Cancer care

Medical oncology care plans: 15 minutes well spent

Medical oncology care plans take a little extra time but should improve patient involvement with decision-making and health outcomes, Australian clinicians say.

A team from the department of medical oncology at the Townsville University Hospital and the James Cook University have developed a holistic care plan template integrated into the electronic medical record.

“The purpose of this integration in electronic records is to ensure care plans are sustainable and easily retrievable for quality improvement purposes.”

“Once completed in partnership with patients, the care plan is given to patients (to share information with families) and sent to the patient’s primary care physicians for continuity of care,” the investigators said.

They said the comprehensive plan requires about an additional 15 minutes to complete and includes a broad range of components such as diagnosis, prognosis, problem list, comorbidities, medication list, goals of care, treatment options, patient’s treatment preferences, management of side effects, geriatric assessment and advanced care planning.

Pre and post implementation surveys of patients have shown high overall satisfaction with information and care (92%) although implementation of the plan made no significant difference to patient understanding of the diagnosis, prognosis or intent of care.

Clinicians and healthcare professionals involved in the care plans reported back positively:

‘The Care Plan is a clear record of note for staff and patients and ensure no important information is missed so to provide optimal care for our patients’

‘Provides improved communication with the patient’s GP and other health professionals through consistent information’

‘Since we don’t have to dictate and correct letters, overall it might save us time’

The study team, including director of medical oncology Professor Sabe Sabesan, said the care plans encourage gathering of additional information and the delivery of consistent information to patients.

“The free text section of the care plan prompts the clinicians to enquire directly of patient goals, their choices and expectation of treatment and outcomes.”

“This section allows discussion to enhance the patient experience and allow them to be more involved with the decision-making process with regard to their treatment and provide adequate information they are specially enquiring about by health professionals.”

And from a medical training perspective: “It seems that inclusion into routine practice not only prepares basic physician trainees for long case examinations, but also helps fellows to apply long case principles on an ongoing basis.”

They said the content and format of the care plan template would continue to evolve.

“Highlighting the importance of addressing information needs of patients through education, ongoing review of contents of care plans and allocation of additional time for new patient consultations may improve the overall quality of care plans without compromising patient flow in clinics.”

Read the Brief Communication in the Internal Medicine Journal 

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