Background Post-treatment cancer follow-up by clinicians in specialist centres does not meet survivors’ supportive care needs post-treatment. Due to increasing numbers of survivors and the resultant burden on hospital resources, there is growing interest in developing alternative models of cancer follow-up. The aim of this study was to ask hospital-based oncology health professionals what they think about different types of follow-up for survivors of prostate and colorectal cancer. We were interested in participant’ views about hospital-based nurse-led, GP-led, and patient-initiated follow-up, as well as any barriers to implementing these models.
Methods We carried out in-depth, semi-structured, interviews with 23 multidisciplinary health professionals (clinicians, specialist nurses, and allied health professionals) involved in prostate and colorectal cancer follow-up in Ireland. Participants were asked about their views about alternative models of follow-up and barriers to implementation. Analysis drew on the extended Normalisation Process Theory (ExNPT) framework.1
Results Due to increasing numbers of cancer survivors, most participants reported a need for new models of follow-up. GP-led, nurse-led, and patient-initiated follow-up were all acceptable to varying degrees. Participant preferences depended on their perception of the ability of the health setting and health professionals involved to implement and sustain the different types of follow-up. Analysis of the data using the ExNPT framework allowed identification of a range of barriers to implementation of each of the different follow-up models. For example, participants were concerned about the willingness of various stakeholders to support, or participate in, GP-led and patient-initiated follow-up because of barriers to mobilising the additional resources needed to coordinate and integrate these models into the existing health care system. Concerns about coordination and tracking of hospital-based diagnostics by community-based GPs or for patient-initiated follow-up were also raised. It was suggested that shared care could improve the workability and integration of GP-led or patient-initiated follow-up. In contrast, participants reported fewer perceived barriers to implementation of nurse-led follow-up and many potential benefits were highlighted.
Conclusion Our findings suggest there are fewer barriers to implementation of hospital-based nurse-led follow-up compared to other alternative models of follow-up in our setting. Leadership and advocacy will be essential to mobilise the resources and infrastructure needed to coordinate follow-up and to facilitate implementation of all alternative models.
May C. Towards a general theory of implementation. Implement Sci. 2013;8:18
- cancer survivorship follow-up
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