Follow-up Care Plan Research Articles

Improvement of Communication with Primary Care Practitioners with The Use of Emergency Department Discharge Summaries

Objective: To assess the quality of documentation and the frequency of provision of discharge summaries to general practitioners (GP) for patients discharged from our emergency department (ED). Material and Methods: The ED records of 50 patients who presented to the ED and who had been discharged to self-care or the care of their GP on an arbitrarily chosen day were selected for auditing. A pre-formatted computerised discharge summary was then introduced to the ED and the first 50 consecutive electronic discharge summaries of patients who visited the ED were selected for auditing. Results: In the first audit cycle, a diagnosis was documented in 78% of cases. Documentation of key investigation results was present in 84% of cases. Documentation that a prescription was provided to the patient was present in 46% of cases. Documentation of appropriate follow-up care and self-care instructions was demonstrated in 68% and 50% of cases. Of those discharged to GP care, none had documentation that a GP letter was sent or a copy attached. Second cycle: GP correspondence letters were sent and a copy saved in all cases. A diagnosis, follow-up care plan and results of key investigations were documented in 100% of discharge summaries. Self-care instructions on discharge were documented in 94% of cases. Conclusion: The introduction of electronic discharge summaries improved the quality and safety of the discharge process within our emergency department and paves the way for further improvements in information transfer technology. (JAEM 2014; 13: 22-5)

Childhood cancer survivors’ primary care and follow-up experiences

Although most childhood cancer survivors see a primary care provider (PCP), little is known about these encounters. We explored themes related to survivors' (1) experiences with primary care, (2) communication with their PCPs about their cancer, and (3) their knowledge and impressions about follow-up care, including their interest in a survivor care plan (SCP). From April to July 2012, we conducted in-depth, semi-structured telephone interviews with 53 adult survivors recruited from the Utah Cancer Surveillance, Epidemiology, and End Results (SEER) Registry. Participants were randomly selected from sex, age, and rural/urban strata and were younger than 21 years at the time of diagnosis. Participants were asked if they had a PCP and whether they discussed their cancer history with their provider and their interest in a SCP. Interviews were recorded, transcribed, and content-analyzed. The average age at interview was 39.1 years (SD = 11.2). Most survivors had a current PCP (83.0 %). Almost half were not worried about their health despite having had cancer. Detailed discussions about cancer history with PCPs were generally rare. Few survivors had a follow-up care plan, but over half thought a SCP could empower their medical decision making. However, one-third of the survivors were skeptical about the usefulness of a SCP and some were worried about health-care costs. Childhood cancer survivors need better care coordination. Of concern is that many do not discuss their cancer history with their current PCPs and most have no SCP.

HIV partner services are associated with timely linkage to HIV medical care

The Centers for Disease Control and Prevention (CDC) recommends that persons diagnosed with HIV receive partner services with health department involvement. CDC describes partner services as not only including partner notification, but also linkage to medical care for HIV-infected persons. The New York City Health Department formed a unit in 2006 to expedite partner services. We examined the contribution of our HIV partner services program in improving timely linkage and retention in HIV medical care.

Shared Care For Hematologic Malignancy Survivors: Challenges Between Primary Care Physicians and Hematologist/Oncologists

BackgroundMany cancer patients are cured, or have a series of remissions interspersed with periods of re-treatment. In 2006, the Institute of Medicine's From Cancer Patient to Cancer Survivor: Lost in Transition recommended comprehensive treatment summaries and follow-up care plans for all cancer survivors. [Parry 2013] There were about 14 million cancer survivors in the US as of January 2012; this population is expected to be 18 million by 2022. [Siegel 2012] Among survivors, 64% have survived 5 years or more; 40% have survived 10 years or more; and 15% have survived 20 years or more after diagnosis. [de Moor 2013] Many survivors in this growing population experience physical, psychological, and/or financial long-term/ late effects. The complexities of managing cancer survivors suggest their care should not be conceived as a transition from the hematologist/oncologist to the primary care provider, but rather as an ongoing, flexible collaboration determined by individual survivor needs. MethodsPolling surveys were conducted within the 2012 online education activity Sharing Care for Survivors of Hematologic Malignancies, developed by The Leukemia & Lymphoma Society and Medscape Oncology. Case-based education was delivered by an expert panel of hematologist/oncologists (Hem/Oncs) and primary care physicians (PCPs) to illustrate effective communication methods and critical communication points between (Hem/Oncs) and (PCPs). ResultsAs of June 30, 116 Hem/Oncs and 171 PCPs overall responded to the polling surveys, which address current practices and barriers in shared care of cancer survivors. Responses were analyzed to identify gaps in continuity of care among specialties. A summary of responses shows the most significant barrier in effective management is the lack of survivorship care plans and treatment summaries (41% Hem/Oncs vs 51% PCPs). Only 8% and 5% of Hem/Oncs and PCPs, respectively, use survivorship care plans, although both Hem/Oncs and PCPs agreed that such plans and summaries are the most useful communication vehicle among professionals (73% Hem/Oncs vs 67% PCPs). PCPs used patient self-reported data more frequently to document cancer treatment, compared with Hem/Oncs (21% vs 7%, respectively); Hem/Oncs used caregiver reports more often than did PCPs (12% vs 3%, respectively). Similar numbers of Hem/Oncs and PCPs estimated that PCPs spend more than 4 hours of non-reimbursed time weekly researching issues related to patient care (47% Hem/Oncs vs 41% PCPs). Despite progress in electronic health records and widespread Internet access, these physicians most typically use the phone to communicate about the management of cancer survivors (64% Hem/Oncs vs 74% PCPs), followed by faxed/mailed letters, with email ranking as least used. Lack of prompt communication between Hem/Oncs and PCPs was the second highest barrier listed by respondents to effective management (22% and 27%, respectively). ConclusionAnalysis of the Hem/Onc and PCP learner responses to the polling surveys point to clinical complexities and persistent challenges in the co-management of survivors of hematologic cancers. The challenges relate to communication, technological, healthcare system and healthcare coverage issues.Timely, ongoing communication of the right clinical information between Hem/Oncs and PCPs is essential for optimal management of the growing number of cancer survivors. Hem/Oncs and PCPs devote significant time each week to addressing the cancer survivors' needs; the lack of reimbursed time for PCPs may be an impediment to optimal care. Hem/Oncs and PCPs place a high value on the utility of survivorship care plans; however, they are not widely used. Phone calls are the current preferred communication mode. Until other technological solutions are more widely used to share clinical information, it is important to employ practical solutions, such as providing PCPs with information to help prioritize cancer survivors' follow-up care needs and providing patients/caregivers with brief cancer treatment summaries. Communication strategies to address potentially preventable causes of death, such as cardiac disease and second cancers, as well as acknowledgment and treatment for anxiety and depression related issues [Harrington 2010], which often accompany the uncertainty many cancer survivors live with, are critical. Disclosures:No relevant conflicts of interest to declare.

Can't See the Forest for the Care Plan: A Call to Revisit the Context of Care Planning

In its 2006 report “From Cancer Patient to Cancer Survivor: Lost in Transition,”1 the Institute of Medicine (IOM) provided suggestions for improving transitional and follow-up care for the growing population of cancer survivors. The IOM recommended that all patients completing primary treatment for cancer be provided with a comprehensive treatment summary and follow-up care plan, together referred to as a survivorship care plan (SCP).1,2 The IOM recommended that the SCP be reviewed with the patient during an end-of-treatment consultation, in the hope that use of an SCP and consultation would foster improved care coordination and communication.1 The IOM panel acknowledged the lack of an evidence base for survivorship care planning but concluded that “some elements of care simply make sense—that is, they have strong face validity and can reasonably be assumed to improve care unless and until evidence accumulates to the contrary.”1p5 However, the IOM report went on to call for health services research to assess the impact, cost, and acceptability of SCPs with regard to patients and providers.1

Breast Cancer Survivorship and South Asian Women: Understanding about the Follow-Up Care Plan and Perspectives and Preferences for Information Post Treatment

As more treatment options become available and supportive care improves, a larger number of people will survive after treatment for breast cancer. In the present study, we explored the experiences and concerns of female South Asian (sa) breast cancer survivors (bcss) from various age groups after treatment to determine their understanding of follow-up care and to better understand their preferences for a survivorship care plan (scp). Patients were identified by name recognition from BC Cancer Agency records for sa patients who were 3-60 months post treatment, had no evidence of recurrence, and had been discharged from the cancer centre to follow-up. Three focus groups and eleven face-to-face semistructured interviews were audio-recorded, transcribed verbatim, cross-checked for accuracy, and analyzed using thematic and content analysis. Participants were asked about their survivorship experiences and their preferences for the content and format of a scp. Fatigue, cognitive changes, fear of recurrence, and depression were the most universal effects after treatment. "Quiet acceptance" was the major theme unique to sa women, with a unique cross-influence between faith and acceptance. Emphasis on a generalized scp with individualized content echoed the wide variation in breast cancer impacts for sa women. Younger women preferred information on depression and peer support. For sa bcss, many of the psychological and physical impacts of breast cancer diagnosis and treatment may be experienced in common with bcss of other ethnic backgrounds, but the present study also suggests the presence of unique cultural nuances such as spiritual and language-specific support resource needs. The results provide direction for designing key content and format of scps, and information about elements of care that can be customized to individual patient needs.

The experience of information sharing among primary care clinicians with cancer survivors and their oncologists

Knowledge about information sharing among primary care clinicians, oncologists, and their cancer patients is critical given its importance in facilitating the delivery of quality care to the increasing number of cancer survivors. The purpose of our study was to provide a better understanding of the nature of interactions among primary care clinicians, patients, and oncologists throughout the cancer care continuum to better understand the transition to survivorship. Twenty-one qualitative in-depth interviews were conducted with 11 primary care physicians and 10 nurse practitioners. Themes were identified using content analysis. The following themes emerged from the data including: (1) a visit is worth a thousand written reports--primary care clinicians described the importance of patient visits during cancer treatment; (2) community vs. cancer center oncologists--primary care clinicians described differences in information sharing with community oncologists as compared with those in academic centers; (3) correcting for information deficits--primary care clinicians, unable to obtain regular progress reports directly from oncologists, developed indirect strategies to obtain information; (4) the deficiencies in post-treatment follow-up care plans; and (5) the panacea of electronic medical records and survivor care plans. The themes that emerged from this work describe in detail the absence of systematic information sharing among primary care clinicians, patients, and oncologists that is needed to support quality survivorship care in the primary care setting. The descriptions by primary care clinicians contribute to a deeper understanding of the daily challenges that both interfere and/or support primary care clinicians in their care of survivors of cancer. Managing the complex care of cancer survivors often requires the expertise of a number of skilled providers. Information sharing among these individuals is one of the most fundamental aspects of ensuring effective transitions in care. Our results indicate that systematic information sharing among providers caring for cancer survivors is lacking. Identifying strategies to enhance information sharing among and between providers is essential to facilitating the delivery of high-quality survivor care.

Organizations work to develop guidelines for survivorship care

Organizations work to develop guidelines for survivorship care

Medical Nutrition Therapy in Hospitalized Patients with Diabetes

Medical nutrition therapy (MNT) plays an important role in management of hyperglycemia in hospitalized patients with diabetes mellitus. The goals of inpatient MNT are to optimize glycemic control, to provide adequate calories to meet metabolic demands, and to create a discharge plan for follow-up care. All patients with and without diabetes should undergo nutrition assessment on admission with subsequent implementation of physiologically sound caloric support. The use of a consistent carbohydrate diabetes meal-planning system has been shown to be effective in facilitating glycemic control in hospitalized patients with diabetes. This system is based on the total amount of carbohydrate offered rather than on specific calorie content at each meal, which facilitates matching the prandial insulin dose to the amount of carbohydrate consumed. In this article, we discuss general guidelines for the implementation of appropriate MNT in hospitalized patients with diabetes.

Journey Forward: The New Face of Cancer Survivorship Care

Identifying the Need In light of new and more effective medical advancements, many cancers are now being recognized and treated as chronic conditions, with real and ongoing long-term physical and psychosocial health consequences.1 The 2005 report from the Institute of Medicine (IOM)1 identified the need for ongoing lateand long-term effects monitoring, yet the report found that survivors are often lost in transition after active treatment because of both lack of awareness about survivorship needs and poor coordination of care between oncologists and primary care physicians (PCPs). Care is often fragmented and poorly coordinated because most patients are cared for by community clinicians and are not seen within an integrated health care delivery system. Many of the 12 million survivors of cancer2 in the United States are unaware of their changed health care needs. Those who are aware often have difficulty navigating a system that was not designed to address their needs.1 Fortunately, patient needs and concerns are becoming more integral to cancer care. Studies have shown that patient-centered care has the potential to rectify the barriers outlined by the IOM, improve patient satisfaction and the quality of care and health outcomes, and decrease health care costs.3 This new focus on patient-centered care has begun addressing many of the issues that survivors of cancer face, and it represents a significantly different approach to the delivery of survivorship care through the introduction of facilitated dialogue between the patient and providers. Changing the culture of oncology by involving the patient in shared decision making requires a combination of efforts across key areas: informed and involved patients, receptive and responsive health professionals, and a supportive health care environment.4 One specific strategy to change practice and facilitate posttreatment communication and coordination is the development of survivorship care plans, which include comprehensive treatment summaries and follow-up care plans that are clearly and effectively explained.1 Along with detailing the disease and its treatment regimen, a plan promotes patientcentered care by providing an assessment of the survivor’s psychosocial needs and recommending resources, preventive behaviors, and interventions. Yet, although there is general consensus that survivorship care plans hold promise in addressing post-treatment care, a preliminary market research focus group indicated that plans have not seen widespread use, largely because many patients and PCPs are simply not aware of them and oncology professionals have considered them too time-consuming and burdensome because of their complexity and paper-based format.5,6 A New Model for Change Among its several recommendations, the 2005 IOM report called for a joint effort by health care providers, patient advocates, payers and health plans, employers, and sponsors of research to raise awareness of the needs of survivors of cancer, to establish survivorship as a distinct phase of cancer care, and to ensure the delivery of appropriate care.1 In response, the American Society of Clinical Oncology (ASCO) began developing survivorship care plan templates. Other tools were subsequently developed, such as the LIVESTRONG Care Plan (powered by Penn Medicine’s OncoLink [Philadelphia, PA]), NursingCenter.com’s Prescription for Living (Lippincott, Williams & Wilkins, Ambler, PA), and homegrown solutions to respond to the need for greater survivorship care planning. In early 2007, the pooled knowledge, relationships, and resources of WellPoint, the University of California, Los Angeles (UCLA) Jonsson Comprehensive Cancer Center, the National Coalition for Cancer Survivorship, and Genentech formed the Journey Forward program, which seeks to: • change the way survivorship care is delivered; • establish a new standard of care for survivors of cancer; • enhance patient and physician understanding of lateand long-term effects of cancer treatment and survivorship; and • improve the continuity and coordination of care.

Use of Headings and Classifications by Physicians in Medical Narratives of EHRs

The purpose of this study was to describe and evaluate patient care documentation by hospital physicians in EHRs and especially the use of national headings and classifications in these documentations. The initial material consisted of a random sample of 3,481 medical narratives documented in EHRs during the period 2004-2005 in one department of a Finnish central hospital. The final material comprised a subset of 1,974 medical records with a focus on consultation requests and consultation responses by two specialist groups from 871 patients. This electronic documentation was analyzed using deductive content analyses and descriptive statistics. The physicians documented patient care in EHRs principally as narrative text. The medical narratives recorded by specialists were structured with headings in less than half of the patient cases. Consultation responses in general were more often structured with headings than consultation requests. The use of classifications was otherwise insignificant, but diagnoses were documented as ICD 10 codes in over 50% of consultation responses by both medical specialties. There is an obvious need to improve the structuring of narrative text with national headings and classifications. According to the findings of this study, reason for care, patient history, health status, follow-up care plan and diagnosis are meaningful headings in physicians' documentation. The existing list of headings needs to be analyzed within a consistent unified terminology system as a basis for further development. Adhering to headings and classifications in EHR documentation enables patient data to be shared and aggregated. The secondary use of data is expected to improve care management and quality of care.

C-A4-01: Providing Care for Cancer Survivors in Integrated Delivery Systems: An Assessment of Current Practices and Future Opportunities

Jessica Chubak, PhD1, Clarissa Hsu, PhD2, Leah Tuzzio, MPH1, Beth Kirlin, BA1 and Larissa Nekhlyudov, MD, MPH3,4 1Group Health; 2Group Health Research Institute; 3Harvard Medical School; 4Harvard Vanguard Medical Associates

Celiac Disease: The Endocrine Connection

CD is an immune-mediated enteropathy caused by genetically predisposed individuals eating gluten-containing foods (Catassi et al., 2007; Celiac Working Group et al., 2008; Green & Cellier, 2007; Hill et al., 2005). There are several endocrine disorders that are associated with CD. In many of these cases, CD does not present with the typical gastrointestinal symptoms. Nurses working with children who have endocrine conditions need to consider CD as part of the differential and follow-up care plan. This awareness will facilitate more efficient diagnosis and minimize the risk of conditions associated with untreated CD.

Association of Follow-up Care Characteristics and Outcomes According to Number of Follow-up Providers Among Survivors of Hematologic Malignancies.

Abstract 1375Poster Board I-397 Objectives:There is a critical need to have a better understanding of the role health providers play and the need to develop clinical tools to help clinicians identify patients who after completion of treatment for hematologic malignancies may benefit from a more intense follow-up care. The primary purpose of this study was to examine if number of follow-up providers (FUPs) - single versus multiple, influence healthcare utilization (HCU), quality of life and patient satisfaction at 6 months in a cohort of patients who completed treatment for hematologic malignancies. A secondary purpose was to evaluate characteristics of follow-up care that may identify patients at risk for urgent care or hospitalization within 6 months. Methods:We utilized data from CANCER-CARES, a longitudinal prospective study of 928 patients with various cancers evaluating follow-up care after completing cancer treatment from a university-based hospital. This study was confined to 314 (52%) patients who had leukemia, lymphoma or multiple myeloma with available 6 month follow-up information. The cohort was divided according to the number of FUPs - single versus multiple. FUP is defined as a physician(s) responsible for managing any aspect of patient's health after cancer treatment. Single FUP may consist solely of a university or community oncologist or other physicians, while multiple FUP may be any combination of the above. Outcomes evaluated included healthcare utilization (HCU) - defined as an emergency room visit or hospitalization within 6 mos, quality of life (SF-12) and patient satisfaction (PSQ-18). Characteristics of follow-up care assocatied with HCU were determined using multivariate logistic regression. Factors determined to be predictive of HCU were assigned one point each. The summated score was used to represent the Follow-up Index Score (FUIS). We used the median FUIS of ≤ 2 to dichotomize the cohort to low vs high scores. The association of the FUIS according to single or multiple FUP with HCU was evaluated using multivariate logistic regression to adjust for patient characteristics. Results:Of the 314 patients, 214 (68%) sought follow-up care with a single FUP (80% remained with university providers, 20% moved back to community providers), while 100 (32%) sought follow-up care with multiple FUPs. Patients seen by single FUP were more likely to be older (median 59y vs 55y), live closer to their FUP (median 60 mi vs 150 mi), less likely to have prescription drug insurance (85% vs 94%), and were less likely to have undergone stem-cell transplantation. Patients seen by single FUP chose their physician more because of preference and quality of care than because of proximity, and were seen less frequently by their FUP as compared to the multiple FUPs. In addition, patients of single providers were seen shorter on their follow-up visits and were less likely to call their FUP with health-related questions. Five patterns of follow-up care were associated with HCU within 6 mos: 1) consult made for cancer-related problems, 2) consult made for other medical problems, 3) referral to another specialist, 4) call made to FUP for medical questions, and 5) ancillary procedures performed (ct, x-ray, ultrasound). In the multivariate analysis, patients seen by single or multiple FUP did not differ in HCU, quality of life and patient satisfaction. However, patients who were seen either by a single or multiple FUP and with low FUIS had significantly lower odds of HCU compared with single FUP with high FUIS [OR 0.11 (95%CI 0.05-0.25), p<0.001; OR 0.26 (95% CI 0.09-0.71), p<0.001) respectively. Patients seen by multiple FUP and have low FUIS also had lower odds of HCU compared with patients with multiple FUP and have high FUIS (OR 0.30, 95% CI 0.10-0.85, p<0.001). We failed to detect differences between patients seen by single or multiple FUPs with low FUIS. No differences in quality of life or patient satisfaction were noted. Conclusion:In summary, patients with hematologic malignancies do not differ between patients who sought follow-up care from single or multiple FUP on HCU, quality of life or patient satisfaction. However, the FUIS shows potential to identify patients who may benefit from an intensive follow-up care plan geared towards preventing hospitalization because it demonstrated that high FUIS scores were associated with increased HCU within a 6 mo. period. The utility of the FUIS in predicting HCU between 6 and 12 months and in different types of malignancies should also be evaluated. Disclosures:No relevant conflicts of interest to declare.

Identifying Key Questions to Advance Research and Practice in Cancer Survivorship Follow-Up Care: A Report From the ASPO Survivorship Interest Group

Cancer survivorship encompasses the physical, psychosocial, and economic consequences of cancer, including issues related to health care and follow-up treatment, late effects of treatment, surveillance for recurrence of the primary, screening for second primary cancers, and quality of life. Almost

CancerScope

CancerScope

Implementing a Survivorship Care Plan for Patients With Breast Cancer

The growing number of cancer survivors challenges healthcare organizations to develop programs that support survivors' transition from active treatments to survivorship care. Many individuals and families continue to face complicated care issues resulting from cancer diagnosis and side effects long after completion of their treatments. This article describes a model of a survivorship care plan, Cancer Treatment Summary and Follow-Up Care Plan, piloted in an outpatient clinical setting in a community hospital for patients with breast cancer. The plan can be expanded to include other cancer types. The intent of the survivorship care plan is to strengthen the care connections and coordination of services for survivors of breast cancer to ensure that continuing care needs are met during the survivorship phase of the cancer trajectory. The survivorship care plan is a unique opportunity for oncology nurses to be catalysts for the interdisciplinary interactions that are required to develop survivorship care plans and to implement a change in oncology nursing practice. The intervention shifts the paradigm of cancer survivorship care from an acute care medical model to a wellness model for cancer survivors in the clinical setting.

Physical and psychological long-term and late effects of cancer

The number of long-term cancer survivors (> or =5 years after diagnosis) in the U.S. continues to rise, with more than 10 million Americans now living with a history of cancer. Along with such growth has come increasing attention to the continued health problems and needs of this population. Many cancer survivors return to normal functioning after the completion of treatment and are able to live relatively symptom-free lives. However, cancer and its treatment can also result in a wide range of physical and psychological problems that do not recede with time. Some of these problems emerge during or after cancer treatment and persist in a chronic, long-term manner. Other problems may not appear until months or even years later. Regardless of when they present, long-term and late effects of cancer can have a negative effect on cancer survivors' quality of life. This article describes the physical and psychological long-term and late effects among adult survivors of pediatric and adult cancers. The focus is on the prevalence and correlates of long-term and late effects as well as the associated deficits in physical and emotional functioning. In addition, the emergence of public health initiatives and large-scale research activities that address the issues of long-term cancer survivorship are discussed. Although additional research is needed to fully understand and document the long-term and late effects of cancer, important lessons can be learned from existing knowledge. Increased awareness of these issues is a key component in the development of follow-up care plans that may allow for adequate surveillance, prevention, and the management of long-term and late effects of cancer.

Acute Care for the Chronically Ventilated Child

Children are discharged home on mechanical ventilation because of pulmonary, cardiac, anatomic, neuromuscular, central nervous system, or metabolic reasons. These children are extremely vulnerable and have complex medical needs. They often present to the emergency department with respiratory symptoms that may be related to their underlying condition, to an intercurrent illness, or due to equipment failure. These children require a thorough evaluation that includes a complete review of underlying medical problems and an assessment of the airway and ventilator equipment. It is important to remember that in addition to cardiopulmonary reasons, central nervous system and metabolic processes may produce respiratory distress. The decision to admit the child to the hospital or to discharge home is equally complex. In addition to the child's severity or complexity of illness, factors to consider include availability and competency of home caregivers, integrity of essential ventilator equipment, reliability and safety of transport, and plan for follow-up care.

Perspectives on Post-Treatment Cancer Care: Qualitative Research With Survivors, Nurses, and Physicians

Cancer survivors have many medical and psychosocial needs that are unaddressed in the post-treatment period. Qualitative research was carried out to assess how a survivorship care plan created by oncologists could improve the quality of survivorship care. Focus groups and interviews conducted with cancer survivors, nurses, primary care physicians, and oncologists provide insights into post-treatment follow-up practices and the acceptability and feasibility of providing survivors and referring physicians with a cancer survivorship care plan. Cancer survivors reported satisfaction with post-treatment medical care, but felt that their psychosocial needs were not met. Survivors expressed enthusiastic support for receipt of a follow-up care plan. Primary care physicians viewed themselves as playing an important role during the post-treatment period and indicated that a written care plan for follow-up would help them improve their survivorship practices. Nurses recognized the need to improve the care of cancer survivors and suggested that they could play an active role in creating and implementing cancer survivorship plans. Physicians providing oncology care acknowledged the value of survivorship care plans, but were not inclined to complete them because such plans would not reduce other reporting and communication requirements and would be burdensome to complete given their busy schedules. Survivorship care planning is viewed favorably by consumers, nurses, and physicians, however there are several barriers to its adoption. Barriers may be overcome with: electronic medical records, changes in reporting requirements of insurers, advocacy on the part of patients, and incorporation of care planning in education and training programs.