Integrative model for breast cancer survivorship.

Abstract

132 Background: Efforts to better address needs of survivors, summative care plans, and point of delivery are ongoing at academic, research, and community institutions. Lacking are empiric data to support one method over another. Methods: A quasi-experimental approach was used to measure a multidisciplinary integrative care model that involved the primary nurse, nurse practitioner, and medical oncologist to determine the best time, method, and application of cancer survivorship care planning. A concomitant cross-sectional study was ongoing in which patients completed the Distress Thermometer (0-10 analog score) plus a problem list (34 items) in early survivorship (e.g. during treatment, at its end, at 3- and 6-months later). Results: As a result of our teamwork, data from the electronic medical record (EMR) was integrated into end-of-treatment summaries and care plans; ‘smart-phrases’ provided links to personalized patient data which resulted in individualized care plans. The average self-reported distress level in early survivorship was 4.8, indicating a moderate to severe level of distress. Patients stated practical problems (e.g. finances, work) were of highest concern, followed by physical symptoms (e.g. fatigue, aches/pains), then emotional and family issues were prime distressors. The integrative model allowed our work teams to provide personalized services with a greater understanding of each individual patient. Data is presently being collected to quantify these services. Through this multidisciplinary approach, team-driven initiatives, and EMR integration, the preparation, delivery and follow up required for survivorship encounters was greatly streamlined. Conclusions: An integrative care model that is linked to the electronic medical record provides personalized care in a timely manner that is neither time nor resource intensive. We ‘listened’ to our patients and have diligently worked to increase and expand resources. Future initiatives include group educational sessions, earlier discussion of survivorship goals, and treatment summary generation at diagnosis. We believe this model will serve as the foundation for survivorship care expansion in our breast program, and can potentially be generalized to other institutions.