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Improving patient and GP information and communication with an electronic care plan

ABSTRACT: Interventions: Patients at Footscray Hospital will receive a personalised care plan summary which has the following components including Cancer stage, Planned treatment, Planned follow-up visits and Cancer helpline resources. The care plan summary will be generated and provided to the patient during their second consultation with the oncology clinician. The consultation with the clinician will usually take approximately 30 minutes where they are provided the care plan and informed that they will be asked to complete a survey about how useful the care plan is in 6 months. The patient will be approached to complete the survey at a further consultation with the clinician. The care plan summary will be generated from a HREC approved colorectal registry which all colorectal cancer patients at Footscray Hospital are entered into. This study utilised a waiver of consent approach where the participants will be told about the study and a questionnaire which will be provided to them for completion after they have completed their first course of the treatment. No written consent will be obtained from the participants. The duration of the study is approximately 7 months. The plan is to roll this out to other centres and for other tumour streams if determined to be an effective communication tool. Primary outcome(s): The successful development of electronically generated care plan for Colorectal Cancer (CRC) patients. This outcome will be assessed by running a report from the database on how many patients receive the care plan from the oncologist. We can measure this by comparing with the total number of patients entered onto the database.[Patients will receive their personalised care plan at their second clinic visit];Patient feedback and level of satisfaction with the information provided on their care plan and at their initial oncology clinic visits. This will be assessed through a patient survey that patients will be asked to complete. The name of the survey developed for this study is Bowel Cancer Patient Information Survey’[At completion of patient’s treatment];To evaluate and analyse General Practitioner (GP) satisfaction of the care plan through an evaluation survey. The care plan will be uploaded to the hospital system and sent out electronically to GPs, The name of the survey developed for this study is ‘GP Care Plan Evaluation Survey’[The evaluation of GPs will take place as soon as possible after the GP has received the care plan.] Study Design: Purpose: Natural history;Duration: Longitudinal;Selection: Defined population;Timing: Prospective

DISEASE(S): Colorectal Cancer,Cancer-bowel-back Passage (rectum) Or Large Bowel (colon)

PROVIDER: 2470149 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Interventions: The intervention is a novel, shared model of care between cancer services and primary health care using an interactive e-care plan called Inca and telehealth using telemedicine technology. It is being implemented at 2 public and 2 private cancer services in the South Eastern Sydney Local Health District. The e-care plan program is integrated with GP clinical information systems and includes care plan templates for colorectal and breast cancer follow-up care developed from the published literature and agreed guidelines for survivorship care plans. The e-care plan program provides a collaborative space for clinicians and patients to agree on the goals, tasks, responsibilities and the scheduling and monitoring of care. Other functionalities include the sharing of pathology results, measures (e.g. BMI, blood pressure), a health summary and a progress notes section for the specialist, GP or patient to add a note. Documents can be uploaded and downloaded. It provides the basis for non-urgent communication between specialists, GPs, patients and other care team members (e.g. allied health providers) who can be added to the care team and given access. Inca automatically emails notifications to the care team when changes are made to the e-care plan or when upcoming tasks and appointments are due. Patients will be emailed reminders for appointments or tasks that are upcoming from Inca. The e-care plan is not integrated with cancer service clinical systems. Cancer services and patients access the e-care plan through an online portal. This is a non-randomised quasi-experimental trial. Patients at the St George Cancer Centre and the Prince of Wales Private will be allocated to the intervention. Patients at the Prince of Wales Nelune Comprehensive Cancer Centre and the S Primary outcome(s): The quality of communication and information shared to support patient follow-up will be assessed by comparing participant satisfaction and experiences with communication and information sharing within and between groups. Methods Questionnaires will be administered at baseline, 9 months plus 18 months post commencement of follow-up care for delayed intervention group: The Short Form Patient Satisfaction Questionnaire (access, interpersonal manner and communication subscales) (Marshall GN, 1994) and The Survivors Unmet Needs Survey (access and continuity of care subscale) (Campbell HS, 2011) GP Questionnaire - Satisfaction with communication (Jefford M, 2008). Specialist and care coordinator questionnaire (satisfaction with communication and information shared) Qualitative interviews with a sample of intervention participants (10 patients, 5-7 GPs and 3-5 specialists) by phone with a researcher at 9 months and 18 months post commencement of follow-up care for the delayed intervention group [9 months post commencement of follow-up care plus 18 months for the delayed intervention group];Access to and continuity of follow-up care will be assessed by comparing participant satisfaction and experiences with follow-up care within and between groups. Methods: Questionnaires will be administered at baseline, 9 months plus 18 months post commencement of follow-up care for delayed intervention group: Short Form Patient Satisfaction Questionnaire (Marshall GN, 1994) and The Survivors Unmet Needs Survey (access and continuity of care subscale) (Campbell HS, 2011) Qualitative interviews with a sample of intervention participants (10 patients, 5-7 GPs and 3-5 specialists) by phone with a researcher at 9 months and 18 months post commencement of follow-up care for the delayed intervention group [9 months post commencement of follow-up care plus 18 months for the delayed intervention group] Study Design: Purpose: Prevention; Allocation: Non-randomised trial

Project description:Interventions: The intervention is a web based Colorectal cancer RISk Prediction tool (CRISP) risk assessment tool utilising a risk model to provide patients with a personalised risk assessment and colorectal cancer screening advice based on their risk. Patients in the intervention group will be invited to complete the risk tool with a trained researcher prior to a consultation with their GP. The tool will take a maximum of 7 minutes and will be completed at baseline only. Participants will receive their risk of colorectal cancer and screening advice based on their risk which they will take with them into their consultation with their GP. All participants will also complete a survey collecting information about cancer risk perception, worry and bowel cancer screening intention and behaviour at baseline, 1 month, 6 months and 12 months after recruitment. The follow up survey should take no more than 15 minutes to complete and will be sent through the post or a link to the online survey will be sent via email. We will ask for permission to access GP records, records from Medicare, Victorian Admissions and Emergency Dataset (VAED) and from the National Bowel Screening Program (NBCSP) 1, 3 and 5 years after the participants enrol to track the colorectal cancer screening they have had. Primary outcome(s): The primary outcome will be the proportion of participants who have had risk-appropriate screening after 12 months’ follow-up. Appropriateness of screening will be determined by their absolute 5-year risk of CRC, using a 1% threshold and completion of FOBT, colonoscopy no screening, or a referral to a Familial Cancer Centre for genetic counselling if indicated by their family history. Patient self-report at 12 months will tell us what screening each patient has had and this will be cross-checked with GP records, records from Medicare, Victorian Admissions and Emergency Dataset (VAED) and from the National Bowel Screening Program (NBCSP)[12 months post recruitment] Study Design: Purpose: Prevention; Allocation: Randomised controlled trial; Masking: Open (masking not used);Assignment: Parallel;Type of endpoint: Efficacy

Project description:Interventions: Brief intervention name: Point-of-care clinical prompt (Prompt) Materials and Procedures: A point-of-care clinical prompt stating Encourage Participation in National Bowel Cancer Screening Program” will be attached to the electronic files of eligible patients (average risk patients turning 50, 60 and 70 years of age) within a general practice. These patients represent a sample of the population who will receive a National Bowel Cancer Screening Program (NBCSP) kit during the 12-month trial period. The prompt will remind General Practitioners (GPs) to talk to their patients about using the free kit when it arrives in the mail on or around the time of their birthday. National Bowel Cancer Screening Program (NBCSP) patient information brochures and posters will be available for general practitioner (GP) use as hard and/or electronic copies. Each GP in the trial will also recieve a sample NBCSP kit to show to patients during the consultation. Mode of delivery: The prompt will be set up by general practice administration staff within the electronic files of eligible patients. The prompt will be delivered to GPs as an electronic pop-up reminder at the start of a consultation. When an eligible patient arrives for their consultation at a practice, the prompt will ‘pop-up’ over the patient’s electronic file. The GP will then decide whether to discuss screening at that point in time or whether to ‘close’ the prompt. If the prompt is closed, it will remain as an outstanding action each time the patient attends the practice until such time as the GP marks the task as ‘performed’ by checking the relevent box. Additional resouces including patient information brochures and a sample/demonstration kit, will be made available by the GP during the consultation. Frequency and duration: The intervention will be trialled over 12 months. It is estimated that a total of 1750 patients will be eligible to have the prompt associated with their electronic file within the five intervention sites. This is the maximum number of times the prompt will be acted on by GPs. Location: The intervention will take place in five Tasmanian general practices located within Outer Regional and Remote Tasmania (Remoteness Areas 3 and 4). Adherence: GP adherence to using the prompt will be determined by the number of prompts that were marked as ‘performed’ compared to the number of prompts that were not.

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Improving patient and GP information and communication with an electronic care plan

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