Determinants of survivorship care plan implementation in U.S. cancer programs.

Abstract

78 Background: The Institute of Medicine recommended and many professional societies require survivorship care plan (SCP) use to facilitate cancer survivors’ transition from treatment to follow-up care. Rates of SCP adoption (plans to use SCPs) and implementation (current use) in US cancer programs remain unclear. Our objectives were to (1) assess rates of SCP adoption and implementation and (2) determine what distinguishes cancer programs that have implemented SCPs from those that have not moved beyond adoption. Methods: We surveyed employees knowledgeable about SCP adoption and implementation in a nationally representative sample of 100 US cancer programs. Data were analyzed using descriptive and bivariate statistics. Results: The response rate was 80%. Ninety-six percent of programs adopted SCPs, but only 45% implemented SCPs. Among programs that implemented, SCP use remains inconsistent: Use is restricted primarily to breast (81.58%) and colorectal (55.26%) cancer survivors; in 58.33% of these programs, less than a quarter of providers has ever used SCPs; and SCPs are seldom delivered to survivors or their primary care providers. Employees in many programs indicated that SCPs were adopted because of the belief that SCPs would improve care quality and the release of professional society guidelines; however, neither of these factors influenced SCP implementation. Few quality markers (e.g., NCI-designated program type; Commission on Cancer membership) influenced SCP implementation. Determinants of SCP implementation included teaching hospital program type (p = .04) and NCCCP membership (p = .009). Freestanding facility type had a negative relationship with SCP implementation (p = .02). Conclusions: Given inconclusive evidence of SCPs’ effectiveness in improving care coordination and patient outcomes, many scholars have recently advocated for research to promote SCPs’ effectiveness. These efforts may be in vain if SCPs are not more routinely implemented. Efforts should be targeted at enabling programs to implement quality improvement tools. Future research should determine what promotes SCP implementation among teaching hospitals and NCCCP members, and what inhibits freestanding facilities from implementing SCPs.