Identifying Strategies for Robust Survivorship Program Implementation: A Qualitative Analysis of Cancer Programs

Abstract

PURPOSE The Commission on Cancer seeks to promote robust survivorship programs among accredited cancer programs. In practice, cancer programs' survivorship programs range from cursory (eg, developing care plans without robust services) to robust (eg, facilitating follow-up care). To inform cancer programs' future efforts, in this study, we identified the implementation strategies that cancer programs used to achieve robust survivorship programs, distinguishing them from cursory programs. METHODS We sampled 39 cancer programs across the United States with approaches to survivorship program implementation ranging from cursory to robust on the basis of LIVESTRONG survivorship care consensus elements. Within sampled cancer programs, we conducted in-depth semistructured interviews with a total of 42 health care professionals. We used template analysis to distinguish implementation strategies used in cancer programs with robust survivorship programs from strategies that yielded cursory survivorship programs. RESULTS Cancer programs with robust survivorship programs established clear systems survivorship care and formal committees to improve the survivorship care processes. They sought buy-in from multiple stakeholders to leverage cancer program resources and defined clear roles with shared accountability among multidisciplinary groups. By contrast, cancer programs with cursory survivorship programs reported less consistency in survivorship care processes and lacked buy-in from key stakeholders. They had limited resources, faced persistent structural concerns, and had insufficient clarity in roles among team members. CONCLUSION Accrediting bodies may consider incorporating the implementation strategies that robust survivorship programs have used as guidance for supporting cancer programs in operationalizing survivorship care and evaluating the use of these strategies during the accreditation and review process.

Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer

“…This is not surprising since previous literature has demonstrated that even robust survivorship programs face challenges and implementation struggles. 35 Actions that can be implemented to help overcome these challenges include educational activities for increasing physician awareness, inclusion of digital solutions for minimizing time and distance-related burden (eg, virtual Transition Day), formal economic valorization with protected time for pathway delivery, and continuous cocreation of pathway components with patients to ensure the that they respond to their needs. Moreover, an upfront identification of patients with very low clinical complexity and high self-management skills and who do not need extensive pathway resources is desirable.…”