Breast Cancer: Survivorship Care Case Study, Care Plan, and Commentaries.

This case study highlights the patient's status in care plan format and is followed by commentaries from expert nurse clinicians about their approach to manage the patient's long-term or chronic cancer care symptoms. Finally, an additional expert nurse clinician summarizes the care plan and commentaries, emphasizing takeaways about the patient, the commentaries, and additional recommendations to manage the patient. As can happen in clinical practice, the patient's care plan is intentionally incomplete and does not include all pertinent information. Responding to an incomplete care plan, the nurse clinicians offer comprehensive strategies to manage the patient's status and symptoms. For all commentaries, each clinician reviewed the care plan and did not review each other's commentary. The summary commentary speaks to the patient's status, care plan, and nurse commentaries.

Survivorship Fellowship: Evaluation and Evolution of a Program for Advanced Practice Providers.

A comprehensive cancer center in the midwestern United States implemented a stakeholder-engaged quality improvement process to extend its existing one-year advanced practice provider (APP) fellowship program consisting of general oncology education and clinical experience to include an additional survivorship clinical rotation. APP fellowship alumni and program stakeholders reported noticeable benefits and greater importance attributed to program participation, validating inclusion of a survivorship clinic rotation as part of the fellowship program.

Utilization of an audit tool to evaluate accuracy of treatment summary and survivorship care plans.

PURPOSE: A quality review process was implemented to determine compliance with the requirement from the Commission on Cancer to use the American Society of Clinical Oncology (ASCO) template as the minimum data set for Treatment Summary and Survivorship Care Plans (TS/SCP) provided to cancer survivors. METHODS: TS/SCPs generated during 2017 (N = 1257) were audited for concordance with each of the 66 TS/SCP line items on ASCO's template. Descriptive statistics and chi-square statistics were used to examine line item concordance, overall and by services groups (survivorship vs. other oncology service). Mixed-effects logistic regression was used to estimate the effects of service delivery group on the concordance. RESULTS: Institutional compliance with the ASCO template was very high; 76% of the 66 line items were present in at least 75% of the delivered TS/SCPs. There was a significantly higher rate of concordance for TS/SCPs provided by the survivorship service (83% vs. 66%, P = 0.006). TS/SCPs provided by the survivorship service were nearly twice as likely to be concordant with ASCO template (OR = 1.88, 95% CI = 1.77-2.00) compared to those by other service groups. CONCLUSIONS: Use of the electronic medical record to auto-populate information was instrumental in achieving a high rate of concordance. Institutions should consider providing training to improve or maintain quality of these documents. IMPLICATIONS FOR CANCER SURVIVORS: Ensuring that the information contained on the TS/SCP is consistently present is necessary for a high-quality survivorship visit between the clinician, PCP, and survivor and as a record of care for future health care encounters.

Nurse practitioners & genetic counselors: Collaborative roles in a complex system.

In the United States, the lifetime risk of cancer is approximately 50% for men and 33% for women. Approximately 10% of these individuals have an inherited predisposition and substantially increased cancer risk. This article discusses an approach to identifying and managing patients based on a high-risk breast clinic model.