Sharing Cancer Survivorship Care between Oncology and Primary Care Providers: A Qualitative Study of Health Care Professionals’ Experiences

Karolina Lisy,Michael Jefford,Amanda Piper,Jennifer Kent,Helana Kelly,Jodi Dumbrell

doi:10.3390/jcm9092991

Karolina Lisy, Michael Jefford + Show 4 more

Open Access

https://doi.org/10.3390/jcm9092991

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Abstract

Survivorship care that is shared between oncology and primary care providers may be a suitable model to effectively and efficiently care for the growing survivor population, however recommendations supporting implementation are lacking. This qualitative study aimed to explore health care professionals’ (HCPs) perceived facilitators and barriers to the implementation, delivery and sustainability of shared survivorship care. Data were collected via semi-structured focus groups and analysed by inductive thematic analysis. Results identified four overarching themes: (1) considerations for HCPs; (2) considerations regarding patients; (3) considerations for planning and process; and (4) policy implications. For HCPs, subthemes included general practitioner (GP, primary care physician) knowledge and need for further training, having clear protocols for follow-up, and direct communication channels between providers. Patient considerations included identifying patients suitable for shared care, discussing shared care with patients early in their cancer journey, and patients’ relationships with their GPs. Regarding process, subthemes included rapid referral pathways back to hospital, care coordination, and ongoing data collection to inform refinement of a dynamic model. Finally, policy implications included development of policy to support a consistent shared care model, and reliable and sustainable funding mechanisms. Based on study findings, a set of recommendations for practice and policy were developed.

Highlights

In 2018, there were an estimated 18.1 million new cancer diagnoses worldwide [1]
Hospital-based follow-up typically focuses on surveillance and detection of recurrence or new cancers, with less attention afforded to the whole-of-person needs of patients [8,9]
Five focus groups and one interview were conducted with a total of 22 health care professionals’ (HCPs)

Summary

Introduction

In 2018, there were an estimated 18.1 million new cancer diagnoses worldwide [1]. Increased cancer incidence, together with improved cancer treatments and the ageing of the population is leading to a growing population of people living with and beyond cancer—cancer survivors. In the United States, there were an estimated 16.9 million people living with cancer on 1 January 2019; this number is estimated to rise to 22.1 million by 2030 [2]. In 2014, 1.1 million survivors were estimated to be living in Australia, with this number projected to increase to 1.9 million by 2040 [3]. People living with and beyond cancer experience various unmet care needs across physical, psychosocial and supportive care domains [7]. An increasing number of older cancer survivors, who are more likely to have one or more comorbid conditions, adds additional complexity to the care required [10]. Development, evaluation and implementation of alternative models of care are urgent priorities to effectively and efficiently care for the growing cancer survivor population. There have been calls for an increased role for primary care in cancer follow-up [6,11]

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