Primary care providers (PCPs) are interested in receiving survivorship care plans (SCPs), but all too often they either do not receive them, don’t know that they did, or don’t have easy access to them, according to Larissa Nekhlyudov, MD, MPH, internist at Brigham and Women’s Hospital and Clinical Director of Internal Medicine for Cancer Survivors at Dana-Farber Cancer Institute, Boston, MA.
“It’s what is done with an SCP that matters,” she said at the ASCO Cancer Survivorship Symposium. “Relevant information needs to be pulled into the medical record in the format that PCPs use, and a visit specifically focusing on survivorship care during the transition, or even after the patient transition, may help with the process.”
Lost in Transition
“In preparation for this talk, I decided to survey the primary care providers in my practice,” she said. Via e-mail, she asked if they had received the SCP for any of their patients with a history of cancer. These were, verbatim, their responses:
- “Haven’t seen care plans on patients (maybe just don’t know where they exist).”
- “Where exactly would the survivorship care plan be located?”
- “I might have received them, but not recognized.”
- “If I see any, will pass along to you.”
“This is not surprising,” she said.
But when it comes to their patients with a history of cancer, PCPs find information about late effects and follow-up to be useful. They want to keep it simple (1 page, not more), they want to make it printable or accessible in the electronic medical record, and they typically say they want it about 6 to 12 months posttreatment. “But we also know from a variety of studies that PCPs report not receiving an SCP, although some surveys say that oncology providers almost always provide them,” she noted. I wanted to dig a little bit deeper and see what might be going on.”
She showed the audience a snapshot of her inbox on the Epic platform, and pointed out a small heading titled “Treatment Summary.” “Now to what extent the PCP has any clue what’s in that message or what information it provides, is not clear,” she said.
She then demonstrated how to navigate through a patient’s personal history and click on a prompt that lists a history of cancer, which then leads the PCP to the “Oncology Treatment Summary.”
“So, you finally get to the treatment summary and care plan, of course assuming that the PCP has gone through all of the steps to get to this place,” she noted.
Making SCPs Useful
She compared the SCP to a hospital discharge summary and noted that discharge summaries are, very simply, required, expected, and completed. But according to Dr Nekhlyudov, that process seems to be missing in the discussion about SCPs and survivorship care planning.
“An SCP is just a vehicle for communication,” she said. “It’s really nothing more and nothing less. The question for me was, are SCPs useful for the PCP? Well, I propose that we make it useful.”
PCPs should be given a clear notification when an SCP arrives in their inbox, she emphasized. They should be able to easily understand what it is, and it should be clearly visible to the physician when a patient’s chart is opened.
A patient’s cancer history should not simply state “history of lymphoma,” but should include the type of cancer, when it was diagnosed, what treatments were received, details on existing or potential late effects, and where the patient is being followed.
“I’d like us to focus back on what is important,” she added. “And not on things that will potentially derail us.”