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Cited by 112Cancer survivorship and carePrimary Care and Health OutcomesGlobal Cancer Incidence and Screening

Cancer Survivorship Care in Advanced Primary Care Practices: A Qualitative Study of Challenges and Opportunities

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Rubinstein, Ellen B., Miller, William L., Hudson, Shawna V., Howard, Jenna, O’Malley, Denalee, Tsui, Jennifer, Lee, Heather Sophia, Bator, Alicja +1 more·2017·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2017.4747PMC PMC5820731
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Abstract

Importance: Despite a decade of effort by national stakeholders to bring cancer survivorship to the forefront of primary care, there is little evidence to suggest that primary care has begun to integrate comprehensive services to manage the care of long-term cancer survivors. Objective: To explain why primary care has not begun to integrate comprehensive cancer survivorship services. Design, Setting, and Participants: Comparative case study of 12 advanced primary care practices in the United States recruited from March 2015 to February 2017. Practices were selected from a national registry of 151 workforce innovators compiled for the Robert Wood Johnson Foundation. Practices were recruited to include diversity in policy context and organizational structure. Researchers conducted 10 to 12 days of ethnographic data collection in each practice, including interviews with practice personnel and patient pathways with cancer survivors. Fieldnotes, transcripts, and practice documents were analyzed within and across cases to identify salient themes. Main Outcomes and Measures: Description of cancer survivorship care delivery in advanced patient-centered medical homes, including identification of barriers and promotional factors related to that care. Results: The 12 practices came from multiple states and policy contexts and had a mix of clinicians trained in family or internal medicine. All but 3 were recognized as National Committee on Quality Assurance level 3 patient-centered medical homes. None of the practices provided any type of comprehensive cancer survivorship services. Three interdependent explanatory factors emerged: the absence of a recognized, distinct clinical category of survivorship in primary care; a lack of actionable information to treat this patient population; and current information systems unable to support survivorship care. Conclusions and Relevance: To increase the potential for primary care transformation efforts to integrate survivorship services into routine care, survivorship must become a recognized clinical category with actionable care plans supported by a functional information system infrastructure.

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Authors
Rubinstein, E. B., Miller, W. L., Hudson, S. V., Howard, J., O’Malley, D., Tsui, J., Lee, H. S., Bator, A., & Crabtree, B. F.
Affiliations
  • Rutgers, The State University of New Jersey (US)
  • Lehigh Valley Health Network (US)
  • Rutgers Cancer Institute (US)
Corresponding author
Rubinstein, Ellen B.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2017-12-01
Volume
177
Issue
12
Pages
1726
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2017.4747
PMC
PMC5820731
OpenAlex
W2759630049
Cited by
112
References
4
Citations by year
2026: 10 · 2025: 12 · 2024: 11 · 2023: 6 · 2022: 12 · 2021: 15 · 2020: 16 · 2019: 21 · 2018: 8 · 2017: 1
FWCI
5.55
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Cancer Institute (R01CA176545)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
survivorship care, primary care, patient-centered medical home, health information systems
MeSH terms
Survivorship, Comprehensive Health Care, Humans, Neoplasms, Primary Health Care, Quality of Health Care, United States, Models, Organizational, Qualitative Research

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