Abstract
55 Background: The IOM ’11 and ’13 reports recommend a written care plan (WCP) at cancer diagnosisto enable teamwork and patient (pt) engagement. Standardized multimodality WCP is a key part of the 4R model of care planning and pt engagement proposed under “NCI ASCO Teams” Project (Trosman JOP 2016). 4R (Right Information / Care / Patient / Time) is under implementation at three centers: academic, community and safety net. As current state assessment prior to implementing 4R and standard multimodality WCP, we surveyed pts not impacted by 4R on care planning, enablement and whether they received any WCP. Methods: Survey of breast cancer stage I-III pts who received care at the three sites Jan ’15 - Mar ’16, prior to 4R. We used simple frequencies and Fisher’s exact test in analysis. Results: Survey response rate: 48%, 197/410. Gaps of > 30% were reported in 6 of 8 aspects of care planning and pt enablement - Table. A non standard WCP was received by 45% of pts. Receiving a WCP impacted whether pts were clear about care (90% with WCP vs 50% without, p < .0001), able to manage own care (81% with WCP vs 59% without, p = .001) and overwhelmed (49% with WCP vs 68% without, p = .006). Care complexity was a significant factor for feeling overwhelmed by pts without WCP (60% of pts receiving > 6 care services felt overwhelmed vs. 39% of pts receiving < = 6 services, p = .04), but not a significant factor in pts with WCP (38% vs 44%, p = .7). More pts with WCP reported well managed care by providers than pts without WCP (78%, 64%, P = .04). Conclusions: Serious gaps found in care planning and pt enablement at our sites support the need for 4R implementation. Even pre-4R, non standard WCPs improve pt understanding of care and ability to manage it, and reduce the impact of care complexity on pts. Providers using WCP appear to also coordinate care, but WCP itself may be an important factor of patient enablement. [Table: see text]
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