Improving referrals to survivorship: A patient-driven initiative.

Abstract

44 Background: Patients often feel lost in the transition from cancer patient to survivor. As cancer treatment improves, the number of survivors in the US is expected to approach 22 million by the year 2029. Smaller increases in the MD workforce coupled with long-term effects of new treatments necessitate the creation survivorship clinics led by advanced practice providers (APP) who are disease-specialized and specifically trained to manage unique survivor needs. Although the institutions Survivorship program was established more than a decade ago, the average referral rate to the program is only 30%. Given the high levels of patient satisfaction with the program, we sought to understand and address clinician awareness and referral obstacles. Methods: Based on patient input, members of our Patient & Family Advisory Council for Quality (PFACQ) put forth a proposal aimed at increasing referrals to the Survivorship program. A multidisciplinary working group comprising patients, clinicians, administrators and process engineers was assembled. Process Improvement training was conducted, and a primary goal was developed: increase Survivorship referrals by 25%. Central to the approach was engagement with referring physicians and APPs on a service-by-service basis. A four-question survey was developed to address timing of initial discussion, challenges to referring, knowledge of visit elements, and materials needed to support referrals. A customized ‘roadshow’ presentation was created and delivered by a PFACQ member at a faculty meeting. Highlights included: the importance of Survivorship care to patients and details of the visit, survey responses, and additional faculty discussion and input. Results: Four roadshows were completed from August 2020-June 2021: Gynecologic Surgery, Endocrine, Breast Medicine and Lymphoma. Based on survey responses and dialogue with providers, new material to support patient discussions and education have been developed: a patient-facing brochure, clinician- & patient-facing video, and clinician talking points. Methods to facilitate identifying eligible patients were also discussed, as well as automatic referrals to Survivorship for selected services. Data reveal a significant increase in referral rates from GYN and Endocrine services (follow up > 6 months) of 63% and 228%, respectively. (Breast Medicine and Lymphoma with shorter follow up will be reported.) Engagement with other services is underway. Conclusions: Results have exceeded the goal of increasing referral rates to the program. This process suggests that ongoing engagement with referring clinicians is essential to achieving and maintaining higher referral rates. The patient voice throughout this process has been a powerful tool in raising clinician awareness of their experiences and expectations for comprehensive follow up care, which can be delivered on a greater scale by survivorship providers.