Patient self-management and health maintenance at lung cancer diagnosis and during treatment.

Abstract

e24036 Background: Health maintenance is an integral part of lung cancer care starting at diagnosis and throughout cancer care continuum. Patient self-management (pSM) is a key strategy thought to contribute to promotion of health maintenance in cancer patients (McCorkle, CA Cancer J Clin. 2011, NAM 2014), but its role in lung cancer has been unexplored. We conducted this study as baseline before conducting a quality improvement (QI) to optimize health maintenance utilization and patient self-management in lung cancer. The Q will implement the 4R model (Right Info / Care / Patient / Time) for care delivery, patient self-management and teamwork (Trosman, JOP 2016). Methods: We surveyed patients with lung cancer stages I-IV undergoing cancer treatment at a tertiary cancer center 2018-2019, assessing pSM and health maintenance utilization by patients. We used simple frequencies and Fisher’s exact test in analyses. Results: Survey response rate: 81%, 149/185. We found gaps of at least 20% in all 6 assessed pSM metrics: “know stage of your cancer” (78%), “ability to explain your care to others” (73%), “clarity of care plan” (72%), “ability to manage your own care” (71%), “seldom overwhelmed, not in control of your care” (65%), and “clarity of timing and sequence of care” (35%). High level of composite pSM score ( > 2.8 on 0-4 scale) was found for 50% of patients. Patients also reported insufficient utilization of health maintenance along the 7 metrics we assessed (Table). The level of pSM impacted receipt of health maintenance: patients with high composite pSM score were significantly more likely to obtain 4 of the 7 health maintenance metrics than patients with lower composite pSM score (Table). Conclusions: While serious gaps exist in health maintenance utilization in lung cancer, it is significantly associated with the level of patient self-management. Strategies to improve patient self-management should be utilized to promote health maintenance during lung cancer treatment. Our program to implement the 4R model of cancer care delivery will evaluate if and how 4R facilitates these improvements. [Table: see text]