scholarly journals Shared care involving cancer specialists and primary care providers - What do cancer survivors want?

2017 ◽  
Vol 20 (5) ◽  
pp. 1081-1087 ◽  
Author(s):  
Sharon Lawn ◽  
Julia Fallon-Ferguson ◽  
Bogda Koczwara
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Primary Care Providers ◽  
Shared Care ◽  
Care Providers ◽  
Cancer Specialists

scholarly journals Transitioning to Breast Cancer Survivorship: Perspectives of Patients, Cancer Specialists, and Primary Care Providers

2009 ◽  
Vol 24 (S2) ◽  
pp. 459-466 ◽  
Author(s):  
Melinda Kantsiper ◽  
Erin L. McDonald ◽  
Gail Geller ◽  
Lillie Shockney ◽  
Claire Snyder ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Survivorship ◽  
Primary Care Providers ◽  
Care Providers ◽  
Breast Cancer Survivorship ◽  
Cancer Specialists

The relationship between older cancer survivors’ reports of depression, anxiety and pain to health providers’ findings and mortality

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8597-8597
Author(s):  
P. H. Seo ◽  
R. Sloane ◽  
S. S. Ingram ◽  
D. Misra ◽  
E. C. Clipp ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Karnofsky Performance Status ◽  
Depression Scale ◽  
Primary Care Providers ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Health Providers ◽  
Care Providers ◽  
Pain Anxiety

8597 Background: Older cancer survivors may experience psychological distress due to their cancer experience and aging health. This study aimed to compare primary care and specialty providers’ inquiries of pain, depression and anxiety to older cancer survivors’ questionnaire responses. Methods: 153 patients seen in oncology clinics at the Veterans Affairs Medical Center (Durham, NC) from November 1999 until April 2000 completed the Hospital Anxiety and Depression Scale and a pain thermometer questionnaire. Blinded chart review examined health provider inquiries of pain, anxiety and depression. Cox proportional hazards survival analyses were performed on subjective pain, anxiety and depression with comorbidities and Karnofsky performance status (KPS) added in controlled models. Results: Patients were on average aged 68, had 5.4 comorbidities, 87.4% KPS, and were 3.1 years from a cancer diagnosis. Health providers missed 17 of 94 patients with significant levels of self-reported pain (sensitivity 0.82). Although 28 (20.6%) and 33 (25.8%) patients screened positively for depression and anxiety respectively, providers asked 7 patients about anxiety (sensitivity 0.15) and 16 patients about depression (sensitivity 0.25). The overall three year mortality was 37.9%. Pain was not associated with mortality. Patients screening for depression [HR 2.03 (95% CI: 1.03, 4.01)] and anxiety [HR 2.02 (95% CI: 1.01, 4.04)] had lower 3 year survival. KPS and comorbidities diminished these effects. Conclusions: In older cancer survivors, anxiety and depression may have an association with mortality. To improve detection, oncology and primary care providers should routinely inquire about mood and aim to intervene with pharmacologic or supportive treatments. No significant financial relationships to disclose.

Cancer survivorship algorithms as clinical tools for primary care providers.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 100-100
Author(s):  
Guadalupe R. Palos ◽  
Katherine Ramsey Gilmore ◽  
Paula A. Lewis-Patterson ◽  
Maria Alma Rodriguez
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Primary Care Providers ◽  
Cell Transplant ◽  
Care Providers ◽  
Coordinated Care ◽  
Major Barrier ◽  
Site Specific ◽  
The Impact

100 Background: Clinical decision tools (CDTs) such as survivorship algorithms may be valuable resources for primary care providers who provide post-treatment care for cancer survivors. Our objective was to assess providers’ perceptions, adoption, and satisfaction with clinical practice algorithms tailored to site-specific cancer survivorship clinics. Methods: Eligible providers were those assigned to one of 9 site-specific survivorship clinics, (breast, colorectal, genitourinary, gynecology, head and neck, lymphoma, melanoma, stem cell transplant, and thyroid). Potential respondents were invited to participate by emails. Voluntary return of the survey indicated a provider’s informed consent. Providers had the choice to participate by clicking on a link embedded in an email. Once the link was activated, the user was taken to a 10-item survey with questions asking about the usability, awareness, and satisfaction with the algorithms specific to their clinic. Descriptive statistics (i.e. frequencies and percentages) were used to summarize the responses. Results: Of 35 providers assigned in the survivorship clinics, 18 responded resulting in a 51% response rate. The majority of respondents (94.4%) were aware of the survivorship algorithms specific to their clinic. Over 75% reported using the algorithms occasionally (16.7%), frequently (33%) and always (33.3%). The major barrier to using the algorithms was a lack of awareness on to access the algorithms. Over half of the providers (55.6%) preferred using the digital versions of the algorithms. 68% strongly agreed the algorithms were practical to use and implement in their clinical setting. The majority of providers’ reported being satisfied (62.5%) or very satisfied (25.0%) with the algorithms tailored to their site specific clinic. Conclusions: Survivorship practice algorithms were perceived as useful clinical resources to deliver coordinated care to cancer survivors with diverse cancer diagnoses. Future work is needed to determine the impact of the algorithms on providers’ practice with cancer survivors.

The role of annual personal health visits (APHV) on patients' with cancer knowledge and perceptions of the harms of continued smoking.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 152-152
Author(s):  
Delaram Farzanfar ◽  
Lin Lu ◽  
Jie Su ◽  
Devon Alton ◽  
Rahul Mohan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Cancer Survivors ◽  
Cancer Patients ◽  
Primary Care Providers ◽  
Smoking History ◽  
Care Providers ◽  
Risk Of Death ◽  
Increase Risk

152 Background: With improvements in cancer detection and therapies, important secondary prevention measures in survivorship include smoking cessation. Primary care providers have an opportunity to discuss these measures with cancer survivors at APHV. We evaluated whether having a recent APHV is associated with cancer patients’ awareness and perceptions of the harms of continued smoking. Methods: Cancer survivors were surveyed from April 2014 to May 2016 with respect to their smoking history, knowledge and perceptions of the harms of continued smoking along with the date of their most recent APHV (term changed from annual health physical examination in 2013). Multivariable logistic regression analyses assessed the association of having an APHV with knowledge and perceptions of the harms of continued smoking. Results: Of 985 cancer patients, 23% smoked at diagnosis; 34% quit > 1 year prior to diagnosis; 55% had tobacco-related cancers; 77% received curative therapy. From a knowledge viewpoint, over 52% reported being unaware that smoking negatively impacts cancer outcomes; despite this, most perceived smoking to negatively influence quality of life (75%), survival (76%), and fatigue (73%). Within the last year, 48% had an APHV, while 84% had an APHV at any time in the past; 18 (2%) reported not having a family doctor. Patients who had an APHV in the last year were more likely to be aware that continued smoking can increase risk of death (adjusted odds ratio (aOR)=1.49, 95% CI [1.13-1.96], P=0.004), and more likely to perceive smoking to negatively impact quality of life (aOR=1.37 [0.94-1.99], P=0.10), survival (aOR=1.60 [0.95-2.71], P=0.08), and fatigue (aOR=1.63 [1.11-2.39], P=0.01). Those ever having an APHV were more likely aware that smoking can increase risk of death (aOR=1.61 [1.07-2.43], P=0.02) and second primaries (aOR=1.53 [1.02-2.33], P=0.04). Conclusions: Having a recent APHV was associated with improved awareness and perceptions of the harms of continued smoking, but it is unclear whether this is related to provider counseling or a healthy bias effect. APHV may be an appropriate time for primary care providers to treat tobacco addiction in their cancer survivors.

Factors influencing the use of electronic health record systems to provide follow-up care to cancer survivors.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 182-182
Author(s):  
Guadalupe R. Palos ◽  
Maria Alma Rodriguez ◽  
Paula A. Lewis-Patterson ◽  
Rachel Harris ◽  
Lewis E. Foxhall
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Clinical Information ◽  
Primary Care Providers ◽  
Self Report ◽  
Care Providers ◽  
Convenience Sample ◽  
Major Barrier ◽  
Care Plans ◽  
Electronic Health

182 Background: One of the expected benefits of electronic health records (EHRs) is their interoperability to remotely access and exchange clinical information across systems and clinicians. Cancer survivors’ treatment summaries (TSs) and care plans (CPs) are documents that can be electronically transferred from oncologists to primary care providers. We conducted a needs assessment to identify factors which influenced EHRs in meeting these expectations in rural and underserved primary care settings. Methods: Clinicians from 2 family practice health care systems, located in central and northeast Texas were surveyed. REDCap, a web-based system, was used to develop, manage, and distribute the survey to a convenience sample of clinical staff from both settings. Survey questions focused on respondents’ demographic and clinical practice characteristics, current experience with TSs and CPs, and type of EHR used. Results: A total of 26 surveys were included in this analysis. Respondents were primarily physicians (73%). Overall 61.5% reported that ≤ 25% of their patients were diagnosed with cancer or currently had cancer. A patient’s self-report was the primary method used by majority of respondents to determine if a patient had a history of cancer. 80.8% indicated they would be interested in learning more about the use and development of TSs and CPs. Barriers reported towards the use of EHRs to deliver TSs and CPs included: EHRs interference with workflow (60%); limited knowledge on how to develop TSs and CPs (48%), inadequate access to IT resources (48%), and inefficient EHR systems (44%). In these settings, EHRs used were: Epic (61.6%), Aria (30.8%), and Medit (7.7%). Respondents’ comments on EHRs weaknesses included: “the two systems…do not completely communicate with each other” or “no place where a cancer treatment summary or survivorship plan is documented”. Conclusions: Primary care providers identified limitations in EHR operability as a major barrier to retrieving health information required for TSs and CPs. Clinicians in rural or underserved regions may benefit from education and retraining in EHR systems.

scholarly journals Risk-Stratified Pathways for Cancer Survivorship Care: Insights from a Deliberative Multi-Stakeholder Consultation

2021 ◽  
Vol 28 (5) ◽  
pp. 3408-3419
Author(s):  
Dominique Tremblay ◽  
Nassera Touati ◽  
Karine Bilodeau ◽  
Catherine Prady ◽  
Susan Usher ◽  
...  
Keyword(s):  
Primary Care ◽  
Risk Stratification ◽  
Cancer Survivorship ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
Survivorship Care ◽  
Care Providers ◽  
Stakeholder Consultation ◽  
Cancer Specialists ◽  
Multi Stakeholder

Risk-stratified pathways of survivorship care seek to optimize coordination between cancer specialists and primary care physicians based on the whole person needs of the individual. While the principle is supported by leading cancer institutions, translating knowledge to practice confronts a lack of clarity about the meaning of risk stratification, uncertainties around the expectations the model holds for different actors, and health system structures that impede communication and coordination across the care continuum. These barriers must be better understood and addressed to pave the way for future implementation. Recognizing that an innovation is more likely to be adopted when user experience is incorporated into the planning process, a deliberative consultation was held as a preliminary step to developing a pilot project of risk-stratified pathways for patients transitioning from specialized oncology teams to primary care providers. This article presents findings from the deliberative consultation that sought to understand the perspectives of cancer specialists, primary care physicians, oncology nurses, allied professionals, cancer survivors and researchers regarding the following questions: what does a risk stratified model of cancer survivorship care mean to care providers and users? What are the prerequisites for translating risk stratification into practice? What challenges are involved in establishing these prerequisites? The multi-stakeholder consultation provides empirical data to guide actions that support the development of risk-stratified pathways to coordinate survivorship care.

Nurse navigation: The key to a seamless transition.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 84-84
Author(s):  
Joy M. Fulbright ◽  
Wendy McClellan ◽  
Gary C. Doolittle ◽  
Hope Krebill ◽  
Robin Ryan ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Cancer Survivorship ◽  
Childhood Cancer Survivors ◽  
Primary Care Providers ◽  
Survivorship Care ◽  
Care Providers ◽  
Nurse Navigator ◽  
Seamless Transition

84 Background: Children's Mercy (CM) established a cancer survivorship clinic that cares for approximately 180 survivors a year. A third of the survivors are 18 years or older requiring transition to adult care. The importance of transitioning childhood cancer survivors from pediatric oncology care to adult primary care has been acknowledged in literature, but obstacles remain. Barriers include patient and provider anxiety, difficulty navigating the complex health care system and lack of knowledge regarding late effects. CM and The University of Kansas Cancer Center (KUCC) collaborated to decrease barriers to transition for childhood cancer survivors. Methods: The work group met for 2 years to develop the clinic at KUCC. Models and delivery of survivorship care, including the breast cancer survivorship clinic at KUCC, were reviewed. A shared nurse navigator was identified as an essential component to a seamless transition. Philanthropic support was obtained and job description was developed. Contracts were negotiated to allow the navigator to be present at both institutions. Results: The Survivorship Transition Clinic (STC) at KUCC launched July 2014, with a navigator supporting patients at CM as they begin their transition. The same navigator then meets with the patient at KUCC STC as they initiate care. The navigator provides treatment summaries, patient education and navigates the referral services for survivors. Since clinic launch, 16 survivors out of 16 have successfully transitioned from pediatric to adult survivorship care. Positive feedback was received from patient satisfaction surveys that were administered. A common theme showed a relief from anxiety due to having a contact person to facilitate communication among providers in a complex healthcare system. Conclusions: The nurse navigator has minimized anxiety about transition for patients and parents as she establishes a relationship with patients at CM, and then is able to provide continuity as they transition to the STC at KUMC. The navigator also improves communication between pediatric providers, adult primary care providers and sub-specialists caring for the patients. Overall, our transition process has been effective and is now serving as a model across both institutions.

Comanagement and emergency room admissions in oncology practice.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 21-21
Author(s):  
Jennifer Nadine Slim ◽  
Michelle Marie Loch
Keyword(s):  
Primary Care ◽  
Chest Pain ◽  
Cancer Survivors ◽  
Emergency Room ◽  
Care Provider ◽  
Primary Care Provider ◽  
Management Strategies ◽  
Primary Care Providers ◽  
Care Providers ◽  
Admission Rates

21 Background: Cancer survivors face many challenges and encompass a multitude of specialties. These patients frequently utilize emergency room services with increased admission rates and, often, significant consequences on health care costs. National Hospital Ambulatory Medical Care Survey data from 2011 reports non-ischemic heart disease, chest pain and pneumonia as the most common emergency room discharge diagnoses for adults. We hypothesized that cancer survivors who continue care with primary providers require fewer emergency room based admissions. Our purpose in identifying these demographics was to allow for further consideration of specific interventions that might improve out patient based management. Methods: We considered ongoing primary care as those assigned to a primary care provider. We developed a memorandum of intention to identify patients at risk for over utilization of emergency room services. We gathered anonymous data about oncology patients seen in clinic from July 2014 to August 2015. We were able to determine how many emergency room based admissions were attributed to these patients as well as patients with and without primary care providers assigned in the EMR. We further attempted to identify those at higher risk taking into account co-morbid diagnoses. Results: 2,627 survivors were seen in clinic with 163 emergency room based admissions. 75% of these patients did not have a primary care provider identified in EPIC and account for 51% of the admissions. Only two patients had 3 or fewer co-morbid diagnoses. The most common co-morbid diagnoses among patients with emergency room based admission were abdominal pain, anemia, and chest pain. Conclusions: This data would suggest that co-management with primary care providers alone is not adequate for cancer survivors. While about half of the admissions were those without assigned primary care; the overall percentage of admission was higher from those assigned primary care providers. We suggest risk factors and management strategies are unique to survivors and require a focused multidisciplinary approach. Further study focused on interventions unique to cancer survivors are warranted.

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