Comparing Web-Based Provider-Initiated and Patient-Initiated Survivorship Care Planning for Cancer Patients: A Randomized Controlled Trial

Katherine Clegg Smith, Elliott Tolbert, Susan M Hannum, Archana Radhakrishnan, Kelsey Zorn, Amanda Blackford, Stephen Greco, Karen Smith, Claire F Snyder, Katherine Clegg Smith, Elliott Tolbert, Susan M Hannum, Archana Radhakrishnan, Kelsey Zorn, Amanda Blackford, Stephen Greco, Karen Smith, Claire F Snyder

Abstract

Background: Survivorship care plans (SCPs) are intended to facilitate communication and coordination between patients, oncologists, and primary care providers. Most SCP initiatives have focused on oncology providers initiating the SCP process, but time and resource barriers have limited uptake.

Objective: This trial compares the feasibility and value of 2 Web-based SCP tools: provider-initiated versus patient-initiated.

Methods: This mixed-methods study recruited clinicians from 2 academically-affiliated community oncology practices. Eligible patients were treated by a participating oncologist, had nonmetastatic cancer, completed acute treatment ≤ 2 months before enrollment, and had no evidence of disease. Patients were randomized 1:1 to either provider-initiated or patient-initiated SCPs-both are Web-based tools. We conducted qualitative interviews with providers at baseline and follow-up and with patients 2 months after enrollment. In addition, patients were administered the Preparing for Life as a (New) Survivor (PLANS) and Cancer Survivors' Unmet Needs (CaSUN) surveys at baseline and 2 months.

Results: A total of 40 providers were approached for the study, of whom 13 (33%) enrolled. Providers or clinic staff required researcher assistance to identify eligible patients; 41 patients were randomized, of whom 25 completed follow-up (61%; 13 provider-initiated, 12 patient-initiated). Of the 25, 11 (44%) had initiated the SCP; 5 (20%) provided the SCP to their primary care provider. On the Preparing for Life as a (New) Survivor and Cancer Survivors' Unmet Needs, patients in both arms tended to report high knowledge and confidence and few unmet needs. In qualitative interviews, providers and patients discussed SCPs' value.

Conclusions: Regardless of patient- versus provider-initiated templates and the Web-based design of these tools, barriers to survivorship care planning persist. Further efforts should emphasize workflow functions for identifying and completing SCPs-regardless of the SCP form used.

Trial registration: ClinicalTrials.gov NCT02405819; https://ichgcp.net/clinical-trials-registry/NCT02405819 (Archived by WebCite at http://www.webcitation.org/6jWqcWOvK).

Keywords: mixed methods study; randomized controlled trial; survivorship care plan.

Conflict of interest statement

Conflicts of Interest: None declared.

©Katherine Clegg Smith, Elliott Tolbert, Susan M Hannum, Archana Radhakrishnan, Kelsey Zorn, Amanda Blackford, Stephen Greco, Karen Smith, Claire F Snyder. Originally published in JMIR Cancer (http://cancer.jmir.org), 30.08.2016.

Figures

Figure 1
Figure 1
Enrollment into survivorship care planning trial.

References

    1. Hewitt ME, Greenfield S, Stovall E. From cancer patient to cancer survivor: Lost in transition. Washington, DC: National Academies Press; 2006.
    1. Kantsiper M, McDonald EL, Geller G, Shockney L, Snyder C, Wolff AC. Transitioning to breast cancer survivorship: perspectives of patients, cancer specialists, and primary care providers. J Gen Intern Med. 2009 Nov;24(Suppl 2):S459–66. doi: 10.1007/s11606-009-1000-2.
    1. Grunfeld E, Julian JA, Pond G, Maunsell E, Coyle D, Folkes A, Joy AA, Provencher L, Rayson D, Rheaume DE, Porter GA, Paszat LF, Pritchard KI, Robidoux A, Smith S, Sussman J, Dent S, Sisler J, Wiernikowski J, Levine MN. Evaluating survivorship care plans: results of a randomized, clinical trial of patients with breast cancer. J Clin Oncol. 2011 Dec 20;29(36):4755–62. doi: 10.1200/JCO.2011.36.8373.
    1. Hershman DL, Greenlee H, Awad D, Kalinsky K, Maurer M, Kranwinkel G, Brafman L, Jayasena R, Tsai W, Neugut AI, Crew KD. Randomized controlled trial of a clinic-based survivorship intervention following adjuvant therapy in breast cancer survivors. Breast Cancer Res Treat. 2013 Apr;138(3):795–806. doi: 10.1007/s10549-013-2486-1.
    1. Parry C, Kent EE, Forsythe LP, Alfano CM, Rowland JH. Can't see the forest for the care plan: a call to revisit the context of care planning. J Clin Oncol. 2013 Jul 20;31(21):2651–3. doi: 10.1200/JCO.2012.48.4618.
    1. Keesing S, McNamara B, Rosenwax L. Cancer survivors' experiences of using survivorship care plans: a systematic review of qualitative studies. J Cancer Surviv. 2015 Jun;9(2):260–8. doi: 10.1007/s11764-014-0407-x.
    1. Klemanski D, Browning K, Kue J. Survivorship care plan preferences of cancer survivors and health care providers: a systematic review and quality appraisal of the evidence. J Cancer Surviv. 2016 Feb;10(1):71–86. doi: 10.1007/s11764-015-0452-0.
    1. Smith TJ, Snyder C. Is it time for (survivorship care) plan B? J Clin Oncol. 2011 Dec 20;29(36):4740–2. doi: 10.1200/JCO.2011.38.8397.
    1. Forsythe LP, Parry C, Alfano CM, Kent EE, Leach CR, Haggstrom DA, Ganz PA, Aziz N, Rowland JH. Use of survivorship care plans in the United States: associations with survivorship care. J Natl Cancer Inst. 2013 Oct 16;105(20):1579–87. doi: 10.1093/jnci/djt258.
    1. Mayer DK, Nekhlyudov L, Snyder CF, Merrill JK, Wollins DS, Shulman LN. American Society of Clinical Oncology clinical expert statement on cancer survivorship care planning. J Oncol Pract. 2014 Nov;10(6):345–51. doi: 10.1200/JOP.2014.001321.
    1. Livestrong. [2016-06-28]. Livestrong Care Plan
    1. Journey Forward. 2016. [2016-04-05].
    1. Eysenbach G, Consort-EHEALTHGroup CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res. 2011;13(4):e126. doi: 10.2196/jmir.1923.
    1. Hodgkinson K, Butow P, Hunt GE, Pendlebury S, Hobbs KM, Lo SK, Wain G. The development and evaluation of a measure to assess cancer survivors' unmet supportive care needs: the CaSUN (Cancer Survivors' Unmet Needs measure) Psychooncology. 2007 Sep;16(9):796–804. doi: 10.1002/pon.1137.
    1. Dunn R, Crowley S, Janz N, Jagielski C, Breslin T, Diehl K. Impact of a Transition Visit on Addressing Quality of Life and Readiness to Assume Greater Self-Management Among Breast Cancer Survivors. Psycho-Oncology. 2011;20(Suppl 1):S91. doi: 10.1111/j.1755-148X.2011.01915.x.
    1. R-project. 2016. [2016-07-08]. R: A language and environment for statistical computing
    1. American College of Surgeons FACS. 2014. Sep 9, [2016-04-05]. Accreditation Committee Clarifications for Standard 3.3 Survivorship Care Plan .
    1. Birken SA, Mayer DK, Weiner BJ. Survivorship Care Plans: prevalence and barriers to use. J Cancer Educ. 2013;28:290–296.
    1. Dulko D, Pace CM, Dittus KL, Sprague BL, Pollack LA, Hawkins NA, Geller BM. Barriers and facilitators to implementing cancer survivorship care plans. Oncol Nurs Forum. 2013 Nov;40(6):575–80. doi: 10.1188/13.ONF.575-580.
    1. Nicolaije KA, Ezendam NP, Vos MC, Pijnenborg JM, Boll D, Boss EA, Hermans RH, Engelhart KC, Haartsen JE, Pijlman BM, van Loon-Baelemans IE, Mertens HJ, Nolting WE, van Beek Johannes J, Roukema JA, Zijlstra WP, Kruitwagen RF, van de Poll-Franse L. Impact of an Automatically Generated Cancer Survivorship Care Plan on Patient-Reported Outcomes in Routine Clinical Practice: Longitudinal Outcomes of a Pragmatic, Cluster Randomized Trial. J Clin Oncol. 2015 Nov 1;33(31):3550–9. doi: 10.1200/JCO.2014.60.3399.
    1. Cheung WY, Neville BA, Cameron DB, Cook EF, Earle CC. Comparisons of patient and physician expectations for cancer survivorship care. J Clin Oncol. 2009 May 20;27(15):2489–95. doi: 10.1200/JCO.2008.20.3232.

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