- Care planning and bidirectional communication initiatives may be helpful for improving patient engagement for cancer survivors, according to a study published in JMIR Cancer, but these programs may be difficult to implement and often fail to capture patient and provider enthusiasm.
The study compared two online Survivorship Care Plans (SCPs) aimed at improving patient-provider communication and care coordination following the completion of acute cancer care.
The first SCP was provider-initiated, while the other was patient-initiated.
The research team, led by Katherine Clegg Smith, PhD, initially sought to determine which tool better facilitated patient engagement, but ended up identifying unanticipated obstacles to success.
Noting high provider workloads and limited resources, Clegg Smith and colleagues hypothesized that patient-initiated SCPs may be more successful. Patient-initiated tools are likely to work around provider barriers, they said, integrating more seamlessly as patient engagement strategies.
The research team found that provider- and patient-initiated tools were equally effective in boosting patient engagement, but also found that patient engagement programs face a number of implementation hurdles.
The researchers found it difficult to foster provider buy-in, with only 33 percent of eligible providers participating in the study. This suggests that there is little incentive to encourage providers to engage their patients via programs like an SCP. This could also indicate a high provider workload, which may not have room for further patient engagement efforts.
In order to mitigate this issue, the researchers say that the industry must take a closer look at provider workloads and acknowledge the extra work patient engagement strategies require.
“Effort should be spent identifying strategies for enabling providers and their staff to be reimbursed for the time that it takes to either prepare and provide the SCP or to complete a plan that is initiated by the patient,” the researchers explained.
“One possible way to reduce the time burden is to look for ways that SCP templates can be integrated into EMRs and/or cancer registries such that some or much of the information is auto-populated,” the study suggested.
Those providers who did participate in the study also had difficulty enrolling patients. Only five of the 13 participating clinicians were able to recruit patients for the study. The rest of the recruited patients came with the assistance of the research team, although this tactic is unrealistic in the long term.
The researchers suggest that this was not necessarily a failing on the provider end. Instead, they suggest that the SCP did not tailor specifically enough to certain kinds of patients, and that it was difficult for providers to point to the benefits of the programs.
Despite difficult patient and provider buy-in, SCPs show promise in improving cancer patient survivorship because they address frequently-cited concerns for cancer survivors, including communication between themselves and their care teams.
In a baseline patient survey, Clegg Smith and colleagues found that the lowest-rated knowledge areas were those that the SCPs were designed to address.
The SCP was also successful in raising concerns patients may not have even thought of, such as long-term quality of life issues or psychosocial issues.
While SCPs may be useful for identifying and addressing these problems, the unknown variables emphasized by SCPs may have also created patient ambivalence toward the program. Patients may not have a strong desire to learn about new challenges they had not anticipated, the researchers theorized.
Because the study shows that there is little difference in who manages a patient engagement initiative, it may be helpful to focus more on how these programs can be integrated into clinical workflows. Paying close attention to program design and feasibility for cancer care may facilitate increased patient and provider buy-in.
Likewise, it may be important to consider how to educate patients and providers on these patient engagement strategies. The researchers found that both parties saw little incentive to adopt an SCP. Healthcare leaders and patient engagement advocates may consider addressing these incentives and improve technology education for key healthcare stakeholders.