Primary Care Providers' Needs and Preferences for Information about Colorectal Cancer Survivorship Care
ABSTRACT The Institute of Medicine (IOM) proposed that cancer survivors and their primary care providers (PCPs) should receive survivorship care plans to inform ongoing care. We aimed to determine PCPs' preferences for the content of survivorship care plans for colorectal cancer (CRC) survivors.
PCPs in 3 practice-based research networks completed a survey regarding 45 topics of CRC information based on the IOM's survivorship care plan framework.
One hundred fifty-six PCPs completed the survey. For 35 topics (78%), at least half of respondents felt the topic was very important. Most PCPs reported receiving too little information about problems with chemotherapy (68%) or radiation (60%) and whether the oncologist intended to monitor for other cancers (71%). PCPs widely agreed that they do not have enough information about increased risk of second CRCs, other cancers, and other diseases (78%); long-term effects of chemotherapy (73%) and radiation (67%); and genetic counseling (83%).
PCPs endorse the IOM's survivorship care plan framework as relevant and often report needing more information. Survivorship care plans may provide important information to PCPs by communicating patients' cancer histories and making recommendations regarding which aspects of care should be provided by the oncologist or the PCP.
SourceAvailable from: Johanna M A Pijnenborg[Show abstract] [Hide abstract]
ABSTRACT: This study assesses the effect of sending a Survivorship Care Plan (SCP) to primary care physicians (PCP) on the communication of the PCP with the medical specialist and the patient and to describe PCPs' opinions regarding the SCP. In a pragmatic cluster randomized controlled trial conducted in 12 hospitals, the PCP of endometrial and ovarian cancer patients received usual information, while in addition the SCP-care arm received a copy of the patient's SCP. A questionnaire was returned by 266 PCPs (76 %). One third of the PCPs in the SCP-care arm indicated having received an SCP. PCPs in the SCP-care arm were more likely to have had personal contact with the medical specialist (52 vs. 37 %, p = 0.01) but were equally satisfied with the information as PCPs in the usual care arm (7.2 vs. 6.9 on a scale from 1 to 10, p = 0.25). Of all PCPs, 82 % indicated they would want to receive an SCP in the future. A quarter of the PCPs who received an SCP reported that the SCP supported contact with the patient. However, the SCP was found too long. Supplying an SCP to PCPs potentially has a positive effect on the communication between the PCP and the medical specialist. The SCP should be concise and focused on PCPs' needs, such as contact information and tailored information on patient diagnosis, treatment, and possible consequences. In the light of transition of cancer care to PCPs, survivors may benefit from improved information provision and communication.Journal of Cancer Survivorship 05/2014; 8(4). DOI:10.1007/s11764-014-0368-0 · 3.29 Impact Factor
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ABSTRACT: Cancer survivors need high-quality follow-up care that addresses long-term problems related to cancer and their treatment. With growing numbers of cancer patients transitioning from oncological treatment to survivorship care, primary care physicians (PCPs) will play a major role in the delivery of survivorship care. This pilot study was undertaken to provide initial insights into internal medicine (IM) and family medicine (FM) residents' educational experience, training, and preparedness for practice as healthcare providers of adult cancer survivors (ACS). This study utilizes an anonymous cross-sectional, electronic survey of a sample of US IM and FM residents. A total of 77 residents in their PGY-3 year of training responded to the survey, including 53 IM (69 %) and 24 FM (31 %) residents. The majority (97 %) of respondents performed as PCPs for ACS during their training, and 81 % expected to take care of such patients in the future. However, only a minority reported feeling very comfortable in this role or very confident of identifying cancer recurrence and potential long-term effects of cancer treatment (13 %, 21 %, and 15 %, respectively). Formal education in survivorship care was reported by 27 % of residents and was modestly associated with knowledge responses. High clinical exposure (defined as having ≥10 opportunities to perform as the PCP for ACS) was significantly associated with self-reported knowledge, comfort level, and self-confidence in being able to evaluate and manage potential long-term effects of cancer treatment and their symptoms. Our results suggest there is a substantial disconnect between resident's educational experience, training, and self-reported preparedness for practice in cancer survivorship in both IM and FM training specialties. Inadequate training in cancer survivorship represents a barrier to providing adequate cancer follow-up. Inexperience or unawareness of essential survivorship issues could lead to mistakes which affect survivors' health and timely assessment of long-term cancer-associated morbidity. As PCPs will play a key role in the delivery of survivorship care, effective educational opportunities and achievement of competencies in adult cancer survivorship care by primary care trainees are needed.Journal of Cancer Survivorship 05/2014; 8(4). DOI:10.1007/s11764-014-0366-2 · 3.29 Impact Factor
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ABSTRACT: Purpose/Objectives: To evaluate the feasibility, usability, and satisfaction of a survivorship care plan (SCP) and identify the optimum time for its delivery during the first 12 months after diagnosis.Design: Prospective, descriptive, single-arm study.Setting: A National Cancer Institute-designated cancer center in the southeastern United States.Sample: 28 nonmetastatic colon cancer survivors within the first year of diagnosis and their primary care physicians (PCPs).Methods: Regular screening identified potential participants who were followed until treatment ended. An oncology certified nurse developed the JourneyForward™ SCP, which then was delivered to the patient by the oncology nurse practitioner (NP) during a routine follow-up visit and mailed to the PCP.Main Research Variables: Time to complete, time to deliver, usability, and satisfaction with the SCP.Findings: During one year, 75 patients were screened for eligibility, 34 SCPs were delivered, and 28 survivors and 15 PCPs participated in the study. It took an average of 49 minutes to complete a surgery SCP and 90 minutes to complete a surgery plus chemotherapy SCP. Most survivors identified that before treatment ended or within the first three months was the preferred time to receive an SCP.Conclusions: The SCPs were well received by the survivors and their PCPs, but were too time and labor intensive to track and complete.Implications for Nursing: More work needs to be done to streamline processes that identify eligible patients and to develop and implement SCPs. Measuring outcomes will be needed to demonstrate whether SCPs are useful or not.Oncology Nursing Forum 05/2014; 41(3):266-73. DOI:10.1188/14.ONF.266-273 · 1.91 Impact Factor