Abstract
BackgroundCancer survivors face a myriad of biopsychosocial consequences due to cancer and treatment that may be potentially mitigated through enabling their self-management skills and behaviors for managing illness. Unfortunately, the cancer system lags in its systematic provision of self-management support (SMS) in routine care, and it is unclear what implementation approaches or strategies work to embed SMS in the cancer context to inform health policy and administrator decision-making.Methods/designA comprehensive scoping review study of the literature will be conducted based on methods and steps identified by Arksey and O’Malley and experts in the field. Electronic searches will be conducted in multiple databases including CINAHL, CENTRAL, EMBASE, PsycINFO, MEDLINE, AMED, Cochrane Database of Systematic Reviews, Database of s of Reviews of Effects (DARE) (up to Issue 2, 2015), ISI Proceedings (Web of Science), Psychs, and Sociological s from January 1997 to November 5, 2018. Following the PRISMA-Extension for Scoping Reviews (PRISMA-ScR), two authors will independently screen all titles/abstracts to determine eligibility, data will be abstracted by one author and checked by a second author, and findings will be narratively summarized based on constructs of implementation in the Normalization Process Theory.DiscussionThis will be the first scoping review study to synthesize knowledge of implementation of SMS in the cancer care context and the implementation approaches and strategies on embedding in care. This information will be critical to inform health policy and knowledge end users about the necessary changes in care to embed SMS in practices and to stimulate future research.
Highlights
Cancer survivors face a myriad of biopsychosocial consequences due to cancer and treatment that may be potentially mitigated through enabling their self-management skills and behaviors for managing illness
The five stages of this scoping literature review to be followed are described below: Stage 1: Identification of the research questions Based on the PICOH acronym [37], our overall broad scoping review question is as follows: What is known in cancer populations (P—population) about the approaches to implementation of self-management support (SMS) interventions and/or programs (I—intervention) compared to usual care or other interventions such as implementation of patient education (C—comparator) on changes in outcomes (O—outcomes, may include four levels of change in patient knowledge, skills and/or behaviors, or intermediary variables, i.e., self-efficacy, health care provider knowledge/skills, care delivery processes, or system arrangements or health policy) in the context of cancer care (H—healthcare context: community-based programs, hospitals, primary care practices, ambulatory or outpatient care)
While there are reviews of the implementation of SMS in routine care and significant efforts underway in the UK to integrate SMS in routine care, the emphasis has been on non-malignant chronic conditions [24] and we were unable to identify any scoping reviews of implementation studies of SMS in the context of cancer care
Summary
Cancer survivors face a myriad of biopsychosocial consequences due to cancer and treatment that may be potentially mitigated through enabling their self-management skills and behaviors for managing illness. Cancer healthcare systems lag other chronic diseases in the provision of SMS in routine care, which may leave cancer patients vulnerable to becoming sicker and at risk of worse survival [12] This is not surprising given that implementation of SMS requires “whole-system” change inclusive of (1) training and guidance of patients in self-management, (2) development of clinicians’ skills so they can support patients to do this, and (3) change in care processes to enable these approaches to become a core element of care [22,23,24]. Implementation is a complex endeavor in the context of the rapid, episodic nature of cancer care, and adding greater expectations to existing practice systems is unlikely to be successful [28]
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