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Purpose <p>To explore feasibility of using a Nurse Cancer Care Coordinator (CCC) to synthesize cancer survivorship care data, assess degree of cancer-related distress, and coordinate care for American Indian (AI) patients seen in a tribal primary care clinic.</p> Methods <p>A CCC from one of Choctaw Nation’s primary care facility collected data on American Indian adults who had completed cancer treatment within the preceding five-years. Measures included demographics, cancer type, treatment and potential adverse effects, schedule of follow-up visits, behavioral risk assessment, global distress and checklist of distress sources, and length of time and frequency of attempts to complete data collection.</p> Results <p>None of the participants had ever received a survivorship care plan (SCP). A total of 15 oncology providers were contacted to gather SCP and Distress Thermometer (DT) information on the 23 participants. Time to complete the SCP ranged from 30 to 120&#xa0;min, with an average of 62&#xa0;min per participant. The baseline DT score was 4.4 out of 10 and the average number of problems reported was 5.0. The top five challenges experienced by participants were fatigue (57%), pain (57%), worry (48%), tingling in hands/feet (33%), and sleep (33%).</p> Conclusions <p>A Nurse CCC embedded within a tribal clinic organized clinically relevant survivorship care information, but this was a labor-intensive undertaking. Further work is needed to determine if risk stratification could be used to identify subsets of patients who would most benefit from this intervention.</p> Implications for cancer survivors <p>: Enhancement of Primary Care and Oncology communication may improve survivor care and health outcomes.</p>

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Nurse-Directed coordination of cancer survivorship care in a tribal primary care clinic

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月31日

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  • Amber S. Anderson-Buettner,
  • Kathleen A. Dwyer,
  • Zsolt J. Nagykaldi,
  • LaRessa Perrin,
  • Janis E. Campbell,
  • Stephanie F. Pharr,
  • Mark P. Doescher

摘要

Purpose

To explore feasibility of using a Nurse Cancer Care Coordinator (CCC) to synthesize cancer survivorship care data, assess degree of cancer-related distress, and coordinate care for American Indian (AI) patients seen in a tribal primary care clinic.

Methods

A CCC from one of Choctaw Nation’s primary care facility collected data on American Indian adults who had completed cancer treatment within the preceding five-years. Measures included demographics, cancer type, treatment and potential adverse effects, schedule of follow-up visits, behavioral risk assessment, global distress and checklist of distress sources, and length of time and frequency of attempts to complete data collection.

Results

None of the participants had ever received a survivorship care plan (SCP). A total of 15 oncology providers were contacted to gather SCP and Distress Thermometer (DT) information on the 23 participants. Time to complete the SCP ranged from 30 to 120 min, with an average of 62 min per participant. The baseline DT score was 4.4 out of 10 and the average number of problems reported was 5.0. The top five challenges experienced by participants were fatigue (57%), pain (57%), worry (48%), tingling in hands/feet (33%), and sleep (33%).

Conclusions

A Nurse CCC embedded within a tribal clinic organized clinically relevant survivorship care information, but this was a labor-intensive undertaking. Further work is needed to determine if risk stratification could be used to identify subsets of patients who would most benefit from this intervention.

Implications for cancer survivors

: Enhancement of Primary Care and Oncology communication may improve survivor care and health outcomes.