Survivorship care plans: Processes, effective strategies, and challenges in a rural state.

Abstract

47 Background: Annually, South Dakota (SD) averages nearly 4,000 new cancer cases with over 40,000 cancer survivors residing in the state. While the cancer incidence and survivorship rates in SD may be similar to the rest of the nation, SD’s unique geographic and demographic landscape offers challenges in cancer survivorship care. The purpose of this presentation is to illustrate the development and implementation of cancer survivorship care plans (SCP) at three health systems in the rural state of SD. Each of these health systems is unique in its history, culture, and infrastructure. Collectively, they serve most cancer patients living in SD. Methods: An observational qualitative design was used. Key players at each health system were interviewed using a structured interview. The interviews were audio-recorded and transcribed. The authors synthesized the transcriptions with member-checking completed for each system. Results: Processes for development and implementation of SCPs similar across health systems were (a) gathering a leadership team or making a designated staff role for survivorship care, (b) developing a SCP template(s), (c) provider/staff in-put and endorsement, and (d) tracking and identifying patients for scheduling and receipt. On the other hand, the health systems approached SCP completion and delivery differently. For example, at one health system multiple individuals from the patient’s care team were responsible for SCP population and completion. Effective strategies across health systems comprised incorporating prior SCP work, open communication, and standardization of SCPs with flexibility in implementation. Challenges included incompatibilities of electronic health record platforms for automatic SCP template population and adequate staffing for the complexities of enacting SCPs. Key findings suggest a process framework is beneficial for the development and implementation of SCPs. Conclusions: As health systems consider developing and implementing SCPs, consideration of the following recommendations for a process framework may be helpful: building a foundation, gathering resources, reviewing the evidence, eliciting input, and implementing in stages.