Development of the medical appointment planner.

Abstract

86 Background: Breast cancer survivors experience multiple physical and emotional symptoms. Difficulties occur when women cannot effectively present questions and concerns during surveillance visits resulting in unmet needs and unanswered questions. Methods: The Medical Appointment Planner (MAP) is a structured visit preparation approach providing communication skills to facilitate presentation of a woman’s symptoms/concerns to medical providers. MAP was developed sequentially in 4 phases: Phase 1) Focus groups explored women’s issues during surveillance visits. Phase 2) Feasibility pilot, using paper-pencil delivery. Phase 3) IPad feasibility, usability / satisfaction pilot. Phase 4) National trial pilot with Susan Love’s Army of Women comparing electronic MAP delivery to a usual care group developing question lists. Results: Focus Groups. A major theme was “difficult interactions with medical providers” especially presenting concerns. Paper-Pencil Feasibility. Eight women (age 30-79) used MAP for medical visit preparation; the average number of symptoms endorsed was 17 out of a possible 21. All women successfully used MAP to prepare for their upcoming medical visit. MAP was determined to be feasible with women asking for electronic delivery for ease of use. IPad Prototype: 26 women (age 40-80); Outcomes of symptoms, mood, uncertainty, and well-being, improved pre to post-visit. National pilot: 49 women (age 50-77); 21 in the MAP intervention group, 28 in the usual care group preparing questions pre-visit. No differences between groups in age or breast cancer stage were observed. After first use, women report MAP is helpful, and providers have reacted favorably to visit preparation with feasible electronic national delivery. The question list group also reports ease of program use. Conclusions: Across MAP pilot studies women report that MAP helps organize thinking, condense thoughts, and stay “on track”. Improving current practice that recommends preparing question lists before medical appointments; the structured MAP visit preparation approach teaches communication skills to facilitate presentation of symptoms and concerns to providers, enabling women to break into the medical “script” and get their symptoms/concerns addressed.