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Long-Term Care Plans, Engagement Improve Cancer Survivorship

Long-term care and engagement plans increased clinician treatment implementation and patient satisfaction.

Long-term care and engagement plans are beneficial for breast cancer survivors.

Source: Thinkstock

- Breast cancer survivors who receive written long-term care and engagement plans, and meet individually with self-care coaches experience better clinical outcomes, according to a recent study published in the Journal of Clinical Oncology.

With modern medical advances, more patients are surviving cancer, resulting in nearly 15.5 million cancer survivors in the country. Nearly one-fifth of those survivors are breast cancer survivors.

This increase in cancer survivors highlights a need to develop and refine strong long-term care and engagement plans for patients, the researchers said.

“Patients with breast cancer can expect long-term survival; however, the complex, multimodal treatments that achieve these outcomes need to be summarized to provide better long-term follow-up care,” the researchers said. “[Treatment summaries and survivorship care plans] are strongly advocated by the American Society of Clinical Oncology, and patients endorse the need for written follow-up plans after treatment is ended.”

However, little research has been done on the clinical benefits of long-term care summaries, specifically in low-income or medically underserved populations. Low-income patients are more likely to require stronger and more meaningful follow-up engagement, the researchers hypothesized, showing a need to better develop and understand the effects of long-term care summaries.

In a randomized controlled trial, the researchers tested 212 low-income, mostly Latina (72.6 percent of the study population) breast cancer survivors between December 2012 and July 2014. The intervention participant cohort received both written treatment and long-term care summaries, as well as individualized self-care coaching from nurses.

The researchers primarily tested for clinician implementation of long-term care plans, alongside patient knowledge of survivorship issues, perceived efficacy of patient-provider interactions (PEPPI), and satisfaction with care and information.

Overall, patients in the intervention group saw better clinical outcomes than the control group. The median physician implementation score for the intervention group was 66.7 points out of 100, compared with 50 points for the control group.

The intervention group also received higher raw adherence scores compared to the control group (55.7 versus 48.7), although the researchers reported that this difference was not statistically significant.

PEPPI was also not significantly higher for the intervention group than for the control group, the researchers found.

“This finding may be explained by the fact that the intervention was specifically aimed at the patient’s next encounter with her primary cancer provider, whereas PEPPI measures self-efficacy with physicians in general,” the researchers explained. “Furthermore, PEPPI was measured 1 year after the intervention, and a 1-hour-long intervention may be insufficient to sustain a long-term impact.”

The intervention group did report higher satisfaction with care and information, the researchers reported. This was likely due to certain intervention characteristics, such as offering materials and coaching sessions in Spanish and utilizing one-on-one coaching sessions. Latina patients typically experience poor patient-provider communication due to both language and culture barriers. These meetings may have broken those barriers, the researchers hypothesized.

“The study intervention differed from those in previous RCTs in that it was coupled with a nurse counseling session, outside the health care setting, and included patient empowerment, which may have been particularly effective in this low-income Latina population,” the researchers explained. “The TSSPs were provided in Spanish when appropriate, and this may have enhanced an effect.”

Improved patient-provider communication may have also positively influenced physician implementation of care plans, the researchers posited.

Although these results do suggest several benefits for long-term care plans in breast cancer survivorship, the researchers said there are still several barriers they must understand. For example, patients who were married or had a partner were less likely to adhere to their treatment plans, opening one opportunity for further study.

Additionally, the team said more researchers should go into understanding the best timing for implementing these interventions to achieve optimal outcomes.

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