Bone Marrow Transplant Survivorship Care Plan: Bridging the Knowledge and Care Access Gap: A Pilot Study

In 2006, the Institute of Medicine (IOM), now known as National Academy of Medicine (NAM), recognized that there is a lack of continuation of cancer survivor care in the United States. The IOM recommended that all comprehensive cancer centers address the need of survivor care by using survivorship care plans (SCP) for all patients who have received chemotherapy with curative intent. The SCP is a personalized documentation that includes treatment summaries, potential side effects, complications, late effects of chemotherapy, recommendation for follow up care, secondary cancer screening recommendations, immunization recommendations, and community resources. The purpose of this DNP project is to address care access and knowledge gap of patients and their primary care and/or referring providers with the use of the SCP in patients who have received allogeneic hematopoietic stem cell transplant. The SCP will be integrated into the electronic health record (EHR) system in the local comprehensive cancer center. The objectives and implementation steps for this project are: (1) Develop a bone marrow transplant (BMT) SCP that will be implemented in a comprehensive cancer facility (2) Conduct telephone interviews to gather information to be used to create a formal survey to be used on a larger scale for the SCP (3) Develop and administer formal survey to all patients to identify potential knowledge gap and gain insight on what information should be included in SCP (4) Develop BMT SCP with the use of electronic health record (EHR) (5) Disseminate study findings. Evidenced literature was utilized to evaluate survivorship care and the utilization of SCP in the United States. Pros and cons of existing SCP that have been utilized for other types of cancers were assessed to guide the development of the SCP in this project. Survivorship care plans in other cancers have been found to increase patient and referring/primary care provider's knowledge on treatment received and how to manage lasting effects of cancer treatments. The SCP also empowers patients to allow for greater autonomy. The biggest challenge of implementing SCP is amount of time involved in completing the care plan. There is currently no literature on the use of SCP in the bone marrow transplant (BMT) population. Five patients were selected for a telephone interview to guide the research team in developing a formal survey that was administered to all patients who had received allogeneic hematopoietic stem cell transplant at least one year prior. At the beginning of the project, a total of 76 patients were alive and fit the inclusion criteria of the study. The surveys would assist the research team in modifying the existing SCP that could be individualized and customized. The SCP had been integrated into the EHR system for easy modification per individual's needs. Results of the surveys will be evaluated and utilized in developing programs that will improve BMT patients' quality of life.