title: Thyroid cancer survivors' perceptions of survivorship care follow-up options: a cross-sectional, mixed-methods survey.
abstract: OBJECTIVE
  This study investigated thyroid cancer (TC) survivors' perceived satisfaction with and perceptions of survivorship care follow-up options.
  
  
  METHODS
  Well-differentiated TC (WDTC) patients receiving follow-up care at an academic cancer centre completed a questionnaire assessing perceived satisfaction with follow-up care involving different clinicians and mediated by the Internet (email or videoconference) and their perceptions of these follow-up options. We examined associations between patient characteristics and perceived satisfaction with follow-up care options. Qualitative responses were analysed using conventional content analysis.
  
  
  RESULTS
  Two hundred and two respondents completed the questionnaire (80 % response rate). The majority strongly agreed or agreed that they would be satisfied with specialist (surgeon, oncologist, or endocrinologist) follow-up (90.6 %) or a shared-care model that integrates specialists with primary care (67.5 %). One third (32 %) would be satisfied with video-based and 26 % with email-based specialist follow-up, 15 % with primary care alone. Longer time since diagnosis and health-related Internet use were associated with higher perceived satisfaction with Internet-based follow-up. Younger age was associated with higher perceived satisfaction with primary care follow-up. Qualitative responses (n = 145) revealed that survivors need reassurance they are receiving adequate care, regardless of the model or medium. Enablers to primary care and Internet-based follow-up are discussed.
  
  
  CONCLUSIONS
  WDTC survivors want specialists involved in their follow-up. A specialist/primary care shared-care approach appears to be a suitable alternative to specialist-led follow-up for TC survivors. Internet-based visits could address some aspects of follow-up care for some WDTC survivors. Future work should examine patient and provider requirements for shared, multi-modal survivorship care.
authors.affiliation: ELLICSR Health, Wellness and Cancer Survivorship Centre, University Health Network, Toronto, ON, Canada. jackie.bender@uhnresearch.ca.|Centre for Global Health Innovation, University Health Network, Toronto, ON, Canada. jackie.bender@uhnresearch.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. jackie.bender@uhnresearch.ca.
authors.forename: Jacqueline L
authors.initials: JL
authors.lastname: Bender
authors.affiliation: Centre for Addiction and Mental Health, Toronto, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Wiljer
authors.affiliation: Division of Endocrinology, University Health Network, Toronto, ON, Canada.|Department of Endocrinology, University of Toronto, Toronto, ON, Canada.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Sawka
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.|Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Tsang
authors.affiliation: ELLICSR Health, Wellness and Cancer Survivorship Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Nour
authors.initials: N
authors.lastname: Alkazaz
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.|Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
authors.forename: James D
authors.initials: JD
authors.lastname: Brierley
mesh_terms: D000328:Adult; D000367:Age Factors; D002170:Canada; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D000068237:Distance Counseling / Q000379:methods / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D057240:Patient Preference; D036301:Qualitative Research; D012938:Social Perception; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data; D013964:Thyroid Neoplasms / Q000523:psychology / Q000628:therapy
keywords: Follow-up; Internet; Survivorship; Technology; Thyroid cancer