Provision Of Survivorship Care Plans Research Articles

Current practice patterns and gaps in guideline-concordant breast cancer survivorship care

PurposeBreast cancer-specific survivorship care guidelines for the more than 3.8 million survivors in the U.S. are available, but implementation in clinical practice remains challenging. We examined current practice patterns and factors associated with guideline-concordant survivorship care among oncologists.MethodsA national sample of medical oncologists, recruited using two databases, participated in a survey focused on practice patterns for breast cancer survivorship care. A “survivorship care composite score” was calculated for each respondent based on provision of services recommended in the survivorship guidelines. Descriptive statistics and multivariable linear regression analyses examined associations between physician and practice characteristics and composite scores.ResultsThe survey was completed by 217 medical oncologists, with an overall response rate of 17.9% and eligibility rate of 56.9% for those who responded. Oncologists reported high engagement in evaluation of disease recurrence (78%). Performed less frequently were the provision of survivorship care plans (46%), assessment of psychosocial long-term and late effects (34%), and screening for subsequent cancers (34%). Lack of survivorship care training (p = 0.038) and not routinely informing patients about potential late effects (p = 0.003) were significantly associated with poorer survivorship care composite scores.ConclusionsDespite the availability of disease-specific survivorship care guidelines, adherence to their recommendations in clinical practice is suboptimal. Survey results identified key gaps in survivorship care for breast cancer survivors, particularly related to subsequent primary cancers and psychosocial long-term and late effects.Implications for Cancer SurvivorsImproving the delivery of comprehensive survivorship care for the growing population of breast cancer survivors is a high priority. Disease-specific clinical guidelines for cancer survivorship provide valuable recommendations, but innovative strategies are needed to integrate them into the care of long-term breast cancer survivors.

Implementing survivorship care planning in two contrasting health systems: lessons learned from a randomized controlled trial.

Survivorship care plans (SCPs) are recommended to promote appropriate follow-up care, but implementation has been limited. We conducted a randomized controlled trial comparing three SCP delivery models in two health systems. We utilize mixed methods to compare the feasibility and participants' perceived value of the three models. Patients completing treatment for stage I-III breast, prostate, or colorectal cancer from one urban-academic and one rural community cancer center were randomized to (1) mailed SCP, (2) SCP delivered during an in-person survivorship visit, or (3) SCP delivered during an in-person survivorship visit plus 6-month follow-up. Clinics had flexibility in intervention implementation. Quantitative data summarize intervention fidelity and protocol deviations. Qualitative interview data provide patients' perspectives on feasibility and intervention value. Of 475 eligible participants approached, 378 (79%) were randomized. Of 345 SCPs delivered, 265 (76.8%) were by protocol. Protocol deviations were more common at the urban-academic center. In post-study qualitative interviews, participants recalled little about the SCP document or visit(s). SCPs were valued for information and care coordination, although their static nature was limiting, and sometimes SCP information differed from that provided elsewhere. Visits were opportunities for care and reassurance, but time and distance to the clinic were barriers. SCP provision was challenging. Patients were interested in SCP, but not necessarily additional survivorship visits, particularly at the urban-academic hospital. These findings suggest that patients value careful consideration of health care needs during the transition out of treatment; SCP documents are one element of this. For many patients, models without additional visits and dynamic SCPs may be preferred.

Abstract P2-13-16: A multidisciplinary approach to implement personalized multifaceted care plans in standard breast cancer care: A quality improvement project

Abstract Background: IOM, ASCO and Commission on Cancer have emphasized the provision of survivorship care plans (SCPs) to cancer patients. Cancer Care Ontario (CCO) aims to ensure that SCPs are developed and shared with healthcare providers (HCPs) to facilitate integrated cancer care. In 2016, a randomized mixed-methods study at St. Michael’s Hospital (SMH) provided a paper based Personalized Multifaceted Care Plan (PMCPs) to breast cancer (BC) patients, which included an upfront treatment plan. The PMCP was generated by entering non-repetitive patient data into a care plan database software developed by the team. The study results showed that patients and primary care providers (PCPs) found PMCP to be useful. Despite the benefits, implementation of SCPs as standard of care remained a challenge due to lack of designated personnel for developing SCP and limited resources causing poor provider buy-in. In 2017, we initiated a quality improvement (QI) project to implement the PMCP by integrating it into existing workflow by involving the care team. Methods: This REB approved QI project was done in two phases. Phase 1 was to identify key members to create the PMCP and to secure the software to the SMH IT server. In phase 2, the PMCPs were delivered to newly diagnosed invasive BC patients, receiving chemotherapy. The PMCPs were also shared with respective PCPs. At SMH, new patients diagnosed with BC are seen initially at the Multidisciplinary Clinic (MDC) by a medical and radiation oncologist, and a patient navigator (PN) to plan treatment. In phase 1, the PN who coordinated the MDC was identified as the most appropriate care team member to initiate the PMCP. To incorporate the PMCP into the PN’s existing workflow, a Transfer of Accountability (TOA) document was designed using the care plan software to replace a patient summary that was created in silos. The TOA was electronically shared with the team and had most of the information provided in the PMCP. The primary outcome measures were proportion of information completed to generate the PMCP and care plans delivered by patients’ care team. Secondary Outcome measures were patient and provider satisfaction with PMCP assessed using surveys at three time points and single time point respectively. Data were summarized using median and IQR as well as frequency and percentages. Data was also shared at QI team meetings, practice patterns were observed for changes and incorporated into subsequent PDSA cycles. Results: From 2017 to 2019, 90% (120/134) of eligible BC patients were provided with the PMCP. At the first 2 PDSA cycles 100% PMCP preparation and delivery was done by research staff. We have achieved 80% compliance in Phase 1 by involving the PN in data entry for PMCP while preparing the TOA document. TOA had been incorporated into standard of care at MDC and a recent nursing project found that HCPs surveyed perceived TOA to be a useful tool in information exchange and care coordination. Patient satisfaction surveys for PMCP found their responses were consistent over all time points with high levels of agreement. Surveys also showed that 73% (86/117) patients agreed that the PMCP helped with communication with their PCPs and 81% (95/117) agreed it helped with communication with the team. Of the 25 PCPs and 5 oncology HCPs surveyed, 91% (22/25) PCPs and 100% (5/5) oncology HCPs agreed that the PMCP should be incorporated into BC care. Conclusions: Implementation of SCPs with a multidisciplinary approach is feasible in BC care. Integration of SCPs within the existing work flow and involvement of members of the care team can lead to increased SCP uptake, better care coordination, sustainability and provider buy-in. With the high patient and provider satisfaction with PMCP, and recommendation by CCO, we are in the process of integrating PMCPs for BC patients as standard of care in the oncology clinic. Citation Format: Rashida Haq, Amy Kong, Ronita Lee, Geetha Mukherji, Christine Brezden-Maesley, Pauline Gulasingam. A multidisciplinary approach to implement personalized multifaceted care plans in standard breast cancer care: A quality improvement project [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-16.

Using Quality Improvement Methodology to Implement Survivorship Care Plans.

Accreditation requirements for cancer centers by the American College of Surgeons' Commission on Cancer have included provision of survivorship care plans (SCPs) to patients treated with curative intent soon after completion of therapy. These were traditionally provided in a dedicated survivorship clinic for our pediatric oncology patients later in the survivorship time period. Our goal was to increase timely provision of SCPs to eligible patients in our acute care pediatric oncology clinic and to have this serve as a bridge to longer-term survivorship care. Our pediatric oncology clinic used quality improvement methodology to implement a process for creation of SCPs. We defined eligible patients on the basis of curative intent. Cancer registry data were queried to find eligible patients, and chart reviews were done weekly. A P chart and run chart were used to monitor our process for creation of plans and overall completion rate, respectively. During the intervention period, we increased the percentage of eligible patients with an SCP from 28% on June 30, 2017, to 53% by December 31, 2017. Since that time, we have continued to increase the percentage of patients with SCPs, reaching 69% by June 30, 2019. By using quality improvement methodology, our pediatric oncology clinic was able to change its clinical practice and implement a sustainable process for provision of SCPs and survivorship planning earlier in the post-treatment course, and meet the Commission on Cancer accreditation standard.

After cancer, what’s more important? The survivorship care plan or the survivorship care visit?

11618 Background: The Commission on Cancer has made the provision of survivorship care plans (SCPs) a prerequisite for accreditation of cancer programs. However, whether all patients desire or derive benefits from an SCP is not established. This study sought to characterize the provision of survivorship care at the Lifespan Cancer Institute (LCI) to (1) determine clinical and distress characteristics at first visit to the LCI among patients treated with curative intent for a solid tumor diagnosis; (2) characterize which factors are associated with receipt of an SCP with or without a survivorship care visit (SCV); and (3) determine referral patterns and outcomes among patients with an SCP with or without an SCV. Methods: We have retrospectively reviewed 650 patients at Lifespan Cancer Institute so far, all of whom were initially seen between the years 2014-2017. As part of routine practice, all new patients are screened with the NCCN Distress Thermometer (DT). Data related to demographics, treatment variables, and presenting distress score were gathered using our electronic medical records. Categorical data were analyzed using Fisher’s Exact Test or Chi-Square. Multinomial logistic regression was performed for multivariate analysis. All analyses were performed in STATA 15.0. Results: The median age was 63 (range 29 to 90), 74.8% were female, and 39.5% were married or partnered. The major cancers represented included breast (52.2%), lung (16.6%), and prostate (6%) cancers. Severe distress (DT≥4) was reported in 49.5% of patients at their first visit with top concerns being worry (54.3%), nervousness (46.6%) and fatigue (37.3%). An SCP was documented in 461 patients (71.1%) and of these, 267 (57.9%) were seen in an SCV as well. On multivariate analysis, gender, marital status, and stage were significantly associated with the receipt of an SCP. However, only disease site was significantly associated with being seen in an SCV. Compared to those with an SCP but not seen in an SCV, those who attended an SCV were significantly more likely (p < 0.005) to be referred for post-treatment evaluation, including psychological counseling (15.7 vs 6.7%), physical therapy (56.9 vs 22.7%), and nutrition (26.6 vs 8.2%). The majority of patients followed up with referrals, though it was significantly higher among those with an SCV (95.4 vs 87%, p = 0.015). Conclusions: Survivorship care varies by cancer type, with highest rates of visits for patients with gynecologic and GI cancers. Referral to other resources is significantly higher among those seen in visits, and those who are referred will follow up.

Survivor and Clinician Assessment of Survivorship Care Plans for Hematopoietic Stem Cell Transplantation Patients: An Engineering, Primary Care, and Oncology Collaborative for Survivorship Health.

The long-term care of hematopoietic stem cell transplantation (HSCT) survivors poses special challenges owing to a myriad of possible chronic and/or late complications. Survivorship care plans (SCPs) have been proposed as tools to communicate information on the late effects of treatment and recommended follow-up care to clinicians and survivors. The primary aims of this study were to determine SCP content and format, as well as to assess the preferred timing of SCP provision following HSCT. HSCT survivors and nontransplantation clinicians (oncologists and primary care physicians) were invited to participate in a survey evaluating the usefulness and utility of a sample HSCT-specific SCP with a treatment summary generated by autopopulation from an electronic health record (EHR). All participating HSCT survivors (n = 29) and clinicians (n = 18) indicated a desire to receive an SCP. More than 85% of the participants perceived information about treatments received, recommended follow-up and health maintenance including vaccinations, survivor and clinician resources, and graft-versus-host disease and other late/chronic side effects to be useful. The majority of survivors also believed that care team contact information was useful. In addition, >85% of survivors and clinicians agreed that the SCP increased their understanding of treatments and chronic/late side effects, improved health care provided, and were satisfied with the SCP and found it understandable and easy to use. The majority of survivors indicated that additional information should be added to the SCP, whereas some clinicians deemed the SCP too long. Survivors preferred to receive the SCP as a paper document at the end of a regular follow-up visit and review it with a cancer clinician, whereas clinicians preferred to receive the SCP through the EHR. These findings will help improve the design of future SCPs for use by HSCT survivors and clinicians. Future work will include leveraging the EHR to ease the burden of creating user-centered documents.

Evaluating Survivorship Care Plans for Use By Hematopoietic Stem Cell Transplant Survivors and Non-Transplant Clinicians: An Engineering, Primary Care, and Oncology Collaborative for Survivorship Health

Background Survivors of hematopoietic stem cell transplants (HSCTs) face many chronic and late complications that pose challenges to future survivorship care. The provision and review of Survivorship Care Plans (SCPs) has been proposed as a method to improve knowledge of these complications as well as screening and treatment recommendations among survivors and their non-transplant clinicians. Creating SCPs can be work intensive, however, using the electronic health record (EHR) can reduce the time and personnel resources required to generate SCPs and complement efforts to discretely capture HSCT data. Objectives Our objectives were to determine what content should be included in HSCT-focused SCPs for these diverse users as well as format and preferred timing of SCP provision. Results will be used to create HSCT-focused SCP templates generated by and integrated with an EHR. Methods Eligible HSCT survivors were ≥18 years and received a HSCT > 12 months ago. Non-transplant primary care and oncology clinicians were eligible if they provided care to HSCT patients. Those eligible were invited to complete a survey evaluating a HSCT-focused SCP with treatment summary data generated by an EHR. The usefulness of content, format and utility of the document, and timing of provision were considered especially pertinent. The survey utilized both 5-point Likert scales and open-ended questions. Results Survey response rate exceeded 80% (n=29/36 survivors; n=18/22 clinicians). Our survivor respondents were a median age of 59 (range 32-73), White (100%), mostly female (52%) and educated (52% held an associate degree or higher). Clinician respondents were predominately female (67%), White (78%) and providing primary care (56%). Over 85% of survivors and clinicians perceived information about treatments received, recommended follow-up and health maintenance including vaccinations, survivor and clinician resources, graft versus host disease and other late/chronic side effects to be useful or very useful. The majority of survivors also found care team contact information useful or very useful. Additionally, over 85% of survivors and clinicians agreed or strongly agreed that the SCP would improve follow-up care and increase their understanding of treatments and chronic/late side effects. Overall, 88% were satisfied with the SCP and found it understandable and easy to use. All respondents indicated a desire to receive SCPs. Survivors (93%) prefer to receive the SCP as a paper document at the end of a regular follow-up, and most would like to receive the SCP immediately after transplant (70%) or two to three months after transplant (67%). Clinicians (89%) would prefer to receive the SCP through the EHR. Conclusion These results will help improve future HSCT-focused SCP templates to meet the needs of these users. Future work will include leveraging the EHR for creation and provision of SCPs with ease.

A randomized trial of immediate versus delayed survivorship care plan receipt on patient satisfaction and knowledge of diagnosis and treatment.

Survivorship care plans (SCPs) and care-planning sessions have been recommended for over a decade, yet evidence for their benefit remains mixed. In a randomized trial, changes in survivor knowledge and satisfaction before and after the receipt of an SCP were assessed. Patients with breast cancer who had completed curative-intent treatment were randomized to immediate versus delayed receipt of an individualized SCP. All participants completed the modified Wisconsin Survey of Cancer Diagnosis and Management in Breast Cancer and the Preparing for Life As a New Survivor survey to assess individual knowledge about cancer diagnosis, treatment, side effects, and follow-up as well as satisfaction with communication and care coordination. Surveys were completed at baseline, at 4 weeks (before delayed receipt), and again at 12 weeks (after all participants had received SCPs); the primary outcome was change in knowledge at 4 weeks. In total, 127 eligible women were randomized. An improvement in individual knowledge was observed between baseline and week 12 for both arms combined (+1.6; 95% confidence interval, 0.9-2.3; P < .001). There was no statistically significant difference in the change in knowledge from baseline through week 4 between the arms. No significant change occurred for satisfaction scores over time. This randomized trial of immediate versus delayed SCP receipt demonstrated a small improvement (4%) in survivor knowledge. However, this improvement did not appear to be related to SCP provision. The authors hypothesized that the improvement was because of repeated administration of the knowledge survey. If improved survivor knowledge is a goal, then strategies beyond the 1-time provision and review of an SCP should be explored.

Impact of Survivorship Care Plans and Planning on Breast, Colon, and Prostate Cancer Survivors in a Community Oncology Practice.

With a growing number of cancer survivors, survivorship care plans (SCPs) are recommended to communicate information about late effects of treatment and follow-up care. Community oncology practices follow 85% of adult cancer survivors but report more difficulty in providing SCPs compared to academic centers. Our objective was to evaluate the impact of delivering SCPs in a community oncology practice by examining awareness of SCP receipt as well as how provision affects survivors' perception of care quality and of their condition. Survivors who accepted a SCP as standard of care were recruited from a community oncology practice in the Midwest and completed surveys prior to SCP provision (baseline) and 4weeks later (follow-up). Within-survivor changes in knowledge of SCP receipt, satisfaction and perceived care coordination were assessed. Thirty cancer survivors (breast, colon, and prostate) completed the baseline survey, while 24 completed the follow-up survey (80% response rate). Participants reported receiving SCPs and treatment summaries more frequently at follow-up after receiving a SCP. At follow-up, there was a significant increase in survivor activation and involvement in care along with satisfaction of knowledge of care. Communication about and during SCP provision may need to be clearer: 34% of survivors could not correctly identify SCP receipt in this study. This may place these survivors at a disadvantage, if this leads to less awareness of important information regarding follow-up surveillance and management. Of those aware of SCP receipt, SCP provision had positive impacts in this small, short-term study.

Digital Solutions for Cancer Survivorship Care

Background: Both the National Cancer Institute (NCI) and Institute of Medicine have stressed the importance of survivorship care plans (SCP) for cancer patients/survivors and discussed the significance and importance of required input from survivors and advocates. However, there are many barriers to cancer care coordination and the creation of SCPs, including oncology staff time required to write them. Although survivors valued SCPs and liked them, few survivors or caregivers report receiving survivorship information and in some studies, reported no receipt of an SCP. Digital platforms can support cancer survivorship care by integrating with the existing Electronic Health Record and presenting information in a dynamic and user-friendly format that improves coordination and communication. Objective: In this paper, we describe our involvement of stakeholders, including medical staff, patients/survivors and informal caregivers in developing a user-centered design for TOGETHERCARE, a smartphone app envisioned to provide critical functionality including planning and sharing of the SCP among survivors, physicians, and informal caregivers. Methods: Two interviewers conducted a total of nine semi-structured interviews, including a convenience sample of three health care providers who work with cancer patients, three cancer patients/survivors, and three informal caregivers currently caring for cancer patients/survivors. The interviews with Spanish-speaking patients/survivors and caregivers were conducted with a translator. Notes from the interviews were transcribed into a prepared template. The results were compiled and coded by two members of the core team. Results: We identified areas of consistency in responses between the three different groups in terms of how the application should work, as well as areas of difference. Additional suggestions for features for the application are also presented. Health care providers focused on the efficiency of using the application, features that would improve follow-up visits with patients and reduce the nursing triage, ER visits and readmissions. Survivors and caregivers were more focused on features that would provide assistance with patient appointment schedules, at-home medical tasks and activities of daily living. Although all three groups agreed that there is currently no systematic way for specialists to keep in touch with patients once they have moved to community care, and that SCPs would be useful, the practice of providing SCPs is rarely implemented. Survivors, caregivers, and providers all agreed that they have smartphones and that an app that includes the ability to communicate between the different groups, along with other features such as guidance on assisting with daily medical tasks and activities of daily living would be useful. Conclusions: The pervasiveness of mobile devices and mobile app use provides an opportunity to make survivorship information and plans more readily available to caregivers and survivors, and to incorporate patient outcome reporting. Health care providers, cancer survivors, and informal caregivers all responded positively to a variety of features that could improve the efficiency of cancer care coordination and dynamic SCP provision.

Survivorship care plans: Recommended vs delivered care.

10076 Background: The Committee on Cancer set a benchmark for the provision of survivorship care plans (SCP) to ≥50% of early cancer patients by the end of 2017 despite limited data indicating benefit. One hypothesis is that SCP will reduce overuse of medical care in survivors. Methods: We performed a retrospective review of all patients with early breast cancer (BC) who were seen by a single nurse practitioner (NP) for provision of SCP after completion of primary therapy (surgery, radiation +/- chemotherapy). We evaluated adherence to recommendations for follow-up (FU) care and testing in accordance with established guidelines. Results: Between August 2013 and December 2014, 152 patients received SCP after completion of primary therapy (median 2 months, range 0-27). 98% of SCP were given to patients, but only 38% were sent to primary care providers (PCP). Median FU was 23 months. Among 130 patients who did not undergo bilateral mastectomy for whom surveillance breast imaging (SBI) was recommended, 10 (8%) had 1st SBI ≥3 months earlier than time recommended (TR), 102 (78%) within 2 months of TR, 12 (9%) ≥3 months after TR, and 6 (5%) lacked confirmation of 1st SBI. Among 113 in whom 2nd SBI dates were specified, 25 (23%) had SBI ≥3 months earlier than TR, 62 (55%) within 2 months of TR, 7 (6%) ≥3 months after TR, and 18 (16%) lacked confirmation of 2nd SBI. Among 71 patients for whom first medical oncology (MO) FU visit dates are known, 64 (90%) occurred within 3 months of TR and among 81 patients for whom first radiation oncology (RO) FU visit dates are known, 67 (83%) occurred within 3 months of TR. However, among 47 patients for whom first FU visit dates with at least 2 types of providers (MO, RO and/or surgery) are known, 15 (32%) visited 2 providers within 2 months of one other. During the 1styear after completion of primary therapy, 22% underwent body imaging (CT, PET-CT, or bone scan) and 21% had liver function tests. Conclusions: Despite provision of a SCP to patients, PCP were often not notified and healthcare utilization exceeded recommendations. Nearly a third of patients had redundant visits, a fourth had SBI earlier than recommended, and a fifth had body imaging and lab testing. Ongoing efforts are needed to coordinate care and minimize unnecessary testing in BC survivors.

Factors influencing implementation of a survivorship care plan\u2014a quantitative process evaluation of the ROGY Care trial

PurposeThe aim of this study is to investigate the factors that influence implementation of Survivorship Care Plans (SCPs) in the intervention arm of the ROGY Care trial by (1) assessing the level of SCP receipt in the ROGY Care trial and (2) identifying patient- and provider-level factors that influence SCP receipt.MethodsBetween 2011 and 2015, a pragmatic cluster randomized-controlled-trial was conducted on the effects of automatically generated SCPs. Endometrial (N = 117) and ovarian (N = 61) cancer patients were allocated to ‘SCP care’, as provided by their SCP care providers (N = 10). Associations between SCP receipt (self-reported SCP receipt and actually generated SCPs), patient-factors (socio-demographic-, clinical-, and personality factors), and care provider factors (profession and a-priori motivation regarding SCP provision) were tested in univariate analysis. The odds ratios of factors influencing self-reported SCP receipt were estimated with a multivariate regression model.ResultsOf all patients in the SCP care arm (N = 178), SCPs were generated by the care provider for 90 % of the patients and 70 % of the patients reported that they had received an SCP. Patients with older age, ovarian cancer, type D (distressed) personality, and patients that completed the questionnaire a longer period of time after the SCP consult were more likely to report no SCP receipt.ConclusionsSCP receipt was influenced by patient- but not care-provider factors.Implications for cancer survivorsCertain patient groups were less likely to report SCP receipt. Whether all patients are in need of an SCP, requires further investigation. If they do, more efforts need to be made towards the implementation of SCPs.

Abstract OT3-03-02: Assessment of cancer Concerns at the End of treatment (ACE): What do survivors need and want?

Abstract Discussion: There are over 14 million cancer survivors in the United States today and this population will continue to grow. Not only are survivors at risk for recurrence, but increasingly complex treatments place them at risk for a range of long-term and late effects. Provision of survivorship care plans (SCPs) at an end of treatment (EOT) visit that includes referrals to appropriate resources may be assumed to improve the care provided to survivors. There are, however, few relevant studies examining the outcomes of providing patients with referrals to resources identified through the completion of patient reported outcomes (PROs) reported in the literature. Current research has focused on documenting the frequency with which SCPs are provided and the perceived usefulness of these documents. Such data are a necessary but an insufficient step in the creation of practice guidelines in part guided by PROs, or standards of care that support the provision of SCPs. This study will provide a comprehensive description of breast cancer (BC) survivors' symptom burden and other concerns, as well as health behaviors as they enter the survivorship phase of care. These items will be evaluated by data generated by a pre visit PROs questionnaire completed through the patient portal. Significant symptoms and concerns will be addressed during a clinical encounter at the EOT visit. It will also describe referrals triggered by these data. Trial Design: Quasi-experimental single-group design with historical controls. Our study describes patient-reported symptom burden, desire for assistance, quality of life (QoL) and health behaviors of BC survivors who have completed initial treatment using a web-based platform to collect PRO data. As well, it estimates differences in referral and uptake between participants and historical controls. Eligibility Criteria: Survivors must understand English, have internet access and a working email address, and be age 18 years or older within 1 year of completing initial treatment (chemotherapy, radiotherapy, and/or surgery). Participants may still be receiving hormonal or targeted therapy. Specific Aims: 1) Describe physical and psychosocial PROs of BC survivors after completion of treatment so as to define targets and develop metrics for future intervention; 1A) examine diagnosis and treatment variables that moderate PROs; 2) determine provider satisfaction with a web based patient questionnaire that includes a summary of significant patient concerns; 3) estimate the impact of providing the summary of patient concerns on utilization of/referral to available services relative to historic controls. Statistical Methods: Parameter estimates with confidence intervals for concerns and desire for help. Bivariate associations between unmet needs and quality of life. Non-parametric comparison of referral patterns between ACE participants and historical controls. Present Accrual and Target: To date 107 BC survivors have consented to complete a self-report survey questionnaire prior to their scheduled EOT visit, 61 completed the survey, 28 pending a visit. Target 250. Citation Format: Jacobs LA, DeMichele A, Glanz K, Schapira M, Pucci DA, Blauch AN, Palmer SC. Assessment of cancer Concerns at the End of treatment (ACE): What do survivors need and want?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-03-02.

Developing electronic health record (EHR)-based program to deliver survivorship care plans (SCPs) and visits at the UW Breast Center.

56 Background: Accreditation guidelines require all breast cancer patients receive SCPs within 6 months of end of treatment (EOT) in 2016. SCPs require significant resources to provide, which EHR assistance might decrease. Our objective was to develop a standardized program for creating, providing, and tracking SCPs using an EHR. Methods: Clinicians and EHR analysts developed processes for implementing an EHR-based program, using our existing SCP to guide overall structure. We piloted this program 5/2015-6/2015 to identify barriers &amp; facilitators to creating EHR-based SCPs, providing EHR-based visits and EHR-based tracking of both. Results: The pilot included 24 patients (2% of annual volume). Facilitators were: 1) pre-entry of cancer history, 2) clearly defined responsibilities for SCP &amp; visit; barriers were: 3) no identified method to assess concerns or track referrals, 4) variability in EOT due to treatment heterogeneity, 5) limited time during routine follow up for SCP provision. The following changes were implemented: 1) SCP auto-population, requiring consensus on essential clinical data, 2) assigning staff roles (MD, NP/PA, RN) for all aspects of SCP creation &amp; visit provision; 3) creating 1-page survey addressing NCCN recommended topics to pre-screen for concerns discussed at SCP visit and using a visit template to track topics covered plus information and referrals provided, 4) establishing processes and delivery dates for SCP &amp; visit to newly diagnosed patients and 5) developing algorithms for referral for SCP &amp; visit (4-8 weeks from EOT) including adding “SCP visits” to EHR-chemotherapy plans and other auto-reminders. Clinic-wide implementation began 7/2015; updated results will include: EHR-tracked, provision rate, type and frequency of survivor concerns and referral patterns and time for SCP creation and visits. Survivor/clinician satisfaction with EHR-based program will also be included. Conclusions: EHR-based SCP creation, provision and tracking is feasible. Future plans include assessing time and personnel resources required, and comparing the accuracy of EHR-tracking with cancer registry data or other standards used to address guideline compliance.

Challenges in the implementation of survivorship care plans in an NCI-designated cancer center.

68 Background: The development and initiation of Survivorship Care Plans (SCPs) across all disease sites was identified as a Strategic Initiative Goals for 2015 by the Clinical Cancer Committee. The 2012 Commission on Cancer requirements for certification provided an additional incentive to meet this goal. Establishing a process that includes the development and distribution of a SCP’s within the electronic medical record (EMR) is necessary to improve on the completion of SCP’s and to improve the utilization of surveillance tests in cancer survivors. We describe the process developed at a free-standing NCI cancer center to meet the standard of SCP provision to all cancer patients. Methods: A multi-disciplinary subcommittee of the Cancer Committee was designated to develop the overall strategic plan for the implementation of this standard. It met with disease teams to facilitate a treatment summary from Cancer Registry data, identify patient reported symptoms using a self report tablet (SupportScreen). Electronic care plans were created using survivorship research program templates and ASCO framework for each disease site team. The disease team Nurse Care Coordinator inputs information into the eSCP. Results: Templates have been established within the EMR in the documents section under survivorship care plan title. These can be initiated and modified when the Nurse Care Coordinator chooses to start them. The disease teams have established their time points for SCP presentation to their patients. Using the cancer registry to provide data related to staging, treatments and genetic testing has helped minimize development time. Individual survivor’s concerns will be reflected in patient reports and physician symptom documentation. This eSCP completion process is a pilot program within the breast cancer disease team and will be expanded to include patients with head &amp; neck and hematologic malignancies with a goal of including all patients by mid 2016. Conclusions: The goal of improving survivorship care coordination and compliance with surveillance guidelines is challenging. Maximizing available interdisciplinary resources has helped to create a viable Survivorship Care plan at our institution.

Completeness and accuracy of survivorship care plans (SCPs) prepared via two methods: Electronic health record (EHR) auto-population versus manual data entry.

62 Background: To improve care for side effects and coordinate follow up, SCPs should correctly and thoroughly report details regarding diagnosis and treatment. However, literature is lacking regarding SCP accuracy and completeness. We audited SCPs for errors and omissions, as part of a clinical trial conducted at two cancer centers. Methods: SCPs were prepared for Stage 0-3 breast cancer patients by 1 of 2 methods, which was based on the standard of care at each center: 1) EHR-based: auto-populated using data entered into the EHR by oncologists for clinical use. SCP finalized by oncologist or advanced practice provider; and 2) Manual entry: prepared by an RN using manual transfer of clinical data into software program. Each participant’s clinical data was abstracted from her chart, with audit and cross-check against each SCP. In the case of discrepancies, oncologists reviewed the chart and adjudicated the “correct” information, as well as completeness and error. Omissions were defined by missing SCP information required per IOM recommendations; errors were defined as data reported in the SCP that did not match the chart. Results: Two sites enrolled 128 women between 11/2013-12/2014; 80 received EHR-based vs 41 manual SCPs. Omissions: 24 (30%) EHR-based versus 6 (15%) manual SCPs contained at least 1 omission. Omissions included failure to provide some dates and specific axillary surgery type (sentinel vs axillary) for EHR-based SCPs and failure to specify receptors for manual SCPs. Errors: 7 (9%) EHR-based versus 19 (46%) manual SCPs contained at least one error. The majority of EHR-based SCP errors were minor discrepancies in dates. Errors in manual SCPs included chemotherapy regimen, incorrect receptors, incorrect stage and axillary surgeries; stage and surgery errors were affected by poor fit with templated SCP fields. Conclusions: Little is known about SCP accuracy and completeness. Manually prepared SCPs may have a higher rate of errors while EHR-based SCPs may have more omissions. Differences in preparation (site, training of preparer) could also account for these differences. In an era of required SCP provision, measures of SCP quality should be considered.

Criteria for Evaluation of Breast Cancer Survivorship Care Plans

Survivorship care plans are comprehensive, individualized documents that are recommended for all cancer survivors by the Institute of Medicine, and soon to be required by the Commission on Cancer. Breast cancer survivors are in many ways an ideal population for provision of survivorship care plans due to prominence within the survivorship population, relatively well-understood risk for late effects, data supporting improved outcomes with aggressive survivorship management and general interest within the population. Care plans that are provided must be of excellent quality in order to provide benefit, and quality should be measured with regard to content accuracy and language, customized information, completeness, applicability to diverse user groups and feasibility.

Abstract P1-09-15: Randomized clinical trial assessing the impact of survivorship care plans on survivor knowledge

Abstract Purpose: Efforts to inform survivors about long-term risks and planned follow-up after cancer treatment have increased. Survivorship Care Plans (SCPs) and care planning sessions have been recommended since 2005, yet the benefits of both SCP provision and care planning are only now being assessed. The impact of SCPs separate from care planning sessions is unclear, however SCPs alone require less time and cost to provide than SCPs combined with care planning sessions. We hypothesized that SCPs alone might enhance patient knowledge. In a randomized trial, we assessed change in patient knowledge of diagnosis, treatment, late/chronic side effects and followup care pre and post receipt of SCP. Methods: Patients who completed primary treatment within the past 2 years for Stage 0-3 breast cancer were consented, enrolled, and randomized to immediate (intervention) versus delayed receipt (control) of an individualized SCP without care planning. All participants completed the Wisconsin Survey of DiagnOsis and Management in Breast cancer (WiSDOM-B), a test of knowledge about one’s own breast cancer diagnosis, treatment and late effects scored out of 40 points. The survey was completed at both baseline and at four weeks (prior to delayed receipt); the primary outcome was change in score. The study was designed with 90% power to detect a between-group difference of 4 points (out of 40 possible). Results: Between November 2013 and March 2014, we recruited 64 women aged 36-78 with Stage 0-3 breast cancer. Most participants were Stage 1-2 (n=50, 79%) with n=7 (10.9%) in Stage 3. Most had received chemotherapy (62.5%), endocrine therapy (89.1%), or radiation (76.6%). At baseline, the average WiSDOM-B score was 28.3 out of 40 (70.8%), range 15.5-38.5. There was no evidence of change in score from baseline to four weeks for either the immediate SCP group (+0.41, 95% CI [-0.97,+1.79]) or delayed receipt control group (+0.95, 95% CI [-0.48,2.38]). Observed variation was consistent with sample size assumptions, and the observed treatment difference (-0.55, 95% CI [-2.53,1.44], p=n.s.) ruled out the prespecified clinically significant effect size of +4.0 (+10%). Overall, participants scored better on questions testing knowledge of diagnosis (side, year of diagnosis, lymph node test results, receptor status, and stage) and surgical side effects than on questions testing knowledge of other treatment (chemotherapy, radiation or endocrine therapy) side effects. Participant satisfaction with knowledge and care team communication was collected pre and post SCP, as well as feedback on SCP content and use of the SCP. These and analyses of selected questions shown to change post SCP by Nissen et al will also be presented. Conclusion: In a controlled, randomized clinical trial, receipt of a SCP without care planning sessions did not appear to significantly increase survivor knowledge about cancer diagnosis, treatment and followup as assessed by the WiSDOM-B survey. Efforts to improve survivor knowledge should investigate the impact of care planning sessions or other interactive health information tools. A second study of patients (n=64) randomized to immediate or delayed receipt of SCPs, in conjunction with care planning sessions, is currently enrolling. Citation Format: Amye J Tevaarwerk, Kevin A Buhr, Kari B Wisinski, Mark Burkard, Mindy Gribble, Willam Hocking, Wenjun Sun, SarahMaria Donohue, Jamie Zeal, Abigail Terhaar, Douglas A Wiegman, Mary E Sesto. Randomized clinical trial assessing the impact of survivorship care plans on survivor knowledge [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-15.

The need for focus on outcomes and the role of informatics.

The need for focus on outcomes and the role of informatics.

Use of Survivorship Care Plans in the United States: Associations With Survivorship Care

Survivorship care plans (SCPs), including a treatment summary and follow-up plan, intend to promote coordination of posttreatment cancer care; yet, little is known about the provision of these documents by oncologists to primary care physicians (PCPs). This study compared self-reported oncologist provision and PCP receipt of treatment summaries and follow-up plans, characterized oncologists who reported consistent provision of these documents to PCPs, and examined associations between PCP receipt of these documents and survivorship care. A nationally representative sample of medical oncologists (n = 1130) and PCPs (n = 1020) were surveyed regarding follow-up care for breast and colon cancer survivors. All statistical tests were two-sided. Multivariable regression models identified factors associated with oncologist provision of treatment summaries and SCPs to PCPs (always/almost always vs less frequent). Nearly half of oncologists reported always/almost always providing treatment summaries, whereas 20.2% reported always/almost always providing SCPs (treatment summary + follow-up plan). Approximately one-third of PCPs indicated always/almost always receiving treatment summaries; 13.4% reported always/almost always receiving SCPs. Oncologists who reported training in late- and long-term effects of cancer and use of electronic medical records were more likely to report SCP provision (P < .05). PCP receipt of SCPs was associated with better PCP-reported care coordination, physician-physician communication, and confidence in survivorship care knowledge compared to receipt of neither treatment summaries nor SCPs (P < .05). Providing SCPs to PCPs may enhance survivorship care coordination, physician-physician communication, and PCP confidence. However, considerable progress will be necessary to achieve implementation of sharing SCPs among oncologists and PCPs.