Optimizing the Treatment of Hematologic Malignancies With HSCT
Shared Care for Hematologic Malignancy Survivors ...€¦ · An itemized list of all chemotherapy...
1
introduction Significant numbers of cancer patients are cured, or have a series of remissions with periods of re-treatment. Many clinicians, patient advocates and patients define a cancer survivor as “anyone who has been diagnosed with cancer, from the time of diagnosis through the balance of his or her life.” 1 In 2006, the Institute of Medicine’s From Cancer Patient to Cancer Survivor: Lost in Transition recommended comprehensive treatment summaries and follow-up care plans for all cancer survivors. 2 There were about 14 million cancer survivors in the US as of January 2012; this population is expected to be 18 million by 2022. 3 Among survivors, 64% have survived 5 years or more; 40% have survived 10 years or more; and 15% have survived 20 years or more after diagnosis. 4 Many survivors in this growing population experience physical, psychological, and/or financial long-term effects. The complexities of managing cancer survivors suggest their care should not be conceived as a transition from the oncologist to the primary care provider, but rather as an ongoing, flexible collaboration determined by individual survivor needs; as such, communication among health care providers is a top priority to ensure optimal care. Sharing Care for Survivors of Hematologic Malignancies, a web-based continuing medical education (CME) and continuing education (CE) activity, was developed by The Leukemia & Lymphoma Society (LLS) and Medscape Education Oncology to educate clinicians about effective communication and critical communication points between oncologists and primary care providers (PCPs) in the co-management of patients with hematologic malignancies. The intended learners for this education activity included physicians, nurses, pharmacists, and other healthcare providers, but this analysis focuses on oncologist and PCP participants only. Case-based education about Hodgkin lymphoma (HL) and myeloma was delivered by an expert panel of oncologists and PCPs to illustrate multidirectional communication strategies and to clarify the roles of health care providers in the ongoing care of cancer survivors. A survivorship care plan, which includes a treatment summary, was referenced as an effective tool to facilitate shared care of survivors among oncologists and PCPs and foster better coordination of care for cancer survivors. The learning objectives for the education activity were: 1. Using a survivorship care plan to communicate multidirectionally with other providers and to coordinate care of cancer survivors. 2. Assessing the special needs of a cancer survivor, in terms of prevention and screening, imaging, and laboratory tests. 3. Identifying and managing long- term and late effects of treatment for hematologic cancers, including Hodgkin lymphoma and myeloma. This CME activity is available online at Medscape Education at http://www. medscape.org/viewarticle/771148; continuing education credit for physicians, nurses, pharmacists, and social workers were offered from September 25, 2012 to September 25, 2013. In this analysis, we summarize findings from interactive questions posed within the web-based education activity and from the post-activity outcomes assessment. Haleh Kadkhoda a , Clare Karten, MS (Presenting Author) b , Emily Van Laar, MS a , Elisa Weiss, PhD b , Robert J. Arceci, MD, PhD (ASH Member) c , Kevin Oeffinger, MD d ; John C. Krauss, MD e , Emily S. Tonorezos, MD, MPH d a Medscape Education, New York, NY, b The Leukemia & Lymphoma Society, White Plains, NY, c The Ron Matricaria Institute of Molecular Medicine at Phoenix Children’s Hospital, Phoenix, AZ, d Memorial Sloan-Kettering Cancer Center, New York, NY, e University of Michigan Hospital, Ann Arbor, MI Shared Care for Hematologic Malignancy Survivors: Challenges for Primary Care Physicians and Oncologists methods results Two online tools were used to assess perceived barriers and current practices in shared care of patients with hematologic malignancies. • The first, an intra-activity assessment, included a series of questions posed throughout the activity from September 25, 2012 to September 25, 2013. — Responses from 122 oncologist and 172 PCP participants were compared to gain insight into clinicians’ knowledge and practice approaches. • The second, a post-activity outcome assessment, was collected by CE Outcomes, LLC. — Activity participants were compared with a matched group (demographics, specialty and number of patient seen who survived hematologic cancers) of non-participants. — 59 participants (25 oncologists /34 PCPs) were matched to 59 non-participants (25 oncologists /34 PCPs). Participant data were provided by Medscape; non-participants were contacted by CE Outcomes via email. • Overall, 3,177 physicians participated in the education activity from September 2012 to September 2013. • During the one-year activity, 122 oncologists and 172 PCPs responded to the intra-activity questions. • 59 participants and 59 non-participants responded to the post-activity outcomes assessment. conclusions/recommendations The analysis of the oncologist and PCP learner responses to the surveys and the post-activity outcomes assessment points to persistent challenges in the co-management of survivors of hematologic cancers. Challenges stem from issues related to: • Clinical complexities • Communication • Technology • Health care systems • Health care coverage. Timely, ongoing communication of appropriate clinical information between oncologists and PCPs is essential for optimal management of the growing number of cancer survivors. While oncologists and PCPs devote significant time each week to addressing the cancer survivors’ needs, the lack of reimbursed time for PCPs may be an impediment to optimal care. Both the oncologists and PCPs place a high value on the utility of survivorship care plans; however, they are not widely used. Phone calls are the current preferred communication mode. Until other technology tools are more widely used to share clinical information, it is important to employ practical solutions, such as: providing PCPs with clear information to help prioritize cancer survivors’ follow-up care needs; and, providing patients/caregivers with brief cancer treatment summaries to enable them to communicate with their health care providers and take active roles in their ongoing care. It is also important to develop communication strategies to address potentially preventable causes of death (e.g., cardiac disease and second cancers), and treatable causes of distress (e.g., anxiety and depression 5 ). References 1. National Cancer Institute. Dictionary of Cancer Terms. http://www.cancer.gov/dictionary?cdrid=450125. Accessed 10/31/13 2. Parry C, et al. JCO. 2013;31: 2651-2653. 3. Siegel R, et al. CA Cancer J Clin. 2012;62:220-241. 4. de Moor JS, et al. Cancer Epidemiol Biomarkers Prev. 2013;22:561-70. 5. Harrington, C, et al. International Journal of Psychiatry in Medicine. 2010;40: 163-181. Acknowledgements Supported by an independent educational grant from The Leukemia & Lymphoma Society with additional support from Incyte. Authors have no relevant conflicts of interest to disclose. Shared Care for Hematologic Malignancy Survivors: Challenges for Primary Care Physicians and Oncologists figure 1 Web-based CME Roundtable Discussion Among Oncologists and PCP Faculty figure 2 a figure 2 b figure 2 c The survivor’s inability to accurately report cancer treatment The survivor’s inability to accurately report cancer treatment The survivor’s inability to accurately report cancer treatment Obtaining a detailed survivorship care plan, which includes a treatment summary Obtaining a detailed survivorship care plan, which includes a treatment summary Obtaining a detailed survivorship care plan, which includes a treatment summary Lack of expeditious communication between the oncologist and PCP Lack of expeditious communication between the oncologist and PCP Lack of expeditious communication between the oncologist and PCP Having the time to investigate optimal cancer screening requirements for each survivor Having the time to investigate optimal cancer screening requirements for each survivor Having the time to investigate optimal cancer screening requirements for each survivor Having patients complete all recommended screenings Having patients complete all recommended screenings Having patients complete all recommended screenings PCPs Oncologist Non-Participants PCP Non-Participants Oncologists Oncologist Participants PCP Participants 60% 50% 40% 30% 20% 10% 0% 40% 35% 30% 25% 20% 15% 10% 5% 0% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 15% 20% 6% 43% 28% 41% 25% 24% 32% 11% 24% 3% 6% 4% 18% 12% 0% 9% 49% 36% 41% 23% 36% 12% 4% 4% 18% 11% 24% 21% Intra-activity Post-activity- Oncologist Responses Post-activity- PCP Responses The most significant barriers to effective co- management of cancer survivors reported in the intra-activity and post- activity outcomes questions are shown in Figures 2a-c. Obtaining a detailed survivorship care plan, which includes a treatment summary, was the most significant barrier, followed by a lack of expeditious communication between the oncologist and PCP (Figure 2a). The post-activity education assessment corroborates this finding for both participants and non- participants (Figures 2b and c). Use of Survivorship Care Plans and Treatment Summaries In your experience, what is the most significant barrier to effective management of cancer survivors? (Please select only 1 answer.) In your experience, what is the most significant barrier to effective management of cancer survivors? (Please select only 1 answer.) In your experience, what is the most significant barrier to effective management of cancer survivors? (Please select only 1 answer.) Oncologists and PCPs agree that survivorship care plans, which include treatment summaries, are the most useful communication vehicles among professionals (Figure 3a). Despite progress in use of electronic health records and widespread Internet and email access, these physicians most typically use the phone to communicate with each other about the management of cancer survivors (Figure 3d). The post-activity education assessment also examined the most useful formats for communication and yielded similar outcomes (Figures 3b and c; Figures 3e and f). Of note, an intra-activity question found that while the majority of oncologists and PCPs use treatment summaries in their practices, only a small percentage of oncologists and PCPs use a survivorship care plan (Figure 3g). Cancer Treatment Documentation and Communication figure 3 a figure 3 b figure 3 e figure 3 f figure 3 c figure 3 d figure 3 g An itemized list of all chemotherapy and radiation treatment details A survivorship care plan, which includes a treatment summary A phone call between the PCP and the oncologist to allow for detailed discussion of treatment The pathology report, including diagnosis, is sufficient for primary care in most cases PCPs Oncologist Non-Participants Oncologist Non-Participants PCP Non-Participants Oncologists Oncologist Participants Oncologist Participants PCP Participants 80% 70% 60% 50% 40% 30% 20% 10% 0% 12% 72% 0% 15% 10% 68% 3% 9% Intra-activity Post-activity- Oncologist Responses Post-activity- Oncologist Responses Post-activity- PCP Responses Post-activity- PCP Responses Intra-activity Intra-activity Which of the following is the most useful format for communicating the patient’s cancer history, treatment, and long-term risks among professionals? An itemized list of all chemotherapy and radiation treatment details A survivorship care plan, which includes a treatment summary A phone call between the PCP and the oncologist to allow for detailed discussion of treatment The pathology report, including diagnosis, is sufficient for primary care in most cases 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 70% 60% 50% 40% 30% 20% 10% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% 12% 60% 76% 60% 4% 9% 0% 12% 6% 28% 24% 9% 4% 16% 35% 84% 36% 32% 0% 8% 6% 12% 40% 26% Which of the following is the most useful format for communicating the patient’s cancer history, treatment, and long-term risks among professionals? When communicating with a PCP, oncologist, or other clinician regarding the care of cancer survivors in your practice, which of the following do you most typically use? When communicating with a PCP, oncologist, or other clinician regarding the care of cancer survivors in your practice, which of the following do you most typically use? An itemized list of all chemotherapy and radiation treatment details A survivorship care plan, which includes a treatment summary A phone call between the PCP and the oncologist to allow for detailed discussion of treatment The pathology report, including diagnosis, is sufficient for primary care in most cases 70% 60% 50% 40% 30% 20% 10% 0% 12% 59% 3% 26% 32% 38% 0% 29% Which of the following is the most useful format for communicating the patient’s cancer history, treatment, and long-term risks among professionals? Phone call Faxed letter Mailed letter Email message PCPs PCPs Oncologists Oncologists 80% 70% 60% 50% 40% 30% 20% 10% 0% 63% 15% 9% 12% 75% 10% 7% 8% When communicating with a PCP, oncologist, or other clinician regarding the care of cancer survivors in your practice, which of the following do you most typically use? Which of the following methods of documenting patients’ cancer treatment do you see or use most commonly in your practice? Phone call Phone call Faxed letter Faxed letter Mailed letter Mailed letter Email message Email message PCP Non-Participants PCP Participants Treatment summary Survivorship care plan Other Patient self-report Caregiver report 80% 70% 60% 50% 40% 30% 20% 10% 0% 73% 8% 1% 11% 8% 66% 6% 4% 3% 21% An intra-activity question assessed the amount of non-reimbursed time that PCPs spend researching issues related to patient care (Figure 4). The responses reveal that similar percentages of oncologists and PCPs estimated that PCPs spend more than 4 hours of non-reimbursed time weekly researching issues related to patient care. Intra-activity questions examined the success of obtaining insurance coverage for screenings of cancer survivors (Figure 5a) and the challenges associated with coordination of care with other providers (Figure 5b). According to the responses, 39% of both oncologists and PCPs had modest success obtaining coverage (after spending time addressing insurance denials and supplying documentation that supported the need for supplemental screenings). Almost half of oncologists (49%) indicated that coordination of care is an ongoing challenge; among PCPs, 41% indicated they sometimes experienced this issue. The Impact of Current Communication Practices Challenges of Health Care Coverage and Coordination of Care figure 4 Intra-activity >4 hours Almost none PCPs Oncologists 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 47% 23% 7% 23% 42% 27% 9% 22% How much nonreimburesed time do you estimate that primary care providers spend on average each week researching treatment issues related to patient care? < 3 hours < 1 hour Not at all successful; I just don’t have time to respond to coverage denials Quite often; it is an ongoing challenge Modestly successful, but only after replying to time- consuming requests for documentation Sometimes, but we usually work it out Successful; I have associates (or a vendor) who handle these types of cases Infrequently Not applicable to my practice Almost never PCPs PCPs Oncologists Oncologists 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 60% 50% 40% 30% 20% 10% 0% 18% 49% 39% 38% 33% 0% 11% 13% 14% 39% 39% 41% 43% 9% 4% 10% Intra-activity Intra-activity How successful have you been in obtaining insurance coverage for screenings of cancer survivors that fall outside of normal ranges? Patients with cancer often have comorbitities that need to be addressed. Coordinating & sharing care with other providers can sometimes be confusing _ particularly with respect to who takes the lead. How frequently do you encounter this in your practice? figure 5 a figure 5 b
Transcript of Shared Care for Hematologic Malignancy Survivors ...€¦ · An itemized list of all chemotherapy...
introductionSignificant numbers of cancer patients are cured, or have a series of remissions with periods of re-treatment. Many clinicians, patient advocates and patients define a cancer survivor as “anyone who has been diagnosed with cancer, from the time of diagnosis through the balance of his or her life.”1 In 2006, the Institute of Medicine’s From Cancer Patient to Cancer Survivor: Lost in Transition recommended comprehensive treatment summaries and follow-up care plans for all cancer survivors.2 There were about 14 million cancer survivors in the US as of January 2012; this population is expected to be 18 million by 2022.3 Among survivors, 64% have survived 5 years or more; 40% have survived 10 years or more; and 15% have survived 20 years or more after diagnosis.4 Many survivors in this growing population experience physical, psychological, and/or financial long-term effects. The complexities of managing cancer survivors suggest their care should not be conceived as a transition from the oncologist to the primary care provider, but rather as an ongoing, flexible collaboration determined by individual survivor needs; as such, communication among health care providers is a top priority to ensure optimal care.
Sharing Care for Survivors of Hematologic Malignancies, a web-based continuing medical education (CME) and continuing education (CE) activity, was developed by The Leukemia & Lymphoma Society (LLS) and Medscape Education Oncology to educate clinicians about effective communication and critical communication points between oncologists and primary care providers (PCPs) in the co-management of patients with hematologic malignancies. The intended learners for this education activity included physicians, nurses, pharmacists, and other healthcare providers, but this analysis focuses on oncologist and PCP participants only.
Case-based education about Hodgkin lymphoma (HL) and myeloma was delivered by an expert panel of oncologists and PCPs to illustrate multidirectional communication strategies and to clarify the roles of health care providers in the ongoing care of cancer survivors. A survivorship care plan, which includes a treatment summary, was referenced as an effective tool to facilitate shared care of survivors among oncologists and PCPs and foster better coordination of care for cancer survivors.
The learning objectives for the education activity were:
1. Using a survivorship care plan to communicate multidirectionally with other providers and to coordinate care of cancer survivors.
2. Assessing the special needs of a cancer survivor, in terms of prevention and screening, imaging, and laboratory tests.
3. Identifying and managing long-term and late effects of treatment for hematologic cancers, including Hodgkin lymphoma and myeloma.
This CME activity is available online at Medscape Education at http://www.medscape.org/viewarticle/771148; continuing education credit for physicians, nurses, pharmacists, and social workers were offered from September 25, 2012 to September 25, 2013.
In this analysis, we summarize findings from interactive questions posed within the web-based education activity and from the post-activity outcomes assessment.
Haleh Kadkhodaa, Clare Karten, MS (Presenting Author)b, Emily Van Laar, MSa, Elisa Weiss, PhDb, Robert J. Arceci, MD, PhD (ASH Member)c, Kevin Oef�nger, MDd; John C. Krauss, MDe, Emily S. Tonorezos, MD, MPHd
aMedscape Education, New York, NY, bThe Leukemia & Lymphoma Society, White Plains, NY, cThe Ron Matricaria Institute of Molecular Medicine at Phoenix Children’s Hospital, Phoenix, AZ, dMemorial Sloan-Kettering Cancer Center, New York, NY, eUniversity of Michigan Hospital, Ann Arbor, MI
Shared Care for Hematologic Malignancy Survivors: Challenges for Primary Care Physicians and Oncologists
methods
results
Two online tools were used to assess perceived barriers and current practices in shared care of patients with hematologic malignancies. • The first, an intra-activity assessment, included a series of questions posed
throughout the activity from September 25, 2012 to September 25, 2013. — Responses from 122 oncologist and 172 PCP participants were compared to
gain insight into clinicians’ knowledge and practice approaches. • The second, a post-activity outcome assessment, was collected by CE Outcomes, LLC.
— Activity participants were compared with a matched group (demographics, specialty and number of patient seen who survived hematologic cancers) of non-participants.
— 59 participants (25 oncologists /34 PCPs) were matched to 59 non-participants (25 oncologists /34 PCPs). Participant data were provided by Medscape; non-participants were contacted by CE Outcomes via email.
• Overall, 3,177 physicians participated in the education activity from September 2012 to September 2013.
• During the one-year activity, 122 oncologists and 172 PCPs responded to the intra-activity questions.
• 59 participants and 59 non-participants responded to the post-activity outcomes assessment.
conclusions/recommendations
The analysis of the oncologist and PCP learner responses to the surveys and the post-activity outcomes assessment points to persistent challenges in the co-management of survivors of hematologic cancers. Challenges stem from issues related to:
• Clinical complexities• Communication• Technology• Health care systems • Health care coverage.
Timely, ongoing communication of appropriate clinical information between oncologists and PCPs is essential for optimal management of the growing number of cancer survivors. While oncologists and PCPs devote significant time each week to addressing the cancer survivors’ needs, the lack of reimbursed time for PCPs may be an impediment to optimal care. Both the oncologists and PCPs place a high value on the utility of survivorship care plans; however, they are not widely used. Phone calls are the current preferred communication mode.
Until other technology tools are more widely used to share clinical information,it is important to employ practical solutions, such as: providing PCPs with clearinformation to help prioritize cancer survivors’ follow-up care needs; and, providingpatients/caregivers with brief cancer treatment summaries to enable them tocommunicate with their health care providers and take active roles in their ongoingcare. It is also important to develop communication strategies to address potentially preventable causes of death (e.g., cardiac disease and second cancers), and treatable causes of distress (e.g., anxiety and depression5).
References
1. National Cancer Institute. Dictionary of Cancer Terms. http://www.cancer.gov/dictionary?cdrid=450125. Accessed 10/31/132. Parry C, et al. JCO. 2013;31: 2651-2653.3. Siegel R, et al. CA Cancer J Clin. 2012;62:220-241. 4. de Moor JS, et al. Cancer Epidemiol Biomarkers Prev. 2013;22:561-70. 5. Harrington, C, et al. International Journal of Psychiatry in Medicine. 2010;40: 163-181.
Acknowledgements
Supported by an independent educational grant from The Leukemia & Lymphoma Society with additional support from Incyte.
Authors have no relevant conflicts of interest to disclose.
Shared Care for Hematologic Malignancy Survivors: Challenges for Primary Care Physicians and Oncologists
figure 1 Web-based CME Roundtable Discussion Among Oncologists and PCP Faculty
figure 2a
figure 2b
figure 2c
The survivor’s inability to accurately report cancer
treatment
The survivor’s inability to accurately report cancer
treatment
The survivor’s inability to accurately report cancer
treatment
Obtaining a detailed survivorship care plan,
which includes a treatment summary
Obtaining a detailed survivorship care plan,
which includes a treatment summary
Obtaining a detailed survivorship care plan,
which includes a treatment summary
Lack of expeditious communication between the oncologist and PCP
Lack of expeditious communication between the oncologist and PCP
Lack of expeditious communication between the oncologist and PCP
Having the time to investigate optimal cancer screening requirements for
each survivor
Having the time to investigate optimal cancer screening requirements for
each survivor
Having the time to investigate optimal cancer screening requirements for
each survivor
Having patients complete all
recommended screenings
Having patients complete all
recommended screenings
Having patients complete all
recommended screenings
PCPs
Oncologist Non-Participants
PCP Non-Participants
Oncologists
Oncologist Participants
PCP Participants
60%
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Intra-activity
Post-activity- Oncologist Responses
Post-activity- PCP Responses
The most significant barriers to effective co-management of cancer survivors reported in the intra-activity and post-activity outcomes questions are shown in Figures 2a-c. Obtaining a detailed survivorship care plan, which includes a treatment summary, was the most significant barrier, followed by a lack of expeditious communication between the oncologist and PCP (Figure 2a). The post-activity education assessment corroborates this finding for both participants and non-participants (Figures 2b and c).
Use of Survivorship Care Plans and Treatment Summaries
In your experience, what is the most significant barrier to effective management of cancer survivors? (Please select only 1 answer.)
In your experience, what is the most significant barrier to effective management of cancer survivors? (Please select only 1 answer.)
In your experience, what is the most significant barrier to effective management of cancer survivors? (Please select only 1 answer.)
Oncologists and PCPs agree that survivorship care plans, which include treatment summaries, are the most useful communication vehicles among professionals (Figure 3a). Despite progress in use of electronic health records and widespread Internet and email access, these physicians most typically use the phone to communicate with each other about the management of cancer survivors (Figure 3d). The post-activity education assessment also examined the most useful formats for communication and yielded similar outcomes (Figures 3b and c; Figures 3e and f). Of note, an intra-activity question found that while the majority of oncologists and PCPs use treatment summaries in their practices, only a small percentage of oncologists and PCPs use a survivorship care plan (Figure 3g).
Cancer Treatment Documentation and Communication
figure 3a
figure 3b
figure 3e
figure 3f
figure 3c
figure 3d
figure 3g
An itemized list of all chemotherapy and radiation
treatment details
A survivorship care plan, which includes a treatment
summary
A phone call between the PCP and the oncologist to allow for detailed
discussion of treatment
The pathology report, including diagnosis, is sufficient for primary
care in most cases
PCPs
Oncologist Non-Participants
Oncologist Non-Participants
PCP Non-Participants
Oncologists
Oncologist Participants
Oncologist Participants
PCP Participants
80%70%60%50%40%30%20%10% 0%
12%
72%
0%
15%10%
68%
3%9%
Intra-activity
Post-activity- Oncologist Responses
Post-activity- Oncologist Responses
Post-activity- PCP Responses
Post-activity- PCP Responses
Intra-activity
Intra-activity
Which of the following is the most useful format for communicating the patient’s cancer history, treatment, and long-term risks among professionals?
An itemized list of all chemotherapy and radiation
treatment details
A survivorship care plan, which includes a treatment
summary
A phone call between the PCP and the oncologist to allow for detailed
discussion of treatment
The pathology report, including diagnosis, is sufficient for primary
care in most cases
90%80%70%60%50%40%30%20%10% 0%
70%
60%
50%
40%
30%
20%
10%
0%
80%70%60%50%40%30%20%10% 0%
12%
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60%
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6%
28%
24%
9%
4%
16%
35%
84%
36%
32%
0%
8%
6%
12%
40%
26%
Which of the following is the most useful format for communicating the patient’s cancer history, treatment, and long-term risks among professionals?
When communicating with a PCP, oncologist, or other clinician regarding the care of cancer survivors in your practice, which of the following do you most typically use?
When communicating with a PCP, oncologist, or other clinician regarding the care of cancer survivors in your practice, which of the following do you most typically use?
An itemized list of all chemotherapy and radiation
treatment details
A survivorship care plan, which includes a treatment
summary
A phone call between the PCP and the oncologist to allow for detailed
discussion of treatment
The pathology report, including diagnosis, is sufficient for primary
care in most cases
70%
60%
50%
40%
30%
20%
10%
0%
12%
59%
3%
26%
32%38%
0%
29%
Which of the following is the most useful format for communicating the patient’s cancer history, treatment, and long-term risks among professionals?
Phone call Faxed letter Mailed letter Email message
PCPs
PCPs
Oncologists
Oncologists
80%70%60%50%40%30%20%10% 0%
63%
15%9%
12%
75%
10%7%8%
When communicating with a PCP, oncologist, or other clinician regarding the care of cancer survivors in your practice, which of the following do you most typically use?
Which of the following methods of documenting patients’ cancer treatment do you see or use most commonly in your practice?
Phone call
Phone call
Faxed letter
Faxed letter
Mailed letter
Mailed letter
Email message
Email message
PCP Non-ParticipantsPCP Participants
Treatment summary Survivorship care plan OtherPatient self-report Caregiver report
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30%
20%
10%
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73%
8%1%
11%8%
66%
6% 4%3%
21%
An intra-activity question assessed the amount of non-reimbursed time that PCPs spend researching issues related to patient care (Figure 4). The responses reveal that similar percentages of oncologists and PCPs estimated that PCPs spend more than 4 hours of non-reimbursed time weekly researching issues related to patient care.
Intra-activity questions examined the success of obtaining insurance coverage for screenings of cancer survivors (Figure 5a) and the challenges associated with coordination of care with other providers (Figure 5b). According to the responses, 39% of both oncologists and PCPs had modest success obtaining coverage (after spending time addressing insurance denials and supplying documentation that supported the need for supplemental screenings). Almost half of oncologists (49%) indicated that coordination of care is an ongoing challenge; among PCPs, 41% indicated they sometimes experienced this issue.
The Impact of Current Communication Practices
Challenges of Health Care Coverage and Coordination of Care
figure 4 Intra-activity
>4 hours Almost none
PCPsOncologists
50%45%40%35%30%25%20%15%10%5%0%
47%
23%
7%
23%
42%
27%
9%
22%
How much nonreimburesed time do you estimate that primary care providers spend on average each week researching treatment issues related to patient care?
< 3 hours < 1 hour
Not at all successful; I just don’t have time to respond
to coverage denials
Quite often; it is an ongoing challenge
Modestly successful, but only after replying to time-
consuming requests for documentation
Sometimes, but we usually work it out
Successful; I have associates (or a vendor) who handle these
types of cases
Infrequently
Not applicable to my practice
Almost never
PCPs
PCPs
Oncologists
Oncologists
50%45%40%35%30%25%20%15%10%5%0%
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9%
4%
10%
Intra-activity
Intra-activity
How successful have you been in obtaining insurance coverage for screenings of cancer survivors that fall outside of normal ranges?
Patients with cancer often have comorbitities that need to be addressed. Coordinating & sharing care with other providers can sometimes be confusing _ particularly with respect to who takes the lead. How frequently do you encounter this in your practice?
figure 5a
figure 5b
