Primary Care Physician Perspectives on Caring for Adult Survivors of Hematologic Malignancies and Hematopoietic Cell Transplantation

Mani, Shylaja; Khera, Nandita; Rybicki, Lisa; Marneni, Naimisha; Carraway, Hetty E.; Moore, Halle C. F.; Whited, Helen; Majhail, Navneet S.

doi:10.1016/j.clml.2019.11.008

Cited by 13 publications

(17 citation statements)

References 28 publications

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“…Only 34% had seen at least 5 late effects and 45% had seen a late effect of grade 3 or higher ( 61 ). These themes were echoed in a study of 86 PCPs regarding care for adult survivors of hematologic malignancies and hematopoietic cell transplantation ( 71 ). PCPs who had cared for more survivors felt more confident and perceived fewer barriers to doing so.…”

Section: Resultsmentioning

confidence: 99%

Realist Review of Care Models That Include Primary Care for Adult Childhood Cancer Survivors

Snyder

Choi

Smith

et al. 2022

JNCI Cancer Spectrum

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Appropriate models of survivorship care for the growing number of adult survivors of childhood cancer are unclear. We conducted a realist review to describe how models of care that include primary care, and relevant resources (e.g., tools, training), could be effective for adult survivors of childhood cancer. We first developed an initial program theory based on qualitative literature (studies, commentaries, opinion pieces) and stakeholder consultations. We then reviewed quantitative evidence and consulted stakeholders to refine the program theory, and to develop and refine context-mechanism-outcome (CMO) hypotheses regarding how models of care that include primary care could be effective for adult survivors of childhood cancer. Effectiveness for both resources and models is defined by survivors living longer and feeling better through high-value care. Intermediate measures of effectiveness evaluate the extent to which survivors and providers understand the survivor’s history, risks, symptoms and problems, healthcare needs, and available resources. Thus, the models of care and resources are intended to provide information to survivors and/or primary care providers to enable them to obtain/deliver appropriate care. The variables from our program theory found most consistently in the literature include oncology versus primary care specialty, survivor and provider knowledge, provider comfort treating childhood cancer survivors, communication and coordination between and among providers and survivors, and delivery/receipt of prevention and surveillance of late effects. In turn, these variables were prominent in our CMO hypotheses. The findings from this realist review can inform future research to improve childhood cancer survivorship care and outcomes.

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Section: Resultsmentioning

confidence: 99%

Realist Review of Care Models That Include Primary Care for Adult Childhood Cancer Survivors

Snyder

Choi

Smith

et al. 2022

JNCI Cancer Spectrum

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“…However, expert nurses spoke of their own role in fostering patient dependency on specialist service, further ingrained by non-specialist healthcare professional’s reticence to address haemato-oncology patients’ needs. These findings are unsurprising as primary care physicians describe barriers to care of including a lack of resources, awareness of screening and prevention guidelines, time and how to address psychosocial needs of haematology patients (Mani et al., 2020). Approaches such as education and training for community based non-oncology specialist healthcare professionals may be one approach to facilitate skill development and build confidence in patient management (Nekhlyudov et al., 2017), as well as reinforcing the concept of shared care with patients themselves.…”

Section: Discussionmentioning

confidence: 99%

Providing Telephone-Based Support for Patients With Haematological Malignancies: A Qualitative Investigation of Expert Nurses

2021

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Background Telephone-based interventions are frequently used to address cancer patient’s needs, often delivered by nurses; however, little is known about nurses’ opinions of such interventions. Purpose The objective of this study was to investigate expert nurses’ perceptions of hemato-oncology patient’s needs, use of telephone interventions providing support and symptom management and intervention acceptability from a service provider perspective. A qualitative study was undertaken with focus group and individual interview. Inductive and deductive data analysis was performed using Framework Analysis and the Theoretical Framework of Acceptability. Results Two themes emerged: (1) perceived needs of haemato-oncology patients across the cancer trajectory – multifactorial influences, dynamic information needs, and continuity of care, (2) acceptability for nurses delivering interventions was determined by identification of need, agreed expectations and organisational support for the intervention. Conclusions Greater understanding of contextual factors for recipients and individuals delivering healthcare interventions may contribute to identification of potential barriers and facilitators to adoption in clinical practice.

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“…The authors of the Dutch RCT in gynecologic cancer survivors conducted a followup analysis that examined how different preferences for information affected the impact of SCPs. 40 They compared "monitors," who desire information about their disease to "blunters," who avoid information. SCPs were more beneficial to monitors across the board, but particularly those who did not have easy access to other information sources, such as the internet.…”

Section: Mechanism A2: Transfer Of Information To Pcpsmentioning

confidence: 99%

Models of Care That Include Primary Care for Adult Survivors of Childhood Cancer: A Realist Review

Snyder¹,

Yuan²,

Wilson³

et al. 2022

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Objectives. We had two aims: (1) identify and analyze models of survivorship care for adult survivors of childhood cancer that include primary care, and (2) identify available tools, training, and other resources for adult survivors of childhood cancer. Methods. For each aim, we used realist synthesis to provide insights on how and for whom, in what contexts, and via what mechanisms the models of care and resources we identified can be effective for adult survivors of childhood cancer. We developed an initial program theory through searches of the literature and discussions with Stakeholders. We then identified and summarized quantitative evidence that supported or refuted the theory and developed specific hypotheses about how contexts and mechanisms may interact to produce outcomes (i.e., “CMO” hypotheses). The final program theory and CMO hypotheses were presented to Stakeholders for feedback. Results. Our final refined theory describes how, within the overall environment, survivor and provider characteristics and facilitators/barriers interact to produce intermediate and final outcomes. We focus on the role of models of care and resources (e.g., care plans) in these interactions. The program theory variables seen most consistently in the literature include oncology care versus primary care, survivor and provider knowledge (i.e., survivor risks and needs), provider comfort treating childhood cancer survivors, communication and coordination between and among providers and survivors, and delivery/receipt of prevention and surveillance of late effects of original cancer treatment. In turn, these variables played the most prominent role in the seven CMO hypotheses (4 focused on survivors and 3 focused on providers) regarding what works for whom and in what circumstances. Conclusions. To enable models of care that include primary care for adult survivors of childhood cancer, there needs to be communication of knowledge to both survivors and primary care providers. Our program theory provides guidance on the ways this knowledge could be shared, including the role of resources in doing so, and our CMO hypotheses suggest how the relationships illustrated in our theory could be associated with survivors living longer and feeling better through high-value care.

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Primary Care Physician Perspectives on Caring for Adult Survivors of Hematologic Malignancies and Hematopoietic Cell Transplantation

Cited by 13 publications

References 28 publications

Realist Review of Care Models That Include Primary Care for Adult Childhood Cancer Survivors

Realist Review of Care Models That Include Primary Care for Adult Childhood Cancer Survivors

Providing Telephone-Based Support for Patients With Haematological Malignancies: A Qualitative Investigation of Expert Nurses

Models of Care That Include Primary Care for Adult Survivors of Childhood Cancer: A Realist Review

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