Lack of Needs Assessment in Cancer Survivorship Care and Rehabilitation in Hospitals and Primary Care Settings

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

Current Oncology ◽

10.3390/curroncol28050295 ◽

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.

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Overview of Cancer Survivorship Care for Primary Care Providers

Cureus ◽

10.7759/cureus.10210 ◽

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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Primary Care Providers’ Knowledge, Attitudes, Beliefs, and Practices Regarding Their Preparedness to Provide Cancer Survivorship Care

Journal of Cancer Education ◽

10.1007/s13187-019-01585-4 ◽

2019 ◽

Vol 35 (6) ◽

pp. 1219-1226 ◽

Cited By ~ 4

Author(s):

Emily M. Geramita ◽

Ira R. Parker ◽

Jill W. Brufsky ◽

Brenda Diergaarde ◽

G. J. van Londen

Keyword(s):

Primary Care ◽

Cancer Survivorship ◽

Primary Care Providers ◽

Survivorship Care ◽

Care Providers ◽

Beliefs And Practices

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Nurse navigation: The key to a seamless transition.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.84 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 84-84

Author(s):

Joy M. Fulbright ◽

Wendy McClellan ◽

Gary C. Doolittle ◽

Hope Krebill ◽

Robin Ryan ◽

...

Keyword(s):

Primary Care ◽

Cancer Survivors ◽

Childhood Cancer ◽

Cancer Survivorship ◽

Childhood Cancer Survivors ◽

Primary Care Providers ◽

Survivorship Care ◽

Care Providers ◽

Nurse Navigator ◽

Seamless Transition

84 Background: Children's Mercy (CM) established a cancer survivorship clinic that cares for approximately 180 survivors a year. A third of the survivors are 18 years or older requiring transition to adult care. The importance of transitioning childhood cancer survivors from pediatric oncology care to adult primary care has been acknowledged in literature, but obstacles remain. Barriers include patient and provider anxiety, difficulty navigating the complex health care system and lack of knowledge regarding late effects. CM and The University of Kansas Cancer Center (KUCC) collaborated to decrease barriers to transition for childhood cancer survivors. Methods: The work group met for 2 years to develop the clinic at KUCC. Models and delivery of survivorship care, including the breast cancer survivorship clinic at KUCC, were reviewed. A shared nurse navigator was identified as an essential component to a seamless transition. Philanthropic support was obtained and job description was developed. Contracts were negotiated to allow the navigator to be present at both institutions. Results: The Survivorship Transition Clinic (STC) at KUCC launched July 2014, with a navigator supporting patients at CM as they begin their transition. The same navigator then meets with the patient at KUCC STC as they initiate care. The navigator provides treatment summaries, patient education and navigates the referral services for survivors. Since clinic launch, 16 survivors out of 16 have successfully transitioned from pediatric to adult survivorship care. Positive feedback was received from patient satisfaction surveys that were administered. A common theme showed a relief from anxiety due to having a contact person to facilitate communication among providers in a complex healthcare system. Conclusions: The nurse navigator has minimized anxiety about transition for patients and parents as she establishes a relationship with patients at CM, and then is able to provide continuity as they transition to the STC at KUMC. The navigator also improves communication between pediatric providers, adult primary care providers and sub-specialists caring for the patients. Overall, our transition process has been effective and is now serving as a model across both institutions.

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