Background
Breast cancer survivorship guidelines with specific recommendations on managing long-term effects are available, but uptake in clinical practice remains low. Using the lens of the Theoretical Domains Framework (TDF), we aimed to understand key factors in guideline-concordant management of long-term effects to inform future implementation efforts in clinical practice contexts.
Methods
As part of a broader survey of oncologists, a theoretically-guided questionnaire was developed. Oncologists were asked to report level of agreement with TDF-based statements, current usage and perceived value of survivorship resources, and frequency of managing long-term effects in routine care. Data analyses included psychometric assessment of the questionnaire, descriptive summaries of theoretical domains and survivorship resources, and multivariable logistic regression models.
Results
217 oncologists completed the TDF-based questionnaire. Fifty-four percent of oncologists reported “always or almost always” evaluating physical effects at routine survivorship appointments, while 34% did so for psychosocial effects. In regression models, Environmental Context and Resources was the only theoretical domain found to be significantly associated with “always or almost always” evaluating both physical (OR 0.29, 95% CI, 0.09-0.80) and psychosocial (OR 0.09, 95% CI, 0.02-0.35) effects.
Conclusions
Findings support application of the TDF in understanding oncologists’ behaviors and perceived barriers in managing long-term effects in breast cancer survivors. In future implementation efforts, this theoretically-informed approach can be used to target relevant domains and strategies focused on embedding guideline recommendations into the clinical context through structured resources and environmental supports.