Multidisciplinary care clinics: A model to deliver personalized survivorship care.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19629-e19629
Author(s):  
Fran Zandstra ◽  
Guadalupe R. Palos ◽  
Ludivine Russell ◽  
Jacklyn J Flores ◽  
Yvette DeJesus ◽  
...  
Keyword(s):  
Multidisciplinary Care ◽  
Comprehensive Approach ◽  
Clinical Activity ◽  
Cell Transplant ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Care Clinic ◽  
Care Plans ◽  
Care Models

e19629 Background: Multidisciplinary care models provide a comprehensive approach to improve the care of long-term cancer survivors as recommended by the Institute of Medicine report.. Here we describe a Multidisciplinary Survivorship Care Model and the metrics used to evaluate the delivery of personalized care to long-term survivors. Methods: Critical components used to develop survivorship services included: 1) engaging clinical and administrative leadership; 2) conducting extensive reviews/syntheses of published literature including health promotion, prevention and risk reduction, late treatment effects, and rehabilitative services for each disease-site; 3) determining eligibility criteria to transition patients from active-disease care to survivorship care; 4) developing, implementing, and evaluating algorithms by involving a multidisciplinary team expert-consensus; 5) obtaining approval for integration of algorithms into practice by institutional credentialing and regulatory committees; 6) identifying appropriate survivorship clinics to pilot the feasibility of algorithms in routine clinical operations; 7) performing improvement checks of the clinic operations; and 8) revising operations and scheduling as needed. Metrics used to evaluate the progress of the clinical activity of each multidisciplinary survivorship care clinic (MSCC) included number of unique patients transitioned, number seen, number of arrived appointments, number of summary care plans issued, and survivors’ satisfaction. Results: The MSCCs included gynecology, thyroid, genitourinary, stem cell transplant, breast, head and neck, colorectal, lymphoma, and melanoma, with varied launch dates for each clinic. Between 09/01/2008 and 12/31/2011, there were a total of 7396 unique survivors, 12,741 arrived appointments, and 10,016 summary care plans completed within 30 days from appointment. Conclusions: Dedicated multidisciplinary survivorship care models are a comprehensive approach to deliver long-term survivorship care. Comparative effectiveness and other health outcomes research examining the feasibility, usability, acceptance, and effectiveness of the MSCC by providers and survivors is warranted.

Who is receiving survivorship care plans? Findings from the 2012 Livestrong survey.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9608-9608
Author(s):  
Ruth Rechis ◽  
Carla Bann ◽  
Stephanie Nutt ◽  
Linda Squiers ◽  
Naveen Rao
Keyword(s):  
Medical Center ◽  
Care Plan ◽  
Cancer Center ◽  
Survivorship Care Plans ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Long Term Effects ◽  
Care Plans ◽  
Key Stakeholders

9608 Background: There are more than 14 million cancer survivors in the US – a number that is on the rise. Care coordination resources will be essential to provide support to this growing population. Key stakeholders, including the Commission on Cancer (CoC) and the Institute of Medicine, have proposed survivorship care plans (SCPs) as a way to extend support. However, limited research has been conducted to date on SCPs. Methods: In 2012, the LIVESTRONG Foundation (LIVESTRONG) administered a survey to understand the role of a treatment summary (TS) and SCPs and how they fit into survivors’ care. Logistic regression models were conducted to identify factors associated with receiving SCPs or TS. Results: 5,303 survivors responded to these questions (Table). While 92% of these respondents received information about where to return to for cancer check-ups, only 51% reported receiving a TS and 17% reported receiving a SCP. Survivors who were more likely to receive SCPs if they had a navigator (p<.001) and if they were male, Black, had finished treatment within the past year, or received care at a university-based medical center or community cancer center (p < 0.05). Also, those receiving a SCP were significantly more likely to have had a detailed discussion with a provider regarding long-term side effects, emotional needs, and lifestyle recommendations. Specifically, 60% of those with a SCP discussed long-term effects compared to 39% who did not. Conclusions: Results here indicate that few survivors receive SCPs but survivors reported benefits from receiving them. Currently many workflow barriers impede delivering SCPs, and LIVESTRONG is working with key stakeholders including the CoC to automate the LIVESTRONG Care Plan powered by Penn Medicine’s OncoLink through a registry and EMR system to understand how to address this issue. [Table: see text]

Who is receiving survivorship care plans? Findings from the 2012 LIVESTRONG survey.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 26-26
Author(s):  
Ruth Rechis ◽  
Stephanie Nutt ◽  
Carla Bann ◽  
Linda Squiers ◽  
Naveen Rao
Keyword(s):  
Medical Center ◽  
Care Plan ◽  
Cancer Center ◽  
Survivorship Care Plans ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Long Term Effects ◽  
Care Plans ◽  
Key Stakeholders

26 Background: There are more than 14 million cancer survivors in the US – a number that is on the rise. Care coordination resources will be essential to provide support to this growing population. Key stakeholders, including the Commission on Cancer (CoC) and the Institute of Medicine, have proposed survivorship care plans (SCPs) as a way to extend support. However, limited research has been conducted to date on SCPs. Methods: In 2012, the LIVESTRONG Foundation (LIVESTRONG) administered a survey to understand the role of a treatment summary (TS) and SCPs and how they fit into survivors’ care. Logistic regression models were conducted to identify factors associated with receiving SCPs or TS. Results: 5,303 survivors responded to these questions. While 92% of these respondents received information about where to return to for cancer check-ups, only 51% reported receiving a TS and 17% reported receiving a SCP. Survivors who were more likely to receive SCPs if they had a navigator (p<.001) and if they were male, black, had finished treatment within the past year, or received care at a university-based medical center or community cancer center (p < 0.05). Also, those receiving a SCP were significantly more likely to have had a detailed discussion with a provider regarding long-term side effects, emotional needs, and lifestyle recommendations. Specifically, 60% of those with a SCP discussed long-term effects compared to 39% who did not. Conclusions: Results here indicate that few survivors receive SCPs but survivors reported benefits from receiving them. Currently many workflow barriers impede delivering SCPs, and LIVESTRONG is working with key stakeholders including the CoC to automate the LIVESTRONG Care Plan powered by Penn Medicine’s OncoLink through a registry and EMR system to understand how to address this issue.

The optimal living and survivorship program: Piloting a novel survivorship care model.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 40-40
Author(s):  
Stacie Corcoran ◽  
John Russell ◽  
Jill Clayton ◽  
Bridget Kelly ◽  
Andrea Smith ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Unmet Need ◽  
Multidisciplinary Care ◽  
Post Treatment ◽  
Survivorship Care ◽  
Care Model ◽  
Supportive Services ◽  
Care Models ◽  
After Cancer

40 Background: Multiple agencies define cancer survivorship as beginning at the time of diagnosis. However, traditional care models deliver “survivorship care” months or years after diagnosis, which can cause care disruption and “transition anxiety”. We hypothesized that an approach centered around wellbeing could be applied across the cancer continuum (starting at diagnosis) and serve as a novel survivorship care model. Methods: We developed the Optimal Living and Survivorship Program with 3 key components: 1) a centralized model that provides multidisciplinary care; 2) an individualized Wellness Plan (WP); and 3) enrollment at the time of diagnosis to mitigate post-treatment transition. Participants complete a digital wellness questionnaire (WQ) prior to the 1st medical oncology consult, receive a validated algorithm-based WP, and meet with a Wellness Advanced Practice Provider (WAPP). The WP consists of individualized education and referrals (e.g., nutrition, exercise, financial counseling). The WAPP will assume post-treatment (“survivorship”) care. We piloted this approach in patients diagnosed with breast cancer beginning in 11/19. The primary outcome is feasibility defined by completion of the WQ. Secondary outcomes include participation in the WAPP visits, attendance at appointments, and quality of life (QOL). Results: Due to COVID-19, the pilot was paused in 2/20. Data collected from 11/19 through 2/20 reveal a total of 67 eligible patients with newly diagnosed breast cancer were approached, with 65 enrolled. All participants completed the WQ and all received a WP with supportive referrals and educational resources. All participants engaged with WP recommendations. Participants were screened at high risk for an average of 3.8 unmet needs, and 98% were at high risk for 2 or more needs at time of diagnosis. Exercise was the highest unmet need (83%). There was 76% adherence with referral to the program’s Exercise Physiologist. Other areas of needs were nutrition (59%) and sleep quality (51%). WAPP tele-visits began in 6/20; visit completion rates will be presented. Qualitative data regarding patient experience and QOL will be obtained via interviews and feedback will be categorized in thematic domains. Conclusions: Most patients enrolled in the program, completed a WQ and engaged with the WP. Our findings suggest that this early intro to survivorship is feasible. Earlier engagement and incorporation of wellness and supportive services from time of diagnosis may improve our ability to address multifactorial needs during and after cancer therapy.

scholarly journals Accuracy and Thoroughness of Treatment Summaries Provided as Part of Survivorship Care Plans Prepared by Two Cancer Centers

2017 ◽  
Vol 13 (5) ◽  
pp. e486-e495 ◽  
Author(s):  
Amye J. Tevaarwerk ◽  
William G. Hocking ◽  
Jamie L. Zeal ◽  
Mindy Gribble ◽  
Lori Seaborne ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Data Entry ◽  
Standard Of Care ◽  
Care Plan ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Cancer Centers ◽  
Treatment Summaries ◽  
Care Plans ◽  
Treatment Information

Purpose: Treatment summaries prepared as part of survivorship care planning should correctly and thoroughly report diagnosis and treatment information. Methods: As part of a clinical trial, summaries were prepared for patients with stage 0 to III breast cancer at two cancer centers. Summaries were prepared per the standard of care at each center via two methods: using the electronic health record (EHR) to create and facilitate autopopulation of content or using manual data entry into an external software program to create the summary. Each participant's clinical data were abstracted and cross-checked against each summary. Errors were defined as inaccurate information, and omissions were defined as missing information on the basis of the Institute of Medicine recommended elements. Results: One hundred twenty-one summaries were reviewed: 80 EHR based versus 41 software based. Twenty-four EHR-based summaries (30%) versus six software-based summaries (15%) contained one or more omissions. Omissions included failure to provide dates and specify all axillary surgeries for EHR-based summaries and failure to specify receptors for software-based summaries. Eight EHR-based summaries (10%) versus 19 software-based summaries (46%) contained one or more errors. Errors in EHR-based summaries were mostly discrepancies in dates, and errors in software-based summaries included incorrect stage, surgeries, chemotherapy, and receptors. Conclusion: A significant proportion of summaries contained at least one error or omission; some were potentially clinically significant. Mismatches between the clinical scenario and templates contributed to many of the errors and omissions. In an era of required care plan provision, quality measures should be considered and tracked to reduce rates, decrease inadvertent contributions from templates, and support audited data use.

Developing a culturally and linguistically responsive survivorship care plan for breast cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 146-146
Author(s):  
Kimlin Tan Ashing ◽  
Monica Rosales ◽  
Gingi Fulcher ◽  
Mayra Serrano ◽  
Jeffrey N. Weitzel ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Cultural Responsiveness ◽  
Advisory Council ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Preliminary Evaluation ◽  
Breast Cancers ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Care Plans

146 Background: African and Latina-American breast cancers patients (BCA) experience the greatest morbidity and mortality, suggesting a critical need for improved surveillance and quality care. The Institute of Medicine (IOM) and the Commission on Cancer (CoC) recommend that survivors receive personalized Treatment Summaries and Survivorship Care Plans (TSSCP) in order to facilitate best practice in clinical surveillance and follow-up care. This TSSCP template development study joined advocacy, scientific and medical communities to comprise a diverse advisory council (AC, N=38) to inform the development of the TSSCP-AA (African American) and TSSCP-S (Latino) templates targeting BCA. This abstract reports on the development, and presents the TSSCP-AA and TSSCP-S. Methods: The overall study was guided by the Shared Care and Psychooncology Models, and Contextual Model of Health Related Quality of Life. The AC provided input into the culturally relevant modifications of the American Society of Clinical Oncology (ASCO) TSSCP template to create the TSSCP-AA and TSSCP-S. Health care professionals enlisted from cancer centers and community hospitals (n=51) evaluated the TSSCP-AA and TSSCP-S templates on the following domains: content, clarity, utility, and cultural and socioecological responsiveness. Results: AC input revealed that the clinical (i.e., comorbidities) and cultural contexts (i.e., language, spirituality) must inform TS and SCP, respectively. Preliminary evaluation analyses documented that health professionals rated our TSSCP-AA and TSSCP-S templates as excellent to outstanding on content, clarity, utility, cultural responsiveness, and socioecological responsiveness (p<0.01). Conclusions: The evaluation results imply that the TSSCP-AA and TSSCP-S templates achieved cultural responsiveness with high acceptability and utility among professionals and survivors. We created both paper and electronic versions of theTSSCP-AA andTSSCP-S (English and bilingual English-Spanish formats) for providers to create individualized TSSCPs. Further, our TSSCP development approach can be adopted for TSSCP template development targeting ethnic/linguistic minority cancer survivors.

Survivorship care plans: Is there buy-in from oncology providers?

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 8-8
Author(s):  
Talya Salz ◽  
Erin Onstad ◽  
Mary S. McCabe ◽  
Shrujal S. Baxi ◽  
Richard L. Deming ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Survivorship Care Plans ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Care Providers ◽  
Care Plans ◽  
Ongoing Care ◽  
Oncology Providers ◽  
To Receive

8 Background: The Institute of Medicine advised that cancer survivors and their primary care providers receive survivorship care plans (SCPs) to summarize cancer treatment and plan ongoing care. However, the use of SCPs remains limited. Methods: Oncology providers at 14 National Cancer Institute Community Cancer Centers Program (NCCCP) hospitals completed a survey regarding their perceptions of SCPs, including barriers to implementation, strategies for implementation, the role of oncology providers, and the importance of topics in SCPs (diagnosis, treatment, recommended ongoing care, and the aspects of ongoing care that the oncology practice will provide). Results: Among 245 providers (70% response rate), a minority reported ever providing an SCP or any of its components to patients. The most widely reported barriers were personnel to creating SCPs and time (69% and 64% of respondents, respectively). The most widely endorsed strategy among those using SCPs was the use of a template with pre-specified fields; 94% of those who used templates found them helpful. For each topic of an SCP, while 87%-89% of oncology providers felt it was very important for primary care providers to receive the information, only 58%-65% of respondents felt it was very important for patients to receive the information. Further, 33%-38% of respondents had mixed feelings about whether it was oncology providers’ responsibility to provide SCPs. Conclusions: Practices need additional resources to overcome barriers to implementing SCPs. We found resistance toward SCPs, particularly the perceived value for the survivor and the idea that oncology providers are responsible for SCP dissemination.

Patient-generated online survivorship care plans for adult survivors of childhood cancer: Feasibility and patient preferences.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 54-54
Author(s):  
Dava Szalda ◽  
Marilyn M. Schapira ◽  
Lisa Schwartz ◽  
Esther Kim ◽  
Carolyn Vachani ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Pediatric Cancer ◽  
Online Survey ◽  
Adult Survivors ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Plans ◽  
Survivors Of Childhood Cancer

54 Background: With improvements in pediatric cancer treatment, the number of childhood cancer survivors is growing rapidly. Survivorship care plans (SCPs) can provide survivors with necessary information and resources to engage in risk-based follow-up care. Online patient motivated SCPs are promising for adult survivors of childhood cancer with multiple care transitions and the need for self-management outside clinical encounters. Methods: An existing online SCP generator (OncoLife) was adapted to create Smart Adult Living After Childhood Cancer plans for survivors of pediatric Acute Lymphoblastic Lymphoma (ALL) and Hodgkin’s Lymphoma (HL) by incorporating Children’s Oncology Group Long Term Follow-Up Guidelines into existing information technology logic. Results: Adult survivors (n = 20) of pediatric ALL or HL, registered to be seen in radiation oncology or survivorship clinic at the University of Pennsylvania, created an online SCP and completed an online survey. Approximately 80% of patients contacted consented and completed SCP indicating high acceptability; two-thirds (66%) completed the survey. Participants were a median of 35.5 years of age and of 26.5 years since diagnosis. They were 50% female, majority Caucasian (90%), 70% ALL and 30% HL survivors. SCPs took an average of 9 minutes 46 seconds to complete. The majority (95%) of respondents found the SCP generator easy to use, would recommend it to others (85%), and were satisfied with the amount of information received (80%). Ninety percent stated they intended to discuss their SCP with a healthcare provider. Only a third (35%) of survivors stated they had previously received a formal SCP. Seventy percent (70%) stated a written or online plan was the best way to convey health information between visits. Preferences for use of online SCP included: 70% wanting a treatment summary to complete their SCP and 50% wanting personal information to be saved for later use. Conclusions: Online patient-motivated SCPs are a feasible and acceptable way to deliver information to adult survivors of pediatric cancer about long term health risks. Further research into optimal methods for creation, use and health benefits of SCPs is warranted.

Innovation, education, and research: A multidisciplinary survivorship care model.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 10519-10519
Author(s):  
Hira Latif ◽  
Patrick Martone ◽  
James Edward Shaw ◽  
Eric Wisotzky ◽  
Asma Ali Dilawari
Keyword(s):  
Physical Function ◽  
Cardiovascular Health ◽  
The United States ◽  
Screening Tools ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Care Plans ◽  
Patient Reported

10519 Background: Advances in early detection, therapeutics, and an aging population are expected to lead to an increase in the number of cancer survivors in the United States to 20 million by year 2026. The Institute of Medicine and Commission on Cancer recommends delivery of survivorship care plans on completion of curative treatment. While models exist for high-quality survivorship care, institutions encounter barriers such as lack of resources and limited training in survivorship. Our institution piloted a unique model combining fellows’ education with guideline-driven recommendations from a multidisciplinary team to provide consolidated survivorship care. Methods: A survey for self-reported competence and experience was conducted amongst the hematology and oncology fellows at the MedStar Washington Hospital Center. A bimonthly clinic staffed by a medical oncologist, oncology fellow and a cancer rehabilitation fellow was initiated in September 2018. Didactic lectures, curriculum syllabus and recommended assessments were established. Screening tools for distress, patients’ confidence in knowledge about survivorship and physical function via PROMIS 20a were administered; clinical assessments including the “6-minute walk test” were used to assess cardiovascular health. Results: Most fellows had not encountered a survivor of lung (16%), GU (0%) and head and neck cancer (33%). Majority of the fellows had never delivered a survivorship care plan. Scores were low in competence and experience in survivorship. By December 2018, 15 patients with 17 diagnoses of cancer were referred to the clinic. 10 were survivors of hematologic malignancies while 7 were of solid tumors. The no-show rate was 40%. Fellows conducted the assessments and were supervised by an oncology attending. Of the 9 patients seen, 4 were referred for physical therapy; additional referrals for psychology and cardiology were frequent. Conclusions: A comprehensive multidisciplinary survivorship clinic focusing on fellows’ education is a feasible model for delivery of survivorship care and aims to bridge the gap in experience and competence of fellows. Future goals include re-assessment of patient-reported outcomes, physical function, and competence of fellows.

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