Learning the landscape: implementation challenges of primary care innovators around cancer survivorship care.
This study describes the experiences of early implementers of primary care-focused cancer survivorship delivery models.



Snowball sampling was used to identify innovators. Twelve participants (five cancer survivorship primary care innovators and seven content experts) attended a working conference focused on cancer survivorship population strategies and primary care transformation. Data included meeting discussion transcripts/field notes, transcribed in-depth innovator interviews, and innovators' summaries of care models. We used a multistep immersion/crystallization analytic approach, guided by a primary care organizational change model.



Innovative practice models included: (1) a consultative model in a primary care setting; (2) a primary care physician (PCP)-led, blended consultative/panel-based model in an oncology setting; (3) an oncology nurse navigator in a primary care practice; and (4) two subspecialty models where PCPs in a general medical practice dedicated part of their patient panel to cancer survivors. Implementation challenges included (1) lack of key stakeholder buy-in; (2) practice resources allocated to competing (non-survivorship) change efforts; and (3) competition with higher priority initiatives incentivized by payers.



Cancer survivorship delivery models are potentially feasible in primary care; however, significant barriers to widespread implementation exist. Implementation efforts would benefit from increasing the awareness and potential value-add of primary care-focused strategies to address survivors' needs.



Current models of primary care-based cancer survivorship care may not be sustainable. Innovative strategies to provide quality care to this growing population of survivors need to be developed and integrated into primary care settings.
Rutgers, The State University of New Jersey, New Brunswick, NJ, USA. omalledm@rwjms.rutgers.edu.|Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA. omalledm@rwjms.rutgers.edu.|Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1500, Somerset, New Brunswick, NJ, 08873, USA. omalledm@rwjms.rutgers.edu.|Rutgers, School of Social Work, New Brunswick, NJ, USA. omalledm@rwjms.rutgers.edu.
Denalee
D
O'Malley
Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.|Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.|Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1500, Somerset, New Brunswick, NJ, 08873, USA.|Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
Shawna V
SV
Hudson
Department of Population Medicine, Harvard Medical School, Boston, MA, USA.
Larissa
L
Nekhlyudov
Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.|Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.|Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1500, Somerset, New Brunswick, NJ, 08873, USA.
Jenna
J
Howard
Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.|Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.|Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1500, Somerset, New Brunswick, NJ, 08873, USA.
Ellen
E
Rubinstein
Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.|Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.|Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1500, Somerset, New Brunswick, NJ, 08873, USA.
Heather S
HS
Lee
Department of General Internal Medicine, University of Colorado, Denver, CO, USA.
Linda S
LS
Overholser
Annadel Medical Group, Santa Rosa, CA, USA.
Amy
A
Shaw
North Perth Family Health, Listowel, ON, Canada.
Sarah
S
Givens
Springfield Medical Associates, Enfield, CT, USA.
Jay S
JS
Burton
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.|Ontario Institute for Cancer Research, Toronto, ON, Canada.
Eva
E
Grunfeld
Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, USA.
Carly
C
Parry
Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.|Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.|Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1500, Somerset, New Brunswick, NJ, 08873, USA.|Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
Benjamin F
BF
Crabtree
D006801:Humans; D008297:Male; D017146:Models, Organizational; D009369:Neoplasms / Q000401:mortality*; D058007:Physicians, Primary Care / Q000639:trends*; D011320:Primary Health Care / Q000379:methods*; D011787:Quality of Health Care; D015996:Survival Rate / Q000639:trends*
Cancer survivorship models; Implementation research; Integration of care; Primary care; Qualitative