Patient perspectives on breast cancer treatment plan and summary documents in community oncology care A pilot program

ArticleinCancer 119(1) · January 2013with11 Reads
DOI: 10.1002/cncr.27856 · Source: PubMed
Abstract
Background: Although the routine use of treatment plans and summaries (TPSs) has been recommended to improve the quality of cancer care, limited data exist about their impact on quality, including patient satisfaction and coordination of care. Methods: Patients received TPSs as part of the American Society of Clinical Oncology Breast Cancer Registry (BCR) pilot program of 20 community oncology practices. Participants were surveyed 2 to 4 weeks after receiving a TPS to evaluate their perceptions of the document. Patients who were receiving chemotherapy received the TPS as separate plan and summary documents (at the start and the end of treatment) and could complete 2 surveys. Others received a single integrated TPS. Eligible survey participants had stage 0 through III breast cancer and were enrolled in the BCR. Results: Of 292 consented patients, 174 (60%) completed at least 1 survey. Of 157 patients who recalled receiving a TPS, 148 (94%) believed that the documents improved patient-physician communication, and 128 (82%) believed that they improved communication between physicians; 113 (72%) said the documents increased their peace of mind, whereas 2 (1%) had less peace of mind. Of 152 patients (97%) who still had their documents, 147 (97%) said they were useful, and 94 (62%) had given or planned to give the documents to another physician. All 63 patients who were surveyed after receiving a summary recommended that practices continue to provide TPSs to patients. Conclusions: Participants in this study expressed high satisfaction with TPSs. Additional research is needed to study the broad-scale implementation of the BCR and to evaluate the impact of routine use of TPSs on the quality of care delivered.
    • "Survivorship care plans (SCPs)—written documents that ideally include a cancer treatment summary and plan for surveillance and preventive care—are intended to improve care communication and coordination, improve patient satisfaction, and reduce the burden of late effects in the nearly 14 million cancer survivors in the United States [1] . Evidence suggests that SCPs improve survivors' satisfaction with care [2] ; communication with pro- viders [3,4]; knowledge about cancer, treatment, and follow-up care567; peace of mind [8]; and engagement in healthy behaviors [9]. SCPs have also been found to improve cancer screening rates [10], decrease patient wait times, and increase cancer programs' capacity for treating cancer patients by shifting survivors to followup care providers [4]. "
    [Show abstract] [Hide abstract] 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.ResultsWe 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.
    Full-text · Article · Nov 2014
    • "All studies evaluated SCPs that consisted of at least two components: a treatment summary and a plan for long-term follow-up care. Nine of the 10 SCPs were accompanied by other survivorship resources such as booklets, DVDs or websites that contained information about late effects of treatment, supportive care, lifestyle/general health information or copies of follow-up care guidelines (Grunfeld et al, 1996Grunfeld et al, , 2006Grunfeld et al, , 2011 Oeffinger et al, 2010; Jefford et al, 2011; Blaauwbroek et al, 2012; Blinder et al, 2013; Brothers et al, 2013; Hershman et al, 2013). Most of the SCPs were developed primarily as a resource for cancer survivors (Oeffinger et al, 2010; Grunfeld et al, 2011; Jefford et al, 2011; Blaauwbroek et al, 2012; Spain et al, 2012; Blinder et al, 2013; Brothers et al, 2013; Hershman et al, 2013). "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Eight years after the Institute of Medicine recommended survivorship care plans (SCPs) for all cancer survivors, this study systematically reviewed the evidence for their use. Methods: Studies evaluating outcomes after implementation of SCPs for cancer survivors were identified by searching databases (MEDLINE, EMBASE and Cochrane). Data were extracted and summarised. Results: Ten prospective studies (2286 survivors) met inclusion criteria (5 randomised controlled trials (RCTs)). Study populations included survivors of breast, gynaecological, colorectal and childhood cancer. Several models of SCP were evaluated (paper based/on-line, oncologist/nurse/primary-care physician-delivered and different templates). No significant effect of SCPs was found on survivor distress, satisfaction with care, cancer-care coordination or oncological outcomes in RCTs. Breast cancer survivors with SCPs were better able to correctly identify the clinician responsible for their follow-up care. One study suggested a positive impact on reducing unmet needs. Levels of survivor satisfaction with, and self-reported understanding of, their SCP were very high. Feasibility was raised by health professionals as a significant barrier, as SCPs took 1-4 h of their time to develop. Conclusions: Emerging evidence shows very few measurable benefits of SCPs. Survivors reported high levels of satisfaction with SCPs. Resource issues were identified as a significant barrier to implementation.
    Full-text · Article · Oct 2014
    M E BrennanM E BrennanJ F GormallyJ F GormallyP ButowP Butow+1more author...[...]
  • [Show abstract] [Hide abstract] ABSTRACT: This editorial comments on 2 companion articles that present the preliminary results of the American Society of Clinical Oncology (ASCO) breast cancer registry (BCR) pilot program. The ASCO BCR demonstrates how registry data can be collected prospectively for quality assessment purposes as well as the creation of treatment and survivorship care plans in a way that is acceptable to oncology clinicians and patients.
    Article · Jan 2013
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