Adult cancer survivorship care: experiences from the LIVESTRONG centers of excellence network
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The objectives of this study were to characterize survivorship models of care across eight LIVESTRONG Survivorship Center of Excellence (COE) Network sites and to identify barriers and facilitators influencing survivorship care.
Using the framework of the Chronic Care Model (CCM), quantitative and qualitative methods of inquiry were conducted with the COEs. Methods included document reviews, key informant telephone interviews with 39 participants, online Assessment of Chronic Illness Care (ACIC) surveys with 40 participants, and three site visits.
Several overarching themes emerged in qualitative interviews and were substantiated by quantitative methods. Health system factors supporting survivorship care include organization and leadership commitment and program champions at various levels of the health care team. System barriers include reimbursement issues, lack of space, and the need for leadership commitment to support changes in clinical practices as well as having program “champions” among clinical staff. Multiple models of care include separate survivorship clinics and integrated models as well as consultative models. COEs’ scores on the ACIC survey showed overall “reasonable support” for survivorship care; however, the clinical information system domain was least developed. Although the ACIC findings indicated “reasonable support” for self-management, the qualitative analysis revealed that self-management support was largely limited to health promotion provided in clinic-based education and counseling sessions, with few COEs providing patients with self-management tools and interventions.
The CCM framework captured experiences and challenges of these COEs and provided insight into the current state of survivorship care in the context of National Cancer Institute-designated comprehensive cancer centers. Findings showed that cancer patients and providers could benefit from clinical information systems that would better identify candidates for survivorship care and provide timely information. In addition, a crucial area for development is self-management support outside of clinical care.
Implications for cancer survivors
Cancer survivors may benefit from learning about the experience and challenges faced by the eight LIVESTRONG Centers of Excellence in developing programs and models for cancer survivorship care, and these findings may inform patient and caregiver efforts to seek, evaluate, and advocate for quality survivorship programs designed to meet their needs.
KeywordsCancer Cancer survivorship Chronic care model Health care
- 1.Horner MJ, Ries LAG, Krapcho M, Neyman N, Aminou R, Howlader N, et al. SEER cancer statistics review, 1975–2006. Bethesda: National Cancer Institute, 2009; http://seer.cancer.gov/csr/1975_2006/.
- 2.Hewitt ME, Greenfield S, Stovall E. From cancer patient to cancer survivor: Lost in transition. Washington, DC: National Academies; 2006.Google Scholar
- 7.Wagner EH, Austin BT, Vonkorff M. Improving outcomes in chronic illness. Manage Care Q. 1996;4:12–25.Google Scholar
- 9.Feuerstein M, Ganz PA. Quality health care for cancer survivors. In: Feuerstein M, Ganz P, editors. Health care for cancer survivors. New York: Springer; 2011.Google Scholar
- 10.The MacColl Institute. Improving chronic illness care. Seattle: The MacColl Institute; 2010.Google Scholar
- 13.Agency for Healthcare Research and Quality. Toolkit for implementing the Chronic Care Model in an academic environment. Rockville: AHRQ Publication No. 08-MP085, 2008. http://www.ahrq.gov/populations/chroniccaremodel/. Accessed 2010.
- 14.Roberts M. Cancer deaths across Europe tipped to fall in 2011. BBC news, February 8, 2011, http://www.bbc.co.uk/news/health-12394329.
- 19.Wang MC, Hyun JK, Harrison M, Shortell SM, Fraser I. Redesigning health systems for quality: lessons from emerging practices. Joint Comm J Qual Patient Saf. 2006;32:599–611.Google Scholar
- 20.Sperl-Hillen JM, Solberg LI, Hroscikoski MC, Crain AL, Engebretson KI, O'Connor PJ. Do all components of the chronic care model contribute equally to quality improvement? Joint Comm J Qual Patient Saf. 2004;30:303–9.Google Scholar