Abstract
BackgroundCancer is now viewed as a chronic disease, presenting challenges to follow-up and survivorship care. Models to shift from haphazard, suboptimal and fragmented episodes of care to an integrated cancer care continuum must be developed, tested and implemented. Numerous studies demonstrate improved care when follow-up is assured by both oncology and primary care providers rather than either group alone. However, there is little data on the roles assumed by specialized oncology teams and primary care providers and the extent to which they work together. This study aims to develop, pilot test and measure outcomes of an innovative risk-based coordinated cancer care model for patients transitioning from specialized oncology teams to primary care providers.Methods/designThis multiple case study using a sequential mixed-methods design rests on a theory-driven realist evaluation approach to understand how transitions might be improved. The cases are two health regions in Quebec, Canada, defined by their geographic territory. Each case includes a Cancer Centre and three Family Medicine Groups selected based on differences in their determining characteristics. Qualitative data will be collected from document review (scientific journal, grey literature, local documentation), semi-directed interviews with key informants, and observation of care coordination practices. Qualitative data will be supplemented with a survey to measure the outcome of the coordinated model among providers (scope of practice, collaboration, relational coordination, leadership) and patients diagnosed with breast, colorectal or prostate cancer (access to care, patient-centredness, communication, self-care, survivorship profile, quality of life). Results from descriptive and regression analyses will be triangulated with thematic analysis of qualitative data. Qualitative, quantitative, and mixed methods data will be interpreted within and across cases in order to identify context-mechanism associations that explain outcomes.DiscussionThe study will provide empirical data on a risk-based coordinated model of cancer care to guide actions at different levels in the health system. This in-depth multiple case study using a realist approach considers both the need for context-specific intervention research and the imperative to address research gaps regarding coordinated models of cancer care.
Highlights
Cancer is viewed as a chronic disease, presenting challenges to follow-up and survivorship care
Methods/design The methodological approach (Fig. 2) is adapted to our research questions and to the stages involved in development, implementation, and evaluation of the intervention [48], along with conditions required to produce the outcomes of the Risk-based Coordinated Cancer Care Model (RbCCCM)
The design involves a multiple case study based on qualitative data that draws on the principles of realist evaluation and quantitative data in an experimental approach
Summary
Cancer is viewed as a chronic disease, presenting challenges to follow-up and survivorship care. This study aims to develop, pilot test and measure outcomes of an innovative risk-based coordinated cancer care model for patients transitioning from specialized oncology teams to primary care providers. Between 35% and 40% of survivors will need expert support to manage symptoms and distress, while 10% to 15% will require close follow-up and more complex interventions [16] This follow-up care must consider the physical, psychological and side effect aspects of survivorship [16], as well as multimorbidity [8, 17]. This is especially important during transitions between specialized cancer care and primary care with a family physician [8, 9, 15]. Coordinated care models are sought by both clinicians and survivors to ensure that needs are met in the right way, at the right time, by the most appropriate professional [6]
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