Transition After Breast Cancer Treatment: Implementing Survivorship Care Plans
Background: Over the last three decades, advances in screening, diagnosis, and treatment have created an evolution in cancer care. In the United States it is estimated 12 to 14 million people, 4% of the population, are survivors of cancer. Breast cancer survivors are a prominent subset, accounting for nearly 2 million survivors. The 2006 Institute of Medicine report; From Cancer Patient to Cancer Survivors: Lost In Transition, identified survivorship as a distinct phase in the trajectory of cancer care and called attention to the significant gaps in the provision and coordination of care to this population. TS/SCP are a tool designed to improve outcomes, bridge the knowledge gap, decrease fragmentation of care, and increase satisfaction in the post treatment phase of cancer care. TS/SCP’s are incorporated into 43% of all National Cancer Institute (NCI) designated cancer centers. In the project facility, there was no TS/SCP in use with patients.
Practice Innovation Process: The purpose of this EBP project is for 80% of participants to increase their knowledge and satisfaction regarding breast cancer survivorship care. The database of a single office of a large community-based oncology practice in Southern California was queried to identify women who had completed primary adjuvant treatment for stage I-III breast cancer within the previous 12-months. Women were called and invited to attend a single, one-on-one survivorship visit with an Oncology Nurse Practitioner. A personalized TS/SCP was developed using the Journey Forward Care Plan Builder. Knowledge was measured pre-visit using the Confidence in Survivorship Information tool (CSI). The women were provided with a copy of the NCI publication Facing Forward: Life After Cancer Treatment. The TS/SCP and publication were reviewed and related questions and concerns were addressed. Women were educated on risk reduction strategies. Follow-up visits and referrals were made based on identified ongoing issues. At the completion of the visit, knowledge was reassessed using the CSI and satisfaction was measured using the Patient Satisfaction with Cancer Care (PSCC) tool. The TS/SCP was updated and a final copy was provided to the patient and mailed to the primary care provider (PCP).
Outcomes: In progress. It is anticipated upon completion of this project that 80% of participants will have increased knowledge and satisfaction regarding breast cancer care
Conclusions: Preliminary data shows TS/SCP delivered in the context of a survivorship visit with a Nurse Practitioner consistently increases knowledge of all domains measured in the CSI tool. Satisfaction with the intervention was high. As with many education and wellness interventions, the Nurse Practitioner is uniquely qualified to support patients completing chemotherapy with curative intent as they transition to survivorship care. Furthermore, depending on payer mix, post treatment survivorship visits represent a potential revenue stream for a community-based oncology practice.