Breast Cancer Survivorship Care Plan: Integration into the EHR

The cancer survivor population is growing and requires specific coordinated continual care. In 2005, the Institute of Medicine (IOM) noted a gap in the continuum of survivorship care. As a result, they recommended that all cancer survivors be provided a survivorship care plan (SCP) upon completion of active cancer therapy. These recommended documents are used as a tool for oncologists to communicate with primary care providers (PCPs) and other specialists, thus ensuring that the patients' care remains continual and coordinated. SCPs are also provided to manage survivors' psychosocial needs, prevent and screen for cancer reoccurrences and offer recommendations for healthy living. In addition, SCPs give patients a document to assist in keeping track of their care by providing them with a plan with which they can self-advocate. The purposes of this DNP scholarly project were to develop the surveillance (follow-up) plan and the long-term follow-up plan sections of a breast cancer survivorship care plan, and to implement said plan into an existing electronic health record (EHR) for a local COC accredited cancer institute. The objectives and implementation steps for this project were: (1) Initiate & participate in the QI project that will address and create survivorship care plans for use at a local cancer institute (2) Identify & develop a breast cancer survivor surveillance & long-term follow-up plan, based on existing national recommendations & evidenced literature (3) Integrate surveillance and long-term follow-up plan sections of the breast cancer survivorship care plan into the EHR (4) Evaluate the use and effectiveness of the surveillance and long-term follow-up plan portion of the breast cancer survivorship care plan by surveying participating oncology providers regarding ease or barriers to use (5) Disseminate survey results to the Quality Improvement committee at the local cancer institute to guide future improvements and serve as a guide for future SCPs. Evidenced literature was utilized not only to create an SCP, but also to identify barriers and incorporate suggested improvements to already existing SCPs. For example, a literature review revealed that the use of EHRs decreases barriers, such as time restraints. Through this project's evaluation process, utilizing RedCap online survey tools, oncology provider preferences and SCP experience were discovered and adapted to, in hopes of increasing the utilization of SCPs and meet CoC compliance regulations. A total of 12 surveys were sent out to medical oncologist, radiation oncologist, surgical oncologist, and nurse practitioners specializing in breast cancer. Six of them utilized the breast cancer SCP on patients and distributed them. When surveyed why the others did not, the majority of them responded that a different type of provider, like a nurse practitioner should be filling them out due to time restraints. Time continues to be a barrier despite integration into the EHR. Although, it was revealed that the providers that reported completing more than one SCP, most of them noted a significant decrease in time spent completing them due to familiarity. Survey results were reviewed with the QI team & administration. It was discovered that NPs have opportunity to improve patients continuum of care and can increase autonomy by having NP-led survivorship clinics.