Background: Survivorship care plans will be mandated for use by 2015. Few studies have focused on the care transition process, and few show an impact on the patient experience or health outcomes. This study examines the effect of a patient-owned survivorship care plan (POSCP) intervention on patient outcomes and care coordination. Based on a conceptual model that incorporates IOM survivorship priorities and the chronic care model, the POSCP intervention is a single coaching encounter utilizing motivational interviewing to engage patients in the development of a POSCP that incorporates health goals and strategies related to surveillance, symptom management, and health behavior.
Methods: 79 recent breast cancer survivors Stage I-IIIB were randomized to receive POSCP intervention (n=40) or usual care (n=39). Patient outcomes were assessed using SF-36 Health Survey (SF-36), Social/Role Activities Limitations, Self-Efficacy for Managing Chronic Disease Scale, and Personal Health Questionnaire Depression Scale (PHQ-9) at baseline and 3 month follow up. Care coordination was assessed using confirmed primary care physician (PCP) visits and reported discussion of survivorship plan at follow up. Logistic and linear regressions were conducted to examine the effect of intervention on care coordination, patient experience, and health outcomes.
Results: In this sample age M= 58.35, SD = 10.62, 81% (N=64) non-hispanic white, 16.5% (N=13) African American. A greater proportion of participants in the intervention group reported a confirmed appointment (59.5% vs. 51.4%) and discussed survivorship issues (47.4% vs. 35.1%) with their PCPs compared to those in the usual care group, however these differences did not achieve statistical significance (p= .70 and .65). After controlling for education and perceived financial adequacy, participants in the intervention group demonstrated significantly higher self-reported health (F (3, 70) = 3.57, p< .05), lower social role limitation (F (3, 70) = 3.82, p < .05), as well as a trend toward greater self-efficacy (F (3, 69) = 2.51, p = .07) compared to those in the usual care group. Results of paired-samples t-tests revealed a significant decrease in depression scores from baseline to 3 months follow up in the intervention group, t (36)= 3.21, p < .01, η^2 =.23. No between group differences were identified in symptom burden or patient activation.
Conclusion: This pilot study of a POSCP process utilizing motivational interviewing techniques to enhance patient engagement has a positive impact on patient outcomes and demonstrates promise as a strategy to improve survivor patient experience, care coordination, and health outcomes.
Citation Format: Elizabeth A Kvale, Wendy Demark-Wahnefried, Karen Meneses, Sejong Bae, Chao-Hui S Huang, Casey B Azuero, Christine S Ritchie. Patient centered support in the survivorship care transition: Outcomes from the patient-owned survivorship care plan intervention [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-07.