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From active treatment to surveillance: how the barriers and facilitators of implementing survivorship care planning could be an opportunity for telehealth in oncology care for rural patients

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Abstract

Purpose

Cancer survivorship care planning is a recognized yet underutilized aspect of care delivery, and the opportunity for telehealth in cancer survivorship is examined.

Methods

We conducted a mixed-methods study in Vermont and New Hampshire to characterize perceptions of rural cancer providers and survivors regarding survivorship transitions in care, consisting of (a) key informant interviews with primary care and oncology clinicians, (b) a broader survey of clinicians, and (c) surveys and focus group discussions with cancer survivors. In these interactions, we also explored the use of a shared telehealth survivorship care planning appointment between oncology clinicians, primary care clinicians, and survivors.

Results

Results from surveys and interviews clustered around several themes, namely (1) infrequent care transitioning back to primary care, (2) lack of mental health services, (3) lack of side effect education, (4) low perceived utility of survivorship care plans, (5) clinicians exclusively communicate using the EMR and finding it imperfect, and (6) clinicians and survivors reported conflicting perceptions regarding survivors’ access to telehealth options.

Conclusions

Our results suggest that telehealth has the potential to augment the delivery of survivorship care planning; however, key technical and logistical concerns need to be addressed, particularly enhanced coordination across clinician scheduling and ensuring payment parity for various telehealth implementation strategies.

Implications for Cancer Survivors

Cancer survivorship care planning is a recognized yet underutilized aspect of care delivery. There is an opportunity for the application of telehealth for supportive care in survivorship care planning, which should be a focus of further research.

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Data availability

Data created in this study are confidential and not available for redistribution due to small numbers.

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Funding

NCI Award P30CA0231108.

Author information

Authors and Affiliations

  1. Dartmouth Cancer Center, Lebanon, NH, 03756, USA

    Jennifer Alford-Teaster, Jenna Schiffelbein, Nirav Kapadia, Ardis Olson & Elizabeth B. McGrath

  2. Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA

    Jennifer Alford-Teaster & Nirav Kapadia

  3. Center for Program Design and Evaluation (CPDE) at the Dartmouth Institute for Health Policy and Clinical Practice (TDI), Lebanon, NH, USA

    Danielle Vaclavik & Karen Schifferdecker

  4. Population Health, Dartmouth Health, Lebanon, NH, USA

    Inger Imset

  5. MGH Institute of Health Professions, Boston, MA, USA

    Kathleen Lyons

  6. Department of Population Health Sciences, University of Utah and Huntsman Cancer Institute, Salt Lake City, UT, USA

    Tracy Onega

  7. Department of Radiation Oncology, Dartmouth Health, Lebanon, NH, USA

    Nirav Kapadia

Authors
  1. Jennifer Alford-Teaster
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Contributions

All authors have read and approved the manuscript, and each author has participated sufficiently in and stands by the validity of this work. Jennifer Alford-Teaster, MA, MPH, directed the study implementation, drafted the manuscript, and gave final approval for the submission. Dr. Danielle Vaclavik, Kathleen Lyons, and Dr. Karen Schifferdecker provided scientific mixed-methods expertise and study implementation, drafting, and review of the manuscript. Dr. Nirav Kapadia and Dr. Ardis Olson provided clinical content guidance and manuscript review. Ms. Inger Imset and Ms. Jenna Schiffelbein provided study implementation and analytic review and drafting of the manuscript. Ms. Elizabeth B. McGrath provided telehealth guidance and manuscript review, and Dr. Tracy Onega PhD, MA, MS, designed the study and provided a scientific overview and manuscript drafting.

Corresponding author

Correspondence to Jennifer Alford-Teaster.

Ethics declarations

Ethics approval

Study procedures and materials were reviewed and approved by the Dartmouth-Hitchcock Health Institutional Review Board (IRB).

Consent to participate

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research, supporting data is not available.

Conflict of interest

The authors declare no competing interests.

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Alford-Teaster, J., Vaclavik, D., Imset, I. et al. From active treatment to surveillance: how the barriers and facilitators of implementing survivorship care planning could be an opportunity for telehealth in oncology care for rural patients. J Cancer Surviv (2023). https://doi.org/10.1007/s11764-023-01447-5

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