Development and pilot testing of a nurse-led posttreatment support package for bowel cancer survivors.

BACKGROUND: Colorectal cancer (CRC) is the most common cancer affecting both men and women in Australia. The illness and related treatments can cause distressing adverse effects, impact on emotional and psychological well-being, and adversely affect social, occupational, and relationship functioning. Current models of follow-up fail to address the complex needs arising after treatment completion. Strategies to better prepare and support survivors are urgently required. OBJECTIVES: This study aimed to develop and pilot test an innovative supportive care program for people with potentially curative CRC. METHODS: The SurvivorCare intervention was developed by a multidisciplinary team using 3 key principles: (1) promote patient involvement and engagement; (2) address the specific needs of individual patients, and (3) use evidence-based strategies to promote well-being and reduce treatment sequelae. It also addressed 4 essential components of survivorship planning, defined by the US Institute of Medicine. Ten survivors completed questionnaires and satisfaction interviews before and after receiving the intervention. RESULTS: SurvivorCare comprises survivorship educational materials (booklet, DVD, and question prompt list), a tailored survivorship care plan, a tailored nurse-led end-of-treatment consultation, and 3 follow-up telephone calls. Pilot data demonstrated that survivors considered the intervention appropriate, relevant, and useful. CONCLUSIONS: SurvivorCare is a well-received, comprehensive intervention that will now be evaluated in a randomized controlled trial aiming to reduce distress and unmet needs and improve quality of life in CRC survivors. IMPLICATIONS FOR PRACTICE: If SurvivorCare is shown to be effective, it will be possible to quickly and broadly disseminate this model of care.

The views of bowel cancer survivors and health care professionals regarding survivorship care plans and post treatment follow up.

GOALS OF WORK: Increasing numbers of people survive cancer beyond diagnosis and treatment. Many survivors have ongoing needs and they may encounter fragmented, poorly coordinated follow up care. Survivorship care plans (SCP) have been promoted as a key aspect of survivorship care. This study aimed to survey key stakeholders in the care of people with colorectal cancer (survivors, primary care providers and hospital-based healthcare professionals) regarding follow-up and SCP. PATIENTS AND METHODS: In study 1, cancer survivors completed a questionnaire regarding their follow-up and experiences during survivorship. Participants' primary care physicians completed a phone interview regarding proposed SCP elements. A subgroup of survivors reviewed a sample SCP and participated in a phone interview regarding this. In study 2, healthcare professionals working with colorectal cancer patients completed a questionnaire regarding follow-up and proposed elements of a SCP. MAIN RESULTS: Twenty survivors completed the questionnaire, 14 primary care providers completed a phone interview and 12 survivors reviewed the sample SCP. Ninety-five healthcare professionals (30 medical professionals and 65 nurses) completed the questionnaire. There was strong support for core elements of the SCP. Additionally, nurses and survivors expressed support for supportive care and psychosocial elements. There was lack of consensus regarding who should prepare and discuss the SCP. CONCLUSIONS: There is strong support for the development and use of SCPs for bowel cancer survivors. There is some variation in opinion regarding ideal content of the SCP, who might prepare it, and how it might be discussed and utilised. IMPLICATIONS FOR CANCER SURVIVORS: Overcoming identified barriers to implementing SCPs for bowel cancer survivors is necessary for high quality cancer care.

Glycemic control in diabetic patients served by community health centers.

The Community Health Center Network measured the prevalence of glycemic control in diabetic patients at 7 community health centers as part of its clinical quality improvement program. A cross-sectional survey was carried out in a random sample of 1817 diabetic patients having 1 or more encounters from October 1, 2000 to September 30, 2001. Computerized laboratory results for hemoglobin A1c (HbA1c) tests were available for half the sample. Manual review of medical charts was carried out for the rest. The proportion of diabetic patients with 1 or more HbA1c tests in the measurement year was 91% (CI95%: 90-93%) and poor glycemic control (HbA1c > 9%) occurred in 27% (CIM%: 25-30%). The mean of the most recent test was 7.8%. The frequency of testing varied significantly by clinic from 79% to 94% and increased with the number of encounters. Poor glycemic control also varied significantly by clinic (17-48%) and was significantly better in females and older patients. Measures of glycemic control were not associated with ethnicity or insurance status in multivariate analyses. A high proportion of diabetic patients received appropriate care, and this care was not associated with ethnicity or insurance status. The data warehouse was an essential tool for the clinical quality improvement program.