Lauren Kelley, MSW, MPA Adrienne Lofton, RN, MSN Ms Kelley described Project Access–New Haven, a volunteer, community-based program that uses a best-practice model to increase access to care for underserved [ Read More ]
December 2012 VOL 3, NO 6
Navigation Update 2012: Current Regulations—Navigation and Survivorship Care Plan
Dr Ferris presented an overview of the American College of Surgeons Commission on Cancer (CoC), which represents 50 professional organizations with a goal to improve quality of life and outcomes. She spoke about the new CoC standards “ensuring high quality patient-centered care.” Other quality programs of the American College of Surgeons include the National Accreditation Program for Breast Centers, the Bariatric Surgery Center Network Accreditation Program, the National Surgical Quality Improvement Program (NSQIP), and the Trauma Verification Program.
New initiatives of the CoC include new standards ensuring patient-centered care and improved resources for cancer programs. Dr Ferris noted that programs have to be specific to each institution and the patient populations they serve. In developing a needs assessment, she suggested going for the “biggest bang for the buck” considering who are the stakeholders and who will benefit the most, using data from cancer registries. Among the new standards that will be phased in by 2015 are patient navigation, psychosocial distress screening, and survivorship care plans. She gave an example of a needs assessment to evaluate the cancer care experience, the patient navigation process, and an overall rating of care received, noting it should target patients with early stage cancer, not just those with stage III or IV cancer.
Compliance with the standard will require annual reporting including the following:
- Identified healthcare disparities and/or barriers addressed by the navigation process
- Description of established navigation process
- Identification of community served (who and how many)
- Documentation of activities and metrics
- Options for future directions such as quality improvement and enhancements
Dr Ferris also described suggestions for implementing a successful navigation program, noting that CoC resources are available for assistance. These include the CoC Answer Forum and Best Practices Repository, which are available online. She discussed why survivorship plans are needed, as well as the minimum requirements for a survivorship plan as outlined in the Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition. She said one issue that she is grappling with is when to give survivorship plans to patients. One factor is considering when patients are cognitively ready to receive their plan. Sample survivorship care plans, which Dr Ferris described, are available online:
She noted that the Journey Forward is from the patient perspective whereas the American Society of Clinical Oncology (ASCO) plan at cancer.net is very medically oriented. Other resources are available from the Institute of Medicine and various medical centers and online cancer-related communities. Another issue is how to have survivorship plans integrated with the EMRs. Dr Ferris also discussed how compliance with the new standards for survivorship plans will need to be documented, then briefly discussed healthcare reform.
Ms Shockney commented that there will be a shortage of primary care physicians. Because patients become attached to their cancer care team, there will be a need to set expectations up front, get patient buy-in on the treatment plan, and depending on diagnosis and treatment, they can expect either to be transitioned back to their primary care physician or other care providers. Both the oncologist and the patient need to let go. She said the primary care physician should continue to be responsible for patient basic health maintenance care, eg, flu shots, and she never wants patients to disconnect while under the oncologist’s care for their cancer. The survivorship care plan is an opportunity to prepare the patient for engagement and self-management. Underserved and nonadherent patients tend to hold on longer. Dr Ferris agreed that patients in active care should maintain communication with primary care physicians, who should be part of the team managing the patient’s health.