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Commission on Cancer Standard 3.3 - Survivorship Care Plans

November 21, 2017 | AONN+ Blog | CoC Standards, Survivorship
Featuring:
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Editor-in-Chief, JONS; Co-Founder, AONN+; University Distinguished Service Professor of Breast Cancer, Administrative Director, The Johns Hopkins Breast Center; Director, Johns Hopkins Cancer Survivorship Programs; Professor of Surgery and Oncology, JHU School of Medicine; Co-Creator, Work Stride-Managing Cancer at Work

I was privileged to chair a task force for the purpose of revisiting this standard and determining what issues lay within it that are barriers to cancer centers being able to achieve it. Upon the creation of such recommended changes, another task force for which I also served, reviewed these recommendations, and, I am pleased to say, approved them. Hot off the press, here is information that you get to hear even before it is announced to accredited facilities.

The current standards that were to begin in 2018 required that 75% of patients, upon completion of their acute treatment, receive treatment summaries and survivorship care plans. In polling cancer centers recently accredited, I learned that, in most cases, the current 50% requirement for 2017 really wasn’t being met; however, the method of conducting the survey did not really require it. Cancer center representatives were asked to show some medical records that contained these documents and were verbally asked how they are doing with this standard. Usually a surveyor would randomly select medical records of patients who completed treatment and determine whether 50% of them contained the required information. So this standard was loose, and likely because everyone, including the surveyors, knew how hard it was to fulfill these percentage requirements. For 2018, the percentage will remain at 50%.

There were lengthy discussions about how this standard came about too. The intent of this standard was to fulfill the issues identified in the Institute of Medicine report—Lost in Transition—who will take care of the cancer survivor. This report explained the growing shortage of oncology specialists and the growing increase in the number of people being diagnosed with cancer. The results would be the inability of oncologists to follow their patients long-term once treatment was completed; therefore, there would be a need to transition patients back to their community providers to oversee their cancer care. Ironically, the development of the elements of a treatment summary as well as the survivorship care plan were never scientifically studied. This was the first time a standard was implemented without performing the due diligence of performing evidence-based research validating what elements are meaningful and which ones are not. It was considered logical that these 2 documents and all of the elements contained with them would be the “right ones.” Over time, however, ASCO has continued to revisit these documents and decrease the number of elements within them by getting feedback and learning that the original elements were too many, difficult to collect, time-consuming to record, and lacked purpose. So we have seen ASCO continue to revisit these documents annually or at least biannually and tweak them some more. Ironically, there was no requirement for the community providers, such as the primary care provider (PCP), to receive a copy of them. However, it is the expectation that the PCP become the cancer survivor provider going forward. And what about the health insurance company? We expect them to cover the tests, scans, and visits listed on the survivorship care plan, so why don’t they get a copy too? Hopefully, in future revisions of the standard, we can also make that happen.

For those institutions that are really struggling to meet the standard, even at the 50% mark, there will be a requirement to have an Action Plan in place to demonstrate the efforts underway to improve this process. Consider, too, developing and implementing several performance improvement initiatives to improve survivorship care, keep survivors on track for their screenings, and adhering to medications as prescribed. These documents have no value if they are not concurrently used. It was already intended to be more than 2 pieces of paper that went into a survivor’s medical files she keeps at home. However, if you poll survivors, as I have nationally, you will learn that the majority, and frankly nearly all of them, haven’t looked at these papers since the day they received them. That was never the goal. We need our survivors to know that they too play a key role in their cancer care long-term. Navigating them day by day is virtually gone. They need to take charge of their survivorship care and keep themselves on track for their tests, as well as setting and keeping new lifestyle behavioral changes that will further reduce their risk of cancer recurrence.

Also, note that this standard recognized that oncology nurse navigators are excellent professionals to data abstract from the medical records all of the needed elements to complete both documents and then meet with the patient for their transitional consultation. The only downside to this is that unless the nurse navigators happen to be APNs, there will not be a way to bill for this consultation.

So stay tuned for the official information coming out in a few months, and know that AONN+ is well-positioned to continue to raise issues that are tied to the expectations of certain standards so that we are always focused on improving patient care.

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