Survivorship Programs and Care Plans in Practice: Variations on a Theme

Purpose: This qualitative study examined cancer survivorship programs at four health care organizations in Los Angeles County, CA: an academic medical center, a community hospital, a primary-care medical group, and a county hospital. The purpose was to describe the successful implementation of four distinctly different models of care, focusing on the creative development and use of the Institute of Medicine-recommended survivorship care plan (SCP) document in each setting. Methods: In-depth semistructured interviews were done with survivorship teams to characterize each program and the development and use of the SCP at each institution. Results: Each survivorship program has developed and implemented unique types of SCP documents. Specifically, a com-prehensive SCP at the academic center, completed by the clinical team, which covers many facets of cancer survivorship; a patient-directed SCP at the community hospital, completed by the survivor with assistance of an oncology nurse and focused on treatment history and appropriate surveillance; an adapted ASCO SCP template at the primary-care medical group, completed via a partnership with contracted oncologists and focused on the treatment history, surveillance, and shared care between oncology and primary care; an adapted ASCO SCP template at the county hospital, completed by the survivorship nurse practitioner and focused on patient education, post-treatment care, and institutional care coordination. Conclusion: The SCP document is a flexible tool that can be successfully adapted for use in extremely varied settings, from primary care to hospitals, to inform and educate patients and providers alike.