A new mixed methods approach to uncover multi-level barriers and facilitators of cancer survivorship.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 36-36
Author(s):  
Autumn Kieber-Emmons ◽  
Benjamin F Crabtree ◽  
William Miller
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Cancer Survivorship ◽  
Cancer Mortality ◽  
Qualitative Inquiry ◽  
Barriers And Facilitators ◽  
Assessment Process ◽  
Survivorship Care ◽  
Multi Level ◽  
Multiple Levels

36 Background: As healthcare becomes increasingly complex, research needs to take into account multi-level interactions that contribute to public health issues. One such area ripe for multi-level investigation is cancer survivorship care, illuminated in the 2006 Lost in Transition Institute of Medicine report on cancer survivors. We have developed a novel method that aims to understand barriers and facilitators of cancer survivorship from multiple levels, including community factors, medical system features, and policy and environmental influences. Methods: Our method, focused Rapid Assessment Process (fRAP), utilizes mixed methods at multiple levels to better understand cancer survivorship care with a primary care lens. fRAP begins with Geographic Information Systems (GIS) to map variables relevant to cancer survivorship care, such as cancer mortality rates, insurance coverage, and oncology and primary care provider sites. Qualitative participant observation and semi-structured interviews of informants from each level are then undertaken to better understand how cancer survivorship care is delivered within a county or census tract. Lastly, modifiable contextual factors from all levels are identified, as potential future environmental policy change targets. Results: As a development and pilot of our novel fRAP, we have designed, tested, revised and retested our methods over the last 3 years within the framework of two national grant-funded studies on cancer survivorship in primary care. Preliminary modifiable factors of interest affecting cancer survivorship care have been identified for future dissemination. The newest and current iteration of our methods has focused on utilizing GIS specifically to identify hot spots of cervical cancer mortality disparities in order to provide the richest contextual environment for subsequent qualitative inquiry into survivorship care. Conclusions: fRAP is a novel mixed method that has potential to identify modifiable barriers and facilitators of high-quality cancer survivorship care nationally, and may aid in policy improvements in health and healthcare delivery for survivors.

A Novel Mixed Methods Approach Combining Geospatial Mapping and Qualitative Inquiry to Identify Multilevel Policy Targets: The Focused Rapid Assessment Process (fRAP) Applied to Cancer Survivorship

2021 ◽  
pp. 155868982098427
Author(s):  
Autumn M. Kieber-Emmons ◽  
William L. Miller ◽  
Ellen B. Rubinstein ◽  
Jenna Howard ◽  
Jennifer Tsui ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Cancer Survivorship ◽  
Rapid Assessment ◽  
Qualitative Inquiry ◽  
Assessment Process ◽  
Survivorship Care ◽  
Medical Systems ◽  
Policy Environments ◽  
Care Relationships ◽  
Geospatial Mapping

Multilevel perspectives across communities, medical systems and policy environments are needed, but few methods are available for health services researchers with limited resources. We developed a mixed methods health policy approach, the focused Rapid Assessment Process (fRAP), that is designed to uncover multilevel modifiable barriers and facilitators contributing to public health issues. We illustrate with a study applying fRAP to the issue of cancer survivorship care. Through this multilevel investigation we identified two major modifiable areas affecting high-quality cancer survivorship care: (1) the importance of cancer survivorship guidelines/data and (2) the need for improved oncology–primary care relationships. This article contributes to the mixed methods literature by coupling geospatial mapping to qualitative rapid assessment to efficiently identify policy change targets.

Physician preferences and attitudes regarding different models of cancer survivorship care: a comparison of primary care providers and oncologists

2013 ◽  
Vol 7 (3) ◽  
pp. 343-354 ◽  
Author(s):  
Winson Y. Cheung ◽  
Noreen Aziz ◽  
Anne-Michelle Noone ◽  
Julia H. Rowland ◽  
Arnold L. Potosky ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivorship ◽  
Primary Care Providers ◽  
Survivorship Care ◽  
Care Providers

scholarly journals Primary Care Providers' Needs and Preferences for Information about Colorectal Cancer Survivorship Care

2012 ◽  
Vol 25 (5) ◽  
pp. 635-651 ◽  
Author(s):  
T. Salz ◽  
K. C. Oeffinger ◽  
P. R. Lewis ◽  
R. L. Williams ◽  
R. L. Rhyne ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Survivorship ◽  
Primary Care Providers ◽  
Survivorship Care ◽  
Care Providers

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

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.

scholarly journals Risk-Stratified Pathways for Cancer Survivorship Care: Insights from a Deliberative Multi-Stakeholder Consultation

2021 ◽  
Vol 28 (5) ◽  
pp. 3408-3419
Author(s):  
Dominique Tremblay ◽  
Nassera Touati ◽  
Karine Bilodeau ◽  
Catherine Prady ◽  
Susan Usher ◽  
...  
Keyword(s):  
Primary Care ◽  
Risk Stratification ◽  
Cancer Survivorship ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
Survivorship Care ◽  
Care Providers ◽  
Stakeholder Consultation ◽  
Cancer Specialists ◽  
Multi Stakeholder

Risk-stratified pathways of survivorship care seek to optimize coordination between cancer specialists and primary care physicians based on the whole person needs of the individual. While the principle is supported by leading cancer institutions, translating knowledge to practice confronts a lack of clarity about the meaning of risk stratification, uncertainties around the expectations the model holds for different actors, and health system structures that impede communication and coordination across the care continuum. These barriers must be better understood and addressed to pave the way for future implementation. Recognizing that an innovation is more likely to be adopted when user experience is incorporated into the planning process, a deliberative consultation was held as a preliminary step to developing a pilot project of risk-stratified pathways for patients transitioning from specialized oncology teams to primary care providers. This article presents findings from the deliberative consultation that sought to understand the perspectives of cancer specialists, primary care physicians, oncology nurses, allied professionals, cancer survivors and researchers regarding the following questions: what does a risk stratified model of cancer survivorship care mean to care providers and users? What are the prerequisites for translating risk stratification into practice? What challenges are involved in establishing these prerequisites? The multi-stakeholder consultation provides empirical data to guide actions that support the development of risk-stratified pathways to coordinate survivorship care.

scholarly journals Overview of Cancer Survivorship Care for Primary Care Providers

Cureus ◽  
2020 ◽  
Author(s):  
Sukesh Manthri ◽  
Stephen A Geraci ◽  
Kanishka Chakraborty
Keyword(s):  
Primary Care ◽  
Cancer Survivorship ◽  
Primary Care Providers ◽  
Survivorship Care ◽  
Care Providers
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