Implementing novel models of posttreatment care for cancer survivors: Enablers, challenges and recommendations

Abstract

The VCSP project outcomes have added to growing evidence around posttreatment care. Future projects should consider the identified enablers and challenges when designing and implementing survivorship care.

Rethinking system change in cancer

“…5 Implementation science recognizes that action is needed at an individual level and a system level in order to make a major change to models of care such as those described by Jefford et al in this issue. 8 Useful frameworks for designing change processes include the Knowledge to Action Cycle 9 , the United Kingdom Medical Research Council Complex Interventions Framework 10 and the Theoretical Domains Framework 11 for the assessment of barriers and enablers to change. The Behavior Change Wheel 12 describes the necessary components of behavior change at an individual level (capability, opportunity and motivation), along with the intervention activities and the policy-level elements (e.g.…”

“…For example, Jefford et al emphasizes pathways, partnerships, rapid access and shared care -all of which require efficient integrated information systems. 8 While rapid and efficient communication is possible via electronic means, current health system networks/interfaces can be highly problematic for electronic sharing of health information.…”

“…Implementation scientists could help address some of the challenges noted in the Jefford article related to current gaps in the measurement of the effects of care on important outcomes. 8 Measurement of outcomes is a crucial element of implementation success. We are hampered by what Kass et al have called the "artificial distinction between research and practice."…”

How will cancer survivors use survivorship care plans?

“…A process of needs assessment is recommended to tailor a SCP to the individual's issues and concerns [3,12].…”

“…For HCPs common barriers to using SCPs in clinical practice include: limited time [3,9,10,[12][13][14][15]; concerns about cost and remuneration [3,9,10,[13][14][15]; uncertainty about effectiveness and limited long-term outcome data [3,9,12,14]; limited advocacy for SCPs from clinical leaders within health services [3,10,12,16]; lack of resources [3,8,9,12,13] and absence of clearly identified personnel responsible for preparation, delivery and update of the SCP [3,9,10,12,13,16].…”