A Collective Impact Approach to Address Survivorship Care Needs in Washington

Post-Treatment Health and Wellness Needs Among Cancer Survivors in Washington State

Authors:

Caitlin Mason (Presenter)
University of Washington

Jennifer Haase Morris, American Cancer Society
Patricia Migliore Santiago, Washington State
Laurel Dillon-Sumner, University of Washington
Thuy Vu, University of Washington
Peggy Hannon, University of Washington

Public Health Statement: The Institute of Medicine has recommended since 2006 that Survivorship Care Plans (SCPs) be provided to assist cancer survivors during the transition from treatment to survivorship. Implementation of SCPs to date is low. Little is known about patient preferences for SCPs or about unmet post-treatment needs.

Purpose: To understand cancer survivors’ preferences for SCPs and post-treatment health priorities, to inform initiatives undertaken by the Washington Alliance for Cancer Survivorship.

Methods/Approach: The American Cancer Society convened and facilitated five focus groups of cancer survivors (n=50) in diverse regions of Washington State between October and December 2016. Participants were mostly female (78%) but varied in age, cancer diagnosis, and time since first diagnosis. Semi-structured questions guided discussion about survivors’ health and wellness needs, desired support, and SCP preferences; a ranking exercise helped prioritize topics affecting survivorship.

Results: Participants were unanimous in their support for SCPs and described their content, timing and delivery preferences; however, only 14% of participants recalled receiving a SCP. Nearly half (48%) of participants identified healthy living as most important to their ongoing post-treatment health and wellness. Finances, social issues, and ongoing rehabilitation also ranked highly. Participants desired resources to assist with returning to work but ranked these as less important relative to other issues.

Conclusions/Implications: Focus group participants desired support for a broad range of issues affecting health and wellness. SCPs could assist with this but few participants were aware of receiving one. Both cancer centers and community organizations have a role to play in supporting survivorship care.

Survivorship Care Plan Utilization and Challenges

Authors:

Patricia Migliore Santiago (Presenter)
Washington Department of Health

Rose Guerrero, EvergreenHealth

Public Health Statement: The Institute of Medicine has recommended that Survivorship Care Plans (SCPs) be provided to assist cancer survivors during the transition from treatment to survivorship. Percentage of patients receiving a SCP from their treatment facility remains low.

Purpose: To understand the current utilization and challenges faced by hospitals in regards to SCPs, to inform implementation activities undertaken by the WA Alliance for Cancer Survivorship (WACS).

Methods/Approach: American Cancer Society (ACS) staff and WACS stakeholders made in-person appeals to each Commission on Cancer accredited program and followed up with non-responders. A 60% survey completion goal was set. A secure electronic survey was deployed in February 2016. ACS staff aggregated the data and prepared the results report.

Results: We achieved a 70% participation rate for accredited programs. 75% of rural facilities, 71% urban but only 50% suburban facilities participated. Facilities are spending 45 minutes to 2 hours to prepare the SCP and an equal amount of time on the patient SCP visit. There is a clear need and desire to have an efficient data gathering process for surveillance recommendations, latent side effect management and ready access for cancer site specific supportive care resources to reduce the time spent in preparation/delivery of the SCP and create a sustainable financial model.

Conclusions/Implications: The transition from active treatment to survivorship care is a complex process, complicated by residual symptoms, educational needs and health risks. Our baseline information will inform our efforts to streamline the development of SCPs. We plan to develop a survey to examine survivors’ recall and adoption of recommendations to measure how SCPs are improving patient and facility outcomes.

Web Plus Survivorship Module Creates Solutions

Authors:

Johna Peterson (Presenter)
Washington Department of Health

Patricia Migliore Santiago, Washington Department of Health

Public Health Statement: The Institute of Medicine has recommended since 2006 that Survivorship Care Plans (SCPs) be provided to assist cancer survivors during the transition from treatment to survivorship. Percentage of patients receiving a SCP from their treatment facility remains low.

Purpose: To provide a solution for ACoS-accredited hospitals based on SCP challenges identified in the Washington Alliance for Cancer Survivorship’s (WACS) 2016 Survivorship survey.

Methods/Approach: Challenges identified were time needed to prepare and deliver care plans and an inefficient data gathering process for these plans; physicians were spending on average 1.5–4 hrs combined on preparation and delivery. 45% of those not using ASCO templates were using tools developed by their institution. Washington State Cancer Registry (WSCR) assessed hospitals for increased SCP needs based on the number of analytic cases submitted per month and need for a solution to meet ACoS accreditation standards for survivorship care planning. WSCR and Comprehensive Cancer Control (CCC) selected one registry with low volume but high need, and another with medium to high volume and high need to implement the Web Plus Survivorship Care Plan module.

Results: WSCR has installed the Survivorship Module and has moved into testing status.

Conclusions/Implications: WSCR and CCC will follow-up with hospitals and assess time spent generating and delivering care plans with the module. We will obtain expertise on evaluating improvement from Health Promotions Research Center. We will add additional hosptials once WSCR goes into production.

Addressing Survivorship Challenges Using a Collective Impact Approach

Authors:

Katie Treend, (Presenter)
Comprehensive Cancer Control Coordinator

Patricia Migliore Santiago, Washington Department of Health

Rose Guerrero, EvergreenHealth

Public Health Statement: The American Cancer Society estimates 352,830 cancer survivors in WA today. WA CARES About Cancer Partnership no longer had a survivorship workgroup.

Purpose: To organize stakeholders in WA CARES wanting to address survivorship issues. Individual organizations were going their own way creating duplication of effort.

Methods/Approach: We turned to FSG’s research on collective impact. We formed a cross-sector group, mapped the cancer survivorship landscape utilizing cancer registry data and local facility input. A common agenda was agreed upon. Shared measurements of success were set. Mutually reinforcing activities were developed. Methods and frequency of communication were decided. Washington Department of Health (DOH) was designated as the hub organization.

Results: DOH provides adaptive leadership skills and the ability to mobilize people without imposing an agenda or taking credit for success. Hosted a GW Cancer Institute Executive Training, June 2015. Hosted 2 day retreat to develop common agenda and action plan, December 2015. Developed and deployed survey for CoC accredited hospitals to create a baseline for SCP utilization and challenges, February 2016. May 2016 finalized action plan and added a pilot in Yakima County to partner with 2-1-1. We have moved from having uncoordinated plans to embracing a centralized system.

Conclusions/Implications: We recognize the need to identify and catalog previously unnoticed resources and make them available statewide; perform ongoing evaluations to elicit feedback for decision making; and, the need for further study to determine if tailored SCP and 211 resources improve patient/provider survivorship experience and attain financial sustainability.