title: Experiences with the survivorship care plan in primary care providers of childhood cancer survivors: a mixed methods approach.
abstract: Focusing on primary care providers (PCPs) of known childhood cancer survivors, we used a mixed methods approach to understand providers' experiences with the survivorship care plan (SCP), as well as preferences and barriers regarding survivorship care.
  
  
  
  The SCP was sent to 202 eligible PCPs of patients attending a regional survivorship clinic. The PCPs then completed quantitative postal surveys. Sixteen PCPs underwent an additional qualitative interview. Provider characteristics were examined as potential predictors of experiences, preferences, and barriers regarding survivorship care. Grounded theory was utilized to analyze the qualitative data.
  
  
  
  Respondents (n=134) included 55% pediatricians, 23% internists, 20% family practitioners, and 2% obstetricians/gynecologists. Only 8% of PCPs preferred to have primary responsibility for survivorship care; 46% favored a specialized clinic. A minority of PCPs reported that they felt "very comfortable" using the SCP to guide surveillance (31%) or deliver all survivorship care (3%). Endorsed barriers included lack of knowledge/training (74%), not recalling or understanding the contents of the SCP (69%), and uncertainty about who is responsible for providing care (58%). Two distinct themes emerged from the qualitative interviews: a preference not to be responsible for survivorship care, and uncertain utility of the SCP.
  
  
  
  Our study suggests that PCPs of childhood cancer survivors generally felt uncomfortable using the SCP and providing survivorship care. Even with the availability of the SCP, the biggest barrier was lack of knowledge. Our data suggests that including PCPs in survivorship care will require additional educational opportunities and evaluation of more collaborative models of care delivery.
authors.affiliation: Lake Erie College of Osteopathic Medicine, 1858 W. Grandview Blvd, Erie, PA, 16509, USA.
authors.forename: Neel S
authors.initials: NS
authors.lastname: Iyer
authors.affiliation: Department of Psychology, University of Miami, PO Box 248185-0751, Coral Gables, FL, 33124, USA.
authors.forename: Hannah-Rose
authors.initials: HR
authors.lastname: Mitchell
authors.affiliation: Department of Pediatrics, Section of Hematology/Oncology, Yale School of Medicine, 333 Cedar Street, LMP 2073, New Haven, CT, 06520, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Zheng
authors.affiliation: Department of Pediatrics, Section of Hematology/Oncology, Yale School of Medicine, 333 Cedar Street, LMP 2073, New Haven, CT, 06520, USA.
authors.forename: Wilhelmenia L
authors.initials: WL
authors.lastname: Ross
authors.affiliation: Department of Pediatrics, Section of Hematology/Oncology, Yale School of Medicine, 333 Cedar Street, LMP 2073, New Haven, CT, 06520, USA. nina.kadan-lottick@yale.edu.|Yale Cancer Center, PO Box 208028, New Haven, CT, 06520, USA. nina.kadan-lottick@yale.edu.
authors.forename: Nina S
authors.initials: NS
authors.lastname: Kadan-Lottick
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000473:pathology; D058007:Physicians, Primary Care; D017741:Survivors
keywords: Childhood cancer survivorship; Long-term follow-up care; Mixed methods; Primary care providers; Surveillance; Survivorship care plan