Alberta CancerBridges development of a care plan evaluation measure

Original Article

Alberta CancerBridges development of a care plan evaluation measure

J. Giese-Davis, PhD*, J. Sisler, MD, L. Zhong, MSC*, Y. Brandelli, BA*, J.L. McCormick, MSC*, C. Railton, RN MN ACNP CON(C)§, L. Shirt, RN MN CON(C) CHPCN(C), H. Lau, MD#, D. Hao, MD#, J. Chobanuk, BSCN MN CON(C) CHPCN(C)§, B. Walley, MD**, A.A. Joy, MD††, A. Taylor, MD§‡‡, L. Carlson, PhD*




No standardized measures specifically assess cancer survivors’ and healthcare providers’ experience of Survivor Care Plans (scps). We sought to develop two care plan evaluation (cpe) measures, one for survivors (cpe-s) and one for healthcare providers (cpe-p), examine initial psychometric qualities in Alberta, and assess generalizability in Manitoba, Canada.


We developed the initial measures using convenience samples of breast (n = 35) and head and neck (n = 18) survivors who received scps at the end of active cancer-centre treatment. After assessing Alberta’s scp concordance with Institute of Medicine (iom) recommendations using a published coding scheme, we examined psychometric qualities for the cpe-s and cpe-p. We examined generalizability in Manitoba, Canada, with colorectal survivors discharged to primary care providers for follow-up (n = 75).


We demonstrated acceptable internal consistency for the cpe-s and cpe-p subscales and total score after eliminating one item per subscale for cpe-s, two for cpe-p, resulting in revised scales with four 7-item and 6-item subscales, respectively. Subscale scores correlated highly indicating that for each measure the total score may be the most reliable and valid. We provide initial cpe-s discriminant, convergent, and predictive validity using the total score. Using the Manitoba sample, initial psychometrics similarly indicated good generalizability across differences in tumour groups, scp, and location.


We recommend the revised cpe-s and cpe-p for further use and development. Studies documenting the creation and standardization of scp evaluations are few, and we recommend further development of patient experience measures to improve both clinical practice and the specificity of research questions.

KEYWORDS: Care plans, survivorship, distress screening, breast cancer, head and neck cancer, oncology


For many cancer survivors, ending active treatment leads to uncertainty about their risk of recurrence and the organization of their care moving forward1,2. To address these concerns, oncology providers in the United States are mandated at the end of curative-intent treatment to clarify for patients what comes next through the provision of survivor care plans (scps)3. The Institute of Medicine (iom) report on cancer survivorship2 strongly encouraged post-treatment individualized scps to enhance coordinated and quality care while addressing survivors’ and primary care providers’ (pcps’) transition concerns. An scp contains individualized diagnostic and treatment details, follow-up and surveillance guidelines, symptoms of recurrence to monitor, information on health behaviour, coping, and resources1,2,4, and some include specific tools supporting health-behaviour-change planning or self-management1. Although no jurisdiction or accreditor mandates delivery, Canadian provincial oncology centres are beginning to offer and evaluate scps1,5,6. While scp research has grown, best practices for patient and provider assessment and scp delivery post-treatment remain unclear or not broadly instituted2,7,8. A developing literature supports the use of scps914, and describes optimal content, formats4,1522, and key-stakeholders’ views1,23,24, but methods of evaluating scps and their impact on stakeholders are just emerging4,2530.

Due to the absence of a common validated measure4,3135, researchers often generate study-specific measures of patients’ and providers’ scp experiences, including satisfaction, usefulness, emotional reaction, or communication value4,2530. Some studies measure how closely scps adhere to recommended iom standards4,36 so that the thoroughness of scp format can be linked with outcomes. Our study, perhaps uniquely, offers scales appropriate across types of scps, health systems, and perspectives, providing psychometric attributes of two scp evaluation measures: Care Plan Evaluation-survivors or cpe-s and Care Plan Evaluation-Healthcare Providers or cpe-p. We used convenience data from delivery of three Canadian scps for cancer survivors: two given in Alberta at active treatment completion, one for breast (bca), another for head and neck (hn); one in Manitoba, (colorectal [crc]), at transfer-of-care to pcps for follow-up. Our aim was to document initial steps so that this measure can be used and improved in future research and practice. We assessed Alberta’s scp-coherence with iom recommendations, followed by item and subscale analysis for cpe-s and cpe-p, cpe-s stability over six months, and cpe-s convergent, divergent, and predictive validity comparing to scales measuring similar or different constructs, and testing associations with outcomes over time. In Manitoba, we assessed cpe-s generalizability to a different setting and scp.

We hypothesized (H) the following:


Care Plan Evaluation (CPE) Development

Because no published scale evaluated survivors’ and providers’ scp experiences, the CancerBridges multi-disciplinary team created the cpe, comprising four face-valid, 8-item (Likert-type scales [1-do not agree to 5-completely agree]) subscales (Satisfaction; Usefulness; Emotional Reaction; Communication Value). We selected domains based on scp delivery goals for survivors and pcps outlined in the iom report2: that they feel satisfied that their questions are addressed; that the scp was useful in the transition following treatment; that receiving the scp would reduce negative emotional reactions, including distress and abandonment fears, and instead provide relief; and that scps would improve communication among health professionals and survivors helping them to navigate health issues. To reduce response bias, we reverse-coded 14 (43.7%) items. We evaluated two scp demonstration projects, funded by the Canadian Partnership Against Cancer (cpac), differing by scp delivery methods, tumour groups, and provinces. Goals for the cpe-s were to examine initial psychometric qualities and generalizability, and, for the cpe-p, to examine initial psychometric qualities in Alberta.


In accordance with the Declaration of Helsinki, this study received ethics and data sharing approval through respective research ethics boards (The Conjoint Health Research Ethics Board at the University of Calgary; Research Ethics Board Faculty of Medicine, University of Manitoba, and Research Resource Impact Committee of CancerCare Manitoba). All participants signed informed consent.

Breast Cancer and Head and Neck Cancer Survivors, Nurses, Primary Care Providers

In Alberta, nurses identified consecutive survivors in their cancer clinic/community/and navigator roles (see Collie et al.1 for details). Survivors’ eligibility criteria included over age 18, English literate, stages I–III, and within 2 weeks (+/−) of end of active treatment regardless of formal oncology discharge status. For bca (n = 36), the study was provincial, including two urban (Calgary and Edmonton) and two rural (Drumheller and Lloydminster) Alberta Health Services (ahs) cancer-centre sites, and one community-based organization (cbo). For hn survivors (n = 21) we included one urban location (Calgary). The CancerBridges multidisciplinary team developed scps for bca and hn survivors differing only in tumour-specific details. Trained nurses delivered scps during consultations with survivors who then completed the cpe-s1. Nurses who delivered scps (N = 8 of 8) and pcps who received them by fax after consultations (N = 22 of 57), completed the cpe-p after consultations.

Colorectal Cancer Survivors

Manitoba’s nurse-oncologist teams delivered scps during standard clinical consultations to consecutive colorectal cancer (crc) survivors at the time of medical-responsibility- for-care transfer to community family physicians or nurse-practitioners (pcps). We approached survivors in Cancer-Care, Manitoba cancer clinics (Winnipeg) or Winnipeg Regional Health Authority, with those consenting receiving mailed surveys that included the cpe-s and other measures. Eligibility criteria included patients discharged to pcp care, over age 18, English literate, Stage I–III crc, minimum 12-months post-diagnosis, with ct scan demonstrating no evidence of recurrence.

Survivor Care Plan Development

Both provinces’ care plans included cpac- and iom- recommended features2: diagnosis and treatment summaries (ts); follow-up and surveillance plans; coping, adjustment, and healthy-living recommendations/survivor priorities and goals; resources and activities for survivors; care-team contact information, and distress screening (scps). In Alberta, nurses hand-entered ts information prior to consultations. To empower survivors to set their own priorities and plans, survivors and nurses interactively completed remaining scp items during consultations. In Alberta, in addition to post-consultation surveys that included the cpe-s, we retained scp elements as data.

Breast and Head and Neck

After a full-day group nurse training to assess distress and deliver scps, nurses personalized survivors’ TSs using medical records. Nurses scheduled face-to-face or phone consultations to deliver scps, answer questions, and clarify needs and goals1. One breast nurse (of 7) delivered individualized scps during group classes. Following delivery, we scanned scps into medical records, provided survivors copies, and faxed them to pcps. We encouraged survivors to schedule scp consultations with pcps within the month. Following consultations, nurses, patients, and participating pcps completed respective cpe measures. Survivors completed the minimum dataset for distress screening across Canada37 during scp delivery (T1), as part of surveys following scp delivery (T2), and at 6-months (T3).


CancerCare Manitoba’s electronic record populated scps with printed copies including three sections: a patient-specific TS, a crc-specific guide to survivorship, and a general survivorship information booklet for all cancers. After staff education, the nurse-physician team that had cared for patients during their chemotherapy prepared their scps with project-manager support. Physicians were medical oncologists or family physicians in oncology, specially trained family physicians overseeing chemotherapy in smaller hospitals in a shared-care arrangement with medical oncologists. Nurse-physician teams presented and discussed patient scps at their final, 20-minute transitional appointment, where patients completed and staff reviewed with them the minimum data set for distress screening across Canada37. Nurse-physician teams faxed completed scps to participants’ pcps, with whom they were encouraged to meet within the month. Participants completed surveys once after pcp consultation, usually one to three months later.


Demographics and Cancer History

Alberta and Manitoba survivors completed separate demographic and medical questionnaires (Table I).

TABLE I Demographic, medical, and study variables by tumour group


H1: SCP Concordance with iom Recommendations

In Alberta, the cpe-s and cpe-p development site, we ensured that our scps matched closely with iom recommendations4 so these evaluations were based on fulsome scp experiences. To ensure comparability with standardized scp templates, we used a coding scheme that matches aspects of actual-use tss and scps with the guidelines, yielding a concordance score4. Coding-scheme authors developed these for bca tss and scps in the United States, so several items were irrelevant to Alberta’s public healthcare system. Coding-scheme authors developed no coding guidelines for hn scps, so we copied bca coding-scheme guidelines applicable to both and added criteria through consultation with a hn nurse specialist. Two independent coders rated our bca and hn scps separately against these criteria with kappa (κ) statistics of agreement calculated. They then consensus-coded their work to resolve conflicts (bca: ts κ = 0.733, scp κ = 0.500; hn: ts κ = 0.808, scp κ = 0.455).

Edmonton Symptom Assessment System (ESAS)

In Alberta, to reduce multiple testing when examining discriminant and predictive validity, we used the mean (of 9 items) esas3739. The esas is a valid and reliable part of the Canadian minimum dataset for distress screening. Patients rate current experience of nine symptoms (pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath) on 10-point Likert-type scales (0-symptom is absent to 10-most severe).

Contact Sheets

In Alberta, we used survivors’ ratings of topic-discussion frequencies (5-point Likert-type scales: 1-not at all to 5-a lot) following nurse scp consultations to assess cpe-s convergent validity40 because each topic theoretically relates to pieces of an ideal scp consultation. Interactive consultations led by survivors’ priorities determined whether survivors discussed these nine topics: Information about cancer, Resources for cancer patients, Coping with cancer, Feelings, Work issues, Sexuality, Life-style changes, Taking control of life, and Follow-up tests and appointments. For predictive validity, we used survivor ratings of five positive and four negative affect words (Likert-type scale: 0-not applicable to 5-a lot) describing their pcp consultations, predicting that better scp nurse consultations (higher cpe-s) at baseline would prepare them to feel more positively about pcp consultations one month later.

Patient Continuity of Care Questionnaire (PCCQ)

In Manitoba, we examined convergent validity with the pccq41,42 consisting of 41 Likert-type items identifying continuity-of-care issues post-discharge from a hospital setting. This is a reliable and valid short questionnaire developed in Canada that Manitoba investigators modified for use at the time of discharge to pcp follow-up43. Delivering more highly evaluated scps should improve survivors’ continuity of care4446.

Data Analysis

We conducted the following tests of our hypotheses:

We present descriptive cpe-s statistics and box plots of tumour groups’ total scores to explore distributions. For all analyses, due to the large number of tests, we used p ≤ 0.01.



Alberta’s bca and hn survivors were similar in age, distance to cancer centre, race, marital status, education, employment status, majority English first language, but differed in expected ways by sex, time to scp delivery (differing treatment lengths), medical details, and household incomes (Table I). Breast cancer scp delivery time was 33 days (6–63 days) and for hn -2 days (−32–100 days). Colorectal cancer survivors in Manitoba were older with longer time from diagnosis to scp meetings (consistent with recruitment at discharge).

(H1) IOM-Recommendation Concordance

For Alberta’s bca scp, consensus-coded total scores based on Stricker et al.’s4 scoring were 40/54 (74%) for ts, and 21/30 (70%) for scp. Total scores for hn scps were 25/42 (60%) for ts and 20/27 (74%) for scp. Compared with Stricker et al.’s4bca survivors (in LIVESTRONG™ Network of Survivorship Centers of Excellence), our TSs and scps looked more concordant with iom recommendations (ts: theirs M = 46%, ours M = 67%; scps: theirs M = 59%, ours M = 72%). Within tss, our discordant categories were supportive treatment (0/3, 0%) and chemotherapy details (3/7, 43%). Within scps, our discordant categories were cancer surveillance (0/3, 0%) and non-cancer surveillance (0/3, 0%). In our hn ts, chemotherapy details (2/8, 25%), and radiation details (1/3, 33%) were most discordant, but for hn scps, cancer surveillance (0/3, 0%) and signs of cancer (recurrent and second; 1/2, 50%) were most discordant.

(H2.a) CPE-S Item and Subscale Analysis

In Alberta, four people completed too few items to score subscales (2 bca, 2 hn), but few items were missed (missing: bca mean = 0.31, standard deviation [sd] = 0.80, median = 0.0, range = 0.0 to 3.0; hn mean = 0.39, SD = 0.85, median = 0.0, range = 0.0 to 3.0).

Based on Cronbach’s alphas and item-to-total correlations, we eliminated one item per subscale. The removal of these four items (three reverse-scored) improved alphas: (Satisfaction, 0.70 to 0.72; Usefulness, 0.78 to 0.84; Emotional reaction, 0.78 to 0.79; Communication value, 0.78 to 0.82; Total score, 0.93 to 0.94). The revised, shortened cpe has four 7-item subscales (Table II). We found that items had acceptable skewness (−1.84 to −0.25, median = −0.96) and kurtosis (−1.01 to 2.95, median = 0.24) (2 greater than ±2), indicating that they met normality assumptions. Subscales and total scores had acceptable skewness (−0.99 to −0.40, median = −0.52) and kurtosis (−0.95 to 0.68, median = −0.20).

TABLE II Means, internal consistency, and subscale and total score correlations for the Care Plan Evaluation-Survivors (cpe-S)


The revised cpe-s has acceptable baseline and six-month internal consistency, with Total score the strongest: (baseline, six-month) α = 0.94, 0.93; Satisfaction α = 0.72, 0.77; Usefulness α = 0.84, 0.74; Emotional reaction α = 0.79, 0.79; Communication value α = 0.82, 0.79 (Table II).

(H2.b) Subscale Inter-Relationships

Table III shows moderate to large Spearman correlations among subscales in each tumour group. To eliminate redundancy, analyses below use Total scores as providing the best cpe measure. Tumour-group correlation patterns were similar, showing a high degree of generalizability.

TABLE III Discriminant and convergent validity with cpe-S total scores for Alberta and Manitoba


(H3) Stability

Total score intra-class correlation demonstrated stability between baseline and six months (0.651). We examined change over time and could demonstrate no significant Time (F = 3.8(36), p = 0.06) or Group × Time (F = 0.83(36), p = 0.78) changes. Out of a possible total score of 140, bca (mean = 116.49, SD = 15.98) and hn (mean = 105.67, SD = 21.70) survivors evaluated the scp positively; however, hn survivors rated it somewhat lower (F = 5.8(51), p = 0.02).

(H4) Discriminant/Convergent Validity

(H4.a) Discriminant

As hypothesized, the cpe-s Total score correlations with demographic and medical variables were small, demonstrating that it is not measuring age, time, or treatment-related issues. As predicted, correlations between cpe-s Total score and esas total were small and non-significant for bca (r = −0.05, p = 0.77); however, hn was moderate though non-significant (r = −0.41, p = 0.10). Care plan evaluation-survivors is related to distress at a low level, but does not measure symptom distress (Table III).

(H4.a) Convergent

As expected, cpe-s correlations with relevant scp-consultation topic discussions were moderate to large (bca: median = 0.31; SD = 0.09; range 0.28–0.54; hn: median = 0.53; sd = 0.17; Range 0.29–0.76) (6 correlations significant at p ≤ 0.01). Breast cancer and hn differed on significant correlations: bca – Coping with cancer, Feelings, and Work issues; hn – Information about cancer, Feelings, and Follow-up tests and appointments (Table III). Intra-class correlations between nurses’ cpe-p and survivors’ cpe-s indicated similar scp-consultation ratings (0.75), providing evidence of convergent validity from multiple perspectives. Survivors did not complete a cpe-s rating for their scp consultation with pcps.

(H4.b) Predictive Validity

As predicted, we found moderate cpe-s correlations with survivors’ affect during pcp consultations about one month (1.33, SD = 1.30) later (bca, hn: Negative Affect: r = −0.39, p = 0.03, r = −0.34, p = 0.28; Positive Affect: r = 0.32, p = 0.08, r = 0.51, p = 0.09). We found partial support for higher cpe-s baseline ratings predicting steeper declines in esas Total Symptom Distress over six months with bca more related than hn (bca: r = −0.49, p = 0.003; hn: r = −0.13, p = 0.61).

(H5.a) Generalizability

Manitoba’s cpe-s for crc survivors (Table II) had similar internal consistency (Total Score α = 0.94; Satisfaction α = 0.78; Usefulness α = 0.75; Emotional reaction α = 0.80; Communication value α = 0.83). Subscale scores also correlated with similarly large effect sizes (0.77 to 0.93). Figure 1 shows that the 3 tumour groups reported similar cpe-s levels despite scp-delivery differences.



FIGURE 1 CPE-S and CPE-P Distributions across Survivor and Provider Samples. Graphed are box-and-whisker plots. A) Care Plan Evaluation-Survivor (CPE-S) distributions for three tumour groups, two in Alberta and one in Manitoba. B) Care Plan Evaluation-Provider (CPE-P) distributions for two providers, nurses who delivered care plans and primary care physicians (PCPs) who received them. Bottom line on whisker = the smallest observation; bottom line on box = lower quartile; middle line on box = median; top line on box = upper quartile; top line on whisker = largest observation; circles = mild outlier.

(H5.b) Likewise as predicted, the cpe-s correlated at a low level with demographic and medical variables, but significantly with pccq scores, indicating a strong relationship with continuity of care (Table III).

(H2.a) CPE-P Item and Subscale Analysis

We used cpe-s psychometric analysis processes to evaluate cpe-p. In Alberta, nurses rated the cpe-p after scp deliveries (57 total), and pcps rated it after scp consultations (returning 16 bca, 6 hn cpe-ps). Nurses failed to complete more items than pcps (nurse mean missing = 1.30, SD = 1.55, median = 1.0, range = 0.0 to 8.0; pcps mean missing = 0.36, sd = 0.73, median = 0.0, range = 0.0 to 2.0), so that we could not score one nurse Satisfaction (hn) and four nurse Usefulness subscales (3 bca, 1 hn).

We randomly selected one cpe-p per nurse for alpha calculations so nurses who filled these out for multiple patients were not represented more than once. Based on item-to-total correlations, missing items, and comments, we eliminated two items per subscale. The removal of these eight items (6 reverse-scored) improved some alphas, eliminated confusing items, and provided a shortened measure (Satisfaction, 0.73, to 0.70; Usefulness, 0.62, to 0.69; Emotional reaction, 0.57, to 0.74; Communication value, 0.51, to 0.71; Total score, 0.89, to 0.90). The shortened cpe-p demonstrated acceptable internal consistency, particularly the Total Score, and has four 6-item subscales (Table IV). Most items, subscales, and total scores had acceptable skewness (Items: −2.15 to −0.05, median = −0.92; 2 greater than ±2; Subscales and total scores: −0.09 to 0.44, median = −0.22) and kurtosis (Items: −1.34 to 7.64, median = 0.44; 7 greater than ±2; Subscales and Total scores: −0.15 to 0.30, median = 0.05).

TABLE IV Means, internal consistency, and subscale and total score correlations for the Care Plan Evaluation-Healthcare providers (cpe-P)


(H2.b) Subscale Inter-Relationships

For nurses and pcps, most subscales were highly correlated, indicating that Total Score best represents the cpe-p (Table IV). Nurses reported somewhat lower total scores than pcps (Table IV).


We report first steps in scp-evaluation-measure creation for survivors (cpe-s) and healthcare providers (cpe-p). Each measures satisfaction, usefulness, emotional reaction, and communication value for the specific scp delivered. For initial psychometrics, we used scp-delivery data from bca and hn survivors in Alberta. To ensure the scps we evaluated matched closely with iom recommendations47, we applied a published coding system4, demonstrating close concordance with guidelines at or above levels reported by LIVESTRONG™ Survivorship Centers in the United States. We demonstrated acceptable internal consistency for cpe-s and cpe-p after eliminating one and two items per subscale, respectively. We recommend revised scales with four 7-item, and 6-item subscales respectively (Appendix 1, 2). Subscale constructs overlap with moderate to large effect sizes. Therefore, total scores best represent the two measures. We found survivors’ cpe-s ratings reliable over six months, and that higher cpe-s at baseline predicted distress-symptom improvement over six months. Better survivor ratings at baseline also predicted a more positive pcp scp-discussion experience a month later.

We found that cpe-s generalized to another province, tumour group, and an independently developed scp. We found evidence for discriminant/convergent validity in both provinces. For convergent validity, cpe-s correlated moderately with their ratings of scp-delivery topic discussions in Alberta, and better continuity-of-care in Manitoba. Discriminant correlations were low for cpe-s with demographic and medical variables, and with distress symptoms.

These indicators further scp-evaluation development from multiple perspectives. We encourage clinicians to use these scp-implementation tools for patients and healthcare providers. Measuring patient perceptions of scps and healthcare consultations as they leave oncology-centre treatment can facilitate clinical understanding of unmet needs and clarify empowerment strategies for self-managing survivorship tasks. Through cpe-s correlations, we found that tumour groups valued aspects of scp conversations differently: bca ratings correlated highly with coping, feelings, and work-issue discussions, whereas hn correlations highlighted cancer information, tests and appointments, and feelings. These correlations offer evidence that patients valued discussing feelings and coping as much as receiving cancer information. For crc patients, the cpe-s strongly correlated with management of continuity of care. The cpe-s thus captures an aspect of continuity of care as patients enter survivorship, an important patient-related outcome at discharge.

Interestingly, higher end-of-treatment cpe-s scores also correlated with future improvements in symptoms over six months. This indicates the potential for comprehensive care planning consultations to facilitate better prospective symptom management during survivorship transition, a time-period associated with many difficulties for survivors.

These measures also facilitate clearer examination of where and how patients benefit from transition consultations at discharge, and might improve the types of conversations we have and processes we engage as healthcare providers. Primary care providers could utilize their cpe-p for guidance to improve communication with survivors in their practices. If they or their survivors gave low ratings on communication value following an scp discussion, for instance, they might seek to provide better guidance, information, or referrals to the survivor that would improve communication with other providers.

Patient and provider scp-experience evaluations could also facilitate research, for instance, moderator or mediator analyses when examining medical, psychosocial, healthy lifestyle, and survival outcomes. If survivors are given one scp at discharge, then their cpe-s could correlate with or moderate their longitudinal outcomes. If survivors’ scp conversations with pcps evolve over time, with multiple opportunities to update and enhance their scp and provide multiple cpe-s ratings over time, researchers could examine whether those changes mediated outcomes. Sharpening our understanding of the links between patients’ evaluations of the scps we deliver and their outcomes might allow researchers to understand whether and how scps improve patient experience, allowing deeper insight if randomized trials have null outcomes35,48,49.


This study used convenience data from two Canadian provinces during funded demonstration projects. These two cpe measures would benefit from further development and psychometric evaluations using larger survivor samples. Questions that ask providers about integrating scps into their practices may be welcome additions and improve the cpe-p26,35. Small sample sizes, predominantly Caucasian and urban participants, and many exploratory tests (despite p ≤ 0.01 criterion) may limit generalizability. However, studies documenting the creation and implementation of scp evaluations are few, and this work may be a valuable starting point to facilitate further development of patient-experience measures to improve clinical practice and the specificity of scp research questions.


Cancer survivors, nurses, and pcps valued our scps, and initial psychometrics of our evaluation measures are promising even though groups’ post-treatment symptoms, prognoses, and trajectories widely diverged. We recommend our revised cpe-s and cpe-p with four 7-item, and 6-item subscales, respectively, comprising each total score. We hope this initial work allows researchers and clinicians to improve the specificity of their research questions and individualized scp consultations. We also hope others will continue to improve these scp measures.


We thank The Canadian Partnership Against Cancer Corporation for funding this study #CCCR -28, in addition to salary funding for Dr. Giese-Davis through Alberta Cancer Research Institute-Recruitment and Retention Grants #4739 and #24397, and the Enbridge Research Chair in Psychosocial Oncology. Dr. Carlson holds the Enbridge Research Chair in Psychosocial Oncology, co-funded by the Alberta Cancer Foundation and the Canadian Cancer Society Alberta/NWT Division. She also holds an Alberta Heritage Foundation for Medical Research Health Scholar Award. We thank a donor and the Alberta Cancer Foundation for cancer survivorship funding. Thanks also to other contributors including Louise Smith, Shelley Cloutier, Loring Gimbel, Teresa Skarlicki, Anne Marie Stacey, Kate Rancourt, Shannon Gil, Debbie Blais, Sylvia Huber, Lue Petruk, Audrey Smith, Linda Tkachuk, Lisa Lamont, Beth Kapusta, Guy Pelletier, and Joanne Park.

The Care Plan Evaluation results reported here have not been published elsewhere, although portions of these studies have been presented at the Canadian Association of Psychosocial Oncology conference, Toronto, Ontario, May 4–6, 2011; the Alberta Cancer Foundation Research Conference, Banff, Alberta, November 8–10, 2010; the Care About Cancer Conference, Edmonton, Alberta, June 16–18, 2011; the Canadian Cancer Research Conference, Toronto, Ontario, November 27–30, 2011; and the American Society of Clinical Oncology/American Society for Radiation Oncology Multidisciplinary Head and Neck Cancer Symposium, Phoenix, Arizona, January 26–28, 2012; as well as at a number of local continuing education forums. We published a qualitative analysis that utilized demographic and medical data reported here1.


We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare that we have none.


*Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta;,
Psychosocial Resources, Tom Baker Cancer Center, Alberta Health Services, Calgary, Alberta;,
Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba;,
§Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta;,
Palliative Consult Service-Calgary Zone Urban, Alberta Health Services, Calgary, Alberta;,
#Department of Radiation Oncology, Head and Neck Tumour Group, Tom Baker Cancer Center, Calgary;,
**Comprehensive Breast Care Program (cbcp), Community Oncology, Alberta Health Services-Cancer Care, Edmonton, Alberta;,
††Division of Medical Oncology, Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta; and,
‡‡Breast Cancer Supportive Care Foundation, Calgary, Alberta..


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Correspondence to: Janine Giese-Davis, Department of Psychosocial Resources, 2202 2nd Street SW, Calgary, Alberta T2S 3C1. E-mail:

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Current Oncology, VOLUME 25, NUMBER 1, February 2018

Copyright © 2019 Multimed Inc.
ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)