scholarly journals What do primary care providers think about implementing breast cancer survivorship care?

2018 ◽  
Vol 25 (3) ◽  
pp. 196 ◽  
Author(s):  
M. Luctkar-Flude ◽  
A. Aiken ◽  
M.A. McColl ◽  
J. Tranmer
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Early Stage ◽  
Primary Care Providers ◽  
Evidence Based ◽  
Survivorship Care ◽  
Care Providers ◽  
Structured Interviews ◽  
Educational Preparation ◽  
Care Guidelines

Purpose As cancer centres move forward with earlier discharge of stable survivors of early-stage breast cancer (bca) to primary care follow-up, it is important to address known knowledge and practice gaps among primary care providers (pcps). In the present qualitative descriptive study, we examined the practice context that influences implementation of existing clinical practice guidelines for providing such care. The purpose was to determine the challenges, strengths, and opportunities related to implementing comprehensive evidence-based bca survivorship care guidelines by pcps in southeastern Ontario.Methods Semi-structured interviews were conducted with 19 pcps: 10 physicians and 9 nurse practitioners.Results Thematic analysis revealed 6 themes within the broad categories of knowledge, attitudes, and resources. Participants highlighted 3 major challenges related to providing bca survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden. They also described 3 major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles.Conclusions We identified several important challenges to implementation of comprehensive evidence-based survivorship care for bca survivors, as well as several strengths and opportunities that could be built upon to address those challenges. Findings from our research could inform targeted knowledge translation interventions to provide support and education for pcps and bca survivors.

scholarly journals Evidence-based recommendations on care for breast cancer survivors for primary care providers: a review of evidence-based breast cancer guidelines

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e015118 ◽  
Author(s):  
Inge Spronk ◽  
Joke C Korevaar ◽  
Francois G Schellevis ◽  
Tit Albreht ◽  
Jako S Burgers
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Methodological Quality ◽  
Primary Care Providers ◽  
Evidence Based ◽  
Survivorship Care ◽  
Care Providers ◽  
Recurrence Prevention ◽  
Cancer Guidelines ◽  
Quality Evidence

ObjectiveTo review evidence-based (EB) recommendations on survivorship care for primary care providers (PCPs) in EB breast cancer guidelines.Design and settingGuidelines were collected via experts and via literature database, guideline database and cancer agency websites searches.MethodEB guidelines in any language published between 2012 and 2017 were collected. EB recommendations on survivorship care relevant for PCPs were extracted and grouped into three categories (recurrence detection, long-term effects and recurrence prevention). The content of the recommendations was analysed and summarised in the number and type of clinical topics addressed. The Appraisal of Guidelines for Research and Evaluation II instrument was used to evaluate the methodological quality of the guidelines.ResultsSix guidelines, of which two were of acceptable methodological quality, were included. One was specifically made for general practitioners. Fifteen clinical topics were identified. Guidelines differed in the clinical topics addressed and for some identical topics in the content of the recommendations. Many recommendations were based on low-quality evidence. Recurrence detection received most attention, physical examination and mammography were often highlighted. Potential complications largely varied in number and type. Intimacy concerns, vaginal dryness, dyspareunia, fatigue, menopausal symptoms, peripheral neuropathy and lymphedema were reported in more than one guideline. Recurrence prevention was mentioned in four guidelines; all recommended physical activity.ConclusionThe number of EB recommendations in guidelines is limited. Moreover, recommendations differ between guidelines and most are based on low-quality evidence. More high-quality research is needed to develop and adapt guidelines to support PCPs in providing optimal breast cancer survivorship care.

Primary care providers’ evaluation of survivorship care plans.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 188-188
Author(s):  
Deborah Mayer ◽  
Kim Dittus ◽  
Dorothy Dulko ◽  
Clare Pace ◽  
Brian Sprague ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Patient ◽  
Primary Care Providers ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Providers ◽  
Care Plans ◽  
Care Guidelines ◽  
Barriers To Use ◽  
The Right

188 Background: Survivorship care represents a distinct phase of the cancer care and addresses surveillance, the physical and psychosocial sequelae of the cancer and treatment, and health promotion. Survivorship care plans (SCP) were recommended in the 2005 IOM From Cancer Patient to Cancer Survivor as a tool to address these issues and will be required by the Commission on Cancer in 2015. As part of two studies implementing SCP using the JourneyForward (JF-SCP) template, we evaluated primary care providers (PCP) perspective on their use. Methods: JF-SCP were developed and delivered to patients and PCP at the end of treatment. We collected information about usability, comprehension, barriers to use, and respondent demographics. Results: Of the 61 PCP who responded: 86% were physicians, 60% were women, had an average of 20 years in practice. PCP strongly agreed/agreed that SCP were easy to understand (95.7%), the right length (73.9%), addressed the right topics (95.7%), would be useful in talking with patients about survivorship plans (91.3%), would improve communication with oncologists (74.4%) and with patients (74.4%). Significant barriers interfering with the PCP providing follow-up care included: limited access to survivors as they stay with oncologists (59.5%), insufficient knowledge of issues (53.4%), inadequate recommendations from the oncologist (43.9%), lack of survivor care guidelines (42%), lack of time (38%), and poor reimbursement (16.6%). Specific suggestions about the JF-SCP included making it shorter and being clear about which provider was responsible for obtaining recommended testing. PCP commented on the importance of ongoing primary care provided throughout the cancer continuum. Conclusions: PCP reported ease of SCP use but did identify areas for improvement. Many PCP were frequently not included or did not stay involved with the cancer patient when being seen by oncologists. The SCP was viewed as a tool to facilitate communication with oncologists and patients.

Transition of breast cancer (BC) survivors to primary care: Results of a Cancer Care Ontario (CCO) pilot project.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 58-58 ◽  
Author(s):  
Jonathan Sussman ◽  
Maria Grant
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Primary Care Providers ◽  
Care Process ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Providers ◽  
Transition Clinic ◽  
Prospective Longitudinal

58 Background: Emerging evidence indicates that the transition of well breast cancer survivors to primary care is safe and effective. Methods: Prospective longitudinal cohort study across 14 health regions in Ontario, Canada. Each region received $100 000 (CAN) to develop and implement a sustainable new model of survivorship care for BC survivors that involved transition from medical oncology-led practice. Each region had a designated lead, and support from primary care. Funding could be used to develop any aspect of the model including personnel support, development of communication materials and outcome measurement. A minimal dataset reporting requirement included a description of the program, documentation of transitioned BC survivors as well as standardized patient and provider experience feedback once transition completed. Results: All 14 health regions in Ontario participated and all developed a survivorship care plan and patient educational materials. The models developed included direct transition to primary care in 6 regions, a nurse-led transition clinic in 4 and a GP-led transition clinic in 4. To date, 3,418 BC survivors have transitioned. Of 676 BC respondents to date, 83% felt there was a clear plan for follow up and 87% felt adequately prepared for transition. Feedback from primary care providers demonstrated that many feel informed about intent of transition and understand their role in on-going follow-up care. Process outcomes such as re-referral back to cancer center and adherence to follow-up guidelines are currently underway. Conclusions: The wide scale transition of appropriate BC survivors to a primary setting appears feasible with high acceptability by patients and providers.

Primary care providers propensity to order non-recommended surveillance testing after curative breast cancer treatment.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 52-52
Author(s):  
Lauren P. Wallner ◽  
Paul Abrahamse ◽  
Archana Radhakrishnan ◽  
Ann S. Hamilton ◽  
Kevin C. Ward ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Patients ◽  
Early Stage ◽  
Primary Care Providers ◽  
Early Stage Breast Cancer ◽  
Ca 125 ◽  
Care Providers ◽  
Breast Cancer Patients ◽  
High Propensity

52 Background: Team-based cancer care models promote primary care providers taking on a larger role in survivorship care. However, little is known about PCP attitudes toward and propensity to order non-recommended surveillance testing. Methods: A stratified random sample of PCPs identified by early-stage breast cancer patients diagnosed in 2013-15 who participated in iCanCare Study (Georgia and Los Angeles SEER registries) were surveyed about their experiences caring for cancer patients (N = 519, 58% response rate). PCPs were asked in a clinical vignette whether they would order non-recommended bone scans, other imaging (i.e. PET) or tumor marker testing (i.e. CA-125) in an asymptomatic, early-stage breast cancer survivor. A composite score was created by averaging their responses to the individual items, and categorized by tertiles into low, selective and high propensity to order non-recommended testing. PCP confidence in their knowledge about appropriate testing was also measured (5 pt. Likert-type scale; not all all-very confident) and compared with propensity to order. Multivariable, weighted, multinomial logistic regression was used to then evaluate PCP-reported factors associated with high and selective propensity to order non-recommended testing (vs. low). Results: In this sample, 32% of PCPs had a low propensity, 40% selective, and 28% a high propensity to order non-recommended surveillance tests. Of the 80% of PCPs who reported they were confident in their knowledge about appropriate testing, 27% had a high propensity to order. PCPs practicing in staff-model HMOs were less likely to have a high or selective propensity to order (vs. low) when compared to PCPs in private practice. (high aOR: 0.4, 95%CI: 0.2-0.7; selective aOR: 0.3, 95%CI: 0.2-0.6). Conclusions: Over a quarter of PCPs had a high propensity to order non-recommended surveillance testing for early-stage breast cancer patients, yet the majority reported they were confident in their knowledge about appropriate surveillance testing. Efforts to increase PCP knowledge about the specifics of breast cancer surveillance may be warranted to reduce the overuse of non-recommended testing during survivorship.

scholarly journals Implementation in a Large Health System of a Program to Identify Women at High Risk for Breast Cancer

2011 ◽  
Vol 7 (2) ◽  
pp. 85-88 ◽  
Author(s):  
William L. Owens ◽  
Thomas J. Gallagher ◽  
Michael J. Kincheloe ◽  
Victoria L. Ruetten
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
High Risk ◽  
Health System ◽  
Intervention Program ◽  
Primary Care Providers ◽  
Support Staff ◽  
Evidence Based ◽  
Care Providers ◽  
Breast Care

To implement an evidence-based screening and high-risk intervention program for breast cancer, primary care providers, breast care specialists, administrators, and support staff must work together in a multidisciplinary manner.

scholarly journals Engaging primary care providers in managing pediatric eating disorders: a mixed methods study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jocelyn Lebow ◽  
Cassandra Narr ◽  
Angela Mattke ◽  
Janna R. Gewirtz O’Brien ◽  
Marcie Billings ◽  
...  
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Mixed Methods ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Mixed Methods Study ◽  
Evidence Based ◽  
Care Providers ◽  
Evidence Based Treatment

Abstract Background The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers’ perspective of challenges to identifying and managing eating disorders in the primary care setting. Methods This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. Results Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. Conclusions Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.

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
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