Implementing Cancer Survivorship Care Planning Workshop Summary (2007) / Chapter Skim
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3 Perspectives on Suvivorship Care Planning
3 Perspectives on Suvivorship Care Planning
Pages 31-63
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From page 31... ...
commissioned work from three qualitative research groups: 1. Rebecca Day and Reynolds Kinzey of Kinzey & Day Market Research conducted focus groups among cancer survivors.
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Reynolds Kinzey Three focus groups were conducted among cancer survivors to learn more about follow-up care that is currently being provided, levels of satisfaction with posttreatment care, receptivity to the concept of a Survivorship Care Plan, and reactions to a specific draft care plan template that would summarize a particular patient's cancer treatment and specify a plan for follow-up care (see draft template in Appendix E)
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From page 33... ...
I felt like I was just dropped." Reactions to Survivorship Care Plans Participants in all three groups expressed a great desire for a written follow-up plan. Only one or two members in the three groups had received
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From page 34... ...
Most participants said that their primary care physicians were not very involved with their follow-up care, and virtually none was using oncology nurses or social workers for follow-up care (some said that oncology nurses had been extremely helpful during their active treatment, but not with follow-up)
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From page 35... ...
The proposed template appears to be on target both in terms of organization and format, although it should use a more descriptive title, such as Follow-Up Care Plan for Cancer Patients. The more individualized and personalized the care plan is for the patient, the more helpful it will be.
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From page 36... ...
If nurses are to be compensated for some aspects of survivorship care planning, there will have to be acceptance of such involvement on the part of hospital administrators and office-based physicians. About half of the nurses worked in environments in which electronic medical records were in use.
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From page 37... ...
In some cases, the volume of survivors in their active treatment clinics necessitated the development of survivorship programs because the medical staff could not handle both survivors and their patients in active treatment. Nurses Perceptions of Survivors' Needs Nurses observed that patients often felt abandoned or "cut loose" following their treatment and were often uncertain and anxious about what was going to happen next and who should be seen for various aspects of their care.
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From page 38... ...
Some patients really look forward to their last treatment but then feel anxious because they sense that the treatment has been "keeping them going." These anxieties relate to not being able to do something active at that point. Nursing Roles in Survivorship Nurses in the groups believed that they could develop and deliver survivorship care plans from the materials they had available to them and the experiences they had with their patients.
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From page 39... ...
Components of the Care Plan Participants in the focus groups were asked to itemize important elements of survivorship care plans before they were shown an example of a care plan template. Their suggestions, summarized in Box 3-1, included a plan for surveillance, the postrecovery treatment period, and the long term.
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From page 40... ...
Alternatively, having the guidelines embedded in an online survivorship plan template would ease access to the latest guidelines. Nurses suggested that the care plan be viewed as an active and not a static document and felt that, given the rapid pace of advancement in oncology, the plan would need to be updated at least annually or when the patient's disease status changed.
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From page 41... ...
The ability to implement survivorship care planning into practice will also depend heavily on having access to support services for patients, for example, social workers, nutritionists, and financial counselors. Nurses concluded that they could assume an active role in care planning only if additional resources are allocated and practice patterns change to accommodate survivorship visits.
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PERSPECTIVES OF PRIMARY CARE PHYSICIANS AND ONCOLOGISTS Presenter: Ms. Annette Bamundo To gain the perspectives of physicians on survivorship care planning, 20 in-depth interviews were conducted among oncologists4 and two focus group sessions were conducted among primary care physicians.5 In-depth interviews were conducted with oncology providers because it was felt that they would probably have the primary responsibility of creating and administering the care plan.
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From page 43... ...
According to the practice patterns described by oncology and primary care physicians, there appears to be a duplication of effort, rather than a breakdown in effort, to ensure that cancer patients remain cancer free. Contrary to previously held assumptions, oncology providers report rarely discharging their cancer patients to their primary care physicians for follow-up after active treatment.
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From page 44... ...
While primary care physicians recognize the psychological stress of dealing with cancer and try to broach this subject, they are inundated with work and may not have sufficient time to address their patients' concerns. Oncology providers report that they do not broach the subject of follow-up until the patient has come back after the last acute treatment.
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From page 45... ...
Reactions to the Concept of a Survivorship Care Plan The oncology providers and primary care physicians generally agreed that cancer patients and their primary care physicians would benefit greatly if a summary of the patient's diagnosis, acute treatment, and follow-up plan was provided. However, oncology providers were not inclined to provide such a summary.
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From page 46... ...
Although oncology providers acknowledged that possession of a care plan could be beneficial to cancer patients, some said that they would not give it to all of their patients. There was a concern that certain cancer patients, who are exceedingly anxious or fearful, could become more so if they were given a document that spells out the possibility of recurrence, the long-term effects of the cancer or treatment, and symptoms that they should be aware of.
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From page 47... ...
Oncology providers view it as their prerogative, in fact their responsibility, to alter recommended guidelines for cancer patients' acute and follow-up treatment. Therefore, embedding the recommended guidelines into the care plan template (for example, as dropdown options)
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Overcoming Oncology Providers' Resistance Several factors may have to work in tandem to overcome oncology providers' reluctance to create a document that summarizes a patient's diagnosis and the acute and follow-up plan of treatment. Oncology providers' reluctance to provide this summary may be overcome if: · primary care physicians encourage them to do so.
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From page 49... ...
· steps are taken to encourage designers of electronic medical records software to develop packages that allow for the creation of the document with minimal effort. On the basis of the above criteria, both short-term and long-term strategies are needed to move toward implementing survivorship care planning.
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From page 50... ...
Barriers that have been mentioned are provider time and reimbursement, but the importance of buy-in from patients is critical. She noted that the absence of good-quality care for most cancer survivors needs to be acknowledged and that this was not surprising because there is virtually no one trained to provide good long-term survivor care.
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Dr. Lari Wenzel, from her perspective as a psychologist at the University of California, Irvine, commented on the apparent disconnect observed in the qualitative research between the survivors indicating that their psychological concerns were paramount and the oncology physicians, who, while recognizing these concerns as important, generally wanted to eliminate psychosocial content from the summary care plan template.
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Mr. Richard Boyajian of Dana-Farber Cancer Institute suggested that there will have to be compromise in order to move forward with care planning.
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, emphasized how important a team approach is to the success of survivorship care planning. Social workers are professionally trained, skilled in counseling, and familiar with available community resources.
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She noted that the Children's Oncology Group (COG) model uses nurses extensively in survivorship care planning.
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Members of Group 2 thought that a single template could meet the needs of cancer survivors if there were sufficient adjunctive and supportive materials that would make the plan appropriate and meaningful to the patients and the primary care providers who would use it. Several group members felt strongly that the care plan template should be used at the onset of care, starting with diagnosis and leading up to the handoff at the end of cancer treatment.
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From page 56... ...
With general agreement on the merits of a standardized template, Dr. Greenfield cautioned that, in order for implementation of survivorship care planning to proceed, there will have to be some compromise on this standard.
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Dr. Ferrell raised a concern that, in addition to psychosocial issues, symptom management has not received sufficient attention in developing survivorship care plans.
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The responsibility for completing the plan will probably rest with some combination of the physician and the nursing staff. The group did not think that primary care physicians or other individuals involved in the patient's care could complete the care plan because of their more limited access to diagnostic and treatment information.
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Ms. Mary McCabe reported on experience with survivorship care planning at Memorial Sloan-Kettering Cancer Center in New York City.
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He asked, "If the care plan is developed by the physician responsible for oncology care, should the primary care physician be required to respond in some kind of formal way to indicate his or her agreement with the plan and commitment to implement its recommendations?
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Dr. Ross Martin of Pfizer Human Health advised workshop participants to focus on electronic health records as an endpoint solution to survivorship care planning.
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A minimum standard, not the best that there could be, should be designated for the treatment summary and the prospective care plan. To expedite care planning, group members thought that starting with a few cancers, for example, breast and colon cancer, would be advisable because surveillance and risk guidelines are already available.
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From page 63... ...
Ms. Pamela Haylock mentioned the American College of Surgeons' Commission on Cancer surveys as an opportunity to assess care planning in hospital-based cancer programs.
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