Tactics for Implementation of Primary Care Led-Survivorship Care
Primary care-led models of survivorship care position the primary care provider (PCP) usually the primary care physician (family physician) as the physician responsible for delivering the four components of survivorship care (76,77). Enhancing the role of primary care physicians is essential and a goal for cancer survivorship care service delivery (77). Tactics for implementation of primary care-led models of survivorship care were synthesized from scoping and systematic reviews (78-81).
In 2012, Cancer Care Ontario incentivized 14 regional cancer centers (1.2 million dollars investment) to develop strategies to transition low-risk cancer survivors (colorectal, breast, gynecological) from oncologist specialist led care to primary care physician led care for low-risk breast and colorectal cancer populations (82,83). Survivors were eligible for transition if they had completed cancer treatment, had no evidence of disease or ongoing cancer-related issues, and were deemed appropriate for community-based care. Between 2012–2015, more than 10,000 breast and colorectal cancer survivors were transitioned to PCPs.
In the primary care physician led model of care implemented by Cancer Care Ontario, enablers were identified for a seamless and coordinated transition from oncologist specialist led care that involved designated responsibilities for nurses (84). For example, transitions were facilitated by specific implementation strategies as follows:
Nurse assessment and education provided in a transition clinic visit (1-3 visits) prior to transfer to the primary care physician
Survivorship care plan inclusive of a treatment summary, possible long term and late effects and recommended surveillance completed by a nurse was provided with education/preparation of survivors in a transition clinic visit
Nurses contacted the primary care physicians to coordinate the transfer of care and were available to review the SCP and for any questions.
A population-based evaluation of outcomes of this model of care revealed that clinical and quality outcomes were equivalent in low-risk survivors who were transitioned back to primary care after treatment compared with propensity-matched survivors who did not experience transition (85). Moreover, transitioned survivors in this implementation project had greater rates of surveillance mammography (recommended care), fewer other diagnostic tests (non-recommended care), and incurred lower costs to the health system (85).
In a review of ninety-seven articles published across the globe (USA, Canada, Australia, European Union, and UK identified the following barriers to PCP-led survivorship care in healthcare systems that need to be addressed for effective implementation: (1) insufficient communication between PCPs and cancer specialists, (2) limited PCP knowledge, (3) time restrictions for PCPs to provide comprehensive survivorship care, and (4) a lack of resources (e.g., survivorship care guidelines) (74). Potential solutions to combat these barriers were identified as follows: (1) improving interdisciplinary communication, (2) bolstering PCP education, and (3) providing survivorship supportive care resources (86).