Adult cancer survivorship care: experiences from the LIVESTRONG centers of excellence network

Abstract

Background The objectives of this study were to characterize survivorship models of care across eight LIVESTRONG Survivorship Center of Excellence (COE) Network sites and to identify barriers and facilitators influencing survivorship care. Methods Using the framework of the Chronic Care Model (CCM), quantitative and qualitative methods of inquiry were conducted with the COEs. Methods included document reviews, key informant telephone interviews with 39 participants, online Assessment of Chronic Illness Care (ACIC) surveys with 40 participants, and three site visits. Results Several overarching themes emerged in qualitative interviews and were substantiated by quantitative methods. Health system factors supporting survivorship care include organization and leadership commitment and program champions at various levels of the health care team. System barriers include reimbursement issues, lack of space, and the need for leadership commitment to support changes in clinical practices as well as having program “champions” among clinical staff. Multiple models of care include separate survivorship clinics and integrated models as well as consultative models. COEs' scores on the ACIC survey showed overall “reasonable support” for survivorship care; however, the clinical information system domain was least developed. Although the ACIC findings indicated “reasonable support” for self-management, the qualitative analysis revealed that self-management support was largely limited to health promotion provided in clinic-based education and counseling sessions, with few COEs providing patients with self-management tools and interventions. Conclusions The CCM framework captured experiences and challenges of these COEs and provided insight into the current state of survivorship care in the context of National Cancer Institute-designated comprehensive cancer centers. Findings showed that cancer patients and providers could benefit from clinical information systems that would better identify candidates for survivorship care and provide timely information. In addition, a crucial area for development is self-management support outside of clinical care. Implications for cancer survivors Cancer survivors may benefit from learning about the experience and challenges faced by the eight LIVESTRONG Centers of Excellence in developing programs and models for cancer survivorship care, and these findings may inform patient and caregiver efforts to seek, evaluate, and advocate for quality survivorship programs designed to meet their needs.

Survivorship Care Plans for Breast Cancer Patients: Understanding the Quality of the Available Evidence

“…We are therefore highlighting the urgent need for appropriate studies targeting secondary prevention of cancer for bca survivors, especially studies that explore lifestyle and behavioural factors, including diet. Campbell et al 84 indicated that support for patient self-management and use of evidence-based health promotion interventions were areas of relative weakness when survivorship models of care were analyzed in 8 livestrong Survivorship Centers of Excellence Network sites in the United States, corroborating our statement.…”

Survivorship Care Plans for People with Colorectal Cancer: Do They Reflect the Research Evidence?

“…We are therefore highlighting the urgent need for reliable studies that target secondary prevention of cancer for crc survivors, especially those that explore lifestyle and behavioural factors, including diet. Campbell et al 18 mention that support for patient self-management and use of evidence-based health-promotion interventions were areas of relative weakness when analyzing survivorship models of care used at 8 livestrong Survivorship Centers of Excellence Network sites in the United States, corroborating our statement.…”

“…Although scps are apparently beneficial, there are pragmatic challenges in implementing them not only in crc, but also across all disease groups. Examples include choosing a format, finding resources, managing time constraints, and allocating personnel 18 .…”

Process of diffusing cancer survivorship care into oncology practice

“…With permission, interviews were audio-taped and transcribed verbatim. An openended interview script utilized the framework of the CCM [4,14] and added questions about the strengths and weaknesses of the COE, challenges ORIGINAL RESEARCH (lessons learned) for program development, important accomplishments of the COE, changes over time, and the value of survivorship care to oncology practice. Site visits were conducted in May 2009 with three of the earliest-funded COEs.…”

“…Using both quantitative and qualitative data, findings from the study offered support for several domains of the chronic care model (CCM) which emphasizes the importance of six elements essential to improve chronic illness care: health system organization, delivery design, clinical information systems, selfmanagement care, decisional support, and community linkages [4]. A major issue that emerged from the qualitative data was the experience of the COEs in adopting and implementing the survivorship care programs into the oncology practices of their institutions.…”