Building an embedded primary care survivorship model using an implementation science approach.

Abstract

35 Background: There is limited understanding of factors that affect uptake of different models of survivorship care. Few systems have incorporated implementation science into program planning and implementation. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted an evaluation of stakeholder-perceived acceptability and feasibility of an embedded primary care provider (PCP) survivorship care model as the initial step of an implementation project within an integrated healthcare system. Methods: We identified clinical, operational, and patient stakeholders and conducted semi-structured qualitative interviews. Interviews were recorded, transcribed, coded, and analyzed. Deductive thematic categories were derived a priori from CFIR domains (e.g., acceptability, culture); thematic sub-categories were developed inductively. Results: We interviewed 12 stakeholders; a diverse array of themes was identified. Acceptability: Oncologists and operational leaders perceived the model to be an acceptable solution to issues of capacity and efficiency with the potential to improve quality; however, several oncologists perceived negative consequences including “[loss of] the joy of medicine”. PCPs perceived difficulty in co-managing existing patient panels and new survivors. Patients were less enthusiastic, fearing the loss of a trusted clinician and wary about the introduction of “[someone] who doesn’t know me.” Feasibility: Organizational confidence was high that this model can succeed, although there was concern about finding the right PCP and investment in training and staff support. Culture: Numerous system-level facilitators were identified, including the integrated structure: “We don’t have a fee for service mentality so nobody’s giving up revenue.” Conclusions: Acceptability and feasibility for this model were high among oncologists and operational leaders but patients were ambivalent. Successful implementation requires training and support of engaged PCPs and staff, and a formalized patient transition introduced early in the care trajectory. Operationalization of survivorship models may be improved with integration of implementation science methods.