Abstract
Risk-stratified pathways of survivorship care seek to optimize coordination between cancer specialists and primary care physicians based on the whole person needs of the individual. While the principle is supported by leading cancer institutions, translating knowledge to practice confronts a lack of clarity about the meaning of risk stratification, uncertainties around the expectations the model holds for different actors, and health system structures that impede communication and coordination across the care continuum. These barriers must be better understood and addressed to pave the way for future implementation. Recognizing that an innovation is more likely to be adopted when user experience is incorporated into the planning process, a deliberative consultation was held as a preliminary step to developing a pilot project of risk-stratified pathways for patients transitioning from specialized oncology teams to primary care providers. This article presents findings from the deliberative consultation that sought to understand the perspectives of cancer specialists, primary care physicians, oncology nurses, allied professionals, cancer survivors and researchers regarding the following questions: what does a risk stratified model of cancer survivorship care mean to care providers and users? What are the prerequisites for translating risk stratification into practice? What challenges are involved in establishing these prerequisites? The multi-stakeholder consultation provides empirical data to guide actions that support the development of risk-stratified pathways to coordinate survivorship care.
Highlights
This paper reports on a deliberative consultation designed to incorporate provider and user perspectives and experience into the planning of a larger study to develop, test and measure outcomes of a risk-based coordinated cancer care model for patients transitioning from specialized oncology teams to primary care providers
Building on initiatives underway in other countries [27], the deliberative consultation addresses three main questions: (1) What does a risk-stratified model of cancer survivorship care mean to care providers and users? (2) What are the prerequisites for translating risk stratification into practice? (3) What challenges are involved in establishing these conditions? Findings are intended to assist clinicians and policymakers achieve delivery models that help address important challenges in contemporary survivorship care
The qualitative data collection grid was based on the following questions drawn from the Nose to Tail (NTT) tool [27]: What are your thoughts on the definition of risk stratification? How might this concept be adopted in the current practice environment? Which actors need to be involved in the adoption and implementation process? What do you see as the main barriers and facilitators to implementing a risk-stratified model? Are current conditions in the system favorable to implementing this type of innovation? What are the continuing education and coordination mechanisms required to ensure an effective risk-stratified approach? Discussions were audio recorded and transcribed for further analysis
Summary
2021, 28 to date in the UK suggests that it improves patient experience and patient satisfaction with potentially lower follow-up costs [23] Meeting both the medical and psychosocial needs of cancer survivors and implementing risk-stratified pathways, relies on individualized care coordinated between specialized cancer teams, primary care providers and self-management support. This paper reports on a deliberative consultation designed to incorporate provider and user perspectives and experience into the planning of a larger study to develop, test and measure outcomes of a risk-based coordinated cancer care model for patients transitioning from specialized oncology teams to primary care providers. The deliberative consultation covers the first three stages suggested in the NTT model: identify a shared definition of risk stratification, determine the prerequisites for translating risk stratification into practice and overcoming barriers, and identify resources needed to test a risk-stratified model of follow-up care for cancer survivors.
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