Recruitment challenges to the I CARE study: a randomised trial on general practitioner-led colon cancer survivorship care

ObjectivesThe I CARE study (Improving Care After colon canceR treatment in the Netherlands) aims to compare surgeon-led to general practitioner (GP)-led colon cancer survivorship care. Recruitment to the trial took longer than expected. In this descriptive study, recruitment is critically reviewed.SettingPatients were recruited from eight Dutch medical centres.ParticipantsPatients treated with curative intent for stages I–III colon cancer. Target patient sample size was calculated at 300.InterventionsPatients were randomised to surgeon-led (usual) versus GP-led care, with or without access to an eHealth application (Oncokompas).Outcome measuresBaseline characteristics of (non-)participants, reasons for non-participation and strategies to improve recruitment were reviewed.ResultsOut of 1238 eligible patients, 353 patients were included. Of these, 50 patients dropped out shortly after randomisation and before start of the intervention, resulting in a participation rate of 25%. Participants were on average slightly younger (68.1 years vs 69.3 years) and more often male (67% vs 50%) in comparison to non-participants. A total of 806 patients declined participation for reasons most often relating to research (57%), including the wish to remain in specialist care (31%) and too much effort to participate (12%). Some patients mentioned health (9%) and confrontation with the disease (5%) as a reason. In 43 cases, GPs declined participation, often related to the study objective, need for financial compensation and time restraints. The generally low participation rate led to concerns about reaching the target sample size. Methods to overcome recruitment challenges included changes to the original recruitment procedure and the addition of new study centres.ConclusionsChallenges were faced in the recruitment to a randomised trial on GP-led colon cancer survivorship care. Research on the transition of care requires sufficient time, funding and support base among patients and healthcare professionals. These findings will help inform researchers and policy-makers on the development of future practices.Trial registration numberNTR4860.

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Effect of general practitioner-led versus surgeon-led colon cancer survivorship care, with or without eHealth support, on quality of life (I CARE): an interim analysis of 1-year results of a randomised, controlled trial

The Lancet Oncology ◽

10.1016/s1470-2045(21)00273-4 ◽

2021 ◽

Cited By ~ 1

Author(s):

Julien A M Vos ◽

Laura A M Duineveld ◽

Thijs Wieldraaijer ◽

Jan Wind ◽

Wim B Busschers ◽

...

Keyword(s):

Quality Of Life ◽

Colon Cancer ◽

General Practitioner ◽

Randomised Controlled Trial ◽

Cancer Survivorship ◽

Interim Analysis ◽

Controlled Trial ◽

Survivorship Care ◽

Randomised Controlled

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Need for general practitioner involvement and eHealth in colon cancer survivorship care: patients’ perspectives

Family Practice ◽

10.1093/fampra/cmw139 ◽

2017 ◽

pp. cmw139 ◽

Cited By ~ 2

Author(s):

Ineke C Nugteren ◽

Laura A M Duineveld ◽

Thijs Wieldraaijer ◽

Henk C P M van Weert ◽

Irma M Verdonck-de Leeuw ◽

...

Keyword(s):

Colon Cancer ◽

General Practitioner ◽

Cancer Survivorship ◽

Survivorship Care

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Delivering colon cancer survivorship care in primary care; a qualitative study on the experiences of general practitioners

BMC Primary Care ◽

10.1186/s12875-021-01610-w ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Julien A. M. Vos ◽

Robin de Best ◽

Laura A. M. Duineveld ◽

Henk C. P. M. van Weert ◽

Kristel M. van Asselt

Keyword(s):

Primary Care ◽

Colon Cancer ◽

Cancer Survivorship ◽

Daily Practice ◽

System Level ◽

Normalisation Process Theory ◽

Survivorship Care ◽

Structured Interviews ◽

Delivery Of Care ◽

Roles And Responsibilities

Abstract Background With more patients in need of oncological care, there is a growing interest to transfer survivorship care from specialist to general practitioner (GP). The ongoing I CARE study was initiated in 2015 in the Netherlands to compare (usual) surgeon- to GP-led survivorship care, with or without access to a supporting eHealth application (Oncokompas). Methods Semi-structured interviews were held at two separate points in time (i.e. after 1- and 5-years of care) to explore GPs’ experiences with delivering this survivorship care intervention, and study its implementation into daily practice. Purposive sampling was used to recruit 17 GPs. Normalisation Process Theory (NPT) was used as a conceptual framework. Results Overall, delivering survivorship care was not deemed difficult and dealing with cancer repercussions was already considered part of a GPs’ work. Though GPs readily identified advantages for patients, caregivers and society, differences were seen in GPs’ commitment to the intervention and whether it felt right for them to be involved. Patients’ initiative with respect to planning, absence of symptoms and regular check-ups due to other chronic care were considered to facilitate the delivery of care. Prominent barriers included GPs’ lack of experience and routine, but also lack of clarity regarding roles and responsibilities for organising care. Need for a monitoring system was often mentioned to reduce the risk of non-compliance. GPs were reticent about a possible future transfer of survivorship care towards primary care due to increases in workload and financial constraints. GPs were not aware of their patients’ use of eHealth. Conclusions GPs’ opinions and beliefs about a possible future role in colon cancer survivorship care vary. Though GPs recognize potential benefit, there is no consensus about transferring survivorship care to primary care on a permanent basis. Barriers and facilitators to implementation highlight the importance of both personal and system level factors. Conditions are put forth relating to time, reorganisation of infrastructure, extra personnel and financial compensation. Trial registration Netherlands Trial Register; NTR4860. Registered on the 2nd of October 2014.

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Implementing Quality Colon Cancer Survivorship Care: A Practical Proposal for a Path Forward

JCO Oncology Practice ◽

10.1200/op.20.00290 ◽

2020 ◽

pp. OP.20.00290

Author(s):

Ronald M. Kline ◽

Larissa K. F. Temple ◽

Larissa Nekhlyudov

Keyword(s):

Health Care ◽

Colon Cancer ◽

Health Care System ◽

Cancer Survivorship ◽

Care Delivery ◽

Quality Measurement ◽

The United States ◽

Survivorship Care ◽

Practical Proposal ◽

Care System

There are currently close to 17 million survivors of cancer in the United States. This number is expected to grow as both an aging population and improved treatment increase the number of survivors. Consequently, the importance of quality survivorship care has been recognized, but implementing, measuring, and paying for this care in a highly fragmented health care system, across a broad spectrum of diseases, is difficult. Quality measurement tied to payment is one approach that has commonly been used to improve the quality of care in the US health care system, but the complexity of applying quality measurement metrics across the spectrum of cancer survivorship care had led to stalemate. In this article, we draw on prior work to develop a quality cancer survivorship framework and propose a practical path forward with a focus on the provision of colon cancer survivorship care within integrated health care delivery networks. With this narrowly defined approach, we hope that we can promote a practical solution that can be extended to other diseases and payment systems over time.

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