Lessons Learned in Creating Evidence-Based Electronic Oncology Care Plans

The delivery of patient-facing treatment summaries and symptom management care plans has been an important step forward in the provision of evidence-based, patient-centered cancer care. This has also been accelerated by the Institute of Medicine’s recommendation to address the quality chasm in oncology care. Studies of the use of evidence-based electronic care plans in the cancer population have demonstrated an improvement in the overall patient care experience, decreased negative outcomes, and enhanced physician/patient communication. Electronic delivery of these plans can streamline the documentation process, provide an overview of the patient’s care in one concise document, and enhance provider and patient communication through identification of goals of care. Despite this evidence, use of electronic evidence-based care plans remains low.

This presentation details a nurse-led process of creating electronic patient facing care-plans (responsive to unique patient-reported symptoms), that are supported by high level evidence and clinical practice guidelines. Lessons learned, barriers and facilitators to their development and clinical considerations for future products will be reviewed.

This electronic care plan addressed oncology patient needs at one of three phases of the cancer treatment spectrum: treatment planning, active treatment (including distress and symptom management), and survivorship. An over-arching goal of providing the electronic care plan was to reduce distress, improve the quality of patient cancer care, as well as improve patient involvement in care through patient action items supported by high level evidence. Nurse led electronic care plan development can enhance patient understanding and education, which can reduce patient distress. The novel care plan delivery fosters interdisciplinary involvement. Further analytics are needed to assess the effectiveness of reaching these goals.

Clinical nursing staff used the care plans to review common symptom experiences during the treatment planning, active and survivorship care periods. Development of evidence matrixes supported clinician and patient interventions in managing symptom experiences. These interventions were translated into an electronic patient care plan that provided symptom management strategies along with cancer-specific education, recommended referrals and potential treatment-related side-effects. The strength of the care plan content was in the rigorous evidence-based review process which included an expert panel review and consensus building for interventions with low-level supporting evidence. To facilitate implementation of the care plan readability of the content was reviewed by a health educator and targeted at a 7^th grade level; plan length was monitored as was ease of electronic use (e.g. connecting to education documents through hyperlinks).

Barriers identified to the process include the continued burden of evidence review and content maintenance to ensure alignment with current best practices (a process facilitated by the electronic nature of this product). Additionally, obtaining resources such as national clinical practice guidelines and oncology experts’ review required unanticipated fees, permissions and consents, resulting in the re-evaluation of the project budget and timeline.

Future nursing research efforts should focus on the electronic care plan’s ability to improve provider-patient communication and document its impact on the patient symptom experience. With a standardized approach to literature review and a process to sustain current supporting evidence, the electronic patient care plan offers the opportunity to close the quality chasm through an effective and patient centered approach.