[PDF] Perspectives Of Survivorship Care Plans Among Older Breast Cancer Survivors A Pilot Study eBook
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Introduction: The Commission on Canceru2019s (CoC) Standard 3.3 requires that at least 50% of patients at CoC-accredited hospitals receive survivorship care plans (SCPs) by 2019. A focus on older breast cancer survivors is needed, as they are the majority of the breast cancer population, and their experiences and perspectives about SCPs are limited in the literature.Methods: This pilot study utilized a mixed methods approach (focus groups and self-report questionnaire data) to gather information from breast cancer survivors age 65 years or older. Topics covered were cancer survivorship, communication with their healthcare providers, and the value of SCPs. Questionnaires were completed individually by the participants prior to the focus group, and contained items on their demographics and health status following cancer treatment.Results: Only a minority of women who attended the focus groups actually developed a SCP. Those who developed a SCP in collaboration with their providers valued the personal care and attention received. However, some participants reported poor communication with their providers and healthcare team, resulting in frustration and confusion. Participantsu2019 suggestions for ideal SCPs included better education and personalization, particularly in appropriate nutrition and exercise, and managing side effects and comorbidities. Lastly, the women believed that additional long-term care resources, such as health coaches, were important in improving their survivorship. Conclusions: These findings provide insight into enhancing the content, communication, and application of SCPs to improve the survivorship experience of older breast cancer survivors.
Introduction: Survivorship care plans (SCPs) should be coordinated with multiple healthcare providers including the survivoru2019s primary care physician (PCP). Despite the growing consensus of the importance of PCPs in survivorship care, research examining PCPsu2019 experiences and opinions regarding survivorship care and survivor outcomes under their care is limited.Methods: This pilot study utilized a web-based questionnaire and semi-structured interviews to evaluate PCPsu2019 role in survivorship care of older breast cancer survivors, their experiences and opinions of SCPs, and suggestions for improving care coordination and facilitation of SCPs among older (u226565 years) breast cancer survivors.Results: Physician participants (n=29) had an average 13.5 years in practice. PCPs surveyed that their main role was to provide general health promotion and their least common role was to manage late-and/or long-term effects. Semi-structured interviews indicated that the majority of PCPs did not receive a SCP from their patientsu2019 oncologists and that communication regarding survivorship care was poor. Participantsu2019 suggestions for improvements to SCPs and survivorship care included regular communication with oncologists, delegation from oncologists regarding roles, and mutual understanding of roles.Conclusions: Participants indicated that survivorship care and SCPs have room for improvement regarding communication and roles related to their patientsu2019 survivorship. These findings provide insight into enhancing the content, communication, care coordination, and application of SCPs to ultimately improve the survivorship experience of older breast cancer survivors. More attention needs to focus on the importance of PCPs, as they are an integral part of dual management for older breast cancer survivors post-treatment.
This timely revision of the authoritative handbook gives a wide range of providers practical insights and strategies for treating cancer survivors’ long-term physical and mental health issues. Details of new and emerging trends in research and practice enhance readers’ awareness of cancer survivor problems so they may better detect, monitor, intervene in, and if possible prevent disturbing conditions and potentially harmful outcomes. Of particular emphasis in this model of care are recognizing each patient’s uniqueness within the survivor population and being a co-pilot as survivors navigate their self-management. New or updated chapters cover major challenges to survivors’ quality of life and options for service delivery across key life domains, including: Adaptation and coping post-treatment. Problems of aging in survivorship, disparities and financial hardship. Well-being concerns including physical activity, weight loss, nutrition, and smoking cessation. Core functional areas such as work, sleep, relationships, and cognition. Large-scale symptoms including pain, distress, and fatigue. Models of care including primary care and comprehensive cancer center. International perspectives PLUS, insights about lessons learned and challenges ahead. With survivorship and its care becoming an ever more important part of the clinical landscape, the Second Edition of the Handbook of Cancer Survivorship is an essential reference for oncologists, rehabilitation professionals, public health, health promotion and disease prevention specialists, and epidemiologists.
National Academies of Sciences, Engineering, and Medicine
Author : National Academies of Sciences, Engineering, and Medicine Publisher : National Academies Press Page : 161 pages File Size : 13,78 MB Release : 2018-08-09 Category : Medical ISBN : 0309472989
The 2006 Institute of Medicine (IOM) consensus study report From Cancer Patient to Cancer Survivor: Lost in Transition made recommendations to improve the quality of care that cancer survivors receive, in recognition that cancer survivors are at risk for significant physical, psychosocial, and financial repercussions from cancer and its treatment. Since then, efforts to recognize and address the unique needs of cancer survivors have increased, including an emphasis on improving the evidence base for cancer survivorship care and identifying best practices in the delivery of high-quality cancer survivorship care. To examine progress in cancer survivorship care since the Lost in Transition report, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a workshop in July 2017, in Washington, DC. Workshop participants highlighted potential opportunities to improve the planning, management, and delivery of cancer survivorship care. This publication summarizes the presentations and discussions from the workshop.
Background: There is conflicting evidence regarding the effectiveness of providing cancer survivors with a survivorship care plans (SCP) at the end of their treatment. Further research is needed using health behavior theories to study its impact on realistic and relevant outcomes. Purpose: To identify 1) the effect of receiving a SCP on breast cancer survivors' medical and lifestyle behaviors using the Social Cognitive Theory; 2) the impact of receiving a SCP on breast cancer survivors' fear of recurrence; and 3) the factors that predict receipt of a SCP among breast cancer survivors. Method: Female breast cancer survivors were recruited using social media marketing on pages maintained by three large national cancer survivorship organizations and a local cancer survivorship center. We also recruited survivors using direct emails from two local hospitals. Data on SCP receipt, medical and lifestyle behaviors, Social Cognitive Theory constructs, fear of cancer recurrence, socio-demographics, and cancer history were collected using validated online survey. Linear and ordinal regressions were used to assess the impact of SCP receipt on fear of recurrence and health behaviors. Results: 263 breast cancer survivors completed the online survey of which 53% reported receiving a SCP. Only 54% of those who received a SCP had someone from their cancer care center discuss their SCP with them. Year of diagnosis was a significant predictor of SCP receipt with those diagnosed in 2013-2015 (OR=2.70; 95%CI: 1.20- 6.09) and after 2016 (OR=3.02; 95%CI: 1.29-7.06) having higher odds of SCP receipt compared to those diagnosed between 2010-2012. Components of the SCP pertaining to the relevant topics rather than the entire SCP was associated with fear of recurrence (b=- 1.176 ±0.542; p
"Coordination between oncology specialists and primary care physicians in the management of cancer survivors involves complex transitions across multiple stages of care. As more and more patients survive cancer treatment, there is an increasing need to ensure that the transition from active cancer treatment to follow up survivorship care is supported by the efficient communication of key patient information. One key strategy to address the communication of this information has been the creation of documents called survivorship care plans.This study addressed the information needs of three distinct stakeholder groups; breast cancer survivors, primary care physicians, and oncology specialists in the context of survivorship care plans. Three related research questions were explored for each group: (1) what are the information items of the Institute of Medicine's survivorship care plan framework that are most important for inclusion in a survivorship care plan, (2) what are the preferred communication channels, (3) how is the information in survivorship care plans used in associated processes of care. A sequential explanatory mixed methods study was undertaken to answer these questions. In the quantitative component, a Delphi study was undertaken to measure consensus within stakeholder groups concerning key information items. In the qualitative component, focus groups were used to explore the concept of information use in relation to the consensus items identified in the Delphi study. Breast cancer survivors had consensus on the largest number of items (84/92), while primary care physicians (53/92) and oncology specialists (6/24), had notably less. All three groups showed consensus for preference of electronic communication of a survivorship care plan. Survivors and primary care physicians discussed a need for both instrumental and conceptual information as part of an SCP. This mixture was seen as important to facilitate not only the long term care of cancer survivors, but the relationship building that occurs as part of transitioning back from a cancer centre to a primary care physician. Oncologists emphasized the importance of instrumental information, primarily concerning any indications of recurrence or second cancers. This study makes significant contributions to the understanding of both the conceptual and instrumental use of information within context of primary and cancer care. Conceptual use of information was found to facilitate the communication of personal narrative and help in establishing a common ground between survivors and physicians. In light of a general bias towards deeming instrumental information use (e.g., decision making) as the most important, it is vital to emphasize the role of conceptual information use in regards to its ability to affect outcomes such as increases in personal empowerment, decreases in information anxiety and overall quality of life. Instrumental use of information was also found to be critical, however it was found that information intended to support instrumental use needed to be communicated within the context of jointly negotiated roles and responsibilities in a formal model of care. Taken as whole this study provides a pragmatic lens from which to view the conceptual and instrumental use of information. The findings of this research have the potential to help facilitate complex transitions in healthcare and improve information/communication tools by allowing creators to account for the different ways information is used by different stakeholder groups. This research contributes to practice of survivorship by providing a re-usable framework of information items, each characterized by the different stakeholder groups' assessment of importance, preferred communication channel and information use. Other organizations could use this framework in an 'a la carte' manner to help create survivorship care plans that are responsive to the unique elements of their context." --
More people are living with, through and beyond cancer which makes cancer survivorship an increasingly important area of public health focus. Cancer survivors manage cancer and treatment-related health impacts and life complexity during and post-treatment. These cancer-related impacts, whether visible or invisible, can cause intermittent yet considerable problems. Cancer survivorship research explores ways to improve care and management for people living with, through or beyond cancer. Evidence-based intervention is a fruitful area for cancer survivorship research. Intervention can inform survivorship care pathways. Chronic care approaches have not been adequately explored as a basis for survivorship intervention. Using Te Whare Tapa Wha and Wagner’s Chronic Care Model as theoretical frameworks, the application of supported self-management programs in cancer care is explored herein. This thesis reports on survivorship experiences and a pilot study of a supported self-management intervention program for cancer survivors in New Zealand (NZ). Background: The objectives of this thesis are to report on NZ cancer survivors’ experiences and explore the acceptability, feasibility and pilot delivery of a supported self-management program. Supported self-management intervention programs aim to empower and support people living with chronic conditions to navigate social, physical, emotional and spiritual impacts associated with chronic disease management. The supported self-management intervention program chosen for trial, The Flinders Program, is tailored based on self-assessment surveys and guided interviews/sessions. It results in development of a care plan and, ideally, improved wellbeing. To date, supported self-management programs have not been trialled in NZ as a component of cancer care survivorship pathways that emphasise wellbeing. Methods: The purpose of this study was to explore NZ survivors, as well as health and supportive care workers’, experiences of cancer treatment impacts and care gaps. A supported self-management intervention program was delivered in a NZ hospital setting to see if it could acceptably and feasibly address cancer survivor impacts and unmet needs. A Medical Research Council (UK) framework guided the two-phase study design. The pilot was limited to patients diagnosed with colorectal cancer because these cancers are common in NZ and intervention with colorectal cancer survivors is comparatively under-researched. The first phase of the study qualitatively explored the lived experiences of survivors and the views on survivorship held by a selection of health and supportive care workers. The data showed unmet survivor needs, existing self-management strategies employed, and possible acceptability of The Flinders Program. The second phase of the study piloted The Flinders Program with cancer patients over three sessions coinciding with standard appointments during treatment. Phase two aimed to test the feasibility of procedures for recruitment, randomisation, intervention delivery and outcome evaluation in outpatient cancer clinics. The intervention was delivered using a two-arm pre- post-assessment design to inform intervention acceptability and feasibility. Process evaluation explored enablers/ barriers of intervention delivery while distress, resilience, self-efficacy and quality of life patient-reported outcomes were assessed. Results: The MRC Framework on complex interventions provided a strong structure for conducting planned and stepped intervention research. The phase one qualitative study findings were that both Māori and non-Māori cancer survivors experienced social, physical, emotional and spiritual impacts through cancer treatment that affected their ability to self-manage effectively during active treatment and in the post-cancer treatment transition and extended survival period. Survivor impacts were managed through survivorship work. Phase one data indicated cautious acceptability of The Flinders Program. Phase two data showed that the supported self-management intervention program is questionably feasible, but had the potential to contribute to improved self-management competence if issues related to enablers and barriers at the individual (i.e. self-management readiness) and environmental levels (i.e. staff resourcing) could be addressed. Discussion: A Chronic Care Model-based supported self-management intervention, The Flinders Program, can be delivered in cancer care settings to address survivorship impacts. However, there are important differences between the setting of chronic conditions and the cancer clinical setting as identified by survivors’ shared experiences. The Flinders Program was deemed acceptable to both Māori and non-Māori survivors as well as health and supportive care workers participating in the pilot study but there were feasibility challenges associated with delivering the program in hospital-based cancer treatment settings. The Flinders Program did impact on patient-reported outcome measures but in no clear significant pattern or consistent manner. Further intervention research into supported self-management programs or other types of survivorship care is needed to progress survivorship care pathways.
Introduction: Survivorship care may require adaptation to account for contextual differences of the intended population (e.g. differences in culture). This presentation describes provider perspectives of survivorship care for the needs of young African American breast cancer survivors.Methods: In a preliminary study exploring perceptions of a quality of life intervention targeted to young African American survivors, we conducted semi-structured interviews prompting providers to recall care of this population of survivors. Interview transcripts were analyzed using content analysis. Two reviewers independently coded the data. Reviewers iteratively reduced the coding structure until inter-coder agreement was met. Results: Participants included ten interdisciplinary care providers (registered nurses, advanced practice nurses, physicians, and social workers) with 9-33 years (mean: 21 years) of experience in their professions. Most (60%) saw young African American survivors on a weekly basis. Providers perceived the needs of these survivors were similar to those of other racial/ethnic backgrounds. Providers indicated general ambiguity of culture and cultural needs that would influence the survivorship care provided, rather they addressed individual needs during their discussion of general survivorship topics. Consensus around potential cultural differences from other survivors were young African American survivorsu2019 references to the importance of spirituality and extended family for social support.Conclusions: Care of young African American survivors is predominately need-based. Findings suggest that culture may not be integrated into the survivorship care of these survivors, potentially presenting barriers to optimal assessment and care. Provider cultural competency training may reduce these barriers, improving care acceptability and survivorship outcomes.Acknowledgements: This work was supported by a seed grant from The Ohio State University Comprehensive Cancer Center- The James Nex Gen Ambassadors.
Health has been conceptualized by world and national health organizations (WHO, CDC, Healthy People 2010) as more than the absence of disease. It involves a focus on physical, psychosocial, and functional aspects of life as well as the prevention of future illnesses. At this point in the development of quality health care for cancer survivors, there is sufficient knowledge and expert opinion to push efforts forward to improve the health of cancer survivors. Clearly there is more research in the most prevalent forms of cancers (e.g., breast cancer) than others that provide us with guidance on how to optimize their health, but there are data on other forms of cancers that can also better inform practice. There may also be general care practices that can cut across cancer types. There has been an emergence of epidemiological and clinical research in cancer survivors that can form the basis for a revolution in the quality and nature of health care that survivors receive. This book not only provides the reader with diverse perspectives and data but also integrates this information so it can serve as the foundation necessary to improve and maintain the health of cancer survivors. Reporting of symptoms to health care providers is a complex, multi-determined problem influenced not only by the pathophysiology but also, as we have learned over the years through pain research, by societal, cultural, and biobehavioral factors. This book will consider this important aspect of follow-up for millions of cancer survivors because of the strong reliance on symptom reporting for clinical decision making. In order for us to generate meaningful and effective treatment, we need to better understand the symptom experience in cancer survivors. This book provides much information that will assist us to better understand and manage this complicated end point. The presenting problems need to be articulated and “conceptualized” as clearly as possible by both parties so appropriate actions can be taken. Since health care costs are a major concern for patients, payers, and providers, this area will also be addressed in all the relevant sections. In taking an interdisciplinary perspective, this book illustrates the importance of a team approach to the improvement of health care and associated health, well-being, and functioning in cancer survivors. The 17 chapters cover critical topics of which physicians and providers of all types must be aware in order to provide the most comprehensive and responsive care for cancer survivors. All of the clinical care chapters include case studies to illustrate the real-world application of these approaches in cancer survivors. Information about sources of referral both within and outside the traditional health care communities will be provided in tabular form. There is no other text that provides both an overview of the problems and their challenges, case illustrations of direct application, and the reality of reimbursement for such care. The editors hope that there may be no need for the clinician or the survivor to adapt to a “new normal” if the presenting problems are understood and handled from an interdisciplinary perspective as outlined here.