Delivery Of Survivorship Care Plans Research Articles

Implementation of survivorship care plans in the pediatric oncology clinic.

55 Background: Quality survivorship care and follow up have been well described in the pediatric oncology population to improve overall health of cancer survivors. Typically, a key component is the delivery of a survivorship care plan (SCP) in a dedicated survivorship program. Creation of an SCP in the immediate post-treatment period has not been commonly adopted. To address the Commission on Cancer's (CoC) requirement to provide SCPs within six months of ending therapy, our pediatric oncology clinic has used quality improvement (QI) methods to incorporate SCPs into clinic workflow with subsequent survivorship program referral. Our aim is to meet the CoC’s benchmark of 50% of eligible patients receiving SCPs by December 31, 2017. Our secondary goal is to improve the timeliness of delivery to patients, families, and primary care providers (PCP). Methods: Registry data from our cancer center was utilized to identify eligible patients. Upcoming appointments were then identified for a panel of eligible patients using the electronic medical record (EMR). Providers use a standardized SCP template which includes the components required by the CoC. The SCP is then reviewed with families, electronically sent to the PCP, and saved in the EMR. Evaluation of the process included subjective feedback from providers and Plan-Do-Study-Act cycles. Based on this feedback and cycles, iterations of the template have been progressively streamlined and the EMR panel has been updated. Results: Care plan creation and delivery is ongoing. At baseline, 28% of eligible patients had SCPs previously created in the survivorship program. After implementation of our QI methods, to date, we have increased the proportion of eligible patients with an SCP to 40.3%, approaching our goal of 50% by December 31, 2017. We have also decreased the time from end of therapy to delivery of a care plan from 22.9 months to 14 months. This is expected to further improve as the process continues. Conclusions: The QI process has been successful in implementing a new standard of care for delivery of SCPs. Ongoing use of QI methods will increase compliance with the CoC standards and result in improved survivorship care.

Integrating survivorship care planning in radiation oncology workflow.

Various groups, including the American College of Surgeons' Commission on Cancer and the National Accreditation Program for Breast Centers, are mandating the provision of a survivorship care plan (SCP) to cancer survivors who have completed curative-intent treatment as a requirement for oncology practice accreditation. This article reviews the development of survivorship care, including survivorship care in radiation oncology. Challenges of developing treatment summaries and SCPs and implementing their delivery are explored. Details of the article include how the University of Wisconsin Health radiation oncology department integrated a survivorship visit into the existing radiation oncology workflow. Oncology practices may benefit from the model described here to meet accreditation requirements for SCP delivery to cancer survivors.

Cancer survivorship care plans: Processes, effective strategies, and challenges in a Northern Plains rural state.

Health systems face resource and time barriers to developing and implementing cancer survivorship care plans (SCPs) when active cancer treatment is completed. To address this problem, the South Dakota (SD) Department of Health partnered with two of SD's largest health systems to create the SD Survivorship Program. The purpose of this program evaluation study was to describe and compare SCP development and implementation at the two health systems. A descriptive qualitative design was used. Interview participants were instrumental in the development and implementation of SCPs within their respective health system. Content analysis was used to analyze the interview data. The two health systems used similar processes for (a) early designation of program personnel, (b) developing SCP templates, (c) provider/staff input, and (d) identifying/tracking eligible patients. In contrast, they developed differing processes for SCP completion and delivery. The two health systems also identified effective strategies and challenges in SCP development and implementation. This evaluation suggests that partnerships between state health departments and local health systems could be key for meeting the nation-wide goal of universal SCP implementation. Particularly, other low-population rural states like SD can use the findings to help build their SCP programs.

Abstract P6-12-10: The importance of a survivorship coordinator role in the creation of survivorship care plans and maintaining compliance with new accreditation standards

Abstract Background: Froedtert Hospital and the Medical College of Wisconsin's Breast Care Center (F&MCWBCC), is a Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC) accredited facility providing care to over 500 patients a year. The F&MCWBCC recognized the importance of following the IOM survivorship recommendations and in 2014 began providing a survivorship care plan (SCP) to patients completing radiation therapy. In 2015, SCP standards for both CoC and NAPBC were established. A redesign of the process was necessary to meet these new requirements. Methods: A review of accreditation standards was conducted along with an examination of staff availability. A collaborative team of content experts was gathered who worked with an informatics nurse to design content and a template in the EHR that met the elements outlined by the accreditation standards. Initially, treating physicians and advanced practice nurses were responsible for creating the SCP. However, these providers found it to be increasingly difficult to manage on top of their other responsibilities. In May 2015, an experienced breast cancer technician was identified for the survivorship data coordinator role. The coordinator used available sources, patient lists and clinic schedules, to case find. She developed spreadsheets to assist in tracking patients and measuring compliance. The coordinator communicated with providers to alert them to populate and review the SCP and coordinated the survivorship appointment with the nurse. Once the SCP is completed, a dedicated RN position is utilized for a survivorship visit with patients. During this visit, the RN reviews the care plan and provides education on follow up care guidelines and overall health and wellness concepts. Assessments for further supportive services are performed, and appropriate referrals made. The RN shares the SCP with the primary care provider. Results are tracked and reported to Cancer Service Line Leadership and the Breast Steering and Cancer Committees. Results: During the implementation phase, completion of SCPs by physicians and advance practice nurses was inconsistent. Once the survivorship coordinator role was created and implemented, compliance with NAPBC standards improved as SCP delivery numbers increased 141%. The survivorship coordinator improved delivery of SCPs. In 2014, 130 plans were delivered, and 185 in 2015. In 2016, 314 were delivered, achieving 100% compliance to the NAPBC survivorship standard. Conclusion:Compliance with NAPBC and CoC standards to deliver SCPs to patients and primary care providers is labor intensive and requires a large number of resources. Use of a survivorship data coordinator has proven successful in determining and tracking eligible patients and ensuring timely delivery of SCPs to patients. The monitoring of new patients through this process has enabled this center to go from estimates of analytic cases, to a current real-time numbers. This is necessary to provide a comprehensive review of care and survivorship guidelines to cancer survivors and meeting accreditation standards. Further work is needed to assess the impact of the SCPs on patient outcomes and satisfaction. Citation Format: Blissitt J, Scalio R, Myers KB, Sweeney K, Kelly TR, Kong A, Chitambar C, Currey AD. The importance of a survivorship coordinator role in the creation of survivorship care plans and maintaining compliance with new accreditation standards [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-10.

Survivorship needs after head and neck cancer treatment.

10062 Background: Head and neck cancer (HNC) survivors experience significant sequelae of treatment, including long-term physical side effects and ongoing surveillance for recurrence and secondary malignancy. Given the complicated trajectory of HNC survivors, survivorship care plans educating patients and their caregivers about treatment and recovery may be beneficial. However, little is known about patients’ knowledge gaps related to survivor issues. Methods: Through a prospective anonymous self-administered survey, we evaluated the baseline knowledge of HNC survivors regarding common post-treatment issues and mediating factors. Forty-one HNC patients within 3 months of completing treatment participated between July-November 2016. Descriptive statistics were used to characterize patient responses. Results: Patients had undergone a variety of treatment modalities: radiation (97%), chemotherapy (71%), and surgery (39%). 85% of patients had primary care providers, 56% had regular dental care, and 44% had dental insurance. 78% had caregivers. HNC survivors’ correct responses to side-effect (SE) knowledge questions were lowest for items regarding hearing loss (15%), sleep (33%), tiredness (38%), and anxiety (49%). Only 28% correctly identified cancer risk with alcohol intake. 87% correctly linked tobacco products to cancer recurrence. Patients were most interested in learning via discussions with nurse or doctor (76%) followed by reading written materials (61%), and researching online (32%). Most patients desired to learn more about their cancer (73%), short-term SE (80%), and long-term SE (77%). Conclusions: Our study demonstrated clear gaps in knowledge and healthcare access that may inform targeted, individualized survivorship care plans. Patients had the largest knowledge deficits for alcohol use and recurrence, hearing loss after treatment, and a variety of emotional effects of cancer treatment. These topics should be addressed during delivery of survivorship care plans and surveillance encounters to improve survivorship knowledge.

What do social media-savvy cancer survivors tell us about the completeness of survivorship care plans?

10063 Background: The Commission on Cancer (CoC) standard 3.3 became effective in 1/2015 requiring the delivery of a survivorship care plan (SCP) at the completion of curative treatment. Both the CoC and ASCO have recommended minimum requirements for SCPs, which should include both a treatment summary and follow up care plan. Many cancer patients use social media (SM) as a way to obtain support and information. We have shown previously that the majority of SM savvy cancer survivors (88.2%) do not receive SCPs ( J Clin Oncol 35, 2017 suppl 5S; abstr 104). We sought to determine the contents of the SCPs received. Methods: An IRB-approved survey was conducted via the online tool SurveyMonkey from 3/21/2016 to 4/2/2016. Patients were invited to participate via SM outlets reaching cancer-related communities including Twitter chats, Facebook groups, blogs, and targeted emails. Results: A total of 312 patients responded. 63% (194) had completed curative treatment (excluding endocrine therapy). Of these 11.8% (23) reported receiving an SCP at the end of treatment. Of 22 patients who responded, 9/22 (40.9%) found the SCP helpful, 11/22 (50.0%) somewhat helpful, and 2/22 (9.1%) not helpful. The table below shows the components of those SCPs received. Conclusions: Not only did a small percentage of patients receive SCPs but also no patient received a complete SCP per the CoC and ASCO recommendations. Particularly deficient was a description of late/long-term effects of treatment—only 36% received such information. Challenges exist in the delivery of complete SCPs. [Table: see text]

Hard-wiring survivorship care plan delivery.

113 Background: As outlined by the Institute of Medicine (IOM) report, ASCO, the Commission on Cancer, survivorship care planning is an essential part of quality cancer care. Meeting SCP delivery standards is a challenge due to complex systems, difficulty identifying eligible patients, lack of clarity around roles and responsibilities, and time required to complete the care plans. Yale Cancer Center/Smilow Cancer Hospital is a NCI-designated comprehensive cancer center with 12 multidisciplinary cancer programs, a large cancer hospital and 10 care centers in the community. We have approximately 4000 early stage analytic cases per year. We set out to standardize SCP delivery. Methods: A group of multidisciplinary stakeholders convened to outline goals and identify needs. Based on gap analysis and review of national standards, a standard operating procedure for the creation and delivery of SCPs was developed. Models of care were outlined in the policy. Disease specific treatment summary and care plan templates for the most common cancer types were developed within our electronic medical record (EMR) based on ASCO standards and were vetted by disease team experts. The templates were built to minimize the need for manual entry of content. Automated alerts were developed within the EMR to trigger identification of eligible patients. An operational plan was developed for each clinical area to outline responsibilities for care plan creation and delivery. Results: Implementation of model survivorship care within each disease team and community site was performed over a period of one year. The number of care plans delivered has already increased by 20%. At least 10% of early stage analytic cases received SCPs in 2015. Conclusions: Meeting SCP standards in a large, single institution can be challenging. With a standard operating procedure, clear delineation of responsibility within teams, disease specific templates, and EMR tools to trigger visits, meeting these standards becomes an achievable goal. A systematic approach to developing comprehensive survivorship care in a large academic center can hardwire high quality patient care and compliance with standards.

Development and implementation of an electronic measurement process for survivorship care plan dissemination and compliance.

67 Background: Cancer programs must comply with survivorship care plan (SCP) delivery by 2018 to maintain or achieve Commission on Cancer (CoC) accreditation. Barriers to measuring and tracking SCP compliance include insufficient staffing to facilitate the documentation and input of data, lack of electronic medical record automation methods, lack of interoperability and electronic health record reporting processes. In June 2016, The Greenville Health System-GHS Cancer Institute Center for Integrative Oncology and Survivorship-CIOS developed a process to record, measure and track the number of SCP delivery visits delivered to Cancer Survivors. Methods: A patient who attends an SCP visit sees a provider in collaboration with a nurse navigator. The provider explains the elements within the patient’s SCP document. A copy is provided to the patient. The SCP document is embedded within the providers note for the SCP visit. To document the visit and delivery of the SCP, the nurse navigator clicks the “complete SCP visit” button located in the patient’s EMR. The SCP button also identifies the name of the provider and whether the SCP was complete or incomplete. This action in the EMR enables the creation of reports that record and document SCP delivery. Results: Four weeks were chosen during the initial implementation period to evaluate use of the SCP delivery button. For each visit provided, the SCP delivery button was clicked documenting the delivery of the SCP. The weekly data for #SCP deliveries documented and total #SCP visits are: Week 1, 17 of 22 (77%); Week 2, 16 of 17 (94%); Week 3, 13 of 13 SCP (100%); Week 4, 12 of 12 SCP (100%). Of the 64 SCP’s, 42 were complete and 22 incomplete. Conclusions: The development of the electronic measurement process for survivorship care plan delivery has significantly increased efficiency of reporting and has decreased time spent on chart audits.

Survivorship care plan (SCP) program development within a large hospital network.

42 Background: Barriers to SCP delivery are pervasive, with limited data available on strategies to address implementation barriers. Despite the variety of models for SCP-based survivorship care planning, there is a dearth of studies on SCP program development for larger hospital networks. Large networked hospital systems, including the Levine Cancer Institute (LCI), have unique challenges for implementing a SCP program. Methods: Beginning in 2014, LCI implemented a process for delivery of SCPs across its network of 8 Commission on Cancer accredited hospitals. Obstacles to implementation were evaluated and methods of establishing procedures for insuring SCP delivery were reviewed. Improvement in SCP delivery was measured over 3 years. SCP program development involved leveraging technology, developing processes for identifying eligible survivors, and engaging providers and practice managers in this key organizational initiative. Results: In 2014, the SCP program consisted of 3 advanced care providers (ACPs) in 3 LCI medical oncology clinics, delivering SCPs to 67 (2%) of the eligible 3,336 survivors. In the second year of implementation, 14 ACPs and 4 MDs delivered 348 (11%) SCPs to eligible survivors in 14 LCI clinics. By the end of the 2016 calendar year, it is estimated that > 1,029 SCPs ( > 25%) of eligible survivors will receive a SCP throughout the LCI hospital network. Conclusions: While challenging to deliver, SCPs are important both for cancer program accreditation and for communication between patients and physicians. At its large, multi-center cancer program, LCI has implemented a number of methods and protocols to insure that eligible patients receive informative and timely SCPs. LCI’s processes have resulted in an improvement in the number of SCPs delivered and have also served to eliminate obstacles to increasing the number of SCPs that will be delivered in the future. It is recommended that oncology practices consider the methods and interventions that LCI found helpful to improve SCP delivery in large hospital networks. It is also encouraged that oncology practices to continue to share their methods with other centers to promote eventual SCP delivery to eligible survivors.

Use of telemedicine in the delivery of survivorship care plans among breast cancer survivors: Lessons learned at Kaiser Permanente East Bay.

77 Background: Beginning in 2015, the National Accreditation Program for Breast Centers (NAPBC) requires accredited facilities to provide Survivorship Care Plans (SCP) to breast cancer patients treated with curative intent. Here we describe lessons learned with the use of telemedicine in the delivery of SCPs at Kaiser Permanente East Bay. Methods: SCP implementation followed a two-step process: patients who are diagnosed and complete treatment in 2016 are given a SCP at their last surgical or medical oncology appointment (YTD, n=8); 2) patients diagnosed in 2015 who completed treatment in 2015-2016 were contacted by a physician assistant and offered an appointment by telephone or in-person to deliver the care plan (n=152). Both clinic and telemedicine appointments consist of a detailed review of treatment received, post-treatment follow-up care, discussion of health education resources, and provision of referrals as appropriate. Patients also have the opportunity to ask questions about treatment and follow-up care. Results: Among patients diagnosed in 2015 who were offered a TAV or in-person visit, 44.0% preferred a telephone appointment. Actual appointment duration ranged from 10 to 30 minutes. Lack of co-payment and fees associated with transportation as well as loss of income due to taking time off work were the primary factors cited choosing telemedicine over in-person clinic appointments. Interestingly, no differences in member satisfaction scores for in-person vs. telephone visits were observed. Conclusions: Findings suggest telemedicine may be effective in the delivery of SCPs. Similar to rural settings, use of telemedicine in urban settings has a unique capacity to increase service to breast cancer patients.

From common sense to evidence-based: An evaluation of survivorship planning.

76 Background: The Institute of Medicine’s (IOM; 2005) seminal report, From Cancer Patient to Cancer Survivor: Lost in Transition, recommended survivorship care plans (SCPs) as a common sense approach to improve the care of cancer survivors. The American Society of Clinical Oncology (ASCO; Mayer et al., 2014) reiterated the importance of these plans and provided strategic guidance for their implementation. The American College of Surgeons’ Commission on Cancer requires SCP delivery from accredited cancer programs as of 2015. Despite the push from these organizations, SCPs remain understudied (Mayer, Birken, Check, & Chen, 2014). The impact of SCPs on patient outcomes is poorly understood. Additionally, there is limited data on patients’ preferences for SCPs. This evaluation describes the use and assessment of SCPs at six regional cancer centers in the Midwest. Methods: Feedback was collected from 30 cancer survivors after receipt of a SCP. Responses were collected with 22-item questionnaire. Outcomes included survivors’ satisfaction with the clarity and detail of SCPs, likelihood to use SCPs in the future, intention to share SCPs with other health care providers, and perceived knowledge about treatment and follow-up care. Results: Over 75% (n = 23) of survivors agreed that SCPs were easy to understand. Ninety-three percent (n = 28) of survivors indicated that SCPs contained the right amount of information. Fifty-three percent (n = 16) of survivors are very likely to use their SCP in the future, whereas 47% (n = 14) are somewhat likely to use their SCP in the future. The majority (77%; n = 23) of survivors intend to share their SCP with another health care provider. Ninety-seven percent (n = 29) of survivors felt more knowledge about their treatment and follow-up car as a result of receiving a SCP. Conclusions: This evaluation highlights the many benefits of SCPs for cancer survivors. Results suggest that SCPs educate survivors about their treatment and follow-up care. Additionally, results indicate that many survivors intend to share SCPs, perhaps allowing for better coordination between oncology and primary care. Further research is warranted on the adoption of healthy lifestyle behaviors and receipt of routine health care after delivery of SCPs.

Development of phase-specific breast cancer survivorship care plans (SCPs).

61 Background: There are nearly 3 million breast cancer (BC) survivors in the US. Among the recently diagnosed, accrediting organizations (e.g., Commission on Cancer) now require SCPs at the completion of curative therapy. Within the Oncology Care Model, the preparation and delivery of SCPs is recognized as one of the 13 quality metrics. SCPs, combining treatment summaries (TS) and follow-up care plans (FUCPs), assist patients and providers in the delivery of high quality long-term care. BC presents a unique challenge, as the risk of recurrence extends decades past initial treatment; adjuvant risk reduction may extend up to 15 years. Periodic FUCPs provide a mechanism to review updated information and may allow providers to catch up with longer term BC survivors whose care was delivered prior to SCPs. We explored the role of phase-specific SCPs within the heterogeneous BC survivor population. Methods: Oncologists and nurse practitioners (NPs) from the Breast Health and Survivorship Programs at Tufts MC, an academic medical center in Boston, and New England Cancer Specialists, a community-based private oncology practice in Maine--together caring for more than 2,000 BC survivors--convened to develop and test phase-specific survivorship tools. Using an adapted ASCO template for BC, TS were completed at the end of initial therapy by trained NPs. FUCPs for initial, 5-year, and 10-year visits were designed with clinical input, literature reviews, and existing guidelines. Results: FUCPs were pilot tested and refined before incorporation into the electronic health record. Further testing is planned to identify barriers to effective survivorship care, particularly involving documentation of changes in recommendations and the transition from oncologist to primary care physician. Conclusions: SCPs are critical for providing quality health care to BC survivors, but a single SCP, written at the conclusion of curative treatment, might not be sufficient to address changing needs of individuals as they progress through survivorship. Thus, phase-specific SCPs enable providers to focus on salient aspects of care that may change over time. Despite growing recognition of the value of SCPs, implementation remains a challenge across cancer programs.

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

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.

Is survivorship care plan discussion important to patients?

49 Background: The 2015 Commission on Cancer standard requires that cancer survivors receive a personalized survivorship care plan (SCP). There exists a gap in consistency of how and when this plan is delivered. There is a need to evaluate patient satisfaction with personalized care along with direct education regarding the SCP and follow up. The aim of the current study was to determine the 1) rate at which cancer survivors find in-person discussion of SCP helpful, and 2) the rate at which they find the in-person discussion more helpful than the alternatives. Methods: An anonymous questionnaire was routinely administered, for quality assurance purposes, to cancer patients who completed treatment in a radiation oncology setting at a NCI-Designated Cancer Center. The population consisted of survivors of breast, prostate, colon, anal, pancreatic, lung, and liver cancers. Patients were given the questionnaire at the conclusion of a survivorship visit with a nurse practitioner devoted to survivorship care. During the visit they received a SCP with full discussion and explanation of the content. The questionnaire asks two Yes/No questions: 1) Did you find the survivorship visit helpful and/or educational? 2) Was it more helpful to have the survivorship summary explained to you in person? Results: 71 survivorship visit patients were offered a questionnaire to complete at the end of their visit. 71 completed questionnaires were received from patients. Of these 71 questionnaires, 69/71 or 97% of responses were “yes” for question 1. For question 2, 68/71, or 96% of responses were “yes.” Conclusions: Our data show that the majority of patients are finding survivorship summaries to be a positive aspect of the care continuum. In addition, patients are also indicating that visits “in person,” with face-to-face explanation of survivorship summaries, are more helpful than receiving a summary without verbal involvement or explanation. These findings suggest that such in-person discussions could be considered important in quality cancer care. Future directions include investigating the effect of other individual, disease, or treatment characteristics on an individual’s preference for SCP delivery.

What do social media savvy cancer survivors tell us about the state of survivorship programs?

57 Background: Patients treated for cancer are surviving their disease in increasing numbers. The 2005 Institute of Medicine (IOM) report From Cancer Patient to Cancer Survivor - Lost in Transition resulted in a call to develop survivorship programs. The Commission on Cancer (CoC) standard 3.3 became effective in 1/2015 requiring the delivery of a survivorship care plan (SCP) at the completion of treatment. Many cancer patients use social media (SM) as a way to obtain support and information. We sought to determine if SM savvy patients have received a SCP. Methods: An IRB-approved survey was conducted via the online tool SurveyMonkey between 3/21/2016 and 4/2/2016. Patients were invited to participate via SM outlets reaching cancer-related communities including Twitter chats, Facebook groups, blogs, and targeted emails. Cochran-Armitage Trend test, exact version, was performed by year for % of survivors receiving a SCP. Results: A total of 312 patients responded. 63% had completed their treatment (excluding endocrine therapy). Of a total of 194 individuals only 11.8% (23) were given a SCP at the end of treatment. A breakdown by treatment completion year is given below. Of those who did not receive a care plan 65% (112/172) answered that it would still be helpful to receive one. Most SCPs (86%) were supplied in paper form. However, patient-reported preferences for SCP delivery were paper (50%), online patient portal (41%), and email (9%). Conclusions: Despite the IOM report and CoC standard 3.3, the majority of SM savvy cancer survivors (88.2%) do not receive SCPs. In the respondents to this survey, there was no significant increase from 2015 onwards, p = 0.11, confirming an Advisory Board survey that just over 1/3 of programs felt confident that they could implement 3.3 by 2015. The CoC has updated its standard such that 25% of eligible patients should receive a plan by 12/31/2016. According to these data, that goal of 25% may not be achieved. [Table: see text]

The Impact of Survivorship Care Planning on Patients, General Practitioners, and Hospital-Based Staff.

In 2005, the Institute of Medicine recommended that all cancer patients receive a survivorship care plan (SCP). Despite widespread support, few centers have routinely implemented them. Understanding of their impact is limited. The aims of this study were to examine the impact of SCP delivery on patients and healthcare professionals at an Australian comprehensive cancer center and determine enablers and barriers to implementation. Six groups were surveyed: (1) patients who had received SCPs; (2) nurse coordinators using SCPs, (3) general practitioners (primary care, GPs) of patients who had received SCPs, (4) clinical service chairs, (5) heads of allied health, and (6) nurse coordinators not using SCPs (nonengaged nurse coordinators). Groups 1 to 3 completed written questionnaires. Groups 4 to 6 participated in semistructured interviews. Fifty patients, 7 nurse coordinators, 18 GPs, 7 clinical service chairs, 4 heads of allied health, and 8 nonengaged nurse coordinators participated. Eighty-seven percent of patients considered the SCP to be very or somewhat useful; 50% felt it helped them understand their cancer experience. All engaged nurse coordinators reported SCPs to be very or somewhat useful, and 86% believed SCPs improved communication with GPs. General practitioners felt SCPs were very or somewhat useful (67%) and wished to receive SCPs for future patients (83%). Organizational and clinical leadership, multidisciplinary engagement, resourcing, and timing of SCP delivery were considered critical enablers. Patients and healthcare professionals support the use of SCPs; however, they are resource intensive and require significant organizational support. Nurses are instrumental to SCP implementation. Attention to enablers and barriers is important for successful implementation.

Using Survivorship Care Plans to Enhance Communication and Cancer Care Coordination: Results of a Pilot Study

To compare a structured cancer survivorship care plan (SCP) transition visit versus an SCP transition visit coupled with a coordinated follow-up visit from the primary care provider (PCP). . Pilot randomized, controlled study. . REX Cancer Hospital, a community cancer center in Raleigh, North Carolina. . 34 adults completing treatment with curative intent. . Patients and PCPs completed measures at baseline and at six weeks. Wilcoxon signed rank and rank sum tests were used for comparisons of SCP only versus SCP with PCP follow-up visit, as well as between high- and low-activated patients. . Confidence in survivorship information and survivor concerns. . The intervention was feasible and acceptable to patients and their PCPs. All patients (N = 34) had less contradictory information about care after SCP receipt. PCPs reported improved confidence in patients, regardless of intervention arm. Highly activated or empowered patients benefited more and had increased confidence and fewer concerns about cancer care. . The SCP interventions led to increased confidence in survivorship information, but some benefits were greater for highly activated patients. PCPs also had improved confidence in survivorship care after SCP receipt, whether or not they saw the patient in follow-up. A larger study is needed to further explore these findings and the changes over time. . Nurses can be instrumental in facilitating the development and delivery of SCP to survivors and PCPs.

Creating Virtual Integration and Improved Oncology Care Quality Through a Co-Management Services Agreement

Implementation of a co-management services agreement (Co-MSA) creates agreed-upon cancer care delivery quality metrics, a forum for discussion of service line oversight, and virtually integrated care without institutional employment of oncologists. The goal of this project was to demonstrate that a Co-MSA improved predefined quality metrics and provided enhanced communications between a health system's oncology service line and a group of independent oncologists. Iterative planning discussions were scheduled biweekly over an 18-month period. Contractual, quality, and clinical data with benchmarking were considered in the creation of the Co-MSA. Review of the first year's implementation occurred through examination of the metric achievements and qualitative themes that arose through committee meetings, clinical implementation processes, and cross-organizational discussions. Metrics designed for the Co-MSA included improved adherence to the breast cancer, colon cancer, and non-small-cell lung cancer level I pathways; improvement of the medical oncology physician communication component of the hospital system's Hospital Consumer Assessment of Healthcare Providers and Systems survey scores; and increased delivery of survivorship care plans to appropriate patients. Nonquantifiable themes from the first year of implementation included the need for technology to collect data, both organizations needing a wider understanding of quality improvement techniques, and a need for greater executive leadership involvement. In its first year, the Co-MSA resulted in improvement of the delivery of survivorship care plans and adherence to value pathways powered by the National Comprehensive Cancer Network. Improvement of Hospital Consumer Assessment of Healthcare Providers and Systems scores did not occur.

Implementation of a novel application integrating cancer registry data into survivorship care plans.

10074Background: Survivorship care plans (SCP) are comprehensive plans that outline past, present, and future care goals for cancer survivors. As of 2015, delivery of SCP to 10% of eligible patient...

Survivorship care planning in a comprehensive cancer center using an implementation framework.

Cancer survivorship care plans (SCPs) have been recommended to improve clinical care and patient outcomes. Research is needed to establish their efficacy and identify best practices. Starting in 2015, centers accredited by the American College of Surgeons Commission on Cancer must deliver SCPs to patients completing primary cancer treatment with curative intent. We describe how we established routine SCP delivery at the Robert H Lurie Comprehensive Cancer Center in Chicago, Illinois, using the Quality Implementation Framework. We evaluated local practices, gathered clinician and patient stakeholder input, developed customized SCP templates within the electronic health record (EHR), and implemented 2 complementary delivery models. Clinician interviews (n = 41) and survey responses (n = 12), along with input from patients (n = 68) and a patient advisory board (n = 15), indicated support for SCPs and survivorship services. To promote feasible implementation and leverage existing workflows, we harmonized 2 SCP delivery models: integrated care within clinics where patients received treatment, and referral to a centralized survivorship clinic. We are implementing SCP delivery with prominent disease sites and will extend services to survivors of other cancers in the future. We developed four electronic disease-specific SCP templates for breast, colorectal, lung, and prostate cancers and a fifth, generic template that can be used for other malignancies. The templates reduced free-text clinician entry by auto-populating 20% of the fields from existing EHR data, and using drop-down menus for another 65%. Mean SCP completion time is 12 minutes (range, 10-15; n = 64). We designed our framework to facilitate ongoing evaluation of implementation and quality improvement. Funding/sponsorship Robert H Lurie Comprehensive Cancer Center, the Coleman Foundation, and the Lynn Sage Cancer Research Foundation.