The current study was conducted at two sites: Fletcher Allen Health Care, an academic medical center in Burlington, VT, and the Norris Cotton Cancer Center-North, a rural extension of Dartmouth-Hitchcock Medical Center located at Northeastern Vermont Regional Hospital in St. Johnsbury. Eligible patients had stages 0–III breast cancer or stages II–IV colorectal cancer, were aged 18 years and older, and had completed treatment with curative intent within the preceding 12 months. The study was approved by the human subjects institutional review boards at the University of Vermont and Dartmouth Medical School, and all patients provided written informed consent. From January to July 2011, a total of 89 patients were invited to participate in the study and 78 agreed (88%), including 61 with breast cancer and 17 with colorectal cancer.

Survivorship care plans were prepared by advanced practice providers (nurse practitioners and physician assistants) in consultation with oncologists at each study site using the Survivorship Care Plan Builder software tool developed by Journey Forward™ (Hausman, Ganz, Sellers, & Rosenquist, 2011). Each survivorship care plan was developed using the Journey Forward templates for breast and colorectal cancer, and contained the following domains: a summary of the patient diagnosis, a summary of the patient's treatment, information on recommended follow-up tests and secondary cancer prevention, information received on late effects of cancer treatments, and a list of national and local health-promotion resources. The survivorship care plan was delivered to and discussed with patients by the advanced practice providers during a care plan visit at the clinic. The visit lasted about one hour (range = 45–90 minutes) and occurred about 1–6 months following completion of initial oncologic treatment for cancer. The survivorship care plans were modified if necessary with patient input and finalized. A copy of the final survivorship care plan also was mailed to the patients' primary care providers. Although the care plan was added to patient electronic medical records and the oncologists were aware of the study, the oncologists were not directly notified of the care plans for their patients.

Telephone interviews were conducted with the patients about two months after the care plan visit. As many as 15 attempts were made to contact participants, including calls at varying times on weekdays, weeknights, and weekends, as well as voicemails left with a toll-free number to return calls. Of the 78 patients who enrolled in the study, 58 (74%) completed a telephone interview. The remaining 20 either refused to complete the telephone interview (n=6) or could not be contacted (n = 14). Nonrespondents were more likely to be older than age 65 years, but had similar patterns of cancer stage and treatment to those who completed the interview. The telephone interview included questions to assess the care plan as a whole, as well as questions targeted specifically toward the various domains and elements of the care plan. A variety of question types were used, including categorical response, Likert scale, and open-ended response. Patients also were asked to provide basic demographic information including marital status, education, and family income. Medical data, including cancer stage, date of diagnosis, and treatment information, were obtained from the patients' medical records.

All statistical analyses were conducted using SAS^®, version 9. Descriptive statistics were prepared for each survey question of interest. For certain questions pertaining to the care plan in general, the complete set of response frequencies was described. For other questions, response options were collapsed into two groups for analysis. Response options for accuracy (“Was it accurate?”) and ease of understanding (“Was it easy to understand?”) of the various domains included “yes,” “no,” and “somewhat.” The responses were categorized as agree (“yes”) or did not agree (“no” or “somewhat”). Response options for whether the care plan was important in helping to understand general domains of survivorship (e.g., possible late effects of treatment) were dichotomized as “very important” or “critically important” and “somewhat important” or “not important at all.” Response options for whether the care plan was important in helping to understand specific elements of the care plan (e.g., recommended frequency of follow-up tests) were dichotomized as agree (“yes”) and did not agree (“no” or “not sure”). Tests for interaction by cancer site and facility type were conducted using Fisher's exact tests. The 95% confidence intervals were constructed using the Clopper-Pearson method for exact confidence limits for a binomial proportion (Clopper & Pearson, 1934).

The majority of previous studies regarding patient perspectives on survivorship care plans have used qualitative methods to assess patient preferences for survivorship care plans, most often by soliciting responses to a sample care plan (Salz et al., 2012). The studies provided evidence that survivors prefer the inclusion of information such as diagnosis and treatment, expected side effects (physical and psychological), signs and symptoms of recurrence, a recommended follow-up schedule, and resources for health promotion, further information, and support (Baravelli et al., 2009; Brennan, Butow, Marven, Spillane, & Boyle, 2011; Burg, Lopez, Dailey, Keller, & Prendergast, 2009; Hewitt, Bamundo, Day, & Harvey, 2007; Marbach & Griffie, 2011; Smith, Singh-Carlson, Downie, Payeur, & Wai, 2011). The current study provides quantitative evidence that breast and colorectal cancer survivors who receive a personalized survivorship care plan find value in those components of the care plan. The authors also found that cancer survivors considered the care plan visit highly useful. The results are consistent with prior studies suggesting that in-person care plan visits are generally positive experiences for patients and can reduce anxiety and stress related to cancer (Jefford et al., 2011; Mayer et al., 2012).

In contrast, the focus group studies indicated that patients believe that survivorship care plans would be valuable for improving communication among providers of care (Brennan et al., 2011; Kantsiper et al., 2009; Marbach & Griffie, 2011). The results suggest that current versions of survivorship care plans may not meet that goal.

The majority of previous studies regarding patient perspective on survivorship care plans have focused on patients with breast cancer. Unfortunately, the authors of the current article were unable to detect differences in care plan satisfaction between patients with breast and colorectal cancer because of the small number of patients with colorectal cancer enrolled in the current study.

Previous focus group studies have revealed no differences in preferences for care plan content among patients living in urban and rural settings (Smith et al., 2011). The authors of the current study observed few differences in patient evaluation of the care plan according to whether their care was received at an urban academic medical center or a rural community hospital, although those comparisons also were limited by a small sample. Patients at the community hospital were less likely to strongly agree that the care plan was easy to understand, but more than 90% indicated some level of agreement. Patients at the community hospital also found the care plan more important for understanding their diagnosis and for understanding how care would be coordinated. Some of the differences may be attributable to individual level factors such as income and health status, which were somewhat lower in the community hospital population. The results also could have been influenced by the style of delivery of the specific advanced practice providers at the two study sites.

Certain limitations should be considered when interpreting the results of the current study. The lack of racial and ethnic diversity of patients seen at these clinics limits the generalizability of the results. Although the size of the study population was adequate to describe overall satisfaction with the care plans, insufficient power was available to detect small differences in responses by cancer type or type of facility. In addition, the participants who agreed to take part in the study were slightly younger than the target population of cancer survivors at the study clinics and may have differed in other unmeasured ways (e.g., attitudes toward medical care). Therefore, the findings require additional exploration in larger populations across a variety of healthcare settings.

Although the authors assessed patient satisfaction with the survivorship care plans at a single point in time, patient satisfaction with care plans may vary over time. The results should not be generalized to settings in which the document is not delivered during an in-person medical visit. Finally, responses to a series of questions regarding the helpfulness of the survivorship care plans will vary according to the quality of the care plan as well as the preexisting knowledge base of the patients. Although those questions provide a measure of the use of care plans in the patient population, the authors could not distinguish whether any lack of helpfulness was caused by a failure of the care plan document or simply because patients already possessed the knowledge.