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Peterson DE, Stout NL, Shulman LN, Perkins J, LeMarier G, Nekhlyudov L. Gaps in Access to Medically Necessary Dental Care for Patients Living With and Beyond Cancer: We Must Do Better. J Clin Oncol 2024; 42:2495-2499. [PMID: 38630949 DOI: 10.1200/jco.24.00162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 04/19/2024] Open
Abstract
Delivery of high-quality, evidence-based oral care for those living with and beyond cancer needed!
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Affiliation(s)
- Douglas E Peterson
- Department of Oral & Maxillofacial Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT
| | - Nicole L Stout
- School of Medicine, West Virginia University Cancer Institute, Morgantown, WV
- School of Public Health, West Virginia University, Morgantown, WV
| | - Lawrence N Shulman
- Center for Global Cancer Medicine, Innovation Faculty, Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Jennifer Perkins
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California San Francisco, San Francisco, CA
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Dixit N, Rodriguez G, Sarkar U, Burke N, Trejo E, Devore DJ, Couey P, Nápoles AM. Identifying the Needs of Primary Care Providers Caring for Breast and Colon Cancer Survivors in the Safety-Net: a Qualitative Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:845-853. [PMID: 35829986 PMCID: PMC10234859 DOI: 10.1007/s13187-022-02195-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 05/07/2023]
Abstract
As the number of cancer survivors continues to increase and given the shortage of oncology clinicians in safety net health care settings, primary care providers (PCPs) in these settings will increasingly provide cancer survivorship care. In order to ensure equitable care for low-income and underserved breast and colon cancer survivors, it is essential to understand the safety-net PCPs' perspective. We conducted semi-structured, in-depth qualitative interviews with 11 PCPs working in a safety-net health care system to identify their needs in caring for cancer survivors. Interviews were audio-recorded and professionally transcribed. Two coders independently coded the interviews and conducted regular meetings until we reached consensus on the results. Analysis was based in grounded theory and performed using the constant comparative method. Thematic analysis identified six themes as follows: (1) Cancer survivorship care can be integrated with the whole person and chronic disease care management that occurs in primary care; (2) PCPs' perceptions regarding patients' survivorship care needs and their confidence in meeting those needs; (3) preference for a shared care model; (4) coordination of care; (5) PCPs' need for survivorship care education and training; and (6) unique issues involved in the care of older cancer survivors. PCPs in the safety-net believe that providing comprehensive survivorship care requires coordination of care through the cancer continuum. Tools like checklists, electronic health records-based communication, and convenient electronic consultations with cancer specialists would enhance the quality of survivorship care. Respondents advocate the inclusion of survivorship care education in medical education. The continuity of care with PCPs means that they play a particularly important role in the care of older cancer survivors.
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Affiliation(s)
- Niharika Dixit
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Gladys Rodriguez
- Hematology/Oncology, Stanford School of Medicine, Palo Alto, CA, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Center for Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nancy Burke
- School of Social Sciences, Humanities, and Arts, University of California Merced, Merced, CA, USA
| | - Evelin Trejo
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Paul Couey
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Anna María Nápoles
- Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Ko E, Woodruff SI, Zúñiga ML, Cardenas V, Lizarraga M, Urias A. Culturally-tailored survivorship care planning for rural Latina breast cancer patients: a pilot study. J Psychosoc Oncol 2022; 41:475-486. [PMID: 36357323 PMCID: PMC10169530 DOI: 10.1080/07347332.2022.2141168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To explore the feasibility and acceptability of Proyecto Mariposa, a culturally-tailored survivorship care program for rural Latina breast cancer patients. DESIGN Single group mixed-method approach. METHODS Feasibility of recruitment, intervention and evaluation, and perceptions about the intervention were assessed with 18 rural Latina breast cancer patients from the US/Mexico border region. Pre-post assessments evaluated change in patients' knowledge and concerns about survivorship care, and their self-efficacy about patient-physician interaction and managing chronic disease. FINDINGS Feasibility was generally promising but affected by the COVID-19 outbreak. Participants found the intervention to be acceptable and useful, particularly with regard to information provision and encouraging proactive behavior. There was modest pre-post improvement on self-efficacy for managing disease. CONCLUSIONS This pilot study suggested feasibility and acceptability of Proyecto Mariposa for rural Latina breast cancer patients. Change in outcomes was small indicating the need for research with a larger sample to establish reliable findings.
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Affiliation(s)
- Eunjeong Ko
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Susan I Woodruff
- School of Social Work, San Diego State University, San Diego, CA, USA
| | | | - Veronica Cardenas
- Department of Psychiatry, University of California, San Diego, Moores Cancer Center, San Diego, CA, USA
| | | | - Aday Urias
- Cancer Resource Center of the Desert, El Centro, CA, USA
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Morken C, Tevaarwerk AJ, Juckett MB, Swiecichowski AK, Haine JE, Zhang X, Williams ZT, Norslien K, Campbell B, Wassenaar T, Sesto ME. Barriers and facilitators to the use of survivorship care plans by hematopoietic stem cell transplant survivors and clinicians. Support Care Cancer 2022; 30:1323-1330. [PMID: 34482447 PMCID: PMC8732291 DOI: 10.1007/s00520-021-06492-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/07/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Survivors of hematopoietic stem cell transplants (HSCT) have complex care needs for the remainder of their lives, known as the survivorship period. Survivorship care plans (SCPs) have been proposed to improve care coordination and ultimately survivorship outcomes. We explored the barriers and facilitators of SCP use among HSCT survivors and their clinicians in order to develop more useful SCPs for the HSCT context. METHODS Analogous surveys regarding perceived barriers to and facilitators of SCP use based on a sample SCP for a female allogenic HSCT survivor were administered to HSCT survivors and non-transplant oncology and primary care clinicians. RESULTS Twenty-seven HSCT survivors and 18 clinicians completed the survey. The main barriers to SCP use were lack of awareness of SCP existence, uncertainty regarding where to find SCP, unclear roles and responsibilities among healthcare teams, length of SCP, and difficultly understanding SCPs. The facilitators of SCP use were increased understanding of survivorship care needs, clarified roles and responsibilities of survivors and clinicians, SCPs that are readily available and searchable in electronic health record, increased awareness of SCP existence and provision to all survivors, and if the SCP is survivor-specific and up-to-date. CONCLUSIONS Much of the work regarding SCPs has looked at barriers to creation and provision; however, our study examines factors influencing use of SCPs. By determining the barriers and facilitators surrounding SCP use for HSCT survivors and their clinicians, we can create SCP templates and clinical workflows to optimize SCP use, ideally leading to better outcomes for HSCT survivors.
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Affiliation(s)
| | - Amye J Tevaarwerk
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Mark B Juckett
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | | | - James E Haine
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Xiao Zhang
- Carbone Cancer Center, University of Wisconsin, Madison, WI
| | | | | | | | | | - Mary E Sesto
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
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Neher M, Landén Ludvigsson M, Enblom A. Preparedness to Implement Physical Activity and Rehabilitation Guidelines in Routine Primary Care Cancer Rehabilitation: Focus Group Interviews Exploring Rehabilitation Professionals' Perceptions. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:779-786. [PMID: 32062799 PMCID: PMC8328890 DOI: 10.1007/s13187-020-01704-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To explore primary care professionals' perceptions of physical activity and other cancer rehabilitation practice in cancer survivors, investigating the preparedness to implement guidelines regarding cancer rehabilitation. We collected qualitative data through seven semi-structured focus group interviews with 48 rehabilitation professionals, with mean 9 years of experience in primary care rehabilitation (32 physiotherapists, 15 occupational therapists, and 1 rehabilitation assistant) in a primary care setting. Data was analyzed using content analysis. Primary care rehabilitation professionals expressed limited experience of cancer survivors, experienced lack of knowledge of cancer-related disability, and had doubts concerning how to treat cancer survivors. They also experienced uncertainty about where to find collaboration and support in the healthcare system outside their own rehabilitation clinic. There is a need to combine different implementation strategies to tackle multiple barriers for effective cancer survivor rehabilitation in primary care, to boost individual rehabilitation professionals' knowledge and self-efficacy, to clarify roles and responsibilities for cancer rehabilitation across levels of care, and to develop and strengthen organizational bridges to provide adequate access to rehabilitation for cancer survivors.
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Affiliation(s)
- Margit Neher
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Maria Landén Ludvigsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Rehabilitation, and Department of Health, Medicine and Caring Sciences, Linköping University, Motala, Sweden
| | - Anna Enblom
- County Council of Östergötland, Linköping, Sweden
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Salz T, Ostroff JS, Nightingale CL, Atkinson TM, Davidson EC, Jinna SR, Kriplani A, Lesser GJ, Lynch KA, Mayer DK, Oeffinger KC, Patil S, Salner AL, Weaver KE. The Head and Neck Survivorship Tool (HN-STAR) Trial (WF-1805CD): A protocol for a cluster-randomized, hybrid effectiveness-implementation, pragmatic trial to improve the follow-up care of head and neck cancer survivors. Contemp Clin Trials 2021; 107:106448. [PMID: 34023515 DOI: 10.1016/j.cct.2021.106448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
Survivors of head and neck cancer (HNC) can have multiple health concerns. To facilitate their care, we developed and pilot-tested a clinical informatics intervention, HN-STAR. HN-STAR elicits concerns online from HNC survivors prior to a routine oncology clinic visit. HN-STAR then presents tailored evidence-based clinical recommendations as a clinical decision support tool to be used during the visit where the oncology clinician and survivor select symptom management strategies and other actions. This generates a survivorship care plan (SCP). Online elicitation of health concerns occurs 3, 6, and 9 months after the clinic visit, generating an updated SCP each time. HN-STAR encompasses important methods of improving survivorship care (e.g., needs assessment, tailored interventions, dissemination of guidelines) and will be evaluated in a pragmatic trial to maximize external validity. This hybrid type 1 implementation-effectiveness trial tests HN-STAR effectiveness while studying barriers and facilitators to implementation in community oncology practices within the National Cancer Institute Community Oncology Research Program. Effectiveness will be measured as differences in key survivorship outcomes between HNC participants who do and do not use HN-STAR over one year after the clinic visit. The primary endpoint is HNC-specific quality of life; other outcomes include patient-centered measures and receipt of guideline-concordant care. Implementation outcomes will be assessed of survivors, providers, and clinic stakeholders. The hybrid design will provide insight into a dose-response relationship between the extent of implementation fidelity and effectiveness outcomes, as well as how to incorporate HN-STAR into standard practice outside the research setting.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA.
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Chandylen L Nightingale
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Thomas M Atkinson
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Eleanor C Davidson
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Sankeerth R Jinna
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Glenn J Lesser
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Kathleen A Lynch
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Deborah K Mayer
- University of North Carolina Lineberger Comprehensive Cancer Center, 450 West Dr, Chapel Hill, NC 27599, USA
| | - Kevin C Oeffinger
- Duke Cancer Institute, 2424 Erwin Dr, Suite 601, Durham, NC 27705, USA
| | - Sujata Patil
- The Cleveland Clinic Foundation, 9500 Euclid Avenue, CA6-160, Cleveland, OH 44195, USA
| | - Andrew L Salner
- Hartford HealthCare Cancer Institute at Hartford Hospital, 79 Retreat Ave, Hartford, CT 06106, USA
| | - Kathryn E Weaver
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Findley PA, Wiener RC, Shen C, Dwibedi N, Sambamoorthi U. Clinical Preventive Services and Self-Management Practices Among Adult Cancer Survivors in the United States Over Time. Cancer Control 2021; 28:10732748211059106. [PMID: 34823385 PMCID: PMC8641110 DOI: 10.1177/10732748211059106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objective of this research was to determine if the engagement/participation in health promotion activities of cancer survivors in the United States (US) changed between 2006 and 2015. We pooled two independent cross-sectional data of cancer survivors using Medical Expenditure Panel Surveys from 2006 (N = 791; weighted N = 9,532,674) and 2015 (N = 1067; weighted N = 15,744,959). Health promoting activities consisted of past year influenza immunization, routine physical examination, and dental visit. Self-care included maintaining normal weight, not smoking, and engagement in recommended vigorous physical activity. We conducted unadjusted and adjusted logistic regression analyses to examine the change in engagement in health promoting activities over time. We found rates of annual influenza immunization (66.8% vs 70.3%), dental visit (71.8% vs 70.3%), and normal weight (33.9% vs 33.5%) did not change from 2006 to 2015. The percent with physical examination (90.8% vs 93.8%; P = .03) and non-smokers increased (87.9% vs 91.2; P = .04). Between 2006 and 2015, despite guidelines and recommendations for personalized cancer survivorship health plans, health promoting activities among cancer survivors did not change significantly.
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Affiliation(s)
- Patricia A Findley
- School of Social Work, 242612Rutgers The State University of New Jersey, New Brunswick, NJ, USA
| | - R Constance Wiener
- Department of Dental Practice and Rural Health, School of Dentistry, 5631West Virginia University, Morgantown, WV, USA
| | - Chan Shen
- Department of Surgery and Public Health Sciences, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Nilajana Dwibedi
- Department of Pharmaceutical Systems and Policy, 5631West Virginia University, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, 5631West Virginia University, Morgantown, WV, USA
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Benci JL, Vachani CC, Hampshire MK, Bach C, Arnold-Korzeniowski K, Metz JM, Hill-Kayser CE. Factors Influencing Delivery of Cancer Survivorship Care Plans: A National Patterns of Care Study. Front Oncol 2020; 9:1577. [PMID: 32083018 PMCID: PMC7005073 DOI: 10.3389/fonc.2019.01577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/31/2019] [Indexed: 11/15/2022] Open
Abstract
Nearly half of all Americans will develop cancer at least once in their lifetime. Through improved screening and treatments, the number of cancer survivors is reaching all-time highs. However, survivorship care plans (SCPs) are inconsistently used, denying many survivors access to critical information. This study used 46,408 SCPs generated from 2007 to 2016 and applied machine learning to identify predictors of SCP creation, including cancer type, type of physician, and healthcare center where they received care, as well as regional variations in care plan creation. Identifying these disparities in SCP use is a critical first step in efforts toward expanding access to survivorship care planning. Using a convenience sample of survivors, it is possible to model the factors that predict generation of SCPs either by the survivor or by a healthcare provider. This study identifies several important disparities both survivor intrinsic such as cancer type, as well as treatment associated and geographic differences in SCP generation. Identifying these disparities at the national level across cancer types will allow for more targeted recommendations to improve SCP creation and dissemination in underserved groups.
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Affiliation(s)
- Joseph L Benci
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Carolyn C Vachani
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Margaret K Hampshire
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Christina Bach
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Karen Arnold-Korzeniowski
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - James M Metz
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Christine E Hill-Kayser
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Salz T, Schnall RB, McCabe MS, Oeffinger KC, Corcoran S, Vickers AJ, Salner AL, Dornelas E, Raghunathan NJ, Fortier E, McKiernan J, Finitsis DJ, Chimonas S, Baxi S. Incorporating Multiple Perspectives Into the Development of an Electronic Survivorship Platform for Head and Neck Cancer. JCO Clin Cancer Inform 2019; 2:1-15. [PMID: 30652547 DOI: 10.1200/cci.17.00105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To improve the care of survivors of head and neck cancer, we developed the Head and Neck Survivorship Tool: Assessment and Recommendations (HN-STAR). HN-STAR is an electronic platform that incorporates patient-reported outcomes into a clinical decision support tool for use at a survivorship visit. Selections in the clinical decision support tool automatically populate a survivorship care plan (SCP). We aimed to refine HN-STAR by eliciting and incorporating feedback on its ease of use and usefulness. METHODS Human-computer interaction (HCI) experts reviewed HN-STAR using think-aloud testing and the Nielsen Heuristic Checklist. Nurse practitioners (NPs) thought aloud while reviewing the clinical decision support tool and SCP and responded to an interview. Survivors used HN-STAR as part of a routine visit and were interviewed afterward. We analyzed themes from the feedback. We described how we addressed each theme to improve the usability of HN-STAR. RESULTS Five HCI experts, 10 NPs, and 10 cancer survivors provided complementary usability insight that we categorized into themes of improvements. For ease of use, themes included technical design considerations to enhance user interface, ease of completion of a self-assessment, streamlining text, disruption of the clinic visit, and threshold for symptoms to appear on the SCP. The theme addressing usefulness was efficiency and comprehensiveness of the clinic visit. For each theme, we report revisions to HN-STAR in response to the feedback. CONCLUSION HCI experts provided key technical design insights into HN-STAR, whereas NPs and survivors provided usability feedback and clinical perspectives. We incorporated the feedback into the preparation for additional testing of HN-STAR. This method can inform and improve the ease of use and usefulness of the survivorship applications.
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Affiliation(s)
- Talya Salz
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Rebecca B Schnall
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Mary S McCabe
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Kevin C Oeffinger
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Stacie Corcoran
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Andrew J Vickers
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Andrew L Salner
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Ellen Dornelas
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Nirupa J Raghunathan
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Elizabeth Fortier
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Janet McKiernan
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - David J Finitsis
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Susan Chimonas
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Shrujal Baxi
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
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10
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Birken SA, Raskin S, Zhang Y, Lane G, Zizzi A, Pratt-Chapman M. Survivorship Care Plan Implementation in US Cancer Programs: a National Survey of Cancer Care Providers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:614-622. [PMID: 29948925 PMCID: PMC6294719 DOI: 10.1007/s13187-018-1374-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Survivorship care plans (SCPs)-documents intended to improve care for cancer survivors who have completed active treatment-are required, yet implementation is poor. We sought to understand SCP implementation in cancer programs in the USA with the objective of identifying opportunities for improvement. We recruited cancer care providers in the USA via several cancer care networks to participate in a survey regarding SCP implementation. We used descriptive statistics to analyze the data. Three hundred ninety-five providers from diverse cancer programs in 47 states and Washington, DC responded to the survey. The timing of SCP implementation varied across and within cancer programs, with approximately 40% of respondents reporting developing SCPs more than 3 months after primary treatment or adjuvant therapy completion. Nurse navigators were responsible for 48-58% of each stage of SCP implementation. Processes that could have been automated often occurred in-person or via phone and vice versa. Respondents reported spending more than 2 h per SCP to complete all stages of implementation, of which less than a third was reimbursed by third-party payers. We identified several opportunities for improving SCP implementation, including broadening the base of responsibility, optimizing modes of communication, decreasing the time required and increasing the funding available, and limiting variation in SCP implementation across and within cancer programs. Future work should assess the influence of approaches to SCP implementation on desired outcomes.
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Affiliation(s)
- Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
| | - Sarah Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Richmond, VA, USA
| | - Yuqing Zhang
- Institute for Patient-Centered Initiatives & Health Equity, The George Washington University Cancer Center, Washington, DC, USA
| | - Gema Lane
- Institute for Patient-Centered Initiatives & Health Equity, The George Washington University Cancer Center, Washington, DC, USA
| | - Alexandra Zizzi
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA
| | - Mandi Pratt-Chapman
- Institute for Patient-Centered Initiatives & Health Equity, The George Washington University Cancer Center, Washington, DC, USA
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Glenn A, Urquhart R. Adopting patient-centred tools in cancer care: role of evidence and other factors. ACTA ACUST UNITED AC 2019; 26:19-27. [PMID: 30853794 DOI: 10.3747/co.26.4271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Randomized controlled trials (rcts) provide limited evidence to support the use of survivorship care plans (scps), but they provide strong evidence for patient decision aids (ptdas). Despite that evidence, the uptake of ptdas has been limited, but scps are being endorsed and implemented in many cancer programs across Canada. The objective of the present study was to illuminate the decision-making processes involved in the adoption of scps and ptdas. Methods Informed by the principles of grounded theory, in-depth semi-structured interviews were conducted with clinicians, managers, and administrators who work in cancer care programs across Canada (n = 21). Data were collected and analyzed concurrently, using a constant comparative analysis approach. Data collection ended when theoretical saturation was reached. Results For these types of patient-centred tools, participants noted that high-quality research evidence is often unnecessary for adoption decisions. Six key factors contribute to adoption or non-adoption decisions for scps and ptdas:■ Alignment of research evidence with other evidence■ Perceived clinician benefit■ Endorsement by organizations and professional bodies■ Existence of local champions■ Adaptability to local contexts■ Ability to routinize and reach a large patient population. Conclusions High-level evidence is not always the main consideration when adopting new tools into practice. And yet, understanding how clinicians and health system decision-makers decide whether and how to adopt new tools is important to optimizing the use of new tools and practices that are supported by research evidence.
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Affiliation(s)
- A Glenn
- Dalhousie Medical School, Dalhousie University, Halifax, NS.,Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - R Urquhart
- Queen Elizabeth II Health Sciences Centre, Halifax, NS.,Department of Surgery, Dalhousie University, Halifax, NS.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS
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12
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Baxi SS, Sukhu R, Fortier E, Oeffinger K, Corcoran S, Salner A, Vickers AJ, McCabe MS, Salz T. Automating Treatment Summary Development Using Electronic Billing Information: A Pilot Study of Survivors of Head and Neck Cancer. J Oncol Pract 2018; 15:e84-e90. [PMID: 30523752 DOI: 10.1200/jop.18.00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although the provision of a treatment summary (TS) is a quality indicator in oncology, routine delivery of TSs remains challenging. Automatic TS generation could facilitate use, but data on accuracy are lacking in complex cancers such as head and neck cancer (HNC). We developed and evaluated an electronic platform to automate TS generation for HNC. METHODS The algorithms autopopulated TSs using data from billing records and an institutional cancer registry. A nurse practitioner used the medical record to verify the accuracy of the information and made corrections electronically. Inaccurate and missing data were considered errors. We described and investigated reasons for errors in the automatically generated TSs. RESULTS We enrolled a heterogeneous population of 43 survivors of HNC. Using billing data, the information on primary site, lymph node status, radiation, and chemotherapy use was accurate in 93%, 95%, 93%, and 95% of patients, respectively. Billing data captured surgery accurately in 77% of patients; once an omitted billing code was identified, accuracy increased to 98%. Chemotherapies were captured in 90% of patients. Using the cancer registry, month and year of diagnosis were accurate in 91% of cases; stage was accurate in 28% of cases. Reprogramming the algorithm to ascertain clinical stage when pathologic stage was unavailable resulted in 100% accuracy. The algorithms inconsistently identified radiation receipt and treating physicians from billing data. CONCLUSION It is feasible to automatically and accurately generate most components of TSs for HNC using billing and cancer registry data, although clinical review is necessary in some cases.
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Affiliation(s)
- Shrujal S Baxi
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Ranjit Sukhu
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | - Andrew Salner
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Mary S McCabe
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Talya Salz
- 1 Memorial Sloan-Kettering Cancer Center, New York, NY
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13
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Reed SC, Walker R, Ziebell R, Rabin B, Nutt S, Chubak J, Nekhlyudov L. Cancer Survivors' Reported Discussions with Health Care Providers About Follow-Up Care and Receipt of Written Care Plans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1181-1188. [PMID: 28480500 DOI: 10.1007/s13187-017-1228-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Prior studies reveal gaps in cancer survivors' discussions with health care providers about follow-up care and receipt of care plans; however, whether survivorship care planning may vary by cancer type is not known. We surveyed 615 survivors of breast, colorectal, prostate, lung cancer, and melanoma enrolled in three health plans to examine cancer survivors' self-reported discussions of follow-up care, including the need for surveillance, late and long-term effects, emotional needs, and health behaviors. We assessed whether cancer survivors received a written treatment summary and post-treatment care instructions. Most (92%) survivors reported having a discussion about the need for surveillance; 75%, late and long-term effects; 69%, lifestyle and health behaviors; and 53%, emotional and social needs. Most (88%) reported receiving post-treatment care instructions and 47%, a treatment summary. While there was little difference among survivors' receipt of surveillance or health behavior recommendations by cancer type (p = 0.85 and p = 0.66, respectively), discussions of late and long-term effects occurred among 82% of prostate, 78% of breast, 73% of melanoma, 72% of colorectal, and 67% of lung survivors (p = 0.06). Approximately half of survivors reported discussions of emotional needs, with modest differences by cancer type (p = 0.08). Our findings indicate that most patient-provider discussions cover information on surveillance, with less emphasis on late and long-term effects, lifestyle and health behaviors, and substantially less focusing on emotional and social needs. No or modest differences in discussions occurred by cancer type. Whether tailoring information to individual cancer survivor needs is beneficial should be examined.
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Affiliation(s)
- Sarah C Reed
- Jane Addams College of Social Work, University of Illinois at Chicago, 1040 West Harrison Street, Chicago, IL, 60607-7134, USA.
| | - Rod Walker
- Kaiser Permanente Health Research Institute, Seattle, WA, USA
| | - Rebecca Ziebell
- Kaiser Permanente Health Research Institute, Seattle, WA, USA
| | - Borsika Rabin
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Stephanie Nutt
- Dell Medical School, University of Texas, Austin, TX, USA
| | - Jessica Chubak
- Kaiser Permanente Health Research Institute, Seattle, WA, USA
| | - Larissa Nekhlyudov
- Department of Population Medicine, Harvard Medical School and Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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14
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Advancing Uterine Cancer Survivorship Among African American Women. J Natl Med Assoc 2018; 110:391-395. [PMID: 30126566 DOI: 10.1016/j.jnma.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 07/03/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few studies have examined health behavior interventions for African American women who are uterine cancer survivors. Black-white differences in uterine cancer survival suggest that there are unmet needs among these survivors. METHODS This article identifies opportunities to address disparities in uterine corpus cancer survival and quality of life, and thereby to increase uterine cancer survivorship among African American women. RESULTS For cancer survivors, common side effects, lasting for long periods after cancer treatment, include fatigue, loss of strength, lymphedema, and difficulty sleeping. A variety of interventions have been evaluated to address physical and mental health concerns, including exercise and dietary interventions. Considerable information exists about the effectiveness of such interventions for alleviating distress and improving quality of life among cancer survivors, but few studies have focused specifically on African American women with a uterine corpus cancer diagnosis. Research-tested culturally tailored lifestyle interventions are lacking. CONCLUSIONS There is a need for a better understanding of uterine cancer survivorship among African American women. Additional evaluations of interventions for improving the quality of life and survival of African American uterine cancer survivors are needed.
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Birken SA, Clary AS, Bernstein S, Bolton J, Tardif-Douglin M, Mayer DK, Deal AM, Jacobs SR. Strategies for Successful Survivorship Care Plan Implementation: Results From a Qualitative Study. J Oncol Pract 2018; 14:e462-e483. [PMID: 30004824 PMCID: PMC6804914 DOI: 10.1200/jop.17.00054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Care for US cancer survivors is often fragmented, contributing to poor health outcomes. Care and outcomes may improve when survivors and follow-up care providers receive survivorship care plans (SCPs), written documents containing information regarding cancer diagnosis, treatment, surveillance plans, and health promotion. However, implementing SCPs is challenging. As such, we sought to identify strategies for successfully implementing SCPs. METHODS We measured SCP implementation using performance data from cancer programs participating in the American Society of Clinical Oncology Quality Oncology Practice Initiative, an oncologist-led quality assessment and improvement program. We used semistructured interviews with cancer program employees (eg, physicians) to identify strategies for successfully implementing SCPs by comparing approaches in cancer programs that, according to Quality Oncology Practice Initiative performance indicators, developed and delivered SCPs to a relatively small proportion of eligible survivors and their follow-up care providers (ie, low performers; n = 6 participants in five programs) with approaches among programs with better performance (ie, moderate performers; n = 15 participants in nine programs). RESULTS Ten of 14 cancer programs developed SCPs for ≥ 50% of eligible survivors; two of 14 delivered SCPs to any survivors; and eight of 14 delivered SCPs to ≥ 25% of follow-up care providers. We found that moderate performers proactively addressed SCP requirements, leveraged requirements to improve survivorship care, set internal targets, automated implementation, had active leaders and champions, and tasked appropriate employees with SCP implementation. CONCLUSION SCP implementation remains challenging. We identified strategies for successfully implementing SCPs. Future research should examine how cancer programs have achieved these strategies; findings could contribute to an understanding of the changes needed to implement comprehensive survivorship care.
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Affiliation(s)
- Sarah A. Birken
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Alecia S. Clary
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Shampa Bernstein
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Jamiyla Bolton
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Miriam Tardif-Douglin
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Deborah K. Mayer
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Allison M. Deal
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Sara R. Jacobs
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
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16
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Isaacson MJ, Hulme PA, Cowan J, Kerkvliet J. Cancer survivorship care plans: Processes, effective strategies, and challenges in a Northern Plains rural state. Public Health Nurs 2018; 35:291-298. [DOI: 10.1111/phn.12393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mary J. Isaacson
- College of Nursing; South Dakota State University; Sioux Falls SD USA
| | - Polly A. Hulme
- College of Nursing; South Dakota State University; Sioux Falls SD USA
| | - Jenna Cowan
- College of Nursing; South Dakota State University; Sioux Falls SD USA
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Benci JL, Minn AJ, Vachani CC, Bach C, Arnold-Korzeniowski K, Hampshire MK, Metz JM, Hill-Kayser CE. Survivorship care planning in skin cancer: An unbiased statistical approach to identifying patterns of care-plan use. Cancer 2017; 124:183-191. [PMID: 28885696 DOI: 10.1002/cncr.30985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/01/2017] [Accepted: 08/14/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nearly 1 in 5 Americans will develop skin cancer, and as a result, survivors of skin cancer compose one of the largest groups of cancer survivors. Survivorship care plans (SCPs) are an important tool for improving patient outcomes and provide critical information to both survivors and health care professionals. Recent efforts have been made to expand SCP utilization; however, which patients currently receive SCPs is poorly understood. METHODS This study used 596 individuals with a diagnosis of melanoma (n = 391) or nonmelanoma skin cancer (n = 205) who had used an Internet-based SCP tool from May 2010 to December 2016 to model the patient and provider characteristics that determine SCP utilization. RESULTS Survivors were predominantly white (95.3%) and female (56.5%). Survivors who received a treatment summary were more likely to also receive an SCP. University and nonuniversity cancer centers used SCPs at a higher rate than other care settings. Survivors whose care was managed by a team rather than just an individual physician were also more likely to receive an SCP. Survivors older than 70 years at diagnosis were almost twice as likely to receive a plan as survivors who were diagnosed at a younger age. CONCLUSIONS With a convenience sample of skin cancer survivors, it is possible to model factors that predict the receipt of SCPs. Important variables include the diagnosis age, treatment setting, physician type, and treatment-summary utilization. A closer examination of these variables identified several disparities in care-plan use and, therefore, opportunities to improve the distribution of SCPs. Further validation in additional cohorts of survivors is necessary to confirm these conclusions. Cancer 2018;124:183-91. © 2017 American Cancer Society.
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Affiliation(s)
- Joseph L Benci
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andy J Minn
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carolyn C Vachani
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christina Bach
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen Arnold-Korzeniowski
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Margaret K Hampshire
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James M Metz
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christine E Hill-Kayser
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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18
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The Impact of Survivorship Care Planning on Patients, General Practitioners, and Hospital-Based Staff. Cancer Nurs 2017; 39:E26-E35. [PMID: 26720214 DOI: 10.1097/ncc.0000000000000329] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND 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. OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSION Patients and healthcare professionals support the use of SCPs; however, they are resource intensive and require significant organizational support. IMPLICATIONS FOR PRACTICE Nurses are instrumental to SCP implementation. Attention to enablers and barriers is important for successful implementation.
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Desmond RA, Jackson BE, Waterbor JW. Disparities in Cancer Survivorship Indicators in the Deep South Based on BRFSS Data: Recommendations for Survivorship Care Plans. South Med J 2017; 110:181-187. [PMID: 28257542 DOI: 10.14423/smj.0000000000000617] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this investigation was to describe cancer survivorship based on the Behavioral Risk Factor Surveillance System (BRFSS) cancer survivorship modules in Alabama, Georgia, and Mississippi, conducted in 2012 and 2014, and to investigate disparities across the US Deep South region. METHODS The optional BRFSS cancer survivorship module was introduced in 2009. Data from Alabama (2012), Georgia (2012), and Mississippi (2014) were assessed. Demographic factors were analyzed through weighted regression for risk of receiving cancer treatment summary information and follow-up care. RESULTS Excluding nonmelanoma skin cancer cases, a total of 1105 adults in the Alabama 2012 survey, 571 adults in the Georgia 2012 survey, and 442 adults in the 2014 Mississippi survey reported ever having cancer and were available for analysis. Among Alabamians, those with a higher level of education (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.1-1.7) and higher income (OR 1.3, 95% CI 1.1-1.6) were more likely to receive a written summary of their cancer treatments. Adults older than age 65 were only half as likely to receive a written summary of cancer treatments compared with adults 65 years or younger (OR 0.5, 95% CI 0.3-0.8). We found no significant differences in receipt of treatment summary by race or sex. Among those who reported receiving instructions from a doctor for follow-up care, these survivors tended to have a higher level of education, higher income, and were younger (younger than 65 years). Receipt of written or printed follow-up care was positively associated with higher income (OR 1.4, 95% CI 1.1-1.8) and inversely associated with age older than 65 years (OR 0.9, 95% CI 0.1-0.6) in Georgia. CONCLUSIONS Addressing the gap identified between survivorship care plan development by the health team and the delivery of it to survivors is important given the evidence of disparities in the receipt of survivorship care plans across survivor age and socioeconomic status in the Deep South.
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Affiliation(s)
- Renee A Desmond
- From the Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Bradford E Jackson
- From the Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham
| | - John W Waterbor
- From the Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham
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Mackay CB, Antonelli KR, Bruinooge SS, Saint Onge JM, Ellis SD. Insurance denials for cancer clinical trial participation after the Affordable Care Act mandate. Cancer 2017; 123:2893-2900. [DOI: 10.1002/cncr.30689] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Christine B. Mackay
- Department of Health Policy and Management; University of Kansas Medical Center; Fairway Kansas
- University of Kansas Cancer Center; Fairway Kansas
| | | | | | - Jarron M. Saint Onge
- Department of Health Policy and Management; University of Kansas Medical Center; Fairway Kansas
| | - Shellie D. Ellis
- Department of Health Policy and Management; University of Kansas Medical Center; Fairway Kansas
- University of Kansas Cancer Center; Fairway Kansas
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Abstract
BACKGROUND Survivorship care plans (SCPs) are internationally endorsed as an important tool to enhance post-treatment survivorship care. To support broad implementation of SCPs, we investigated survivors' preferences regarding SCPs. MATERIAL AND METHODS The study was conducted at a comprehensive cancer center. Eligible patients from 10 clinical services, generally up to 12 months following end of treatment (EOT) were approached in clinics or via telephone. A purpose-designed survey assessed survivors' intended use of a SCP and preferences regarding format and content. Intended minimum sample size of 200. RESULTS Two hundred and thirty surveys were returned (response rate 68%). Of the 230 participants, over 55% had completed treatment within six months, 35% between six and 12 months, and 10% were receiving ongoing treatments. Most (82%) had not received a SCP and more than one third (42%) reported receiving no information resources at EOT. Almost all (98%) desired further information. Most common information elements desired in a SCP: 'list of symptoms to watch out for and report' (76%), 'summary of treatment received' (70%) and 'things I can do to look after myself' (67%). Most common suggested uses were as: 'a record of cancer treatment' (63%), 'a reminder of things to do to look after myself ' (57%) and 'to help me understand my cancer experience' (56%). Over half (52%) would share the information with their general practitioner. Most indicated preference for paper-based SCPs (91%). There was support for both brief (36%) and detailed versions (42%). Over half requested the information be delivered in a face-to-face discussion with a health professional. Regular telephone support from the treating health care team was most commonly suggested as an additional service to support survivors after EOT. CONCLUSIONS Although similar to international findings, results suggest alternate ways of providing the information that survivors desire. Most desired SCP elements have been defined. A flexible approach to SCP interventions is justified.
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Affiliation(s)
- Nicole A. Kinnane
- Australian Cancer Survivorship Centre, a Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Amanda J. Piper
- Australian Cancer Survivorship Centre, a Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre, a Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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Tisnado DM, Mendez-Luck C, Metz J, Peirce K, Montaño B. Perceptions of Survivorship Care among Latina Women with Breast Cancer in Los Angeles County. Public Health Nurs 2016; 34:118-129. [DOI: 10.1111/phn.12299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Diana M. Tisnado
- Department of Health Science; California State University, Fullerton; Fullerton California
| | | | - Jenifer Metz
- California Healthcare Collaborative; Los Angeles California
| | - Katelynn Peirce
- California State University, Fullerton; Fullerton California
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Mayer D, Deal A, Crane J, Chen R, Asher G, Hanson L, Wheeler S, Gerstel A, Green M, Birken S, Rosenstein D. Using Survivorship Care Plans to Enhance Communication and Cancer Care Coordination: Results of a Pilot Study. Oncol Nurs Forum 2016; 43:636-45. [DOI: 10.1188/16.onf.636-645] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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de Rooij BH, Ezendam NPM, Nicolaije KAH, Vos MC, Pijnenborg JMA, Boll D, Kruitwagen RFPM, van de Poll-Franse LV. Factors influencing implementation of a survivorship care plan-a quantitative process evaluation of the ROGY Care trial. J Cancer Surviv 2016; 11:64-73. [PMID: 27480883 PMCID: PMC5266782 DOI: 10.1007/s11764-016-0562-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/09/2016] [Indexed: 11/24/2022]
Abstract
Purpose The 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. Methods Between 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. Results Of 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. Conclusions SCP receipt was influenced by patient- but not care-provider factors. Implications for cancer survivors Certain 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.
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Affiliation(s)
- Belle H de Rooij
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands. .,The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
| | - Nicole P M Ezendam
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Kim A H Nicolaije
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - M Caroline Vos
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center South, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk, The Netherlands
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center South, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk, The Netherlands
| | - Dorry Boll
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Roy F P M Kruitwagen
- Department of Gynecology and GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lonneke V van de Poll-Franse
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Psychological distress among adult cancer survivors: importance of survivorship care plan. Support Care Cancer 2016; 24:4523-31. [DOI: 10.1007/s00520-016-3291-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/30/2016] [Indexed: 11/26/2022]
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26
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Salz T, McCabe MS, Oeffinger KC, Corcoran S, Vickers AJ, Salner AL, Dornelas E, Schnall R, Raghunathan NJ, Fortier E, Baxi SS. A head and neck cancer intervention for use in survivorship clinics: a protocol for a feasibility study. Pilot Feasibility Stud 2016; 2:23. [PMID: 27965842 PMCID: PMC5153865 DOI: 10.1186/s40814-016-0061-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/19/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Head and neck cancer survivors commonly experience severe long-term toxicities, late-occurring symptoms, and significant risks of the second primary malignancy and comorbid illnesses. With multiple simultaneous health issues, these complex cancer survivors often do not receive comprehensive health care that addresses their needs. A tool is needed to streamline and standardize comprehensive care for this cohort. METHODS/DESIGN We designed the Head and Neck Survivorship Tool: Assessment and Recommendations (HN-STAR) to address health care challenges for head and neck cancer survivors. HN-STAR is an electronic platform that aims to simplify the provision of personalized care in cancer survivorship clinics. It uses an algorithmic approach to integrate patient-reported outcomes, clinical details, and evidence-based guidelines to standardize comprehensive care provided in routine survivorship visits. It has four integrated components: (1) a simplified treatment summary, which pulls treatment details from a clinical database or can be completed manually using a streamlined form; (2) an online self-assessment for patients to report their own symptoms; (3) an interactive discussion guide presenting all relevant information to the provider during the clinic visit; and (4) a survivorship care plan generated at the end of each visit that reflects decisions made during the visit. By using a modifiable electronic platform, HN-STAR provides a method for incorporating survivorship care plans into clinical practice and for disseminating evidence on symptom management and preventive care. This is a study to assess the feasibility of a future multi-site, randomized clinical trial of HN-STAR. We will enroll head and neck cancer survivors who are followed in one of two nurse practitioner-led survivorship clinics. We will implement HN-STAR for one routine survivorship visits. We will assess (1) usability and feasibility outcomes of HN-STAR from the perspective of key stakeholders and (2) the planned outcomes intended for the larger trial. We will collect usability and feasibility data from online surveys of survivors and their providers. Our findings will inform whether it is feasible to advance HN-STAR to trial. If so, we will adapt HN-STAR and the study design of the trial in response to feedback from survivors and providers. The long-term goal is to determine if such an intervention will lead to improved and simplified comprehensive survivorship care. DISCUSSION This feasibility study will evaluate implementation of HN-STAR into clinical practice in terms of usability, practicality, and clinical flow in two distinct clinical settings. This study will also provide critical baseline data to characterize this vulnerable population. Findings from this study will inform a multicenter randomized trial of HN-STAR, aimed at standardizing and streamlining the delivery of evidence-guided comprehensive care for head and neck cancer survivors. Ultimately, if found effective, the modular structure of HN-STAR could permit its expansion to survivors of other complex cancers. TRIAL REGISTRATION ClinicalTrials.gov, NCT02571673.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Mary S. McCabe
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Kevin C. Oeffinger
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Stacie Corcoran
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Andrew J. Vickers
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | | | - Ellen Dornelas
- Hartford Hospital, 80 Seymour St, Hartford, CT 06102 USA
| | - Rebecca Schnall
- Columbia University School of Nursing, 617 W 168th St, New York, NY 10032 USA
| | | | - Elizabeth Fortier
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
| | - Shrujal S. Baxi
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA
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Salz T, Baxi S. Moving survivorship care plans forward: focus on care coordination. Cancer Med 2016; 5:1717-22. [PMID: 27075650 PMCID: PMC4944899 DOI: 10.1002/cam4.733] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/19/2016] [Accepted: 03/18/2016] [Indexed: 11/08/2022] Open
Abstract
After completing treatment for cancer, the coordination of oncology and primary care presents a challenge for cancer survivors. Many survivors need continued oncology follow-up, and all survivors require primary care. Coordinating the shared care of a cancer survivor, or facilitating an informed handoff from oncology to primary care, is essential for cancer survivors. Survivorship care plans are personalized documents that summarize cancer treatment and outline a plan of recommended ongoing care, with the goal of facilitating the coordination of post-treatment care. Despite their face validity, five trials have failed to demonstrate the effectiveness of survivorship care plans. We posit that these existing trials have critical shortcomings and do not adequately address whether survivorship care plans improve care coordination. Moving forward, we propose four criteria for future trials of survivorship care plans: focusing on high-needs survivor populations, tailoring the survivorship care plan to the care setting, facilitating implementation of the survivorship care plan in clinical practice, and selecting appropriate trial outcomes to assess care coordination. When trials meet these criteria, we can finally assess whether survivorship care plans help cancer survivors receive optimal oncology and primary care.
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Affiliation(s)
- Talya Salz
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shrujal Baxi
- Head and Neck Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weil Medical College of Cornell University, New York, New York
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Hill-Kayser CE, Jacobs LA, Gabriel P, Palmer SC, Hampshire MK, Vachani C, Edge SB, Metz JM. Feasibility Study of an Electronic Interface Between Internet-Based Survivorship Care Plans and Electronic Medical Records. J Oncol Pract 2016; 12:e380-7. [DOI: 10.1200/jop.2015.006841] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Survivorship care plans (SCPs) are recommended for all cancer survivors. Myriad barriers to implementation exist. This study was performed to evaluate the feasibility of interface development between an SCP and an electronic medical record (EMR). Methods: An information technology application was developed to extract data from the EMR in use at our center (Epic). Data were transferred to autopopulate an Internet-based tool for creation of SCPs (LIVESTRONG Care Plan) that had been previously used for the creation of more than 35,000 plans. Results: Data (demographic characteristics, surgeries, chemotherapy drugs, radiation site) were extracted from the EMR and transferred to the care plan platform, without transfer of protected health information. Care plans were created and transferred back to the EMR. During clinical testing, SCPs were created by nurse practitioners during scheduled clinic visits for 146 sequential, eligible patients (67% breast cancer, 33% colorectal cancer). All patients received completed care for a single cancer diagnosis at our institution. All data points that were automatically populated were reviewed by practitioners, and missing/blank data fields were populated manually when necessary. Data entered into generated care plans were accurate in 97% of audited cases, and the process of care plan generation could be completed in < 1 minute. Conclusion: This is a feasible solution for the autopopulation of SCPs from the EMR. It represents a future methodology through which widespread implementation of SCPs may be undertaken. Future directions include further clinical testing, assessment of provider-perceived usefulness, and integration into routine clinical care.
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Affiliation(s)
- Christine E. Hill-Kayser
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania; and Baptist Memorial Cancer Center, Memphis, Tennessee
| | - Linda A. Jacobs
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania; and Baptist Memorial Cancer Center, Memphis, Tennessee
| | - Peter Gabriel
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania; and Baptist Memorial Cancer Center, Memphis, Tennessee
| | - Steven C. Palmer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania; and Baptist Memorial Cancer Center, Memphis, Tennessee
| | - Margaret K. Hampshire
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania; and Baptist Memorial Cancer Center, Memphis, Tennessee
| | - Carolyn Vachani
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania; and Baptist Memorial Cancer Center, Memphis, Tennessee
| | - Stephen B. Edge
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania; and Baptist Memorial Cancer Center, Memphis, Tennessee
| | - James M. Metz
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania; and Baptist Memorial Cancer Center, Memphis, Tennessee
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Hill-Kayser C, Vachani C, Hampshire MK, Metz JM. Criteria for evaluation of breast cancer survivorship care plans. BREAST CANCER MANAGEMENT 2015. [DOI: 10.2217/bmt.15.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Christine Hill-Kayser
- Perelman School of Medicine at the University of Pennsylvania, Department of Radiation Oncology, 3400 Civic Center Boulevard, 2nd Floor West, Philadelphia, PA 19104, USA
| | - Carolyn Vachani
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 2nd Floor West, Philadelphia, PA 19104, USA
| | - Margaret K Hampshire
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 2nd Floor West, Philadelphia, PA 19104, USA
| | - James M Metz
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 2nd Floor West, Philadelphia, PA 19104, USA
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Coughlin SS, Yoo W, Whitehead MS, Smith SA. Advancing breast cancer survivorship among African-American women. Breast Cancer Res Treat 2015; 153:253-61. [PMID: 26303657 DOI: 10.1007/s10549-015-3548-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/12/2015] [Indexed: 12/20/2022]
Abstract
Advances have occurred in breast cancer survivorship but, for many African-American women, challenges and gaps in relevant information remain. This article identifies opportunities to address disparities in breast cancer survival and quality of life, and thereby to increase breast cancer survivorship among African-American women. For breast cancer survivors, common side effects, lasting for long periods after cancer treatment, include fatigue, loss of strength, difficulty sleeping, and sexual dysfunction. For addressing physical and mental health concerns, a variety of interventions have been evaluated, including exercise and weight training, dietary interventions, yoga and mindfulness-based stress reduction, and support groups or group therapy. Obesity has been associated with breast cancer recurrence and poorer survival. Relative to white survivors, African-American breast cancer survivors are more likely to be obese and less likely to engage in physical activity, although exercise improves overall quality of life and cancer-related fatigue. Considerable information exists about the effectiveness of such interventions for alleviating distress and improving quality of life among breast cancer survivors, but few studies have focused specifically on African-American women with a breast cancer diagnosis. Studies have identified a number of personal factors that are associated with resilience, increased quality of life, and positive adaptation to a breast cancer diagnosis. There is a need for a better understanding of breast cancer survivorship among African-American women. Additional evaluations of interventions for improving the quality of life and survival of African-American breast cancer survivors are desirable.
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Affiliation(s)
- Steven S Coughlin
- Department of Community Health and Sustainability, Division of Public Health, University of Massachusetts, Lowell, MA, USA,
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Birken SA, Ellis SD, Walker JS, DiMartino LD, Check DK, Gerstel AA, Mayer DK. Guidelines for the use of survivorship care plans: a systematic quality appraisal using the AGREE II instrument. Implement Sci 2015; 10:63. [PMID: 25935752 PMCID: PMC4425878 DOI: 10.1186/s13012-015-0254-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/22/2015] [Indexed: 11/28/2022] Open
Abstract
Background Survivorship care plans (SCPs) are written treatment summaries and follow-up care plans that are intended to facilitate communication and coordination of care among survivors, cancer care providers, and primary care providers. A growing number of guidelines for the use of SCPs exist, yet SCP use in the United States remains limited. Limited use of SCPs may be due to poor quality of these guidelines. The purpose of the study was to evaluate the quality of guidelines for SCP use, tools that are intended to promote evidence-based medicine. Methods We conducted a comprehensive search of the literature using MEDLINE/PubMed, EMBASE (Excerpta Medica Database), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) published through April 2014, in addition to grey literature sources and bibliographic and expert reviews. Guideline quality was assessed using the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation, 2nd edition), a tool developed by an international group of scientists to advance the quality of clinical practice guidelines. To promote consistency with extant studies using the AGREE II instrument and to clearly and unambiguously identify potentially useful guidelines for SCP use, we also summarized AGREE II scores by strongly recommending, recommending, or not recommending the guidelines that we evaluated. Results Of 128 documents screened, we included 16 guidelines for evaluation. We did not strongly recommend any of the 16 guidelines that we evaluated; we recommended 5 and we did not recommend 11. Overall, guidelines scored highest on clarity of presentation (i.e., guideline language, structure, and format): Guidelines were generally unambiguous in their recommendations that SCPs should be used. Guidelines scored lowest on applicability (i.e., barriers and facilitators to implementation, implementation strategies, and resource implications of applying the guideline): Few guidelines discussed facilitators and barriers to guideline application; advice and tools for implementing guidelines were vague; and none explicitly discussed resource implications of implementing the guidelines. Conclusions Guidelines often advocated survivorship care plan use without justification or suggestions for implementation. Improved guideline quality may promote survivorship care plan use. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0254-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
| | - Shellie D Ellis
- Department of Health Policy and Management, University of Kansas School of Medicine, Mail Stop 3044, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - Jennifer S Walker
- Health Sciences Library, The University of North Carolina at Chapel Hill, 335 S. Columbia Street, Chapel Hill, NC, 27599-7585, USA.
| | - Lisa D DiMartino
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
| | - Devon K Check
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
| | - Adrian A Gerstel
- School of Nursing, University of North Carolina at Chapel Hill, 2800 Carrington Hall CB# 7460, Chapel Hill, NC, 27599, USA.
| | - Deborah K Mayer
- School of Nursing, University of North Carolina at Chapel Hill, 2800 Carrington Hall CB# 7460, Chapel Hill, NC, 27599, USA.
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Mayer DK, Shapiro CL, Jacobson P, McCabe MS. Assuring Quality Cancer Survivorship Care: We've Only Just Begun. Am Soc Clin Oncol Educ Book 2015:e583-e591. [PMID: 25993226 DOI: 10.14694/edbook_am.2015.35.e583] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Clinical practice guidelines, quality metrics, and performance improvement projects are the key tools of the national movement to improve and assure quality cancer care. Each of these evaluation instruments is intended to assess quality from a unique perspective, including that of the individual provider, the practice/hospital, and the health care system. A number of organizations have developed or endorsed quality measures specific to cancer, however, these have not formally included survivorship measures. Fortunately, the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network, the American Cancer Society, and the American College of Surgeons (ACoS) have taken a leadership role in developing survivorship guidelines and quality metrics. Both ASCO and ACoS have focused their efforts on the treatment summary and care plan, a document that was proposed in the 2006 Institute of Medicine report on cancer survivorship. ASCO has proposed a care plan template for implementation and incorporation into the electronic health records (EHR), which will lend itself to structure, process, and outcome measurement. ACoS, conversely, has included the care plan in its cancer program standards with annual evaluation metrics. In addition, ASCO has developed a number of key survivorship-relevant metrics as part of its Quality Oncology Practice Initiative (QOPI), a tool developed to measure quality cancer care and assess adherence to guidelines across academic and community practices. Together, these efforts will direct us to more effective ways to disseminate guideline recommendations and to better methods of assessing quality survivorship care nationally.
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Affiliation(s)
- Deborah K Mayer
- From the School of Nursing, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Dubin Breast Center, Translational Breast Cancer Research, Tisch Cancer Institute, Mount Sinai Medical Center, Division of Hematology/Medical Oncology, Tisch Cancer Institute, New York, NY; Clinical Programs, Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charles L Shapiro
- From the School of Nursing, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Dubin Breast Center, Translational Breast Cancer Research, Tisch Cancer Institute, Mount Sinai Medical Center, Division of Hematology/Medical Oncology, Tisch Cancer Institute, New York, NY; Clinical Programs, Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Jacobson
- From the School of Nursing, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Dubin Breast Center, Translational Breast Cancer Research, Tisch Cancer Institute, Mount Sinai Medical Center, Division of Hematology/Medical Oncology, Tisch Cancer Institute, New York, NY; Clinical Programs, Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mary S McCabe
- From the School of Nursing, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Dubin Breast Center, Translational Breast Cancer Research, Tisch Cancer Institute, Mount Sinai Medical Center, Division of Hematology/Medical Oncology, Tisch Cancer Institute, New York, NY; Clinical Programs, Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY
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Hershman DL, Ganz PA. Quality of Care, Including Survivorship Care Plans. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:255-69. [PMID: 26059941 DOI: 10.1007/978-3-319-16366-6_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
With the expectation of prolonged survival in the vast majority of women diagnosed with breast cancer, making initial treatment decisions that minimize or prevent late complications, and maximize the quality as well as quantity of life, is absolutely critical. Unfortunately, such care is not uniformly delivered. Patient, provider, and system barriers contribute to delays in cancer care, lower quality of care, and poorer outcomes in vulnerable populations, including low income, underinsured, and racial/ethnic minority populations. Covering the costs of cancer care is a major concern for many cancer survivors, and as a result, a major challenge will be to provide cost-effective follow-up care by reducing overuse of unnecessary tests and procedures so that access to effective medications can be preserved. One of the recently promoted means of improving the coordination of care for breast cancer survivors has been the use of survivorship care planning, as coordination of care will be absolutely essential to deliver high-quality care. Patient navigation is another approach to help overcome healthcare system barriers and facilitate timely access to quality medical care. Understanding the challenges and opportunities in delivering high-quality cancer care is one of the most critical issues of the day. With the large numbers of breast cancer patients and the tremendous advances in our understanding of the disease and treatments (leading to large numbers of survivors), breast cancer will likely be the focus of new models for the delivery of better and more efficient cancer care.
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Affiliation(s)
- Dawn L Hershman
- Medicine and Epidemiology, Herbert Irving Comprehensive Cancer Center Columbia University, 161 Fort Washington, 1068, New York, NY, 10032, USA,
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Birken SA, Presseau J, Ellis SD, Gerstel AA, Mayer DK. Potential determinants of health-care professionals' use of survivorship care plans: a qualitative study using the theoretical domains framework. Implement Sci 2014; 9:167. [PMID: 25398477 PMCID: PMC4236456 DOI: 10.1186/s13012-014-0167-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 10/30/2014] [Indexed: 11/25/2022] Open
Abstract
Background Survivorship care plans are intended to improve coordination of care for the nearly 14 million cancer survivors in the United States. Evidence suggests that survivorship care plans (SCPs) have positive outcomes for survivors, health-care professionals, and cancer programs, and several high-profile organizations now recommend SCP use. Nevertheless, SCP use remains limited among health-care professionals in United States cancer programs. Knowledge of barriers to SCP use is limited in part because extant studies have used anecdotal evidence to identify determinants. This study uses the theoretical domains framework to identify relevant constructs that are potential determinants of SCP use among United States health-care professionals. Methods We conducted semi-structured interviews to assess the relevance of 12 theoretical domains in predicting SCP use among 13 health-care professionals in 7 cancer programs throughout the United States with diverse characteristics. Relevant theoretical domains were identified through thematic coding of interview transcripts, identification of specific beliefs within coded text units, and mapping of specific beliefs onto theoretical constructs. Results We found the following theoretical domains (based on specific beliefs) to be potential determinants of SCP use: health-care professionals’ beliefs about the consequences of SCP use (benefit to survivors, health-care professionals, and the system as a whole); motivation and goals regarding SCP use (advocating SCP use; extent to which using SCPs competed for health-care professionals’ time); environmental context and resources (whether SCPs were delivered at a dedicated visit and whether a system, information technology, and funding facilitated SCP use); and social influences (whether using SCPs is an organizational priority, influential people support SCP use, and people who could assist with SCP use buy into using SCPs). Specific beliefs mapped onto the following psychological constructs: outcome expectancies, intrinsic motivation, goal priority, resources, leadership, and team working. Conclusions Previous studies have explored a limited range of determinants of SCP use. Our findings suggest a more comprehensive list of potential determinants that could be leveraged to promote SCP use. These results are particularly timely as cancer programs face impending SCP use requirements. Future work should develop instruments to measure the potential determinants and assess their relative influence on SCP use. Electronic supplementary material The online version of this article (doi:10.1186/s13012-014-0167-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
| | - Justin Presseau
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, NE2 4AX, Newcastle upon Tyne, UK.
| | - Shellie D Ellis
- Department of Health Policy and Management, University of Kansas School of Medicine, Mail Stop 3044, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - Adrian A Gerstel
- School of Nursing, University of North Carolina at Chapel Hill, 2800 Carrington Hall CB# 7460, Chapel Hill, NC, 27599, USA.
| | - Deborah K Mayer
- School of Nursing, University of North Carolina at Chapel Hill, 2800 Carrington Hall CB# 7460, Chapel Hill, NC, 27599, USA.
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Poplack DG, Fordis M, Landier W, Bhatia S, Hudson MM, Horowitz ME. Childhood cancer survivor care: development of the Passport for Care. Nat Rev Clin Oncol 2014; 11:740-50. [PMID: 25348788 DOI: 10.1038/nrclinonc.2014.175] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Survivors of childhood cancer are at risk of long-term adverse effects and late effects of the disease and/or its treatment. In response to national recommendations to improve evidence-based follow-up care, a web-based support system for clinical decision making, the Passport for Care (PFC), was developed for use at the point of care to produce screening recommendations individualized to the survivor. To date, the PFC has been implemented in over half of the nearly 200 clinics affiliated with the Children's Oncology Group across the USA. Most clinician users report that the PFC has been integrated into clinic workflows, and that it fosters improved conversations with survivors about the potential late effects a survivor might experience and about the screening and/or behavioural interventions recommended to improve health status. Furthermore, clinicians using the PFC have indicated that they adhered more closely to follow-up care guidelines. Perspectives on the challenges encountered and lessons learned during the development and deployment of the PFC are reviewed and contrasted with other nationwide approaches to the provision of guidance on survivor follow-up care; furthermore, the implications for the care of childhood cancer survivors are discussed.
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Affiliation(s)
- David G Poplack
- Hematology-Oncology Section, Department of Paediatrics, Texas Children's Cancer Center, Baylor College, One Baylor Plaza, Houston, TX 77030, USA
| | - Michael Fordis
- Center for Collaborative and Interactive Technologies, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Wendy Landier
- Department of Population Sciences, City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Smita Bhatia
- Department of Population Sciences, City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Melissa M Hudson
- Cancer Survivorship Division, Departments of Oncology and Epidemiology, and Cancer Control, St Jude's Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Marc E Horowitz
- Hematology-Oncology Section, Department of Paediatrics, Texas Children's Cancer Center, Baylor College, One Baylor Plaza, Houston, TX 77030, USA
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