Supporting Evidence
Results of the Systematic Evidence Review for Intervention Effects
A total of 31 relevant systematic reviews were identified and cross-referenced, and 36 unique randomized controlled trials were included in our evidence synthesis.
The full results of the meta-analysis with the effect estimates and certainty of evidence ratings for each of the outcomes of interest are shown in the linked Evidence-to-Decision frameworks and associated GRADE Evidence Profiles.
Randomized Controlled Trials of Models of Survivorship Care
Types of Cancers Included
Health Outcomes Evaluated in Included Trials
Interpretation of Findings
As noted in the justifications for the recommendations, there are few risks of harm for these alternative models of care, which the panel judged as trivial based on pre-established thresholds for the magnitude of effects as described in the evidence-to-decision frameworks, and we are not suggesting replacement of oncologist specialist led care. However, our systematic review of the research evidence shows that these alternate models of care are likely at least equivalent to oncologist specialist led-care with the panel judging that there were trivial to small effect differences for improved outcomes for some models of care (shared care, primary care-led, nurse-led). This finding suggests that these models of care may be appropriate for many cancer survivor populations depending on local human and financial resources and health care policy. The evidence for patient-led/patient-initiated follow-up models of care is less certain given the smaller number of studies, with small sample sizes resulting in imprecision in the estimates of effects.
Results of the Systematic Evidence Review for Implementation Strategies
A total of 11 relevant systematic reviews were identified, and nine unique studies were included for evidence synthesis. We developed a narrative framework to summarize the implementation challenges, barriers and facilitators that were identified and lessons learned for successful implementation across the studies. This approach was used to extract and organize the most important information on barriers and facilitators to implementing models of care, as well as their feasibility, adoption, sustainability, penetration, or reach, and healthcare and/or practice change. The evidence on barriers to implementation was organized into patient-level factors, healthcare provider-level factors, model-related factors and external factors. Furthermore, during the evidence synthesis process, special attention was given to the key statements informing implementation outcomes used across the included studies, reflecting the real-world experience.
The complexity of change and cultural shift needed to support alternate models of care was noted in all studies. Key facilitators identified included flexibility in survivorship models, education, mechanisms for coordination and communication, reworking of clinical workflow, financial strategies (i.e. funding positions), and paying attention to clinician behaviour change. The key implementation considerations from these studies were added to the EtD frameworks