Background: With rapid advances in research clinicians often struggle to remain current on evolving care guidelines as well as current National Quality Standards (NQS) relevant to breast cancer management. Adherence to NQS now drives much reimbursement for cancer center services but clinical workflow processes and IT solutions are often not in place to effectively document adherence. The On Q Care Planning SystemTM (CPS), an evidence-based patient assessment and care planning software, has been designed to close gaps in quality cancer care and facilitate data collection to help centers both better understand and document their adherence rates to quality care standards. Methods: This multi-site study will enroll approximately 150 non-metastatic breast cancer patients, presenting for no greater than their second medical oncology visit, across five cancer centers. Patients must be planned for but not yet receiving chemotherapy treatment. A between subject design using 150 matched historical controls will be used to assess the impact of the 2-part intervention, at both the patient and provider level, on select quality metrics. At two consecutive clinical visits, patients will engage with the On Q CPS to assess family and medical history and current symptoms and receive two separate care plans. Care plans include (when applicable) recommendations for symptom management and appropriate referrals (i.e. genetic counseling for those at increased hereditary risk, and/or reproductive endocrinology for those interested in preserving fertility). To augment the effectiveness of the On Q CPS, providers will also participate in certified continuing medical education activities designed to educate about evidence-based assessment, decision-making, and management strategies for breast cancer patients. The primary aim is to evaluate provider adherence to select quality metrics among recently diagnosed breast cancer patients following the intervention, and compare to adherence rates for historical controls from the pre-intervention period. Metrics of primary interest include distress screening and management, complete family history assessment, genetic counseling referral, discussion of infertility risk, and discussion of fertility preservation options and/or referral to a specialist. These metrics have been chosen as the primary endpoints given that they have been historically documented as being resistant to change. Outcomes will be assessed by chart abstraction using a score card method of select quality metrics for both enrolled patients and matched historical controls. Analysis/Results: Patient enrollment begins in June 2015 and thus data will be presented at time of symposium. Patient characteristics and primary outcomes will be analyzed using a multi-step approach to first describe and then compare, at the individual patient level, provider adherence to the select quality metrics evaluated in this study. Descriptive statistics will also be estimated within a mixed model approach for the rate with which each single metric was achieved across patients. Conclusions: The On Q CPS, a care planning software tool, has the potential to both improve provider adherence to NQS and allow institutions an easy and accessible way to document that adherence. Citation Format: Hathaway A, Halilova K, Gaguski ME, Thomas K, Dudley WN, Stricker CT, Hammelef KJ, Panzer SL, Rocque GB. Improving provider adherence to breast cancer care quality metrics: Use of a novel care planning tool. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-16.

Introduction: Survivorship care plans (SCPs) have been suggested as a solution to the fragmentation of care and suboptimal outcomes experienced by the more than 13 million cancer survivors in the US. Provider and patient acceptance of SCPs is generally high, but trials to date have examined outcomes such as cancer-related distress rather than constructs more directly related to the purpose of SCPs, such as improving coordination of care, knowledge about survivorship issues, and perceived usefulness by patients. Moreover, little is known about processes by which SCPs are developed and delivered in practice – who is involved and the level of resources needed for implementation. This pilot study used a quasi-experimental, pre-test/post-test design to examine the process of delivering standardized SCPs and the outcomes achieved by post-treatment breast cancer survivors at seven cancer centers affiliated with the LIVESTRONG™ Survivorship Centers of Excellence Network. Method: Outcomes were assessed prior to SCP delivery and 3 months following and included survivors’ use of and satisfaction with SCPs, perceived knowledge about survivorship care and potential late effects, and survivors’ assessment of the quality and coordination of survivorship care. Process variables included type of provider delivering the SCP and time required to complete and deliver the SCP. Results: 139 breast cancer survivors completed baseline and follow-up measures and received a comprehensive, standardized SCP at a survivorship visit (Age M = 53.9 years, 3.4 years post-diagnosis, 90.6% Caucasian). Satisfaction with the SCP was high, with 90% of participants being at least ‘satisfied’ and 56% being ‘very’ or ‘extremely satisfied’. Perceived knowledge about survivorship care improved following SCP delivery (p < 0.001), as did survivor perception of quality of survivorship care received and coordination among providers (all p < 0.001). A trend toward improvement in satisfaction with the follow-up care provider was also noted (p = 0.11). Most participants (88%) reported reading their SCP carefully following delivery. In the 3 months following delivery, participants reported they most commonly used SCP materials to make decisions about appropriate exercise (69%), which tests to receive and when (65%), and to make dietary changes (65%), but only 23% shared the SCP with their primary care providers during that time frame. With respect to process, providers were predominately NPs and Pas (80%). Although implementation varied, time burden was consistently high (M = 72 minutes to prepare, M = 48 minutes to deliver). Discussion: This is the first known study to demonstrate significant improvements in perceived knowledge regarding and perceived quality of survivorship care following receipt of a comprehensive SCP. Survivors were satisfied with their SCP, and most frequently reported using SCPs in making decisions regarding behavioral changes. Results warrant further consideration in a randomized controlled trial, and approaches that maximize efficiency are needed given the time burden of providers to provide an SCP. SCPs have been recommended for all cancer survivors and these data provide preliminary support for this recommendation. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-02.

Introduction: Cancer survivors experience late and long-term effects, though post-treatment follow-up is generally focused on monitoring for disease recurrence. Survivors may hesitate to volunteer symptom concerns for fear of burdening their providers with ‘insignificant complaints.’ Survivorship care plans (SCPs) have been recommended by the IOM and mandated by the American College of Surgeons as a means of improving outcomes and enhancing communication between survivors and providers. To date, however, little research has evaluated the effect of SCPs on patient-reported outcomes, and less has examined the optimal timing of SCP interventions. This study examined symptom burden, quality of life (QoL), health concerns, use of SCP materials and differences by time since diagnosis in a pre-post quasi-experimental design. Method: 139 breast cancer survivors completed assessments prior to and 3 months following a structured SCP visit at one of seven LIVESTRONG™ affiliated survivorship programs. Measures at both time points included global and individual symptom burden, QoL (SF-12), cancer-specific and general health worry, personal survivorship concerns, and family/genetic Survivorship Concerns. Patients also reported use of SCP materials for informational, decisional, and communication Support at follow-up. Subjects were grouped according to time since diagnosis into two categories: near term (≤ 24 months, n = 84), long term (> 24 Month, n = 55) survivors. Results: Global symptom burden decreased following SCP intervention (p < .001). Participants reported decreased pain (p = .001), fatigue (p < .001), disturbance from hot flashes (p = .02), emotional concern (p = .02), and numbness/neuropathy (p = .006), and a trend toward decreased cognitive disturbance (p = .09). Near term survivors reported marginally greater decrease in global symptom burden relative to long term survivors (p = .08), and in the specific areas of cognitive difficulties (p = .05), fatigue (p = .006), and emotional concerns (p = .10). Although there were no differences over time in physical functioning on the SF-12, near term survivors reported worse mental health than long term survivors (p = .008). Across groups, cancer-specific worry, general health worry, personal survivorship concerns, and family/genetics concerns did not change over time. However, near term survivors reported more cancer-specific worry (p = .03) and marginally greater family/genetics concern than long term subjects (p = .10). Near term survivors were also more likely to use their SCP documents for informational (p = .02) and decisional (p = .08) support following their SCP visit. Discussion: Although limited by a quasi-experimental design, results suggest that SCPs may have a beneficial effect on symptom burden generally, with physical symptoms of pain, fatigue and neuropathy most responsive to care.. Much of the benefit appears to accrue to near term survivors. Moreover, near term survivors report more concerns relative to long term survivors, and are more likely to use SCP materials following visits. If these findings are replicated in better controlled studies, survivorship care will provide greater benefit in the first two years after completion of treatment. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-07.