title: Provider perceptions and expectations of breast cancer posttreatment care: a University of California Athena Breast Health Network project.
abstract: OBJECTIVE
  The Athena Breast Health Network collaboration is a University of California system-wide project initiated with the intent to drive innovation in breast cancer prevention, screening, and treatment. This qualitative research examines provider perceptions and expectations of posttreatment breast cancer care across five network sites with the goal of better understanding provider behavior during the posttreatment phase of the cancer care trajectory.
  
  
  METHODS
  Investigators at each site conducted semi-structured interviews with oncology specialists and primary care providers (PCPs). Interviews used case study examples and open- and closed-ended questions on the delivery of posttreatment breast cancer care. Informant responses were manually recorded by the interviewer, compiled in a database, then coded and analyzed using NVivo 9 software.
  
  
  RESULTS
  There were 39 key informants across the sites: 14 medical oncologists, 7 radiation oncologists, 11 surgeons, 3 oncology nurses, and 4 PCPs. Care coordination was a major unprompted theme identified in the interviews. There was a perceived need for greater care coordination across institutions in order to improve delivery of posttreatment health care services and a need for greater care coordination within oncology, particularly to help avoid duplication of follow-up care and services. Participants expect frequent follow-up visits and to use biomarker tests and advanced imaging services as part of routine surveillance care. Implementing survivorship care programs was perceived as a way to improve care delivery.
  
  
  CONCLUSIONS
  These results identify a need for increased focus on care coordination during the posttreatment phase of breast cancer care within the University of California system and the potential for system and provider-level interventions that could help increase coordination of posttreatment care.
  
  
  CONCLUSIONS
  Breast cancer survivors do not always receive evidence-based care. This research helps to better understand what motivates provider behavior during the posttreatment phase and lays a foundation for targeted interventions to increase adherence to evidence-based recommendations.
authors.affiliation: Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center at UCLA, 650 Charles Young Drive South, Los Angeles, CA 90095-6900, USA. EHahn@mednet.ucla.edu
authors.forename: Erin E
authors.initials: EE
authors.lastname: Hahn
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Melisko
authors.forename: John P
authors.initials: JP
authors.lastname: Pierce
authors.forename: Marlene
authors.initials: M
authors.lastname: von Friederichs-Fitzwater
authors.forename: Karen T
authors.initials: KT
authors.lastname: Lane
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hiatt
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology / Q000628:therapy*; D002140:California; D019058:Community Networks; D003266:Continuity of Patient Care / Q000458:organization & administration; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008495:Medical Oncology / Q000379:methods / Q000458:organization & administration; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration / Q000706:statistics & numerical data; D010465:Perception; D010820:Physicians / Q000523:psychology*; D011320:Primary Health Care / Q000458:organization & administration; D011795:Surveys and Questionnaires