Evaluating Survivorship Care Planning in Colorectal Cancer

随着越来越多的癌症幸存者群体现在达到1100万美国人，适当的后续护理对他们持续的长期健康至关重要。尽管有关于监测复发和监测毒性和迟发效应的指导方针，但癌症幸存者往往无法随访，导致护理分散，不足。最近，人们越来越重视癌症幸存者的需求与当前实践之间的差距。生存护理计划，特别是提供治疗总结和生存护理计划（TS/SCP）完成积极治疗的患者，已提出由医学研究所作为一个解决方案，这一日益增长的公共卫生问题。TS/SCP的目标是：1）提高患者对其癌症护理和现存健康风险的认识; 2）提高患者对获得必要的后续护理的认识和信心; 3）患者和提供者之间的护理沟通和协调; 4）通过关注健康促进和预防影响患者的生存时间和质量。尽管治疗总结和生存护理计划具有可预见的优势，但尚未被广泛采用或进行实证研究，部分原因是缺乏评估其潜在益处的方法和结果指标。因此，开发和试点的方法，目标是检测实施治疗总结和生存护理计划的好处是一个关键的第一步，一个可能有影响的理解长期的结果。拟议项目将; 1）开发方法来评估治疗总结和生存护理计划的潜在益处; 2）在过渡到停止治疗的癌症患者中试行已开发的结局指标。在研究1中，将进行定性研究，通过与不同利益相关者（医疗保健提供者和结直肠癌幸存者）的访谈，制定和完善结局指标。研究1中确定和完善的结局指标将用于研究2，以评价向完成积极治疗并过渡到停止治疗状态的结直肠癌患者提供TS/SCP的获益。研究2将评估结局指标检测治疗总结和生存护理计划预期获益的能力。在随机化等待列表对照设计中，将比较接受书面治疗总结和生存护理计划的患者与未接受书面治疗总结和生存护理计划的患者的结局指标。因此，这项研究预计将产生的措施和方法，经验性地评估治疗总结和生存护理计划的潜在好处。这项研究的结果将在未来的随机纵向研究中一起使用，以更明确地评估治疗总结和生存护理计划对结直肠癌和其他常见类型癌症患者的影响。

With the growing cohort of cancer survivors now numbering 11 million Americans, appropriate follow-up care is pivotal to their ongoing long-term health. Despite guidelines regarding surveillance for recurrence and monitoring of toxicities and late effects, cancer survivors are often lost to follow-up, resulting in fragmented, inadequate care. Recently there has been increased emphasis on the gap between the needs of cancer survivors and current practice. Survivorship care planning, specifically provision of a treatment summary and survivorship care plan (TS/SCP) to patients completing active treatment, has been proffered by the Institute of Medicine as one solution to this growing public health issue. The goals of TS/SCPs are: 1) enhance patient knowledge of their cancer care, and extant health risks; 2) increase patient awareness of and confidence in obtaining requisite follow-up care; 3) communication and coordination of care between patients and providers and 4) impact patients' length and quality of survival via a focus on health promotion and prevention. Treatment summaries and survivorship care plans have yet to be widely adopted or empirically investigated despite their foreseeable advantages, due in part to a lack of methodology and outcome measures to assess their potential benefits. Thus, development and pilot of methodology targeting detection of the benefits of implementation of treatment summary and survivorship care plans is a crucial first step, one that may have implications for understanding longer-term outcomes. The proposed project will; 1) develop methodology to assess potential benefits of treatment summaries and survivorship care plans; and 2) pilot the developed outcome measures with cancer patients transitioning to off-treatment. In Study 1, qualitative research will be conducted to formulate and refine outcome measures via interviews with diverse stakeholders (health care providers and colorectal cancer survivors). The outcome measures identified and refined in Study 1 will then be used in Study 2 to evaluate the benefits of providing TS/SCPs to colorectal cancer patients finishing active treatment and transitioning to off-treatment status. Study 2 will assess the ability of the outcome measures to detect the anticipated benefits of treatment summaries and survivorship care plans. In a randomized wait-list control design, patients who receive written treatment summaries and survivorship care plans will be compared to patients who did not receive written treatment summaries and survivorship care plans on outcome measures. Thus, this study is expected to yield measures and methodology to empirically assess the potential benefits of treatment summaries and survivorship care plans. Findings from this study will be used together in a future randomized longitudinal study to more definitively evaluate the impact of treatment summaries and survivorship care plans for patients with colorectal cancer and other common types of cancer.