Improving quality of pediatric cancer survivor care: Providers’ support of and experience with survivor care plans.

Abstract

190 Background: Clinical integration of Survivor Care Plans (SCPs) varies. This study assessed pediatric oncology providers’ familiarity with and preferences for providing survivor care and SCPs. This research aims to inform efforts to improve the quality of pediatric cancer survivorship care through increased implementation of SCPs. Methods: From November 2013-April 2014 oncology providers (physicians n=18; nurses n=23) were recruited from the Pediatric Oncology clinic at Primary Children’s Hospital in Salt Lake City, UT. Participants completed a 25-item survey (N=41). A subset participated in a 45 minute focus group (n=17). Participants reported their familiarity with and training on survivorship care, opinions on SCP efficacy, and barriers to using SCPs. To evaluate differences in survey responses for physicians and nurses, we generated Fischer’s exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Results: More oncologists reported familiarity with SCPs (94% vs. 30%, p<0.01) than nurses. Top sources of training for cancer late effects included colleagues (66%), conferences (54%) and medical journals (37%). More oncologists (35%) than nurses (5%) reported ever providing a patient with an SCP (p=0.03). Oncologists also prioritized the clinical integration of SCPs more than nurses (69% vs. 29%, p=0.02). Top perceived barriers to using SCPs in clinical practice included: not knowing enough about SCPs (67%), using SCPs not expected (54%) and no champion (49%). In the qualitative comments, providers expressed that patient age variation made timing of SCP delivery difficult. Most participants were supportive of testing an SCP intervention program (95%) and felt this effort should be done within the context of the multidisciplinary healthcare team. Conclusions: As of now, this clinic has no standard procedures for disseminating SCP and survivorship care, yet the providers we surveyed supported testing an SCP program to improve the quality of their patients’ care. The implementation of coordinated pediatric cancer survivor care should include provider training and testing strategies to implement SCPs more consistently within clinical care.