Background: In 2014, the American College of Surgeons Commission on Cancer mandated in Standard 3.3 that survivorship care plans (SCPs) be provided for all patients at the completion of active cancer treatment. Minimum requirements for what the SCP should include were provided; however, no standardized model was proposed. Multiple third-party tools exist for providing SCPs (eg, LIVESTRONG, Journey Forward), but these are cumbersome to work through and are not personal even when the patient’s treatment information is put into these programs. Rather than approaching the requirements for Standard 3.3 as an obstacle, we chose to look at this as an opportunity to provide SCPs unique to our institution and in a personalized way.
Objective: To describe a pilot project designed to provide personalized SCPs to patients treated at a large academic medical center and meet the requirements of Standard 3.3.
Methods: To approach the problem of providing SCPs to all patients treated within a large academic medical center, a patient-centered SCP template was created specifically for The University of Tennessee Medical Center Knoxville Cancer Institute (UTMCK, CI). This unique template met all minimum requirements set forth by Standard 3.3 and was created in such a way that it would be applicable to all cancer types. The template was created utilizing the existing electronic health record platform (Cerner) and dictation/voice recognition software. This approach allowed for efficient but personalized input of patient information into the template, as well as quick and universal repetition of standardized information such as information about different types of chemotherapy agents, contact information for treating providers, and evidence-based follow-up screening recommendations for secondary cancers. In other words, because each SCP was created uniquely using dictation software rather than “filling in boxes,” the result was a personalized SCP for each patient. This was accomplished with the guidance of a physician champion who helped to identify all major stakeholders within the Cancer Institute, including mid-level providers (nurse practitioners and PAs who provide survivorship care to patients), patients, and primary care providers. Input from these providers was considered when creating the universal SCP template to create the best fit for our organizational challenges and workflow. SCPs were delivered either by mail or in person at follow-up appointments depending upon how the patient’s survivorship care was provided.
Results: During the 12-month pilot, the SCP template created by the UTMCK, CI was tested and completed by the Division of Surgical Oncology. Specifically, a nurse practitioner within this group was tasked with creating the template and designing the workflow for providing SCPs, as well as reviewing the SCPs with patients during survivorship follow-up exams. This approach allowed us to identify problems within the template and make appropriate revisions throughout the process. In the 2015 calendar year, 2700 cancer patients were treated, and SCPs were provided for 325 patients (12.04%). This represents patients treated with surgery; however, as SCPs were given at the conclusion of treatment, patients received SCPs after completing chemotherapy and radiation as well when these treatment modalities were part of the treatment regimen. Therefore, we exceeded our goal of providing SCPs to 10% of patients for 2015 as mandated by Standard 3.3. SCPs were provided for a total of 12 cancer types, including both hematologic and solid tumor diagnoses. This pilot process also allowed us to confirm that the SCP we created in-house was applicable to all patient types and treatment types.
Conclusion: Compliance with Standard 3.3 and providing SCPs for patients upon completion of treatment does not have to be a daunting task. An institution, no matter what size, can create its own SCP template that meets all requirements of Standard 3.3 with the input from appropriate stakeholders and at the same time provide a personalized touch to the SCP for each patient. By starting small within 1 division of the Cancer Institute, as shown in this study, workflow challenges can be identified and resolved before dispersing the SCP template systemwide.
