Potential determinants of health-care professionals' use of survivorship care plans: a qualitative study using the theoretical domains framework.
BACKGROUND
Survivorship care plans are intended to improve coordination of care for the nearly 14 million cancer survivors in the United States. Evidence suggests that survivorship care plans (SCPs) have positive outcomes for survivors, health-care professionals, and cancer programs, and several high-profile organizations now recommend SCP use. Nevertheless, SCP use remains limited among health-care professionals in United States cancer programs. Knowledge of barriers to SCP use is limited in part because extant studies have used anecdotal evidence to identify determinants. This study uses the theoretical domains framework to identify relevant constructs that are potential determinants of SCP use among United States health-care professionals.


METHODS
We conducted semi-structured interviews to assess the relevance of 12 theoretical domains in predicting SCP use among 13 health-care professionals in 7 cancer programs throughout the United States with diverse characteristics. Relevant theoretical domains were identified through thematic coding of interview transcripts, identification of specific beliefs within coded text units, and mapping of specific beliefs onto theoretical constructs.


RESULTS
We found the following theoretical domains (based on specific beliefs) to be potential determinants of SCP use: health-care professionals' beliefs about the consequences of SCP use (benefit to survivors, health-care professionals, and the system as a whole); motivation and goals regarding SCP use (advocating SCP use; extent to which using SCPs competed for health-care professionals' time); environmental context and resources (whether SCPs were delivered at a dedicated visit and whether a system, information technology, and funding facilitated SCP use); and social influences (whether using SCPs is an organizational priority, influential people support SCP use, and people who could assist with SCP use buy into using SCPs). Specific beliefs mapped onto the following psychological constructs: outcome expectancies, intrinsic motivation, goal priority, resources, leadership, and team working.


CONCLUSIONS
Previous studies have explored a limited range of determinants of SCP use. Our findings suggest a more comprehensive list of potential determinants that could be leveraged to promote SCP use. These results are particularly timely as cancer programs face impending SCP use requirements. Future work should develop instruments to measure the potential determinants and assess their relative influence on SCP use.
Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA. birken@unc.edu.
Sarah A
SA
Birken
Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, NE2 4AX, Newcastle upon Tyne, UK. justin.presseau@ncl.ac.uk.
Justin
J
Presseau
Department of Health Policy and Management, University of Kansas School of Medicine, Mail Stop 3044, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA. sellis4@kumc.edu.
Shellie D
SD
Ellis
School of Nursing, University of North Carolina at Chapel Hill, 2800 Carrington Hall CB# 7460, Chapel Hill, NC, 27599, USA. gerstel@email.unc.edu.
Adrian A
AA
Gerstel
School of Nursing, University of North Carolina at Chapel Hill, 2800 Carrington Hall CB# 7460, Chapel Hill, NC, 27599, USA. dmayer@unc.edu.
Deborah K
DK
Mayer
D001291:Attitude of Health Personnel; D002173:Cancer Care Facilities / Q000458:organization & administration; D002983:Clinical Competence / Q000592:standards; D006040:Goals; D006282:Health Personnel; D006284:Health Plan Implementation / Q000458:organization & administration; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D009042:Motivation; D009369:Neoplasms / Q000628:therapy*; D010347:Patient Care Planning / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000458:organization & administration; D058996:Quality Improvement; D017741:Survivors; D014481:United States