title: Barriers and facilitators to implementing cancer survivorship care plans.
abstract: OBJECTIVE
  To evaluate the process of survivorship care plan (SCP) completion and to survey oncology staff and primary care physicians (PCPs) regarding challenges of implementing SCPs.
  
  
  METHODS
  Descriptive pilot study.
  
  
  METHODS
  Two facilities in Vermont, an urban academic medical center and a rural community academic cancer center.
  
  
  METHODS
  17 oncology clinical staff created SCPs, 39 PCPs completed surveys, and 58 patients (breast or colorectal cancer) participated in a telephone survey.
  
  
  METHODS
  Using Journey Forward tools, SCPs were created and presented to patients. PCPs received the SCP with a survey assessing its usefulness and barriers to delivery. Oncology staff were interviewed to assess perceived challenges and benefits of SCPs. Qualitative and quantitative data were used to identify challenges to the development and implementation process as well as patient perceptions of the SCP visit.
  
  
  METHODS
  SCP, healthcare provider perception of barriers to completion and implementation, and patient perception of SCP visit.
  
  
  RESULTS
  Oncology staff cited the time required to obtain information for SCPs as a challenge. Completing SCPs 3-6 months after treatment ended was optimal. All participants felt advanced practice professionals should complete and review SCPs with patients. The most common challenge for PCPs to implement SCP recommendations was insufficient knowledge of cancer survivor issues. Most patients found the care plan visit very useful, particularly within six months of diagnosis.
  
  
  CONCLUSIONS
  Creation time may be a barrier to widespread SCP implementation. Cancer survivors find SCPs useful, but PCPs feel insufficient knowledge of cancer survivor issues is a barrier to providing best follow-up care. Incorporating SCPs in electronic medical records may facilitate patient identification, appropriate staff scheduling, and timely SCP creation.
  
  
  CONCLUSIONS
  Oncology nurse practitioners are well positioned to create and deliver SCPs, transitioning patients from oncology care to a PCP in a shared-care model of optimal wellness. Institution support for the time needed for SCP creation and review is imperative for sustaining this initiative.
  
  
  CONCLUSIONS
  Accessing complete medical records is an obstacle for completing SCPs. A 3-6 month window to develop and deliver SCPs may be ideal. PCPs perceive insufficient knowledge of cancer survivor issues as a barrier to providing appropriate follow-up care.
authors.affiliation: University of Miami, Miami Beach, FL.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Dulko
authors.forename: Claire M
authors.initials: CM
authors.lastname: Pace
authors.forename: Kim L
authors.initials: KL
authors.lastname: Dittus
authors.forename: Brian L
authors.initials: BL
authors.lastname: Sprague
authors.forename: Lori A
authors.initials: LA
authors.lastname: Pollack
authors.forename: Nikki A
authors.initials: NA
authors.lastname: Hawkins
authors.forename: Berta M
authors.initials: BM
authors.lastname: Geller
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000359:Aftercare; D000368:Aged; D001943:Breast Neoplasms / Q000451:nursing / Q000523:psychology; D015179:Colorectal Neoplasms / Q000451:nursing / Q000523:psychology; D003144:Communication Barriers; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility; D006740:Hospital Administrators; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007407:Interviews as Topic; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D010347:Patient Care Planning; D010353:Patient Education as Topic; D010564:Personnel, Hospital; D010865:Pilot Projects; D011320:Primary Health Care; D012424:Rural Population; D017741:Survivors / Q000523:psychology; D014505:Urban Population