Pilot Implementation of Cancer Survivorship Care Plans in Veterans Affairs: Challenges and Opportunities

M Bryant Howren; Peter J Kaboli

The number of persons living with a cancer diagnosis continues to rise, primarily due to improvements in detection and treatment of cancer. Diagnosis and treatment are well-recognized as difficult periods associated with numerous deleterious outcomes, but the time beyond the completion of treatment has received relatively less attention, despite recent estimates indicating that more than 13 million Americans are now considered cancer survivors. Cancer survivors may experience a number of late and long-term effects that require coordinated follow-up care after completion of primary treatment. Consequently, in 2006, the Institute of Medicine issued a report recommending that every cancer patient receive an individualized survivorship care plan (SCP) that includes complete treatment summaries and guidelines for monitoring and maintaining health. Uptake of SCPs in practice, however, has been slow and fraught with challenges. This may be especially problematic for rural, underserved Veterans who often experience barriers related to access and problems with care coordination. Thus, this project recruited rural Veteran lung cancer survivors to evaluate the process and impact of SCP implementation in Veterans Affairs (VA) using aspects of the Consolidated Framework for Implementation Research (CFIR), a theory-based taxonomy of constructs related to the implementation of healthcare interventions. Specifically, rural Veteran lung cancer survivors receiving care from the VA Iowa City Healthcare System were delivered a tailored SCP within 1 week of treatment completion. A brief, phone-based nurse counseling session was administered to orient survivors to the SCP. Each plan consisted of the following: (1) a complete treatment summary including details of the diagnosis, treatments received, and contact information for all VA providers (ie, primary care, oncology, psychology/mental health, social work, rehabilitative care); (2) a detailed follow-up plan with specific recommendations for ongoing care, symptom self-management, and health promotion strategies. Challenges and opportunities related to the implementation process within the CFIR framework--including information on the implementation climate, intervention complexity and adaptability, and reflection/evaluation--will be discussed and strategies for overcoming implementation obstacles will be highlighted. Future directions, including possibilities for broader VA expansion, will also be discussed. This presentation will cover challenges and opportunities related to the implementation of survivorship care plans according to the Consolidated Framework for Implementation Research (CFIR), a theory-based taxonomy of constructs related to the implementation of healthcare interventions. Clinicians will be able to learn about challenges related to the implementation of survivorship care plans and what they should contain, which has immediate implications for patients and individual practices. VA Office of Rural Health.

Pilot Implementation of Cancer Survivorship Care Plans in Veterans Affairs: Challenges and Opportunities

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