Developing innovative models of care for cancer survivors: use of implementation science to guide evaluation of appropriateness and feasibility.

Purpose: Limited understanding of factors affecting uptake and outcomes of different cancer survivorship care models hampers implementation of best practices. We conducted a formative evaluation of stakeholder-perceived acceptability and feasibility of an embedded primary care provider (PCP) survivorship care model.

Methods: We identified clinical, operational, and patient stakeholders within Kaiser Permanente Southern California and conducted semi-structured interviews.

Understanding Comorbidity Profiles and Their Effect on Treatment and Survival in Patients With Colorectal Cancer.

Patients with colorectal cancer (CRC) commonly present at an older age with multiple comorbid conditions and complex care needs at the time of diagnosis. Clusters of comorbid conditions, or profiles, have not been systematically identified in this patient population. This study aimed to identify clinically distinct comorbidity profiles in a large sample of patients with CRC from an integrated healthcare system, and to examine the effect of comorbidity profiles on treatment and survival.

Integrating qualitative research methods into care improvement efforts within a learning health system: addressing antibiotic overuse.

Background: Despite reports advocating for integration of research into healthcare delivery, scant literature exists describing how this can be accomplished. Examples highlighting application of qualitative research methods embedded into a healthcare system are particularly needed. This article describes the process and value of embedding qualitative research as the second phase of an explanatory, sequential, mixed methods study to improve antibiotic stewardship for acute sinusitis.

It takes a (virtual) village: crowdsourcing measurement consensus to advance survivorship care planning.

We report results from the use of an innovative tool (the Grid-Enabled Measures (GEM) database) to drive consensus on the use of measures evaluating the efficacy and implementation of survivorship care plans. The goal of this initiative was to increase the use of publicly available shared measures to enable comparability across studies. Between February and August 2012, research and practice communities populated the GEM platform with constructs and measures relevant to survivorship care planning, rated the measures, and provided qualitative feedback on the quality of the measures.

An action plan for translating cancer survivorship research into care.

To meet the complex needs of a growing number of cancer survivors, it is essential to accelerate the translation of survivorship research into evidence-based interventions and, as appropriate, recommendations for care that may be implemented in a wide variety of settings. Current progress in translating research into care is stymied, with results of many studies un- or underutilized. To better understand this problem and identify strategies to encourage the translation of survivorship research findings into practice, four agencies (American Cancer Society, Centers for Disease Control and Prevention, LIVE STRONG: Foundation, National Cancer Institute) hosted a meeting in June, 2012, titled: "Biennial Cancer Survivorship Research Conference: Translating Science to Care.

Use of survivorship care plans in the United States: associations with survivorship care.

Background: Survivorship care plans (SCPs), including a treatment summary and follow-up plan, intend to promote coordination of posttreatment cancer care; yet, little is known about the provision of these documents by oncologists to primary care physicians (PCPs). This study compared self-reported oncologist provision and PCP receipt of treatment summaries and follow-up plans, characterized oncologists who reported consistent provision of these documents to PCPs, and examined associations between PCP receipt of these documents and survivorship care.

Methods: A nationally representative sample of medical oncologists (n = 1130) and PCPs (n = 1020) were surveyed regarding follow-up care for breast and colon cancer survivors.

Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care.

Background: Cancer survivors represent a growing population, heterogeneous in their need for medical care, psychosocial support, and practical assistance. To inform survivorship research and practice, this manuscript will describe the prevalent population of cancer survivors in terms of overall numbers and prevalence by cancer site and time since diagnosis.

Methods: Incidence and survival data from 1975-2007 were obtained from the Surveillance, Epidemiology, and End Results Program and population projections from the United States Census Bureau.

Identification and correlates of unmet service needs in adult leukemia and lymphoma survivors after treatment.

Purpose: To examine and characterize the psychosocial and health service needs of adult leukemia and lymphoma survivors who had completed active treatment within the past 4 years.

Methods: Self-report surveys were completed by 477 survivors, age 18 to 85 years, to identify areas and correlates of unmet psychosocial, health, and instrumental service needs. Unmet service needs were rank ordered, and nonparametric tests were run to assess relationships.

Now what? Toward an integrated research and practice agenda in distress screening.

Significant gains have been made in the detection and treatment of cancer, contributing to increased survival, but a cancer diagnosis and treatment may be accompanied by physical and psychosocial after-effects. Distress screening has been championed as a mechanism to identify patients with high levels of psychosocial morbidity for subsequent assessment and psychosocial care delivery. However, implementation of distress screening has been variable, in scope and in the consistency and quality of metrics and methods used.

"You're too young for this": adolescent and young adults' perspectives on cancer survivorship.

Adolescent and young adult cancer survivors face unique challenges not systematically addressed by cancer clinicians. Four focus groups and two individual interviews were conducted with 19 survivors to profile experiences and identify key concerns for future interventions. The resultant themes reflect cancer care continuum challenges (such as delays in diagnosis, problems with adherence), psychosocial concerns (such as infertility and reproductive concerns, changing social relationships, financial burden), and the paradox of being diagnosed with cancer as a young adult.

Cancer survivors: a booming population.

Background: In this first article of what is planned to be an annual series, we examine the history of cancer prevalence reporting and the role that these annual figures play in guiding the direction of cancer control research, and specifically the science of cancer survivorship. For this inaugural year, we focus on the confluence of the growing number of survivors and population aging, and the impact these combined trends will have on cancer survivorship in the future.

Methods: State or metro area-level cancer incidence and prevalence data were collected from 9 registries via the Surveillance, Epidemiology, and End Results Program.

Perceived positive impact of cancer among long-term survivors of childhood cancer: a report from the childhood cancer survivor study.

Objective: Investigations examining psychosocial adjustment among childhood cancer survivors have focused primarily on negative effects and psychopathology. Emergent literature suggests the existence of positive impact or adjustment experienced after cancer, as well. The purpose of this study is to examine the distribution of Perceived Positive Impact (PPI) and its correlates in young adult survivors of childhood cancer.

Working without a net: leukemia and lymphoma survivors' perspectives on care delivery at end-of-treatment and beyond.

This study explored survivors' perspectives on care delivery and supportive care needs during reentry. Fifty-one individual interviews were conducted with adult leukemia and lymphoma survivors, 3 to 48 months from treatment cessation. Survivors reported poor continuity of care across the patient-survivor transition, difficulty finding appropriate information/services, lack of preparation, lack of support for survivorship issues, and inadequate or poorly timed follow-up as factors contributing to adjustment difficulties at end of treatment and beyond.

What do 1281 distress screeners tell us about cancer patients in a community cancer center?

Objective: The 2008 Institute of Medicine's Report, Cancer Care for the Whole Patient (IOM, 2008), recommends screening cancer patients for distress. Cancer programs throughout the United States are struggling to achieve this standard. The IOM report indicates that only 14% of 1000 randomly selected American Society of Clinical Oncology (ASCO) members and eight of 15 National Comprehensive Cancer Network (NCCN) centers reported screening for distress in at least some of their patients [J Natl Compr Cancer Netw 2007;5:99-103].

A comparison of two spirituality instruments and their relationship with depression and quality of life in chronic heart failure.

Spirituality is a multifaceted construct related to health outcomes that remains ill defined and difficult to measure. Spirituality in patients with advanced chronic illnesses, such as chronic heart failure, has received limited attention. We compared two widely used spirituality instruments, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) and the Ironson-Woods Spirituality/Religiousness Index (IW), to better understand what they measure in 60 outpatients with chronic heart failure.

Further application of the care transitions intervention: results of a randomized controlled trial conducted in a fee-for-service setting.

The study objective was to test whether a self-care model for transitional care that has been demonstrated to improve outcomes in Medicare Advantage populations--The Care Transitions Intervention--could also improve outcomes in a Medicare fee-for-service population. Intervention patients were less likely to be readmitted to a hospital in general and for the same condition that prompted their index hospitalization at 30, 90, and 180 days versus control patients. Coaching chronically ill older patients and their caregivers to ensure that their needs are met during care transitions may reduce the rate of subsequent rehospitalization in a Medicare fee-for-service population.

Assessing the quality of transitional care: further applications of the care transitions measure.

Background: The Institute of Medicine has identified care transitions as a priority area for performance measurement.

Objectives: To examine the performance of the Care Transitions Measure (CTM) in more diverse populations and to introduce a 3-item CTM.

Research Design: Cross-sectional study with purposive sampling of traditionally underserved populations.

The central role of performance measurement in improving the quality of transitional care.

The objectives of this study were: (1) to demonstrate the ability of the Care Transitions Measure (CTM) to identify care deficiencies; (2) to devise and implement a quality improvement approach designed to remedy these deficiencies; (3) to assess the impact of the quality improvement approach on CTM scores; and (4) to test whether the CTM-3 predicts return to the emergency department. The CTM was found to be a sensitive tool able to capture changes in performance. The 3-item CTM was found to significantly predict post-hospital return to the emergency department within the first 30 days (p = 0.

A qualitative exploration of a patient-centered coaching intervention to improve care transitions in chronically ill older adults.

Persons with chronic illness frequently find they need to navigate the health care system but are ill equipped to do so. Using interview data from 32 participants, this study explored patients' experiences with a coaching intervention that provided patients with support and tools to enhance self-management during care transitions. The findings suggest the efficacy of the model in enhancing self-management, particularly because it fostered the perception of a caring relationship, leading to greater patient investment in the program.

The care transitions intervention: results of a randomized controlled trial.

Background: Patients with complex care needs who require care across different health care settings are vulnerable to experiencing serious quality problems. A care transitions intervention designed to encourage patients and their caregivers to assert a more active role during care transitions may reduce rehospitalization rates.

Methods: Randomized controlled trial.

Thematic evidence of psychosocial thriving in childhood cancer survivors.

Advances in medical treatment for childhood cancer have resulted in dramatically increased survival rates and a growing population of long-term survivors. Until recently, researchers reported primarily negative psychosocial sequelae of childhood cancer. Emergent conceptual frameworks propose that the assumption of pathology or long-term deficits in functioning might obscure an understanding of the full range of outcomes.

Assessing the quality of preparation for posthospital care from the patient's perspective: the care transitions measure.

Background: Evidence that both quality and patient safety are jeopardized for patients undergoing transitions across care settings continues to expand. Performance measurement is one potential strategy towards improving the quality of transitional care. A valid and reliable self-report measure of the quality of care transitions is needed that is both consistent with the concept of patient-centeredness and useful for the purpose of performance measurement and quality improvement.

Preparing patients and caregivers to participate in care delivered across settings: the Care Transitions Intervention.

Objectives: To test whether an intervention designed to encourage older patients and their caregivers to assert a more active role during care transitions can reduce rehospitalization rates.

Design: Quasi-experimental design whereby subjects receiving the intervention (n=158) were compared with control subjects derived from administrative data (n=1,235).

Setting: A large integrated delivery system in Colorado.