Using the approach described, wide-scale transition of appropriate BC survivors from oncology-led practice is feasible over a fairly short timeframe.

103 Background: Primary care providers (PCPs) have an important role in the provision of survivorship care. While there is evidence to support the feasibility and safety of PCP-led survivorship care, there are gaps in knowledge about how to best integrate providers to support transitions, enhance quality of care, increase system efficiencies, and improve patient and provider satisfaction. Methods: A pan-Canadian study comprised of three projects has been initiated to address three key aspects of care integration, based on a previously described system performance framework. Functional integration will be studied through the evaluation of electronic survivorship care plans using a prospective cohort of breast and colorectal cancer patients with pre and post measures of knowledge, care coordination, and satisfaction. Vertical integration will be evaluated through a series of descriptive case studies to document structures and processes that are currently in place to support PCP re-referral to regional cancer centres. Clinical integration will be studied through the development and evaluation of an interspecialty survivorship training curriculum for oncology and family medicine trainees. Results: Functional integration: Development of an electronic platform for care plan outputs is complete. Two sites in Ontario (ON) and one in British Columbia (BC) have been selected to study the impact on 200 patients and their providers. Vertical integration: Using a study-specific interview guide, 48 semi-structured key informant interviews have been successfully conducted in ON; 15 interviews are planned for Manitoba (MB) and 15 for BC. Clinical Integration: a National Advisory Committee was established and needs assessments were performed with postgraduate program directors, cancer survivors, and trainees using online surveys and focus groups. A blended learning curriculum is being piloted in MB, ON, and BC in 2015. Conclusions: Integrating primary care and cancer care in survivorship requires a collaborative approach that begins in residency, supports PCPs with clear mechanisms for re-entry, and optimizes communication. This study will inform approaches to enhancing provider integration and survivorship care.

58 Background: Emerging evidence indicates that the transition of well breast cancer survivors to primary care is safe and effective. Methods: Prospective longitudinal cohort study across 14 health regions in Ontario, Canada. Each region received $100 000 (CAN) to develop and implement a sustainable new model of survivorship care for BC survivors that involved transition from medical oncology-led practice. Each region had a designated lead, and support from primary care. Funding could be used to develop any aspect of the model including personnel support, development of communication materials and outcome measurement. A minimal dataset reporting requirement included a description of the program, documentation of transitioned BC survivors as well as standardized patient and provider experience feedback once transition completed. Results: All 14 health regions in Ontario participated and all developed a survivorship care plan and patient educational materials. The models developed included direct transition to primary care in 6 regions, a nurse-led transition clinic in 4 and a GP-led transition clinic in 4. To date, 3,418 BC survivors have transitioned. Of 676 BC respondents to date, 83% felt there was a clear plan for follow up and 87% felt adequately prepared for transition. Feedback from primary care providers demonstrated that many feel informed about intent of transition and understand their role in on-going follow-up care. Process outcomes such as re-referral back to cancer center and adherence to follow-up guidelines are currently underway. Conclusions: The wide scale transition of appropriate BC survivors to a primary setting appears feasible with high acceptability by patients and providers.

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