Oncology Rounds

New research says survivorship care plans often fall short. Here are 3 ways to do better.

by Deirdre Saulet and Sarah Adam

As the number of patients surviving cancer increases, so does the urgency to provide high-quality care to this population. Survivorship care plans (SCPs) have become a common—and, for programs accredited by the Commission on Cancer (CoC), required—tool that programs create for patients who have completed active treatment.

Read our blog outlining how survivorship care extends beyond the delivery of a care plan

However, a recent review of the existing research on SCPs in the Journal of Clinical Oncology found the quality of research on this topic is low and demonstrates limited evidence of their effectiveness or that they drive positive patient outcomes.

Survivorship care programs need to be more than just a care plan

This study showed that SCPs are often the sole element of survivorship programs. But there is a lack of information and support for patients to help them follow the clinical recommendations contained in care plans. The authors noted, "An SCP is unlikely to be effective if there are no mechanisms in place to implement the plan's recommendations." SCPs need to be woven into more comprehensive care programs following the end of active treatment.

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Struggling to measure the impact of survivorship care plan

Another reason for the lackluster evidence stems from poor analytic rigor in research design and limited consistency in measuring care plan outcomes. For example, much of the available research focuses on distal outcomes that are easy to track, such as "survivors' reports of their health status" as a positive indicator. These distal outcomes take the place of proximal metrics, such as patient knowledge or their satisfaction with provider communication, which could be a better indicator of SCP success. Among the outcomes measured, there are slight indications of the benefits of SCPs in improving psychosocial outcomes and perceptions of care. However, these are not consistently seen across all studies.

Many operational barriers to SCP execution

Another pain point frequently voiced by cancer programs and highlighted in the research is the time and resources needed to create and deliver SCPs. Barriers to effective SCP creation and delivery are multifarious, including challenges with automation, integration with EHR, ambiguous ownership of SCPs, collaboration with PCPs, and continuous updating of SCPs.

Develop your strategy for survivorship

The inconsistent measurement, delivery, and follow through related to survivorship care plans indicate there is much room for improvement. To overcome these hurdles, here are three important steps you can take to improve your survivorship care plan delivery:

  • Care plans should be targeted and brief: use narrative style and limit treatment summary to providing treatment modality, site, and dose.

  • Use templates available online and leverage IT to streamline creation and delivery.

  • Make them patient centered by asking patients what information included in a care plan would be most useful and educate them on how to use care plans.
 

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