A Multidisciplinary Approach to Implement Personalized Breast Cancer Treatment and Care Plans

Abstract

Implementation of survivorship care plans remain a challenge. This quality improvement initiative aims to integrate personalized treatment plans (PTP) and care plans (PCP) into the existing workflow for breast cancer (BC) patients. Methods: Phase 1 was to identify multidisciplinary team members to generate and deliver PTP and PCP. Concurrently, Phase 2 was to deliver PTP and PCP to newly diagnosed invasive BC patients at chemotherapy initiation and completion, respectively. Iterative plan, do, study, act (PDSA) cycles were applied to refine the process. The proportion of information completed for PTP and PCP generation and its delivery by the care team were measured. Patient and provider satisfaction were also assessed. Implementation Process and Results: The care transfer facilitator (CTF) was identified to complete and deliver PTP, and their data entry increased from 0% to 76%, 80%, 92% consecutively during the last 4 PDSA cycles. PTP and PCP were provided to 85% of eligible BC patients. Patients agreed that PTP helped them to actively participate in their care (88%) and communicate with the oncology care team (86%). Primary care physicians agreed that PTP and PCP had the information needed to “stay in the loop” (80%), and oncologists agreed they should be incorporated into oncology clinics (100%). Conclusions: Integrating PTP and PCP generation and delivery into existing workflow has led to an increase in uptake, sustainability and provider buy-in. With limited resources, it remains difficult to find care team members to complete the forms. A dedicated personnel or survivorship clinic is required to successfully implement PTP and PCP as the standard of care.

Rethinking breast cancer follow-up based on individual risk and recurrence management

“…Several studies are promoted on the development of "patient-centered medical homes" whose philosophy is based on primary care patient-centered, complete, teambased, coordinated, accessible and focused on quality and safety [119]. Different players should be involved and considered, including in first place general practitioners (GPs), psychologists and specialists in oncological field (i.e., medical and radiation oncologists, nurse, case manager) [120,121]. The approach to the patient should be multidimensional to take into consideration not only the survivor as a patient within programs aimed at the early diagnosis of disease recurrence but above the person, as entirety, and his family network.…”

Successes and challenges of implementing a cancer care delivery intervention in community oncology practices: lessons learned from SWOG S1415CD

“…TrACER's practice-level standing order intervention presented our team with unique operational opportunities that could have implications for the design and implementation of future CCD interventions. The Practical, Robust, Implementation and Sustainability Model (PRISM) is a commonly used tool to help translate research findings into practice by highlighting activities associated with the success of intervention implementation and sustainability [15]. Although PRISM is not intended to guide the implementation of interventions within a clinical trial, the tool is highly relevant to implementing research in a pragmatic setting and provides a useful framework for sharing our findings.…”

“…2). These steps were modeled on the Plan-Do-Study-Act (PDSA) cycle, a four-stage model for continuous quality improvement management that has been used to implement cancer care delivery quality improvement interventions [14][15][16][17][18]. Clinical site staff were given access to a training video that provided a high-level overview of the reconfiguration process.…”

Social and healthcare professionals’ experiences of end‐of‐life care planning and documentation in palliative care

“…Care planning and documentation in EHR takes time and filling out forms requires resources (Haq et al, 2021). Care plan uptake can be facilitated by legislation (Lepore et al, 2018), structured documentation (Myers et al, 2018), integration into workflow (Haq et al, 2021; Weaver et al, 2020) and multi‐professional teamwork (Haq et al, 2021; Khan et al, 2017; Langley et al, 2022). If care plans are comprehensive, multi‐professional and used between organizations, patients can see their care planning from a holistic perspective and the burden of creating a plan is lessened (Langley et al, 2022).…”