Survivorship care planning in a comprehensive cancer center using an implementation framework

Sofia F Garcia; Sheetal M Kircher; Megan Oden; Aubri Veneruso; June M McKoy; Timothy Pearman; Frank J Penedo

doi:10.12788/jcso.0255

Survivorship care planning in a comprehensive cancer center using an implementation framework

J Community Support Oncol. 2016 May;14(5):192-9. doi: 10.12788/jcso.0255.

Authors

Sofia F Garcia^{1

2

3}, Sheetal M Kircher^{2

4

5}, Megan Oden⁵, Aubri Veneruso⁵, June M McKoy^{2

3

4

5}, Timothy Pearman^{6

2

3}, Frank J Penedo^{6

2

3

7}

Affiliations

¹ Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA. sofia-garcia@northwestern.edu.
² Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA.
³ Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA.
⁴ Department of Medicine, Northwestern University, Chicago, Illinois, USA.
⁵ Northwestern Medicine, Chicago, Illinois, USA.
⁶ Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA.
⁷ Department of Psychology, Northwestern University, Evanston, Illinois, USA.

PMID: 27258051
DOI: 10.12788/jcso.0255

Abstract

Cancer survivorship care plans (SCPs) have been recommended to improve clinical care and patient outcomes. Research is needed to establish their efficacy and identify best practices. Starting in 2015, centers accredited by the American College of Surgeons Commission on Cancer must deliver SCPs to patients completing primary cancer treatment with curative intent. We describe how we established routine SCP delivery at the Robert H Lurie Comprehensive Cancer Center in Chicago, Illinois, using the Quality Implementation Framework. We evaluated local practices, gathered clinician and patient stakeholder input, developed customized SCP templates within the electronic health record (EHR), and implemented 2 complementary delivery models. Clinician interviews (n = 41) and survey responses (n = 12), along with input from patients (n = 68) and a patient advisory board (n = 15), indicated support for SCPs and survivorship services. To promote feasible implementation and leverage existing workflows, we harmonized 2 SCP delivery models: integrated care within clinics where patients received treatment, and referral to a centralized survivorship clinic. We are implementing SCP delivery with prominent disease sites and will extend services to survivors of other cancers in the future. We developed four electronic disease-specific SCP templates for breast, colorectal, lung, and prostate cancers and a fifth, generic template that can be used for other malignancies. The templates reduced free-text clinician entry by auto-populating 20% of the fields from existing EHR data, and using drop-down menus for another 65%. Mean SCP completion time is 12 minutes (range, 10-15; n = 64). We designed our framework to facilitate ongoing evaluation of implementation and quality improvement. Funding/sponsorship Robert H Lurie Comprehensive Cancer Center, the Coleman Foundation, and the Lynn Sage Cancer Research Foundation.

Keywords: cancer; electronic health record; follow-up care; patient-centered care; survivorship; survivorship care plan.