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Learning the landscape: implementation challenges of primary care innovators around cancer survivorship care

Abstract

Purpose

This study describes the experiences of early implementers of primary care-focused cancer survivorship delivery models.

Methods

Snowball sampling was used to identify innovators. Twelve participants (five cancer survivorship primary care innovators and seven content experts) attended a working conference focused on cancer survivorship population strategies and primary care transformation. Data included meeting discussion transcripts/field notes, transcribed in-depth innovator interviews, and innovators’ summaries of care models. We used a multistep immersion/crystallization analytic approach, guided by a primary care organizational change model.

Results

Innovative practice models included: (1) a consultative model in a primary care setting; (2) a primary care physician (PCP)-led, blended consultative/panel-based model in an oncology setting; (3) an oncology nurse navigator in a primary care practice; and (4) two subspecialty models where PCPs in a general medical practice dedicated part of their patient panel to cancer survivors. Implementation challenges included (1) lack of key stakeholder buy-in; (2) practice resources allocated to competing (non-survivorship) change efforts; and (3) competition with higher priority initiatives incentivized by payers.

Conclusions

Cancer survivorship delivery models are potentially feasible in primary care; however, significant barriers to widespread implementation exist. Implementation efforts would benefit from increasing the awareness and potential value-add of primary care-focused strategies to address survivors’ needs.

Implications for Cancer Survivors

Current models of primary care-based cancer survivorship care may not be sustainable. Innovative strategies to provide quality care to this growing population of survivors need to be developed and integrated into primary care settings.

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Acknowledgments

We thank steering committee members: Carlos Jaen, MD, PhD; Kelly Kelleher, MD; Kurt Stange, MD, PhD; Paul Nutting, MD, MSPH; and William L. Miller, MD, MA.

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Authors

Corresponding author

Correspondence to Denalee O’Malley.

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Funding

Data collection for this article was supported by a conference grant from AHRQ (R13HS021287) awarded to Dr. Crabtree. Drs. Crabtree and Hudson were partially supported by National Cancer Institute grants R01 CA176545 and R01 CA176838. Ms. O’Malley was supported through a Doctoral Training Grant in Oncology Social Work (DSW 13-279-01) from the American Cancer Society. This work also benefitted from support from Cancer Center Support Grant P30 CA072720 to the Rutgers Cancer Institute of New Jersey.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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O’Malley, D., Hudson, S.V., Nekhlyudov, L. et al. Learning the landscape: implementation challenges of primary care innovators around cancer survivorship care. J Cancer Surviv 11, 13–23 (2017). https://doi.org/10.1007/s11764-016-0555-2

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  • DOI: https://doi.org/10.1007/s11764-016-0555-2

Keywords

  • Cancer survivorship models
  • Primary care
  • Implementation research
  • Qualitative
  • Integration of care