions. While 92% of these respondents received information about where to return to for cancer check-ups, only 51% reported receiving a TS and 17% reported receiving a SCP. Survivors who were more likely to receive SCPs if they had a navigator (p<.001) and if they were male, black, had finished treatment within the past year, or received care at a university-based medical center or community cancer center (p < 0.05). Also, those receiving a SCP were significantly more likely to have had a detailed discussion with a provider regarding long-term side effects, emotional needs, and lifestyle recommendations. Specifically, 60% of those with a SCP discussed long-term effects compared to 39% who did not. Conclusions: Results here indicate that few survivors receive SCPs but survivors reported benefits from receiving them. Currently many workflow barriers impede delivering SCPs, and LIVESTRONG is working with key stakeholders including the CoC to automate the LIVESTRONG Care Plan powered by Penn Medicine’s OncoLink through a registry and EMR system to understand how to address this issue.

Advanced practice providers and survivorship care plans.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 70-70
Author(s):  
Sabrina Q. Mikan ◽  
Patricia Carter ◽  
Debra A. Patt
Keyword(s):  
Colon Cancer ◽  
Psychosocial Care ◽  
Primary Care Providers ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Advanced Practice ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Plans ◽  
Female Breast

70 Background: The American College of Surgeons mandate in 2012 challenged organizations to create and develop quality survivorship care programs. The NCCN and Commission on Cancer set the standard for quality psychosocial care recognizing distress as part of the cancer continuum. In order to meet this challenge, community cancer care organizations are incorporating delivery of survivorship and psychosocial care into the Advanced Practice Provider (APP) role. APPs include Physician Assistants (PAs) and Advanced Practice Nurses (APNs). We describe the development and feasibility testing of an APP-led survivorship program in a large network of community oncology practices. Methods: A descriptive study design was used with ten practices participating in the implementation of a structured APP-led survivorship program. The goals of each survivorship visit were to: review recommendations for care and healthy lifestyle behaviors, review surveillance recommendations, and to reconnect patients with their primary care providers. Nineteen APPs in the study site practices offered survivorship management between October 2012 and May 2015 to female breast and colon cancers at all stages. Results: Study sites used structured process maps to identify and refer patients to survivorship visits. Evaluations of additional referral strategies are ongoing. Participating APPs reported high self-efficacy in delivering survivorship care plans and high patient satisfaction following visits. All female breast or colon cancer patients, regardless of stage at diagnosis, attended the appointment and received a complete care plan based upon the ASCO Survivorship Care Plan. Surveillance education was provided specific to diagnosis utilizing the NCCN guidelines delivering person-centered care. Visits lasted an average of 60 minutes and were billable as counseling and coordination. Conclusions: Patients diagnosed with breast or colon cancer make up the largest majority of cancer survivors. This project reveals that an APP-led survivorship program is feasible and can help to meet the ASCO and NCCN challenge of providing survivorship care to this large population.

Using a mobile app to enhance the uptake of survivorship care plans (SCP) for adolescent and young adult survivors of childhood cancer.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 74-74
Author(s):  
Lisa Schwartz ◽  
Dava Szalda ◽  
Alexandra M Psihogios ◽  
Elizabeth Shea Ver Hoeve ◽  
Lauren Daniel ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Mobile App ◽  
Text Messages ◽  
Adolescent And Young Adult ◽  
Care Plan ◽  
Self Management ◽  
Survivorship Care Plan ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Plans

74 Background: Survivorship self-management, including adherence to survivorship care plans (SCPs), is variable, especially among adolescents and young adults (AYA). Methods:The present study describes the development of a mobile application (app) for AYA survivors (AYA STEPS), which strives to improve survivorship self-management via a combined texting self-management program (THRIVE 2.0) and an electronic survivorship care plan generator (Smart-ALACC [Smart-Adult Living After Childhood Cancer], hosted on Oncolink.org). Results: AYA STEPS was developed by modifying an existing disease management app, LSTCare. The main feature of the app is the delivery of two-way text messages that are tailored to an individual’s SCP. The messages are designed to enhance uptake of the SCP with information, strategies for adherence, motivational messages, and appointment reminders. Patients may also text back with questions. The SCP and its related text information are customized based on input of patient characteristics and treatment history, such as age, time off treatment, and type of treatment (e.g., anthracycline chemotherapy, mediastinal radiation, cranial radiation). The app also houses a copy of the complete SCP document. The SCP is generated, via patient or provider, via an electronic platform that incorporates patient demographic information, cancer diagnosis, and cancer treatments received with checklist of options. Feedback on the app was provided by AYA ages 15 to 21 via a focus group (n = 5) and interviews (n = 5), through which qualitative data were collected. AYA reported high acceptability of a mHealth intervention to improve self-care as cancer survivors, especially the inclusion of tailored content from an individualized SCP as text messages. They also reported the app as feasible to download and maintain on their phones. Conclusions: We are about to begin a RCT that will test adherence to SCP for those who received the app and the SCP versus the SCP alone. We will report details of the app and the launch of the RCT. We expect high acceptability and feasibility with measured benefit to receiving the self-management app.

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