Trial of a Lung Cancer Survivorship Care Plan within a multidisciplinary team - A cancer care coordination initative

Abstract

The Sunshine Coast Cancer Service offers a comprehensive multidisciplinary approach to the care of patients with lung cancer, facilitated by a lung cancer care coordinator. The multidisciplinary team incorporates medical, nursing and allied health professionals. The team collaborated on the development of a Lung Cancer Survivorship Care Plan, and the cancer care coordinator managed a trial of the document. The Care Plan was designed for patients treated with curative intent only. Main components of the Care Plan include a treatment summary, identification of a lead clinician and recommended follow up pathway as developed by consensus of the MDT. Components of the follow up pathway included recommended appointment and medical imaging schedule, possible effects of treatment, fatigue management, specific recommendations for healthy behaviours and healthy lifestyle choices. Members of the multidisciplinary team, general practitioners and the patients themselves were surveyed. Feedback from the treating team was predominantly positive, with some discord on elements of the plan. General practitioners and patients were extremely supportive of the initiative. One of the major difficulties encountered with the Care Plans was the length of time taken to accurately record a comprehensive treatment summary, due to the fractured nature of multimodality care in a regional setting. The implementation of the plan across the entire cohort will be predicated on the ability to generate an electronic treatment summary. The trial of a survivorship care plan in lung cancer patients treated with curative intent was well received, but at this point in time, full implementation is unsustainable.<br />