Running Head: SURVIVORSHIP CARE PLAN

Survivorship Care Plan: A Pilot Implementation in Colon Cancer Survivors
Lauren Ruegg
Arizona State University

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Abstract
Cancer survivorship has been identified as separate stage in cancer treatment posing unique
issues that arise from the diagnosis of cancer, as well as late effects associated with treatments.
Evidence shows that cancer survivors demonstrate suboptimal follow-up care, and report high
levels of unmet needs related to their cancer experience. To improve care for the increasing
number of cancer survivors in the United States, survivorship care plans (SCPs) have been
proposed as way to strengthen care coordination and improve patient outcomes. Research
suggests that SCPs have favorable impact on patient satisfaction and quality of life, however
little research to date investigates the utility of SCPs in improving patient outcomes, adherence
to follow-up recommendations, or patients’ confidence in self-care management. To further
understand the role of SCPs in survivorship care, a pilot implementation of SCPs in colon cancer
patients was implemented to gather data on the identified gaps.
Keywords: colon cancer, survivorship, care plan, confidence, adherence

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Survivorship Care Plan: A Pilot Implementation in Colon Cancer
According to the Surveillance, Epidemiology, and End Results (SEER) program, cancer
incidence has declined by approximately 1% annually over the last 10 years; however, the
number of cancer survivors has steadily increased, with estimates of 15.5 million people in the
United States currently living with a cancer diagnosis (Miller et al., 2016). By the year 2026 the
number of survivors is projected to increase to 20.6 million. Of those affected, colorectal cancer
is the second leading cancer among men and women, accounting for 1.6 million survivors in the
United States today; with projected 5 and10 year survival of 65% and 58% respectively (Miller
et al., 2016).
Problem Statement

Cancer survivors face unique disease and treatment related changes that evolve along
their care continuum. Cancer and its related treatment is known to cause atypical presentation of
common health conditions, increased risk for infections, accelerated age related changes,
recurrence and increased risk for acquisition of secondary cancers (McCabe et al., 2013).
Additionally, cancer survivors experience a spectrum of psychosocial, financial, emotional, and
spiritual challenges related to their cancer experience (Center for Disease and Control [CDC],
2016). Hematology and oncology specialist, as well as larger organizations that guide oncology
care such as the American Society of Clinical Oncology (ASCO), the CDC, and the National
Cancer Institute (NCI) recognize that cancer survivors have complex needs which require
tailored risk assessments, and personalized care planning (Hewitt, Greenfield & Stoval, 2005).
The 2005 Institute of Medicine (IOM) report illuminated the under-addressed needs of cancer
survivors in current practice and proposed the integration of survivorship care plans (SCP) to
address the comprehensive needs of cancer patients. The report recognized survivorship to be a

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distinct phase in cancer care, and recommended that upon completion of cancer treatment,
patients receive a comprehensive care plan summary and follow-up care plan that can be used
across health care specialties to optimize care and outcome for patients along their survivorship
trajectory (Hewitt, Greenfield, & Stovall, 2005). Following the release of the IOM report, the
Center of Excellence (COE) was founded by the LIVESTRONG foundation, which has served to
pilot and research survivorship care strategies (Campell et. al., 2011). In response to these
initiatives American college of Surgeons (ACoS) Commission on Cancer (CoC) announced its
mandate for SCP implantation; the most recent accreditation requirements propose that
accredited cancer centers should have provided SCPs beginning in 2015 to 10% of patients who
meet survivorship criteria. Survivors are to receive a survivorship care plan at completion of
initial cancer treatment, with incremental increases annually to reach projections 75% of
qualifying patients receive a SCP by 2018 (CoC, 2014).

Purpose and Rationale
A high quality SCP would provide four essential elements: description of specific cancer
diagnosis, treatments received, instruction for follow-up care, and health promotion
recommendations. These elements would provide an explanation of associated late and long-term
effects (LLTE) and foster adherence for disease surveillance and secondary cancer screening. In
addition the SCP would include resources to for healthy lifestyle recommendation, disease
prevention, and coping and psychosocial support (Jabson, 2015). The integration of a high
quality SCP not only serves as way to improve satisfaction and adherence to follow-up
recommendations, but also serves as a way to instill confidence in self-efficacy in health
promotion and disease prevention.

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Background and Significance
With a survival rate of 84% 12 months post treatment, adults with colorectal cancer are
projected to account for a large percentage of long-term cancer survivors (Faul, et al., 2012).
Despite favorable survival statistics, 20-40% of colorectal cancer survivors go onto to develop
secondary malignancies (NCI, 2013). In addition, depression, chronic fatigue, body image
concerns, bowel dysfunction, and sexual dysfunction are among the common adverse sequela for
colon cancer survivors (Faul et al., 2012). Unfortunately many colorectal patients experience
poorly coordinated care after treatment. This results in distress and unmet needs following their
cancer care. Only 50% of patients report satisfaction with care addressing their psychosocial
problems (Wieldraaijer et al., 2016). These findings are congruent with the IOMs national report
by Hewitt, Greenfield, and Soval (2005), “From Cancer Patient to Cancer Survivor: Lost in
Transition”, which emphasized that personalized and well- coordinated care planning is
imperative to meet the complex aftercare needs for colon-cancer survivors.
Despite acknowledged value of SCPs, integration and implementation in practice has
been slow; to date less than half of the LIVESTRONG survivorship centers of excellence sites
are delivering SCPs in accordance to the IOM and CoC’s current recommendations (Kvale,
2016). The process of creating and disseminating SCPs is a resource-intensive process, posing
significant challenges in many health care delivery systems (Brennan, Gormally, Butow, &
Spillane, 2014). Lag in implementation is likely exacerbated by failure of SCP’s to demonstrate
conclusive evidence that SCP delivery improves outcomes of cancer survivors, as concluded by
Mayer, Birken, Check, and Chen (2015). Unfortunately many of the randomized control trials
(RCTs) conducted and reviewed, demonstrate flawed design, and poorly selected variable
measurements (Mayer, Birken, Check, & Chen, 2015). Recent published data however, has

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demonstrated a more promising shift in outcomes. Kvale, et al. (2016) conducted an RCT with
79 cancer survivors, where usual SCP delivery was compared to “Patient owned SCP” and
focused coaching session. A Patient owned SCP was described as an individualized care plan
that is created during a focused coaching session. The intervention group reported lower social
role limitations (p=0.014) and demonstrated higher self-reported health (p=0.017). Significant
changes were also observed in several quality of life (QOL) domains: physical role (p=0.0009),
bodily pain (p= 0.03), and emotional role (p= 0.04) were demonstrated and depression was
significantly decreased (p= 0.003) (Kvale, et al., 2016). These findings provide evidence to
support not only SCPs, but also emphasize the importance of the delivery, suggesting that
dedicated survivorship visits are useful to enhance SCP use for patients. Similarly Palmer, et al.
(2015) utilized survivorship visits to deliver SCPs in a pilot study of 139 breast cancer survivors;
each participant attended a “survivorship visit” where a SCP was delivered and explained., At
the end of the visit participants completed a survey assessing satisfaction, use of SCP material,
knowledge of care, and care coordination. The same survey was used three months post visit, and
compared to baseline data. Results demonstrated high satisfaction, with a report of 90% of
participant being satisfied or more with the SCP. In addition, patient perceived knowledge about
follow-up care, and care coordination were significantly improved (all P< 0.001) (Palmer et
al.,2015). In a cross-sectional study of 1129 colon cancer patients demonstrated similar findings
with SCPs, with a satisfaction rate of greater than 87% and reported use of SCP in care
coordination by 69% of participants (Frick et al., 2017). Satisfaction and QOL metrics are
heavily studied in the body of SCP research. While satisfaction and QOL serve utility in SCP
appraisal, metrics pertaining to outcomes are critically important to quantify and little research
has focused on these areas. Hawkins et al. (2015) evaluated adherence to recommended follow-

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up guidelines in 593 cancer survivors, using a cross sectional design. The sample included
survivors who received verbal explanation of follow-up instruction in conjunction with written
instruction (SCP), one or the other, or none at all. It was found that survivors who received
specific follow-up instructions from health care providers, verbal or written, were associated
with adherence to guide line recommendation follow-up and screening. Colonoscopy’s are part
of the National Comprehensive Cancer Network (NCCN) (2017), recommendation for follow-up
care for all stages of colon cancer and play a crucial part in the identification of colon cancer
recurrence. Adherence to colonoscopies was significantly greater (p=0.05) if a patient received
specific instruction for follow-up (Hawkins et al., 2015). Confidence is an important indicator for
appropriate self-management of disease. Rosenberg et al. (2015) examined SCPs and their
impact on self-management in a cohort study of 1615 cancer survivors. At one year following the
receipt of SCP at an individualize risk associated visit, 94% of survivors felt more confident
communicating about their treatment, 90% were more confident in recognizing signs/symptoms
to report and 98% were more aware of community services and programs (Rosenberg et al.,
2015)
A hospital system that is National Cancer Institute-designated cancer center was
identified for implementation of a Doctorate of Nursing Practice project to facilitate effective
pilot implementation of SCP in colon cancer patients using a developed SCP that can be adapted
to the current electronic medical record (EMR). This hospital organization lacked a uniform
mechanism to deliver and meet the most recent updates for CoC accreditation despite serving an
estimated 130,000 cancer patients at its combined sites annually (Etzioni et al., 2016). At this
particular site it serves an estimate of 200 new colorectal patients annually (Etzioni et al., 2016).
Although the CoC accreditation is not mandatory to deliver cancer treatment, loss of

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accreditation would be a significant insult to this hospitals reputation as a recognized leader in
cancer care (Etzioni et al., 2016). The goal of addressing the fragments in care for cancer
survivors is to shift current methods of care delivery to utilization of comprehensive, individually
tailored care plans that support seamless post-treatment care to all cancer survivors. Additionally
this will serve to provide access to adequate tools, resources and guidance to patients, family
members, primary care providers, and others in the communities at large that are involved with
cancer care. These assumptions lead to the need for a pilot implementation of SCPs and
development of the PICO question: In colon cancer survivors(P), how does a survivorship care
plan(I) compared to standard follow up care(C) affect confidence in self-care, satisfaction, and
adherence to NCCN follow-up recommendations? (O)
Search Strategy
To address the clinical questions regarding SCPs in colon cancer survivors, an exhaustive
search of current evidence was performed. An online database search of CINHAL, Medline, and
PsychINFO using keywords and Boolean connectors was used to obtain all available literature
concerning the clinical questions of interest. Search was initiated in January 2017, and updated
through March 2017. Keywords included: cancer survivor, neoplasm, colon cancer, colorectal
neoplasm, care plan, survivorship care plan, follow-up care, adherence, follow-up care,
satisfaction, self-efficacy, self-management, and confidence. The initial search was intended to
include data on all malignancies; searching title and abstracts in each database for (cancer
survivor or neoplasm) AND (care plan or survivorship care plan). This resulted with 376 from
CINAHL, 324 from Medline, and 43 from psychINFO. The search was further refined by the
following limits: peer reviewed studies, publication in English, Adults, and publication within
the last five year; resulting in 176 from CINAHL, 67 from Medline, and 26 from PsychINFO.

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The search was altered to examine colorectal cancer by adding (colon cancer or colorectal
neoplasm) with AND Boolean to each search. This generated 22, 25 and 32 from CINAHL,
Medline and psychINFO respectively. To focus on the clinical questions of interest;
(satisfaction), (confidence or self-efficacy), (confidence or self-management), and (adherence or
follow-up care) were added independently and in combination to initial search and refined
colorectal search on each database. Demonstration of search can been found in Appendix A
(CINAHL), Appendix B (Medline), and Appendix C (PsychINFO).
Saturation was met with the addition of focused keyword search; a robust yield of
abstracts 62 were assessed and approximately 30 studies were selected for further review and
quality appraisal. Studies were selected if they had strong statistical and methodological
integrity, relevance to clinical question and population, and clear documentation. Studies were
discarded if the population had metastatic disease or palliative intent, if they examined health
care providers only, or had a weak study design. A total of 11 studies, two randomized control
trials (RCTs), four systematic reviews (SR), four cross sectional studies, and two prospective
cohort studies (PCS) were selected for further analysis for quality, relevance, and application to
clinical PICO question (Appendix D).
Critical Appraisal & Synthesis
Rapid Critical Appraisal (RCA) was used to ascertain quality and strength of the 11
selected studies; evaluation of data is found in the evidence table (Appendix D). All but one
study utilized quantitative methodology, with exception of one qualitative systematic review.
The majority of the studies provide high level of evidence; with four level I, four level II, and
three level VI as demonstrated in synthesis table (Appendix E). Sample sizes ranged from 791615 in the RCT, prospective cohort studies and cross-sectional studies (Appendix E). Thorough

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description of data analysis was found in 10 of the 11 studies, with each study noting specific
level of significance (p) standard deviations (sd), confidence interval (CI), and correlation
coefficient (r). Appraisal of statistical methods found congruency with each study design
(Appendix D).
Reliability is confirmed by consistency in outcomes across homogeneous studies, in
addition each study demonstrated at least one significant finding and reported use of validated
measurement tools in each investigation. Three studies (2 RCT, 1 PCS) examined SCP with
focused visits, each study demonstrated significant improvement in satisfaction and at least one
other metric measured (appendix E). Collectively SCP demonstrated increased patient
satisfaction (6) increase in care coordination (5) and increase in survivor knowledge (4).
Validity is confirmed in the RCTs through randomization and use of control. All four of the
experimental studies (2 RCTs, 2 PCS) used control procedures for false discovery rate, therefore
increasing their power (Appendix D). Validity is accepted for the four systematic reviews (SR)
for their comprehensive description of search strategies, use of validated tools for SR, and
inclusion of published RCTs and report of appropriate patient data (appendix D).
All 11 studies investigated SCPs, however heterogeneity in content and delivery was
observed. Three studies (2 cross sectional, and one SR) evaluated treatment summaries (TS) and
SCPs. Four studies (two PCS and two RCT) investigate the delivery of individualized SCP with
a focused survivorship visits. The remaining four studies evaluated SCPs, however consistency
in SCP methodology was weak between studies (Appendix D). Outcomes of interest varied; six
studies evaluated satisfaction, four studies evaluated quality of life, five evaluated patient
knowledge, eight evaluated care coordination, one evaluated guideline adherence, and one
evaluated self-efficacy. Across the 11 studies, the use of SCPs resulted in inconclusive results,

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many studies demonstrated positive outcome, however failed to reach significance (n=6). Studies
that investigated the use of focused survivorship visits (n=4) demonstrated greater significance in
results.
The majority of the studies were done in the United States (n=9), with foreign
contribution from Canada (n=1) and Australia (n=2). Homogeneity was observed in cancer type,
9 of the 11 studies evaluated the use of SCPs in breast cancer survivors, therefore a greater
representation of females (Appendix D). Although useful for reproducibility in this population,
it does limit insight to generalizability to other cancers. Despite a mean age variation between
studies of 37=74.7, most studies provide data from adult cancer survivors between 50-60 years of
age. No biases were revealed, however homogeneity of demographics could influence data
outcomes based on role characteristics and tendencies.
Conclusions
Despite the variability in the early evidence of SCPs, improved designs and focus on
implementation has shifted outcomes related to SCPs in recent years. The culmination of
evidence does demonstrate appreciable improvement in patient care and reported outcomes such
as care coordination and satisfaction. The generation and dissemination of SCPs demonstrates to
be an important element in SCP functionality and benefit, and further research efforts should be
focused to develop strategies that are scalable across settings and disease types. Data regarding
SCPs and their influence in guideline adherence and confidence in care ownership is sparse, and
warrants further investigation. The evidence does support that SCPs are beneficial tools in
survivorship care; however the utility of SCP is greatly improved when patients are provided a
specific visit to review the care plan and discuss survivorship. Therefore, research suggests
efforts should be combined to develop workflows where individualize care plans are delivered in

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person, and reviewed at a focused visit to optimize the effectiveness of SCPs for both patients
and involved care provided. Utilization of current research to guide quality improvement and
evidence based practice projects in SCP delivery would be a useful way to generate data and
improve processes.
Conceptual Framework and EBP
Application of the chronic care model (CCM) was adopted to guide the utilization and
implementation of SCP to colon cancer survivors at the selected academic institution. The CCM
incorporates six essential elements to facilitate optimal chronic disease care, and has
demonstrated useful application in larger healthcare systems. Each identified element:
community, the health system, self-management support, clinical information system, decision
support and delivery system design; utilizes specific evidence base change concepts (Wagner,
1998). Incorporating these elements enhances patient provider communication and encourages
patient participation in their care through informed decision-making, behavior change and
utilization of appropriate health care and community resources (Wagner, 1998). This is useful in
SCP planning by assisting in resource allocation, role organizations, and facilitation of
communication with patient’s and amongst interdisciplinary teams such as oncology and primary
care.
To facilitate this proposed practice change, The Mayo Clinic Nursing Evidence-based
Practice Model (MCNEBP) is utilized (Appendix G). The MCNEBP provides guidance to
facilitate practice change, and quality improvement initiatives through evaluation and application
of evidence based practice (EBP) (Mayo Clinic, 2017). This model utilizes a seven-step process,
which facilitates a unique problem solving approach to improving cancer survivorship care
through SCP implementation. The MCNEBP stepwise process encourages critical evaluation of

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the evidence, and comparison of current practice, the evidence, and desired future state (Mayo
Clinic, 2017). With contextual consideration of the identified stakeholders, and care teams this
model enhances appropriate application of EBP to guide quality improvement and evidence
based practice.
Purpose
To promote the use of SCPs in survivorship care, and develop a standardized method to
achieve the CoC.3.3 standards, an evidence based practice project was implemented in an adult
colorectal cancer practice. This population was selected for its short treatment duration, and
volume of cancer survivors. Given a six-month time frame for project implementation and
assessment, these elements were necessary to adequately observe adherence to practice change
and progress towards meeting accreditation requirements, as well as measuring the effect of
practice change on patient care. To evaluate the impact of project implementation, the following
metrics were evaluated: SCP effects on patient knowledge, confidence, and satisfaction, the
practice adherence to SCP delivery, and systems progress to meet COC 3.3 accreditation
requirement
Methods
The practice intervention included use of a vended product to create a personalized SCP,
and delivery of SCP at a focused survivorship consultation with a survivorship or oncology
provider. Prior to project implementation, Institutional review board approval (IRB) was
obtained from project site, and Arizona State University. The project entailed multi- phase
implementation. During the planning phase, physicians, nurse practitioners, physician assistance
and registered nurses in the colon and rectal cancer practice received focused education and
training for the SCP product, and workflow redesign specific to each professional role. The

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workflow was designed to maximize multi-disciplinary scope of practice and facilitate optimal
delivery of SCP for both patients and providers. At the completion of treatment, oncology
providers place consult for a “survivorship consult”; this scheduled visit prompts the RN
coordinator to create the personalized SCP using the vended software product. The RN sends
draft SCPs to of provider for review, where the document is finalized for delivery at the
survivorship consult visit. The survivorship visit for colon patients was led by the survivorship
MD, and survivorship visits for rectal patients was lead by trained oncology physician assistant.
The visit focused on thorough review and explanation of SCP
The organization’s cancer registry assisted in retrospective identification of patients who
were eligible to receive SCPs based on date of diagnosis and had completed therapy prior to pilot
implementation. Eligibility was determined based upon CoC 3.3 standards and inclusion criteria;
18 years of age or greater, lives within a 50 mile radius of Phoenix, diagnosed with cancer stage
I-III, and received treatment with curative intent.
Beginning in August 2017 practice change was initiated and identified colorectal (CR)
cancer patients were scheduled for survivorship consults. Chart review and cancer registry was
used to capture the baseline number of SCPs delivered to colorectal (CR) cancer survivors prior
to pilot initiation. To track the number of SCPs delivered chart review of identified patients were
assessed for documented SCP in medical record. Percentage increase was tracked through
February 2018. Patient’s perceived knowledge and confidence in self-care, and care satisfaction
was measured using the modified Confidence in Survivorship Information (CSI) survey. The CSI
is a 13-item measurement tool used to assess confidence in survivorship using a three point likert
scale, response options range from one, “not at all confident” to three, “very confident”.
Confidence is assessed in two subscales: Confidence in knowledge of cancer diagnosis and

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treatment details (3 items, reliability: 0.77) and knowledge and confidence in health promotion,
personal cancer risk, disease prevention and available resources (10 items, reliability: 0.95)
(Palmer, Jacobs, Mao, & Stricker, 2012). Psychometric properties of this tool have been
evaluated in a sample of 209 diverse cancer survivors, which yielded a two-factor (past and
future knowledge) that accounted for 58.4% of the variance. With permission three investigatordeveloped items to assess satisfaction and health-promotion were added to CSI questionnaire.
The additional three items utilized a 5-point Likert scale; with responses ranging from one, not at
all satisfied to five, very satisfied. Surveys were delivered and completed by patients prior to
their survivorship consultation, and receipt of SCP. In February 2018 DNP student contacted
survivors who completed initial survey, and received an SCP. Utilizing the IRB approved phone
script the follow-up CSI survey was completed by using verbatim language of survey. Please see
appendix I for survey.
Results
The total number of identified patients equaled 18, of those 16 received the prescribed
intervention of a focused survivorship visit, with delivery of a personalized SCP. This reflected
an 88% adherence to the practice change. Of the 16 patients who attended their survivorship
visit, fifteen completed a pre-survey and seven completed a post survey. Data was collected on
the fifteen patient participants who completed a pre-survey. There were six females and nine
males, with an average age of 65. Paired T-test analysis with an alpha of .05 was used to analyze
the knowledge and confidence of survivors’ pre and post intervention, through CSI response.
Paired analysis demonstrated an overall increase in survivors’ confidence in cancer self-care
knowledge and care satisfaction after receiving focused survivorship visit and personalized SCP.
Statistical significance was achieved in improvement of patient’s confidence and knowledge in

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strategies to prevent disease recurrence or secondary cancer (p= .001); how to prevent (p= .015)
and how to treat (p=. 018) late and long term physical effects of cancer or it’s treatment; how to
prevent (p= .045) and treat (p= .047) emotional effects of cancer diagnosis. Overall satisfaction
with survivorship care improved from an average response of 4 or satisfied to 4.9 or “very
satisfied” (p= .015) after receiving intervention. For comprehensive statistical findings in each
area analyzed by CSI survey reference appendix G. Graphical demonstration of average
response of each question of CSI survey pre and post intervention is displayed in appendix H.
Discussion
A team-based approach demonstrates to be a useful framework to implement practice
change, and adoption of SCPs into cancer practice. In addition to the CR practice, the
organizations breast cancer practice was also include in the pilot. Both patient populations
demonstrated positively improved confidence and knowledge in survivorship care. When
comparing outcomes between practices the colorectal cancer demonstrated more significant
finding in improvement post intervention. This is likely observed due factors involving
consistency in practice habits by the providers, and adherence to the prescribed workflow. The
colon and rectal cancer practice remained stable with two providers who were trained in the
survivorship workflow, use of SCPs tool and recognized the value of providing high quality
survivorship care. This resulted in appropriate identification of eligible patients and referral to
survivorship consult. During CR survivorship visits, providers adhered to workflow designed
visit where personalized SCPs were reviewed, and questions were addressed regarding SCP and
cancer survivorship. When compared to breast cancer practice, transition occurred with the
providers responsible for the survivorship consultation visit throughout the project. Due to
unexpected leave of absence, not all by providers delivering SCPs received the focused training

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on workflow, or valued the importance of SCPs. This resulted in some variation in the
identification of eligible patients, resulting in missed survivorship consult referrals. These lapses
in congruency resulted in some variation in breast cancer practice. It was observed where not all
patients received discussion and review of their care plan at their survivorship visit. This
comparison confirms what has been demonstrated in previous research, where value and effect of
SCPs are maximized when delivered by a trained survivorship provider, and elements of the care
plan discussed in a focused visit.
Although improvement, and statistical significance was observed in the areas of CR
survivor’s confidence and knowledge; generalization of these outcomes must considered in the
context of a relatively small sample size, which is recognized as a limitation. Additional
limitations include short timeframe and observation. The restriction to only 6 months of
observation of intervention limited the DNP student to observation of only the CSI metrics.
Observation of at least 12 months would have allowed for more robust data collection, and
insight to the practice change include larger population size, and additional metrics that evaluate
patient outcomes and behavior, such as adherence to applicable NCCN follow-up guidelines, and
to health promotion behavior such as vaccinations, and smoking cessation. The survivorship
work flow, including the focused survivorship is not absent of labor intensive demand, and
increased cost with use of vended SCP product, which is a limitation for some practices,
however this can also be viewed as “value added” to care provided. This is important to discuss,
because although it may pose some disruption and challenge, over the long-term trajectory,
improving survivorship care is likely to mediate reduced cost of care due to improving patient’s
self-efficacy, and health practices. Self-efficacy and optimized health promotion and disease

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prevention practices is likely to reduce comorbidity, and therefore lessen the burden of
unnecessary or improper use of health care resources.
Although some adjustments are needed to improve provider compliance to practice
change, ongoing dissemination of practice change is advised. Future efforts should focus on
delivery process specific to each unique practice, and optimizing SCP tool to benefit each
practice. Further data collection of patient’s adherence to NCCN follow-up recommendations
and health promotion practices ought to be completed to add knowledge of SCP efficacy, and
value in practice.
Conclusion
Strategic implementation of a structured survivorship visit and delivery of SCP has
demonstrated to be an effective framework to improve the care of cancer survivors. Additionally
the pilot project provides a useful framework to assist in widespread implementation to all cancer
specialties, which will assist the organization to maintain accreditation as a recognized cancer
center. Joining the use of individualized SCPs with a focused visit fosters patient ownership in
care, and empowers self-management. Through discussion of treatment summary and disease,
patients glean greater understanding of risks, and awareness to recommended follow up care.
The SCPs provide tools to promote health and prevent future disease, which in turn can reduce
healthcare cost by reduction of complications of poor health management, decrease misuse of
specialty services and increase use of community resources. Overall, the adoption of this
evidence base practice change encouraged high quality survivorship and generated data that will
assist to direct and improve survivorship care moving forward.

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(2016). A Randomized Controlled Trial of a Nurse-Led Supportive Care Package
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B. E., ... & Pisu, M. (2016). Treatment summaries and follow-up care instructions for
cancer survivors: improving survivor self-efficacy and health care utilization. The
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21

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patients; causes of distress and need for supportive care: Results from the ICARE Cohort
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Appendix A
Search Strategy: CINHAL

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24

Appendix B
Search Strategy: Medline

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25

Appendix C
Search Strategy: PsychINFO

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SURVIVORSHIP CARE PLAN
Appendix D
Evaluation Table
Citation

Brennan, M., E.
(2014).
Survivorship care
plans in cancer:
A systematic
review of care
plan outcomes
Country:
Australia

Conceptual
Framework
Not explicitly
stated; inferred:
Henderson need
theory

Design/Method

Design: SR
Purpose: To
review evidence
of SCP
implementation
in practice.

Sample/Setting

N=2,286
participants.
Studies N=10
RCT: n=5
non RCT: n=5
TC:
BC, CC, GC
Age range: 37-62

No
disclosure/COI
mentioned.
Funded in part by
“the Friends of
The Mater
Foundation

Inclusion criteria:
original studies
evaluating written
care plans for CS,
and reporting HQOL
Exclusion criteria:
Articles evaluating
SCP in metastatic
disease, and studies
that evaluated a
single variable of
care.
AT:
N/A

Major Variables &
Definitions

Measurement

Data Analysis

Findings

IV1– paper
based/online SCP
IV2:
oncologist/nurse/PCP
delivered SCPs
IV3: Other SCP
templates

Cancer survivor
unmet needs
scale.
Multiple likert
scales

“QualSyst” tool
for SR

SCP had no
significant findings
in related to
distress, care
coordination,
satisfaction, or
cancer outcomes.

DV1: Survivor
distress
DV2: CCC
DV3: oncological
outcomes.
DV4: Understanding
of SCP and FU care
(also ability to
Identify FU
provider.)
DV6: change in
unmeet needs.

EORTC quality
of life
questionnaire.
Breif symptom
inventory-18

Descriptive
statistics,
Multivariate
regression and
T-test used as
appropriate .

SCPs improved
patient’s ability to
identify clinicians
responsible for
survivorship care.
(p=.005)
SCPs demonstrated
reduced amount of
survivors unmet
needs. (NS)
Survivors rated
Satisfaction with
SCPs,
understanding and
receptiveness of
SCP (NS)

Decision for Use in
Practice/Application to
Practice
LOE: I
Strengths: great
heterogeneity in SCP
content. Represent data
from 2,288 cancer
survivors.
Limitation: small body
of heterogeneous
literature; few RCTs.
Studies lack of
homogeneity amongst
cancer type and stage of
disease.
Lack of consistency in
evaluation tools.
Ceiling effect in SCP
satisfaction.
Applicability: evidence
supports favors in
patient satisfaction and
self-reported
understanding of
survivorship care.
Feasibility: More
research is needed to
identify SCPs effects on
psychological,

A: anal, AT: attrition rate BC: breast cancer, BCS: breast conserving surgery, BRFSS: behavioral risk factor surveillance system, C: Control, CC: colorectal
cancer, CCC: continuity and coordination of care, CCR: California cancer registry, CE: College degree CHC: childhood cancer, COI: conflict of interest, CS:
cancer survivors, CSS: cross sectional study CRD: cancer specific distress, CT: chemo therapy, d: Day DV: dependent variable, EOL: end of life, EORTC:
European organization for research and treatment of cancer F: female, FU: follow up, G: group, GA: guideline adherence, GC: gynecological cancer, HBM:
health belief model, HCP: health care provider HQOL: health related quality of life, HT: hormone therapy, I: intervention, IV: independent variable, LALTE:
late and long term effects, mo: month LIFE: living in the furture M: male, MA: mean age, MC: metastatic cancer, MFD: months from diagnosis, N: number,
NCI: national cancer institute, NS: not significant, PC: palliative care, PD: psychological distress, PCP: primary provider, PR: peer reviewed, PRO: patient
reported outcomes, PS: patient satisfaction QLS: qualitative study, QTS: quantitative study, R: Rectal, RCT: randomized control trial, S: stage SCP:
survivorship care plan, SCT: social cognitive theory, SOD: stage of disease, SR: Systematic review, TC: type of cancer, TM: total mastectomy, TS: treatment
summary TT: type of treatment U: unknown, US: United States, YO: years old

SURVIVORSHIP CARE PLAN
oncological, and
resource outcomes.

Hawkins, N., A.
(2015).
Examining
adherence with
recommendations
for follow-up in
the prevention
among colorectal
cancer survivors
Country: US
COI/Disclosures:
None
acknowledged.

Not explicitly
stated: Inferred:
Health belief
model

Design: Cross
sectional
Purpose: To
evaluate if
recommendation
for FU were more
effective if
received in
written form
(SCP) or by
verbal
instruction.

N=593
F: n=296
M: n=295
Age
> 50: n=28
50-89: n= 540
</= 90: n=24

TC: Colorectal
cancer
Setting:
Community
survey: CCR
AT: n/a
Inclusion: Non-MC,
no previous cancer,
California resident
at diagnosis, >/=18
at diagnosis, current
vital status, no
participation in
previous CCR study.
Absent of do not
contact flag on CCR
Exclusion: inability
to complete survey
related to language
barrier, physical, or
mental

IV 1: Verbal FU
instruction
IV 2: Written FU
instruction
DV1: Adherence to
guideline
recommendations

Prevention
amongst
colorectal cancer
survivors
(PACCS)
survey.
General health
status was
measured using
5-point likert
scale.

Questions and
close ended
response
modified from
the cancer
control model
from the NIHS
to evaluate last
routine checkup,
colonoscopy,
mammogram or
pap test was.

Descriptive
statistics for
demographics.
Noted to
calculated base
weights for the
race and
ethnicity totals.
Rao-scott chisquare test.
Multivariate
logistic
regression
SAS and
SUDAAN
version 10 was
the statistical
software used.

Adherence to
colonoscopy was
significantly
increased in
patients who
received FU
instructions
compared to those
who received none.
Adherence to
additional FU
recommendations
was increased, but
not significantly in
other selected
domains.

27

LOE: IV
Strengths: large sample
size, homogeneity of
cancer. Higher
cooperation rate of
participants. Diverse
sampling
Limitations: adjusted
response rate of only
46%. Self-reported
methods do not allow for
validation of follow-up.
Under and over
reporting potential due
to reliance on participant
recall.
Applicability: Quality
and engaged
communication is
essential for facilitating
successful follow up
care to cancer survivors.
Oncology nurses can
play an important role in
SCP delivery and
optimizing survivorship
care coordination and
outcomes.
Feasibility: Nursing is in
a strong position to
monitor health behaviors

A: anal, AT: attrition rate BC: breast cancer, BCS: breast conserving surgery, BRFSS: behavioral risk factor surveillance system, C: Control, CC: colorectal
cancer, CCC: continuity and coordination of care, CCR: California cancer registry, CE: College degree CHC: childhood cancer, COI: conflict of interest, CS:
cancer survivors, CSS: cross sectional study CRD: cancer specific distress, CT: chemo therapy, d: Day DV: dependent variable, EOL: end of life, EORTC:
European organization for research and treatment of cancer F: female, FU: follow up, G: group, GA: guideline adherence, GC: gynecological cancer, HBM:
health belief model, HCP: health care provider HQOL: health related quality of life, HT: hormone therapy, I: intervention, IV: independent variable, LALTE:
late and long term effects, mo: month LIFE: living in the furture M: male, MA: mean age, MC: metastatic cancer, MFD: months from diagnosis, N: number,
NCI: national cancer institute, NS: not significant, PC: palliative care, PD: psychological distress, PCP: primary provider, PR: peer reviewed, PRO: patient
reported outcomes, PS: patient satisfaction QLS: qualitative study, QTS: quantitative study, R: Rectal, RCT: randomized control trial, S: stage SCP:
survivorship care plan, SCT: social cognitive theory, SOD: stage of disease, SR: Systematic review, TC: type of cancer, TM: total mastectomy, TS: treatment
summary TT: type of treatment U: unknown, US: United States, YO: years old

SURVIVORSHIP CARE PLAN
incompetence.

Jefford, M.
(2016). A
randomized
controlled trial of
a nurse led
supportive care
package
(SurvivorCare)
for survivors of
color rectal
cancer
Country:
Australia
Disclosures/COI:
authors deny
financial
relationships.
Disclosures
listed.

Not explicitly
stated; inferred:
SCT

Design: RCT
Purpose:
evaluate
effectiveness of
SCP and care
package on
psychological
distress, HQOL,
unmet
informational
needs, and
psychosocial
outcomes in CR
CS.

N: 217
N I: 106
N C: 110
Median age: 64
(M: 52% F:48%)
TC: CC(56%), RC
(35%), OLS (10%)
SOD: S1 (7%) , S2
(22%), S3 (71%)

AT: 1
Inclusion criteria:
diagnosis of CC
stage I-III disease,
treatment with
curative intent. >18
English speaking.
Exclusion criteria:
deemed too unwell
to participate,
previous
malignancy, or
enrollment in a
conflicting

of survivors.

IV1: SuvivorCare
IV2: Usual Care
DV1: Psychological
distress
DV2: HQOL
DV3: Change in
Unmet needs.

BSI-18 and
Global Severity
index (GSI)
European
organization for
research and
treatment
(EORTC QLQ
C-30)
Ideals of
Survivorship
care survey (self
developed)
Cancer
survivors’ unmet
needs measure
(CaSUN)

SPSS statistics.
Descriptive
statistics
T test (Mannwhitney U) and
Chi-square tests
as appropriate.
Hochberg’s
modifiy
Bonferroni test
for primary
outcome
analysis.

Distress and
HQOL were
similar between
IV1 and IV2
IV1 were
significantly more
satisfied with
multiple aspects of
post treatment
care.(p<.05)

28

LOE: II
Strengths: strong
sensitivity with
Assessment tools are
validated, have high
sensitivity, and
appropriate for selective
measurements. N>100,
Diagnosis homogeneity
Limitations:
Heterogeneity of
baseline cancer distress
and time since diagnosis.
Applicability:
Intervention
demonstrates useful
elements in survivorship
care. Demonstrates
highest usefulness in
patients with higher
CaSUN scores.
Feasibility: Future
research needs to
carefully identify study
endpoints. Revised use

A: anal, AT: attrition rate BC: breast cancer, BCS: breast conserving surgery, BRFSS: behavioral risk factor surveillance system, C: Control, CC: colorectal
cancer, CCC: continuity and coordination of care, CCR: California cancer registry, CE: College degree CHC: childhood cancer, COI: conflict of interest, CS:
cancer survivors, CSS: cross sectional study CRD: cancer specific distress, CT: chemo therapy, d: Day DV: dependent variable, EOL: end of life, EORTC:
European organization for research and treatment of cancer F: female, FU: follow up, G: group, GA: guideline adherence, GC: gynecological cancer, HBM:
health belief model, HCP: health care provider HQOL: health related quality of life, HT: hormone therapy, I: intervention, IV: independent variable, LALTE:
late and long term effects, mo: month LIFE: living in the furture M: male, MA: mean age, MC: metastatic cancer, MFD: months from diagnosis, N: number,
NCI: national cancer institute, NS: not significant, PC: palliative care, PD: psychological distress, PCP: primary provider, PR: peer reviewed, PRO: patient
reported outcomes, PS: patient satisfaction QLS: qualitative study, QTS: quantitative study, R: Rectal, RCT: randomized control trial, S: stage SCP:
survivorship care plan, SCT: social cognitive theory, SOD: stage of disease, SR: Systematic review, TC: type of cancer, TM: total mastectomy, TS: treatment
summary TT: type of treatment U: unknown, US: United States, YO: years old

SURVIVORSHIP CARE PLAN
supportive care trial.

Keesing, S.
(2015). Cancer
survivors’
experiences of
using
survivorship care
plans: A
systematic review
of qualitative
studies
Country: US
Disclosures/COI:
Authors declare
no COI

Not explicitly
stated; inferred
Self-care theory.
Addresses
knowledge and
experience
influences cancer
patient selfreliance and
responsibility for
care.

Design:
Systematic
review
Purpose: Review
and document
current
qualitative
literature that
examines CS’s
experience using
SCPs.

N: 11 qualitative
studies.
Interview (4),
focused groups (6)
Action research (1)
Range of number of
participants: 7-40.
TC:
BC (7),
CC (2),
other (3)
Inclusion criteria:
>/= 18 y/o,
publication 20002014, published in
English.
Exclusion criteria:
Abstract only,
studies that
examined palliative
phase of disease, or
experience of cancer
treatment.
AT: N/A

of Intervention in

IV: Use of SCP
DV: CS perspective
on SCPs and
experiences of SCP
use in care.

KMET (Klose
method) 14 item
Community
based
participatory
framework.
Individual
interviews

Critical
appraisal using:
Standard quality
assessment
criteria for
evaluating
primary
research papers
from a variety
of fields by
Kmet, lee and
cook.

SCP significantly
reduced
duplication of
materials,
improved
coordination of
care, and increased
communication
between cancer
survivor and their
health care
provider.

29

LOE: I
Strengths: first published
qualitative systematic
review. 11 databases
included in search.
Utilized Validated
methods/tools for
conducting systematic
review.
Limitations: Disparity in
amount of qualitative
data.
Applicability/Feasibility:
SCPs found to be a
useful practical tool in
survivorship care. Need
for continued research to
examine practical issues
related to delivery or
across a variety of care
contexts.

A: anal, AT: attrition rate BC: breast cancer, BCS: breast conserving surgery, BRFSS: behavioral risk factor surveillance system, C: Control, CC: colorectal
cancer, CCC: continuity and coordination of care, CCR: California cancer registry, CE: College degree CHC: childhood cancer, COI: conflict of interest, CS:
cancer survivors, CSS: cross sectional study CRD: cancer specific distress, CT: chemo therapy, d: Day DV: dependent variable, EOL: end of life, EORTC:
European organization for research and treatment of cancer F: female, FU: follow up, G: group, GA: guideline adherence, GC: gynecological cancer, HBM:
health belief model, HCP: health care provider HQOL: health related quality of life, HT: hormone therapy, I: intervention, IV: independent variable, LALTE:
late and long term effects, mo: month LIFE: living in the furture M: male, MA: mean age, MC: metastatic cancer, MFD: months from diagnosis, N: number,
NCI: national cancer institute, NS: not significant, PC: palliative care, PD: psychological distress, PCP: primary provider, PR: peer reviewed, PRO: patient
reported outcomes, PS: patient satisfaction QLS: qualitative study, QTS: quantitative study, R: Rectal, RCT: randomized control trial, S: stage SCP:
survivorship care plan, SCT: social cognitive theory, SOD: stage of disease, SR: Systematic review, TC: type of cancer, TM: total mastectomy, TS: treatment
summary TT: type of treatment U: unknown, US: United States, YO: years old

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Kenzik, K, M.
(2016).
Treatment
summaries and
follow-up care
instructions for
cancer survivors:
Improving
survivor selfefficacy, and
healthcare
utilization

Country: US

Disclosure/COI:
unreported
Funding: Grant
from department
of health and
human services.

Not explicitly
stated; inferred
Self-efficacy
theory.

Design:
Cross-sectional
Purpose:
Examine how
treatment
summaries (SCP)
both written and
verbal are
associated with
self-efficacy and
healthcare
utilization.

N= 441
MA: 74.7
F(60%) M (40%)
TC: prostate and BC
Mean time from
diagnosis: 4.6 years
Setting: Hospital
based; 12 different
sites across
Alabama, Georgia,
Mississippi, Florida,
Tennessee
AT= 0
Inclusion Criteria:
CS who had
completed
treatment, follow
completion of initial
survey and were >/=
2 years

IV1: Delivery of
Written summary of
cancer treatment w/
verbal explanation of
SCP by health
professional
IV2: written
summary of SCP w/o
explanation.
IV3: Verbal delivery
of follow-up care
plan w/o written
summary.

DV 1: ER Visits
DV 2:
hospitalizations.

Stanford chronic
illness selfefficacy scale
Study pertinent
developed
questions:
SCP type and
delivery.
ER visits in last
year,
hospitalized in
the last year.

Primary
analysis: Three
multiple linear
regression
models to
estimate
association.
Exploratory
analysis:
Mediation
analysis was
used to estimate
association
between chosen
variables
Post Hoc
analysis:
performed

V1 demonstrated
increased selfefficacy scores
(SD=0.27,p=0.009)
and decreased
emergency room
visits and
hospitalization
DV1 and DV2:
decreased
significantly with
IV1

LOE: IV
Strengths: large sample
size, evaluation of
multiple health care
sites. Provides
evaluation of older
cancer survivors, which
has been under studied.
Use of validated
measurement tool.
Limitations: reliance on
patient self-report of
SCP type and delivery.
Patient-provider
relationship, and
recollection of
information have
potential to influence
self-efficacy scores.
Lack of insight to
content of SCP, and/or
standardization of SCPs.
Applicability/feasibility:

A: anal, AT: attrition rate BC: breast cancer, BCS: breast conserving surgery, BRFSS: behavioral risk factor surveillance system, C: Control, CC: colorectal
cancer, CCC: continuity and coordination of care, CCR: California cancer registry, CE: College degree CHC: childhood cancer, COI: conflict of interest, CS:
cancer survivors, CSS: cross sectional study CRD: cancer specific distress, CT: chemo therapy, d: Day DV: dependent variable, EOL: end of life, EORTC:
European organization for research and treatment of cancer F: female, FU: follow up, G: group, GA: guideline adherence, GC: gynecological cancer, HBM:
health belief model, HCP: health care provider HQOL: health related quality of life, HT: hormone therapy, I: intervention, IV: independent variable, LALTE:
late and long term effects, mo: month LIFE: living in the furture M: male, MA: mean age, MC: metastatic cancer, MFD: months from diagnosis, N: number,
NCI: national cancer institute, NS: not significant, PC: palliative care, PD: psychological distress, PCP: primary provider, PR: peer reviewed, PRO: patient
reported outcomes, PS: patient satisfaction QLS: qualitative study, QTS: quantitative study, R: Rectal, RCT: randomized control trial, S: stage SCP:
survivorship care plan, SCT: social cognitive theory, SOD: stage of disease, SR: Systematic review, TC: type of cancer, TM: total mastectomy, TS: treatment
summary TT: type of treatment U: unknown, US: United States, YO: years old

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SURVIVORSHIP CARE PLAN

Data suggest that SCPs
influence survivor’s
behavior, and health
outcome. Future
research directed to
examine how SCPs help
survivors. Identify
strategies to effectively
implement verbal
explanation of SCP.

Exclusion criteria:
incomplete survey, <
2 years post
treatment

Klemanski, D., L.
(2016).
Survivorship care
plan preferences
of cancer
survivors and
health care
providers: A
systematic review
and quality
appraisal of the
evidence.
Country: US
Disclosure/COI:
authors declare
no COI

Not explicitly
states; inferred:
Explanatory
theory

Design: SR
Purpose: To
describe and
examine the use
of treatment
summaries and
SCP in current
practice, as well
as critically
appraise relevant
literature
regarding
preferences and
usefulness of
SCP in practice.

N: 29 total
QTS (19)
RCT (3)
Pre/post test (1)
Survey with
descriptive analysis
(15)
QLS(10)
Study
characteristics:
Survivor
perspectives (N=20)
Cancer survivor
perspective only
(N=14)
Survivor and
provider perspective
(N=6)
TC: BC (n=10) CC
(n=3) GC (n=1),
other malignancies

IV: SCP use
IV2: usual care

Patient variables:
DV 1: Survivorship
experiences
DV 2: quality of care
DV 3: Satisfaction
(with collaborative
communication
between care
providers)
DV4: Perceived gaps
in CS care
DV 5: Delivery of
SCP
Provider variables:
DV 1 : perceived
barriers to SCP
implementation

Focus groups,
individual
interviews
Mixed methods
appraisal tool.
Transparent
reporting of
evaluation with
non randomized
design.

Critical
appraisal of data
using: Quality
assessment tool
for QTS
Joanna Briggs
Institute’s
qualitative
assessment and
review
instrument.

PCPs perceived
enhance
coordination of
care with
oncologist.

LOE: I

SCPs improved
survivors
understanding of
their cancer and
ongoing
survivorship care.

Limitations: many
studies were exploratory
studies. Narrow gender
and cancer type focus
(ie.breast cancer heavily
researched)
heterogeneity in SCPs
format, and health care
settings.

Strengths: Included large
body of heterogeneous
data

Applicability/feasibility:
Demonstrates improved
care from both provider
and patient perspective
in survivorship follow
up care. Future research

A: anal, AT: attrition rate BC: breast cancer, BCS: breast conserving surgery, BRFSS: behavioral risk factor surveillance system, C: Control, CC: colorectal
cancer, CCC: continuity and coordination of care, CCR: California cancer registry, CE: College degree CHC: childhood cancer, COI: conflict of interest, CS:
cancer survivors, CSS: cross sectional study CRD: cancer specific distress, CT: chemo therapy, d: Day DV: dependent variable, EOL: end of life, EORTC:
European organization for research and treatment of cancer F: female, FU: follow up, G: group, GA: guideline adherence, GC: gynecological cancer, HBM:
health belief model, HCP: health care provider HQOL: health related quality of life, HT: hormone therapy, I: intervention, IV: independent variable, LALTE:
late and long term effects, mo: month LIFE: living in the furture M: male, MA: mean age, MC: metastatic cancer, MFD: months from diagnosis, N: number,
NCI: national cancer institute, NS: not significant, PC: palliative care, PD: psychological distress, PCP: primary provider, PR: peer reviewed, PRO: patient
reported outcomes, PS: patient satisfaction QLS: qualitative study, QTS: quantitative study, R: Rectal, RCT: randomized control trial, S: stage SCP:
survivorship care plan, SCT: social cognitive theory, SOD: stage of disease, SR: Systematic review, TC: type of cancer, TM: total mastectomy, TS: treatment
summary TT: type of treatment U: unknown, US: United States, YO: years old

SURVIVORSHIP CARE PLAN
(n=6)
Settings:
Cancer Centers
Oncology clinics
Tertiary care centers
Community cancer
centers

DV 2: role
clarification in SCP
DV 3: Confidence in
management of CS
care.

32

needed to identify and
prioritize patient
preferences regarding
survivorship care, and
standardized delivery
across settings.

Inclusion: QLS or
QTS related to
preference of items
to be incorporated in
SCPs, reported by
CS, care givers, or
health care
providers, published
1/052005-12/2013
Original work/ PR,
English,
Exclusion:
PC/hospice/EOL
care, pertained
mortality statistics,
pediatric or
adolescent
oncology, secondary
works.
AT: N/A

A: anal, AT: attrition rate BC: breast cancer, BCS: breast conserving surgery, BRFSS: behavioral risk factor surveillance system, C: Control, CC: colorectal
cancer, CCC: continuity and coordination of care, CCR: California cancer registry, CE: College degree CHC: childhood cancer, COI: conflict of interest, CS:
cancer survivors, CSS: cross sectional study CRD: cancer specific distress, CT: chemo therapy, d: Day DV: dependent variable, EOL: end of life, EORTC:
European organization for research and treatment of cancer F: female, FU: follow up, G: group, GA: guideline adherence, GC: gynecological cancer, HBM:
health belief model, HCP: health care provider HQOL: health related quality of life, HT: hormone therapy, I: intervention, IV: independent variable, LALTE:
late and long term effects, mo: month LIFE: living in the furture M: male, MA: mean age, MC: metastatic cancer, MFD: months from diagnosis, N: number,
NCI: national cancer institute, NS: not significant, PC: palliative care, PD: psychological distress, PCP: primary provider, PR: peer reviewed, PRO: patient
reported outcomes, PS: patient satisfaction QLS: qualitative study, QTS: quantitative study, R: Rectal, RCT: randomized control trial, S: stage SCP:
survivorship care plan, SCT: social cognitive theory, SOD: stage of disease, SR: Systematic review, TC: type of cancer, TM: total mastectomy, TS: treatment
summary TT: type of treatment U: unknown, US: United States, YO: years old

SURVIVORSHIP CARE PLAN
Kvale, E., A.
(2016). Patientcentered support
in the
survivorship care
transition:
outcomes from
the patient-owned
survivorship care
plan intervention
Country: US
COI/Disclosures:
three authors
receive support
from NIH grant
P30 CA13148
Funding: Grant
support from
American cancer
society.

Explicitly stated:
Derived from
chronic care
model of Wagner
and Care
transition
intervention
model by
Colemen.

Design: RCT
Purpose: To
determine the
“POST-CARE”
intervention’s
impact on patient
outcomes and
care coordination.

N: 79
I: n-40
C: n=39

IV 1: POSTCARE
intervention
IV 2: usual care

MA, I: 57.23
MA, C: 59.51
TOC: breast
TOT, I:
LNB: n=32
LND: n=17
CT: n=23
RT: n=27
S: n=40
TOT C;
LNB: n=30
LND: n=9
CT: n=18
RT:n=26
S: n=39
Inclusion: age >/=
19y, non-metastatic
disease, completion
of treatment with in
one year.
Exclusion: outside
of one year of active
treatment.
AT: 1

DV1: HQOL
DV2: Depression
DV3: Self efficacy
and self-management

Health literacy:
Rapid estimate
of adult literacy
in medicineshort form.
Comorbidity:
Charleston
comorbidity
index
HQOL: 36-item
short-form
health survey
Depression:
PHQ-9
Limitations,
social
role/activities: 4item social/role
activities
limitation.
Selfmanagement:
13-item patient
activation
measure-short
form.
Self efficacy:
Self efficacy for
managing
chronic disease
6-item scale

SPSS: Version
22 and SAS
version 9.4.
Descriptive
analysis:
demographics
and treatment
characteristic.
Chi-square test
for comparison
between groups
regarding
frequency.
Student t test for
within group
comparison.
Generalized
linear model
used to examine
effect of
intervention
coordination
and patient
reported
outcomes.

33

IV 1: reported
lower social role
limitations,
(p=0.014) and
trend towards
higher self-efficacy
(p=0.07).

LOE: II

IV 1: reported
higher self
reported health
(p=0.017).

Limitations: conducted
on breast patients only,
outcomes may not be
generalizable across all
cancer types. Modest
sample size. Limited
power. Limited time
window, does not
capture long-term effect.

IV 1: Three
domains of HQOL
had meaningful
improvement at 3
mo. FU.
Physical role:
(p=0.009)
Bodily pain
(p=0.03) emotional
role (p=0.04)

Strengths: examines
robust amount of
variables, using
validated tools and
measurements.

Applicability: Data
supports and emphasizes
the importance of not
only providing an SCP
but also health care
providers role in
discussing content.
Feasibility: Need for
future research to
examine if/how
identified health care
provider can deliver
SCP interventions
effectively, timely, and
impactful.

A: anal, AT: attrition rate BC: breast cancer, BCS: breast conserving surgery, BRFSS: behavioral risk factor surveillance system, C: Control, CC: colorectal
cancer, CCC: continuity and coordination of care, CCR: California cancer registry, CE: College degree CHC: childhood cancer, COI: conflict of interest, CS:
cancer survivors, CSS: cross sectional study CRD: cancer specific distress, CT: chemo therapy, d: Day DV: dependent variable, EOL: end of life, EORTC:
European organization for research and treatment of cancer F: female, FU: follow up, G: group, GA: guideline adherence, GC: gynecological cancer, HBM:
health belief model, HCP: health care provider HQOL: health related quality of life, HT: hormone therapy, I: intervention, IV: independent variable, LALTE:
late and long term effects, mo: month LIFE: living in the furture M: male, MA: mean age, MC: metastatic cancer, MFD: months from diagnosis, N: number,
NCI: national cancer institute, NS: not significant, PC: palliative care, PD: psychological distress, PCP: primary provider, PR: peer reviewed, PRO: patient
reported outcomes, PS: patient satisfaction QLS: qualitative study, QTS: quantitative study, R: Rectal, RCT: randomized control trial, S: stage SCP:
survivorship care plan, SCT: social cognitive theory, SOD: stage of disease, SR: Systematic review, TC: type of cancer, TM: total mastectomy, TS: treatment
summary TT: type of treatment U: unknown, US: United States, YO: years old

SURVIVORSHIP CARE PLAN
Mayer, D., K.
(2015). Summing
it up: An
integrative
review of studies
of cancer
survivor care
plans
Country: US
Disclosures/COI:
none
Funding/bias:
funded by
University of
North Carolina
University
cancer Research
fund and NCI.

Mentions
Donabedian
Model, but
otherwise no
explicit theory
stated. Inferred
use of
explanatory
theory.

Design:
Integrative
Review
Purpose: To
summarize
current scientific
knowledge, and
empirical data
regarding SCP in
adult CS, and
identification of
knowledge gaps
in survivorship
care.

N: 42 studies

IV: SCP

Populations:
CS
HCP

DV1: SCP
dissemination
DV2: SCP content
DV3: HCP/survivor
outcomes

Categories of Focus:
1.Content of SCP
2.Dissemination/
Implementation
3.Survivor/provider
outcomes.
AT: 0
Inclusion Criteria:
articles must
include: results of
empirical study, CS
diagnosed at 18 y/o,
relate to cancer and
report findings that
associated with
SCPs
Exclusion Criteria:
Abstracts or
presentations, focus
on adult survivors of
COC and nonempirical data

Interviews,,
focus groups and
surveys. Survey
tools not
specified.

Preferred
reporting items
for systematic
reviews and
meta analysis
(PRISMA)
Forward
stepwise
selection.
Multivariable
logistic
regression

Discrepancy
between health
care providers, and
cancer survivors in
the content desired
Survivors report
utility with
Paper/electronic
SCPs
Many studies
failed to study time
preference of
delivery. In studies
that did, patients
elected right before
treatment or
directly after.
Of 10 cancer
programs only
12.5% of patients
received SCP.
SCP receipt
improved PCP
reported CCC and
confidence in
knowledge
(P=0.05)

LOE: I

34

Strength: Large body of
evidence evaluated.
Evaluated both provider
and patient perspective.
Limitations: Only four
high evidence studies
availability. Limited
generalizability due to
lack of diversity.
Lack of systematic
testing of data collection
tools.
Applicability: SCP
receptivity, and
implementation remains
low.
Feasibility: Future
research needed to
address methodology of
SCP use, their context
and their outcomes.

A: anal, AT: attrition rate BC: breast cancer, BCS: breast conserving surgery, BRFSS: behavioral risk factor surveillance system, C: Control, CC: colorectal
cancer, CCC: continuity and coordination of care, CCR: California cancer registry, CE: College degree CHC: childhood cancer, COI: conflict of interest, CS:
cancer survivors, CSS: cross sectional study CRD: cancer specific distress, CT: chemo therapy, d: Day DV: dependent variable, EOL: end of life, EORTC:
European organization for research and treatment of cancer F: female, FU: follow up, G: group, GA: guideline adherence, GC: gynecological cancer, HBM:
health belief model, HCP: health care provider HQOL: health related quality of life, HT: hormone therapy, I: intervention, IV: independent variable, LALTE:
late and long term effects, mo: month LIFE: living in the furture M: male, MA: mean age, MC: metastatic cancer, MFD: months from diagnosis, N: number,
NCI: national cancer institute, NS: not significant, PC: palliative care, PD: psychological distress, PCP: primary provider, PR: peer reviewed, PRO: patient
reported outcomes, PS: patient satisfaction QLS: qualitative study, QTS: quantitative study, R: Rectal, RCT: randomized control trial, S: stage SCP:
survivorship care plan, SCT: social cognitive theory, SOD: stage of disease, SR: Systematic review, TC: type of cancer, TM: total mastectomy, TS: treatment
summary TT: type of treatment U: unknown, US: United States, YO: years old

SURVIVORSHIP CARE PLAN
Oancea, S., C.
(2016).
Psychological
distress among
adult cancer
survivors:
Importance of
survivorship care
plan.
Country: US
COI: declared no
COI
Funding: none

Not explicitly
stated; inferred
HBM.

Design: Crosssectional
Purpose: To
examine
association
between recipient
of SCP and
psychological
distress in adult
cancer survivors
post treatment.

N: 3,191
G1: CS 1-5 y from
diagnosis
N:1046
Median age: 58.85
F (n=610)
M (n=436)
Received FCI: n:789
Recieived TS: n:366
G2: CS >5 y from
diagnosis
N:2145
Median age: 64.52
F (n=1463)
M (n=682)
Received SCI:
n=1424
Received TS; n=611
Setting: Telephone
survey based from
BRFSS registry
Inclusion criteria:
Cancer diagnosis at
>/=18y/o, not
pregnant at time of
study, >1 year post
diagnosis.

IV 1: TS only
IV: FCI only
IV: TS + FCI
IV 4: no TS or FCI

Behavioral risk
factor
surveillance
system
questionnaire.

DV 1: PD
Cancer
survivorship and
anxiety and
depression
modules

Descriptive
statistics.
Critical
analysis: SAS b
9.4, using
survey
procedures.
Multivariable
weighted
logistic
regression to
investigate
association
between chosen
variables.

Short-term cancer
survivors: Distress
was three times
higher for those
who received FCI
only, as compared
to FCI and TS.
(AOR=3.14 95%
CI [1.29-7.65])
Long-term cancer
survivors: distress
was twice as high
if FCI, but no TS
was delivered,
compared to
receiving FCI and
TS.
(AOR= 2.18, 95%
CI [1.14-4.19])

LOE:

35

Strengths: Large
sample size. First study
to investigate long-term
distress.
Limitations: Sub group
who received TS, but no
FCI were underrepresented. Pain
severity, and other
comorbid conditions
could not be controlled
for or assessed using
selected survey.
Questions subject to
recall bias due to being
phone survey.

Applicability: SCPs can
be used to enhance short
and long-term
psychological wellbeing.
Feasibility: Research
needed to investigation
of barriers to SCP
implementation.

Exclusion:
incomplete survey
completion,

A: anal, AT: attrition rate BC: breast cancer, BCS: breast conserving surgery, BRFSS: behavioral risk factor surveillance system, C: Control, CC: colorectal
cancer, CCC: continuity and coordination of care, CCR: California cancer registry, CE: College degree CHC: childhood cancer, COI: conflict of interest, CS:
cancer survivors, CSS: cross sectional study CRD: cancer specific distress, CT: chemo therapy, d: Day DV: dependent variable, EOL: end of life, EORTC:
European organization for research and treatment of cancer F: female, FU: follow up, G: group, GA: guideline adherence, GC: gynecological cancer, HBM:
health belief model, HCP: health care provider HQOL: health related quality of life, HT: hormone therapy, I: intervention, IV: independent variable, LALTE:
late and long term effects, mo: month LIFE: living in the furture M: male, MA: mean age, MC: metastatic cancer, MFD: months from diagnosis, N: number,
NCI: national cancer institute, NS: not significant, PC: palliative care, PD: psychological distress, PCP: primary provider, PR: peer reviewed, PRO: patient
reported outcomes, PS: patient satisfaction QLS: qualitative study, QTS: quantitative study, R: Rectal, RCT: randomized control trial, S: stage SCP:
survivorship care plan, SCT: social cognitive theory, SOD: stage of disease, SR: Systematic review, TC: type of cancer, TM: total mastectomy, TS: treatment
summary TT: type of treatment U: unknown, US: United States, YO: years old

36

SURVIVORSHIP CARE PLAN

Palmer, S., C.
(2015). Outcomes
and satisfaction
after delivery of a
breast cancer
survivorship care
plan: Results of a
multi-center trial
Country
Disclosers/COI:
Disclosures
provided by
author
Funding: Funded
by
LIVESTRONG
foundation.

Not explicitly
stated; inferred:
Theory reasoned
action.
Explains
relationship
between
attitude/behavior
and human
action;
specifically
expected
outcomes to from
this behavior.

Design:
prospective
cohort study
Purpose:
Explore the
outcomes
associated with
delivery of
comprehensive
SCP to BC
survivors.

N: 139
MA: 53.93
Mean MFD: 3.43
Stage at diagnosis:
Stage 0: n=10
Stage 1: n=52
Stage 2 n=51
Stage 3 n=21
TOT:
CT; 93
HT: 96
Setting: Seven NCI
designated
comprehensive
cancer centers and
their community
practices.
Inclusion criteria:
>/= 18 y/o,
diagnosis and
treatment of primary
BC or DCI,

IV1: Care prior to
SCP
IV2: SCP delivery
DV1: SCP utilization
DV2: satisfaction
DV3: knowledge
DV4: CCC

Quality of Life:
Medical study
short form (SF)12
Use of SCP
materials: 16item
investigatory
developed
survey see table
2.
Satisfaction:
global
satisfaction on
5-likert scale.
Perceived
coordination,
perceived
knowledge,
perceived
provider
knowledge, and

Poorly
described
statistical
methods:
software
unlisted.
Descriptive
statistics for
demographics.
Cronchbach’s
alpha, and t-test
as appropriate.

SCP utilization:
IV2: 64% used
SCPs for decision
to exercise, 62%
used it for dietary
changes, and 62%
used SCPs for
directing follow up
care.
SCP satisfactions:
90% were satisfied
with SCP
Knowledge: IV2
demonstrated
improved
perceived personal
and provider
survivorship
knowledge and
care coordination.
(P=<0.001)

LOE: II
Strengths: wellcharacterized sample,
variety of cancer care
settings. Pre and post
assessment was
obtained, high retention.
Standardized visits and
materials across settings.
Limitations: Quasiexperimental design,
narrow demographic
population, use of selfdeveloped tools. Self
reported versus chart
abstraction leaves room
for mis-reporting.
Applicability: results
suggest SCPs and
delivery can be
standardized across
diverse settings and

A: anal, AT: attrition rate BC: breast cancer, BCS: breast conserving surgery, BRFSS: behavioral risk factor surveillance system, C: Control, CC: colorectal
cancer, CCC: continuity and coordination of care, CCR: California cancer registry, CE: College degree CHC: childhood cancer, COI: conflict of interest, CS:
cancer survivors, CSS: cross sectional study CRD: cancer specific distress, CT: chemo therapy, d: Day DV: dependent variable, EOL: end of life, EORTC:
European organization for research and treatment of cancer F: female, FU: follow up, G: group, GA: guideline adherence, GC: gynecological cancer, HBM:
health belief model, HCP: health care provider HQOL: health related quality of life, HT: hormone therapy, I: intervention, IV: independent variable, LALTE:
late and long term effects, mo: month LIFE: living in the furture M: male, MA: mean age, MC: metastatic cancer, MFD: months from diagnosis, N: number,
NCI: national cancer institute, NS: not significant, PC: palliative care, PD: psychological distress, PCP: primary provider, PR: peer reviewed, PRO: patient
reported outcomes, PS: patient satisfaction QLS: qualitative study, QTS: quantitative study, R: Rectal, RCT: randomized control trial, S: stage SCP:
survivorship care plan, SCT: social cognitive theory, SOD: stage of disease, SR: Systematic review, TC: type of cancer, TM: total mastectomy, TS: treatment
summary TT: type of treatment U: unknown, US: United States, YO: years old

37

SURVIVORSHIP CARE PLAN
completion of
cancer therapy, and
scheduled
survivorship visit at
SCOEN.
Exclusion criteria:
Unable to complete
inform consent d/t
barriers, and
previous recipients
of SCP.

Rosenberg, C., A.
(2015).
Promotion of
self-management
for post treatment
cancer survivors:
evaluation of
risk-adapted visit
Disclosures/COI:
All authors report
no conflict of
interest.
Disclosures noted
in article
Funding: none.

Not explicitly
stated: Inferred:
individual and
family self
management
theory

Design:
prospective
cohort study

Completed initial
survey: N=1615
Completed survey at
one year: N=488
TC:
BC: n=1173
GC::n=131
CC: n=56
Other: n=255
Last treatment:
< 6mo: n=1156
6-12mo n=175
>12-18mo: n=284
Setting: Northshore
medical center
Inclusion: referral to
program within year
of treatment
completion.
Treatment
completed at

provider
behavior was
assessed by
investigator
developed
available by
request.

IV: SCP w/ Risk
adapted visit LIFE
program
DV1: SCP utility
DV2: lifestyle
changes
DV3: wellness goals

LIFE program
Pre- and Post
Risk adapted
visit
questionnaire.

providers. Useful in
breast cancer survivors,
particular those who are
new survivors.

Feasibility:
Success at all study sites
with recruiting and
completion suggest that
with Institutional
commitment, and
financial and logistical
support SCPs can be
delivers effectively to
patients.
All Surveys
reviewed,
tabulated and
recorded by the
physician
director of
LIFE.
Descriptive
statics of
evaluations
performed.

At 1 year,
respondents report
SCP with risk
adapted was useful
for the following:
100% useful tool
to summarize
medical
information 97%
FU care, 85%
recognizing
symptoms of
recurrence, 93% in
improving health
and lifestyle
practices,

LOE: II
Strengths: Large
sample size, 6 years of 1
year survivor FU data 7
years of comprehensive
data. Difference in initial
and 1 year out for BC
survivors reached
significance.
Limitations: Lack of
generalizability to due
specific population
characteristic. Results
could be influenced by
compliance
characteristic of
population. Low
response rate at 1 year.
Applicability:
Discussion, and
explanation of SCP
assist survivors to

A: anal, AT: attrition rate BC: breast cancer, BCS: breast conserving surgery, BRFSS: behavioral risk factor surveillance system, C: Control, CC: colorectal
cancer, CCC: continuity and coordination of care, CCR: California cancer registry, CE: College degree CHC: childhood cancer, COI: conflict of interest, CS:
cancer survivors, CSS: cross sectional study CRD: cancer specific distress, CT: chemo therapy, d: Day DV: dependent variable, EOL: end of life, EORTC:
European organization for research and treatment of cancer F: female, FU: follow up, G: group, GA: guideline adherence, GC: gynecological cancer, HBM:
health belief model, HCP: health care provider HQOL: health related quality of life, HT: hormone therapy, I: intervention, IV: independent variable, LALTE:
late and long term effects, mo: month LIFE: living in the furture M: male, MA: mean age, MC: metastatic cancer, MFD: months from diagnosis, N: number,
NCI: national cancer institute, NS: not significant, PC: palliative care, PD: psychological distress, PCP: primary provider, PR: peer reviewed, PRO: patient
reported outcomes, PS: patient satisfaction QLS: qualitative study, QTS: quantitative study, R: Rectal, RCT: randomized control trial, S: stage SCP:
survivorship care plan, SCT: social cognitive theory, SOD: stage of disease, SR: Systematic review, TC: type of cancer, TM: total mastectomy, TS: treatment
summary TT: type of treatment U: unknown, US: United States, YO: years old

SURVIVORSHIP CARE PLAN
Northshore medical
Exclusion: > 18
months since
treatment
completion

38

understand their cancer
experience and have
potential to promote
long-term self
management.

Feasibility: Risk
adapted visits is resource
intense; for both creating
and delivering SCP. RN
is ideal to establish SCP
to optimize resources
and patient outcomes.

A: anal, AT: attrition rate BC: breast cancer, BCS: breast conserving surgery, BRFSS: behavioral risk factor surveillance system, C: Control, CC: colorectal
cancer, CCC: continuity and coordination of care, CCR: California cancer registry, CE: College degree CHC: childhood cancer, COI: conflict of interest, CS:
cancer survivors, CSS: cross sectional study CRD: cancer specific distress, CT: chemo therapy, d: Day DV: dependent variable, EOL: end of life, EORTC:
European organization for research and treatment of cancer F: female, FU: follow up, G: group, GA: guideline adherence, GC: gynecological cancer, HBM:
health belief model, HCP: health care provider HQOL: health related quality of life, HT: hormone therapy, I: intervention, IV: independent variable, LALTE:
late and long term effects, mo: month LIFE: living in the furture M: male, MA: mean age, MC: metastatic cancer, MFD: months from diagnosis, N: number,
NCI: national cancer institute, NS: not significant, PC: palliative care, PD: psychological distress, PCP: primary provider, PR: peer reviewed, PRO: patient
reported outcomes, PS: patient satisfaction QLS: qualitative study, QTS: quantitative study, R: Rectal, RCT: randomized control trial, S: stage SCP:
survivorship care plan, SCT: social cognitive theory, SOD: stage of disease, SR: Systematic review, TC: type of cancer, TM: total mastectomy, TS: treatment
summary TT: type of treatment U: unknown, US: United States, YO: years old

39

SURVIVORSHIP CARE PLAN

HB
SE

Jefford

Keesing

Kenzik

Klemanski

Kvale

Mayer

Oancea

Palmer

LOE
Design
Length
SCP
SCPFV
TS
QOL
SF
SCK
CC
GA
D

Hawkins

Year

Brennan

Studies

Rosenberg

Appendix E
Synthesis Table

2014

2015

2015

2016

2015

2016

SR

CS

SR

RCT

SR

VI

2015

RCT

I

2016

CS

VI

2016

SR

VI

2016

CS

II

PCS

X

X

X

X

X

X

X

X

I

N/A

1d

II

6m

X

I

N/A

NS






1d

X



N/A

X
NS




NS

NS



NS

II

3mo

X

I

N/A



NS






1d

X

3mo

201
5

II

PCS
1y

X














CC: care coordination CS: cross sectional study D: distress GA: guideline adherence, HB: health behavior
LOE: level of evidence, PCS: prospective cohort study, NS: Not significant QOL: quality of life,
RCT: randomized control trial, SCK: survivor knowledge, SCP: survivorship care plan,
SCPFV: Survivorship care plan and focused visit, SE: Self-efficacy, SF: satisfaction,
TS: treatment summary

SURVIVORSHIP CARE PLAN
Appendix F
Mayo Clinic Nursing Evidence-Based Practice Model

40

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Appendix G
Confidence in Survivorship Information Analysis

Paired Samples Test
Paired Differences
95% Confidence
Interval of the
Difference
Upper

t

df

Sig. (2-tailed)

Pair 1

Type - Type2

.207

-1.000

6

.356

Pair 2

Stage - Stage2

.165

-1.987

6

.094

Pair 3

Treatments - Treatments2

.413

-1.000

6

.356

Pair 4

Prevent - Prevent2

-.508

-6.000

6

.001

Pair 5

Physical Effects - Physical

-.505

-4.382

6

.005

-.311

-3.361

6

.015

-.245

-3.240

6

.018

-.025

-2.521

6

.045

-.025

-2.521

6

.045

-.015

-2.500

6

.047

-.154

-2.828

6

.030

-.015

-2.500

6

.047

-.025

-2.521

6

.045

-.621

-3.361

6

.015

-.307

-2.931

6

.026

.068

-2.335

6

.058

Effects2
Pair 6

Prevent Physical Effects Prevent Physical Effects2

Pair 7

Treat Physical Effects - Treat
Physical Effects2

Pair 8

Emotional Effects - Emotional
Effects2

Pair 9

Prevent Emotional Effects Prevent Emotional Effects2

Pair 10

Treat Emotional Effects - Treat
Emotional Effects2

Pair 11

Community Resources Community Resources2

Pair 12

Family Risk - Family Risk2

Pair 13

Family information - Family
information2

Pair 14

Survivorship care - Survivorship
care2

Pair 15

Wellness - Wellness2

Pair 16

Health Promotion - Health
Promotion2

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SURVIVORSHIP CARE PLAN
Appendix H
Average Difference Following SCP Intervention

CSI Survey Comparison
Post

Pre

Health Promotion

3.9

Wellness

3.9

Survivorship care

Family information

Family Risk

Community Resources

Treat Emotional Effects

Treat Physical Effects

Prevent Physical Effects
Physical Effects

Prevent CA

Treatments
Stage

Type

** p-value= 0.001
* p-value= >0.05

2.7*

2.3

2.7*

2.1

2.6*

2.3

Prevent Emotional Effects

Emotional Effects

2.7*

2.3

2.3

2.1

2.7*

2.4

2.0

2.2
2.2

2.7

2.6*
2.6*

2.5

2.5**
2.7

2.6

3.0

2.9

2.8
2.7

4.1

4.7
4.7

4.9*

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SURVIVORSHIP CARE PLAN

Appendix I
Confidence in Survivorship Information Survey

Confidence in Survivorship Information Questionnaire*
How confident are you about your knowledge of each of the following aspects of your cancer
and cancer-related follow up care?
Please select only one box per question.
Not at all Somewhat
Confident Confident
The type of cancer you have/ had?
The stage of cancer you have/ had?
The treatments you received/are receiving for cancer?
Things you can do to help prevent your cancer from recurring?
The long-term physical effects you may experience from cancer and
its treatment?
Strategies for preventing long-term physical effects of cancer
treatment?
Strategies for treating long-term physical effects of cancer treatment?
The long-term emotional effects you may experience from cancer and
its treatments?
Strategies for preventing long-term emotional effects of cancer
treatment?
Strategies for treating long-term emotional effects of cancer
treatment?
Community resources available to help you deal with long-term
effects of cancer and its treatments?
Whether your family members are at increased risk for cancer?
How your family members can get information on their risk for
cancer?

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How satisfied are you with the survivorship care you received at Mayo Clinic?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
How your healthcare provider addressed ways to improve wellness?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
How your healthcare provider addressed ways to promote your health?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
*Used with permission from University of Pennsylvania.

Very
Confident

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