title: A comprehensive framework and key guideline recommendations for the provision of evidence-based breast cancer survivorship care within the primary care setting.
abstract: BACKGROUND
  Breast cancer survivors continue to experience physical and psychosocial health care needs post-treatment. Primary care involvement is increasing as cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up. Research suggests primary care providers (PCPs) are willing to provide survivorship care but many lack knowledge and confidence to provide evidence-based care. Although clinical practice guidelines (CPGs) exist for follow-up surveillance and certain aspects of survivorship care, no single comprehensive guideline addresses all significant breast cancer survivorship issues encountered in primary care.
  
  
  OBJECTIVE
  The purpose of this research was to create a comprehensive clinical practice framework to guide the provision of breast cancer survivorship care in primary care settings.
  
  
  METHODS
  This study consisted of an extensive search, appraisal and synthesis of CPGs for post-treatment breast cancer care using a modified Delphi method. Breast cancer survivorship issues and relevant CPGs were mapped to four essential components of survivorship care to create a comprehensive clinical practice framework to guide provision of breast cancer survivorship care.
  
  
  RESULTS
  The completed framework consists of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations and a one-page list of guideline sources. The framework and key guideline recommendations were verified by a panel of experts for comprehensiveness, importance and relevance to primary care.
  
  
  CONCLUSIONS
  This framework may serve as a tool to remind PCPs about issues impacting breast cancer survivors, as well as the evidence-based recommendations and resources to provide the associated care.
authors.affiliation: Faculty of Health Sciences, School of Nursing, mfl1@queensu.ca.
authors.forename: Marian
authors.initials: M
authors.lastname: Luctkar-Flude
authors.affiliation: Faculty of Health Sciences, School of Rehabilitation Therapy, Canadian Institute for Military and Veteran Health Research.
authors.forename: Alice
authors.initials: A
authors.lastname: Aiken
authors.affiliation: Faculty of Health Sciences, School of Rehabilitation Therapy, Centre for Health Services and Policy Research and.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: McColl
authors.affiliation: Faculty of Health Sciences, School of Nursing, Department of Public Health Sciences, Queen's University, Kingston, Canada.
authors.forename: Joan
authors.initials: J
authors.lastname: Tranmer
mesh_terms: D000359:Aftercare / Q000379:methods*; D001943:Breast Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D057189:Checklist; D003266:Continuity of Patient Care; D019317:Evidence-Based Medicine; D006801:Humans; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D017741:Survivors / Q000523:psychology
keywords: Aftercare; breast neoplasms; nurse practitioners; physicians; practice guideline; primary care; primary health care.