Accuracy and Thoroughness of Treatment Summaries Provided as Part of Survivorship Care Plans Prepared by Two Cancer Centers

Abstract

Intro Treatment summaries prepared as part of surivivorship care planning should correctly and thoroughly report diagnosis and treatment information. Methods As part of a clinical trial, summaries were prepared for Stage 0–3 breast cancer patients at two cancer centers. Summaries were prepared per the standard-of-care at each center via two methods: using the electronic health record (EHR) to create and facilitate auto-population of content or using manual data entry into an external software program to create the summary. Each participant’s clinical data was abstracted and cross-checked against each sumary. Errors were defined as inaccurate information, while omissions were defined as missing information based on the Institute of Medicine (IOM) recommended elements. Results 121 summaries were reviewed: 80 EHR-based versus 41 software-based. Twenty-four (30%) EHR- versus 6 (15%) software-based summaries contained ≥1 omission. Omissions included failure to provide dates and specify all axillary surgeries for EHR-based summaries and failure to specify receptors for software-based summaries. Eight (10%) EHR- versus 19 (46%) software-based summaries contained ≥1 error. Errors in EHR-based summaries were mostly discrepancies in dates, while errors in software-based summaries included incorrect stage, surgeries, chemotherapy and receptors. Conclusion A significant proportion of summaries contained at least 1 error or omission; some were potential clinically significant. Mismatches between the clinical scenario and templates contributed to many of the errors and omissions. In an era of required care plan provision, quality measures should be considered and tracked to reduce rates, decrease inadvertent contributions from templates, and support audited data use.

Alberta CancerBridges Development of a Care Plan Evaluation Measure

“…For initial psychometrics, we used scp-delivery data from bca and hn survivors in Alberta. To ensure the scps we evaluated matched closely with iom recommendations 47 , we applied a published coding system 4 , demonstrating close concordance with guidelines at or above levels reported by LIVESTRONG™ Survivorship Centers in the United States. We demonstrated acceptable internal consistency for cpe-s and cpe-p after eliminating one and two items per subscale, respectively.…”

A randomized trial of immediate versus delayed survivorship care plan receipt on patient satisfaction and knowledge of diagnosis and treatment

“…21 SCP content included 4 main sections: "Guide" (describing the purpose and content of SCPs), "Treatment Summary," "Follow-Up Plan," and "Glossary of Terms" (defining terms such as grade, receptors, etc). 21 SCP content included 4 main sections: "Guide" (describing the purpose and content of SCPs), "Treatment Summary," "Follow-Up Plan," and "Glossary of Terms" (defining terms such as grade, receptors, etc).…”

Moving beyond static survivorship care plans: A systems engineering approach to population health management for cancer survivors

“…Key data to include are well defined, 33 but the tools for preparing SCPs differ. Some SCPs use manual abstraction and data transfer between the medical record into survivorship software (eg, Journey Forward [Canton, MA], Passport for Care), 34,35 whereas others auto-populate SCPs with EHR data 36 or extract such data to separate web platforms and return prepared SCPs into the EHR as static documents. 37 More complexity arises because the individuals delivering SCP and follow-up care also vary.…”

“…Individual(s) who prepare and deliver SCPs may not be member(s) of the care team or plan to participate in follow-up care. 36 Care planning may be distinct, stand-alone visits (whether face-to-face vs phone) or incorporated into routine clinical visits. 36,38 Finally, responsibilities for follow-up tasks are variously delineated, with potentially oncologists, primary care, survivor, or caregiver ensuring that the recommended care is accomplished.…”

“…By understanding the work system elements, the design and integration of tasks, technology, and clinical processes can be designed to better support the respective needs of individuals while optimizing system performance. 36–40 …”