Care Continuum: Prevention Through Survivorship and End of Life
What the exam tests
The continuum runs from prevention through diagnosis, treatment, survivorship, and end of life. Know the three prevention levels, the difference between screening and diagnosis, and the fact that survivorship begins at diagnosis, not at the end of treatment - it includes surveillance, management of late effects, health promotion, and a written survivorship care plan.
Concepts to name
- Primary prevention: HPV and hepatitis B vaccination, tobacco cessation, sun protection, weight and alcohol counseling.
- Secondary prevention: mammography, colonoscopy, low-dose CT for high-risk smokers, Pap/HPV testing in asymptomatic people.
- Tertiary prevention: rehabilitation, lymphedema care, recurrence surveillance, cardiac monitoring after anthracyclines.
- Care coordination and transition management: prior authorization, oral adherence, transportation, cost and health-literacy barriers, disparities in access.
- Palliative care integrated alongside curative treatment, versus hospice (prognosis of about 6 months or less if the disease follows its usual course, with the patient electing comfort-focused care and forgoing curative treatment for the terminal diagnosis).
- Advance care planning, health care proxy, and the distinction between an advance directive and a portable do-not-resuscitate/POLST order.
Traps
Questions blur the prevention levels. A vaccine given to a healthy adolescent is primary prevention, not screening. Also: a palliative care referral does not mean abandoning treatment, and hospice is not "palliative care for people who failed therapy."
Rule of thumb
Ask: before, find, or after? Primary = before disease; secondary = find it early in an asymptomatic person; tertiary = limit disability or recurrence after diagnosis.