Abstract
BackgroundWith over 3 million US prostate cancer survivors, ensuring high‐quality, coordinated cancer survivorship care is important. However, implementation of recommended team‐based cancer care has lagged, and determinants of quality care across primary and specialty care remain unclear. Guided by the theoretical domains framework (TDF), we explored multidisciplinary determinants of quality survivorship care in an integrated delivery system.MethodsWe conducted semistructured interviews with primary (4) and specialty (7) care providers across 6 Veterans Health Administration clinic sites. Using template analysis, we coded interview transcripts into the TDF, mapping statements to specific constructs within each domain. We assessed whether each construct was perceived a barrier or facilitator, examining results for both primary care providers (PCPs) and prostate cancer specialists.ResultsCancer specialists and PCPs identified 2 primary TDF domains impacting their prostate cancer survivorship care: Knowledge and Environmental context and resources. Both groups noted knowledge (about survivorship care) and procedural knowledge (about how to deliver survivorship care) as positive determinants or facilitators, whereas resources/material resources (to deliver survivorship care) was noted as a negative determinant or barrier to care. Additional domains more commonly referenced by cancer specialists included Social/professional role and identity and Goals, while PCPs reported the domain Beliefs about capabilities as relevant.ConclusionsWe used the TDF to identify several behavioral domains acting as determinants of high‐quality, team‐based prostate cancer survivorship care. These results can inform prostate cancer survivorship care plan content, and may guide tailored, multidisciplinary implementation strategies to improve survivorship care across the primary and specialty care interface.
Highlights
Providing high‐quality cancer survivorship care is challenging
While most men have follow‐up with both primary care providers (PCPs) and cancer specialists, which provider is responsible for delivering survivorship care is often unclear leading to gaps in quality prostate cancer survivorship care.[4,5,6,7,8]
We explored prostate cancer survivorship care among PCPs and cancer specialists within an integrated healthcare delivery system
Summary
Providing high‐quality cancer survivorship care is challenging. are the number of cancer survivors rapidly growing, many older with several medical comorbidities, there is an increasing oncologist shortage leading to an inability to meet the demands of the cancer survivor population.[1,2] Nearly a quarter of cancer survivors have faced prostate cancer and many of these men have persistent urinary, sexual, bowel, and psychosocial symptoms, necessitating long‐term management similar to a chronic disease.[3]. PCPs might endorse a lack of knowledge in survivorship care, while oncologists report lack of time and resources to deliver this care.[14,15,16] optimizing survivorship care requires better understanding behavioral determinants acting as barriers and facilitators, and addressing those determinants through tailored, multidisciplinary interventions. Results: Cancer specialists and PCPs identified 2 primary TDF domains impacting their prostate cancer survivorship care: Knowledge and Environmental context and resources. Conclusions: We used the TDF to identify several behavioral domains acting as determinants of high‐quality, team‐based prostate cancer survivorship care These results can inform prostate cancer survivorship care plan content, and may guide tailored, multidisciplinary implementation strategies to improve survivorship care across the primary and specialty care interface
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