Article Figures & Data
Figures
- Figure 1.
Preferred Approach to Survivorship Care for Patients with Early-Stage Cancer. Abbreviations: ONCs, oncology care providers; PCPs, primary care providers.
Tables
Selected Characteristics ONC (n = 101) PCP (n = 58) p-Value Provider Discipline (%) 0.29 Physician 73.8 82.4 Other Provider type (ARNP, PA, or RN) 26.2 17.6 Years in practice (%) 0.03 <10 24.7 12 10 to 19 18.2 40 20 to 29 27.3 18 30 or more 29.9 30 Practice location (%) 0.05 Urban 65.9 45.1 Suburban 18.3 23.5 Rural 15.9 31.4 Number of patients seen per week 0.03 25 or fewer 30.0 11.8 26 to 50 23.8 21.6 51 to 75 23.8 19.6 76 to 100 15.0 23.5 101 or more- 7.4 23.5 Practice size Solo practice 13.4 7.8 0.21 2 to 5 clinicians 28.1 31.4 5 to 10 clinicians 23.2 11.8 >10 clinicians 35.3 49.0 Practice has electronic billing system (% yes) 57.4 53.7 0.66 Practice has electronic health record (% yes) 67.8 57.3 0.14 Practice has secure messaging (% yes) 47.8 47.6 1.0 Practice has patient registry/tracking available (% yes) 35.7 26.8 0.22 Practice Referral Processes (%) No specific system (handled case-by-case) 43.6 21.6 0.06 Protocols and tracking system 10.2 13.7 Comprehensive, health system-wide referral system 15.4 15.7 All of the above + dedicated personnel 30.8 49.0 Practice care coordination processes (%) No specific system (handled case-by-case) 28.6 35.3 0.04 Organized communication approach (e.g., messaging) 24.7 37.3 Communication approach and dedicated personnel 27.3 7.8 Comprehensive, health system-wide care coordination 19.4 19.6 Perceived organizational/practice change capacity (%) Practice has not tried to implement changes or improvements in care processes 3.7 0 0.32 It has been very difficult to implement changes 7.4 11.8 It has been challenging, but possible to implement changes 24.7 35.3 Several changes/improvements have been implemented successfully 37.0 25.5 The organization welcomes change and has a process to implement care improvements 27.2 27.5 Abbreviations: ARNP, advanced registered nurse practitioner; PA, physician assistant; RN, registered nurses.
- Table 2.
Provision of Cancer Care Coordination Services by Oncology Providers (ONCs) and Primary Care Providers (PCPs)
ONC PCP p-Value How often do you routinely communicate with patient's other provider(s) about which provider(s) will… …follow the patient for cancer? (%) <0.001 Never 6.1 10.9 Rarely 3.7 41.8 Sometimes 17.1 20.0 Often 36.6 18.2 Always/Almost Always 36.6 9.1 …handle patient's other medical issues? (%) 0.028 Never 7.2 12.7 Rarely 15.7 29.1 Sometimes 27.7 32.7 Often 26.5 18.2 Always/Almost Always 22.9 7.3 How often do you… … send (ONC)/receive (PCP) a comprehensive summary including detailed cancer treatment information from the ONC? (%) Never 4.9 10.5 <0.001 Rarely 6.1 28.9 Sometimes 23.2 26.3 Often 23.2 28.9 Always/Almost Always 35.4 5.3 N/A 7.3 0.0 …provide (ONC)/receive (PCP) information from the oncologist in a timely manner? (%) Never 1.2 7.9 <0.001 Rarely 1.2 18.4 Sometimes 13.6 34.2 Often 32.1 34.2 Always/Almost Always 46.9 7.9 N/A 4.9 0.0 …experience difficulties transferring patient care responsibilities between you and the PCP/ONC? (%) Never 3.7 2.0 0.603 Rarely 21.0 22.0 Sometimes 42.0 32.0 Often 18.5 24.0 Always/Almost Always 9.9 18.0 N/A 4.9 2.0 …assist patients with recurrent cancer in making decisions about whether and how their cancer should be treated? (%) Never 2.4 8.0 <0.001 Rarely 4.9 20.0 Sometimes 6.1 38.0 Often 29.3 28.0 Always/Almost Always 54.9 6.0 N/A 2.4 0.0 …have a specific discussion with the patient regarding recommendations for future care and surveillance? (%) Never 1.2 6.0 <0.001 Rarely 1.2 26.0 Sometimes 7.4 28.0 Often 21.0 34.0 Always/Almost Always 64.2 6.0 N/A 4.9 0 …clearly understand the division of care responsibilities between you and the ONC/PCP team? (%) Never 1.2 16.2 <0.001 Rarely 8.6 27.0 Sometimes 28.4 37.8 Often 28.4 16.2 Always/Almost Always 32.1 2.7 N/A 1.2 0 …provide (ONCs)/receive (PCPs) information that cancer has recurred? (%) Never 1.3 8.3 <0.001 Rarely 7.5 22.9 Sometimes 11.3 31.3 Often 17.5 31.3 Always/Almost Always 56.3 6.3 N/A 6.3 0 - Table 3.
Confidence and Perceived Skill in the Provision of Cancer Survivorship Care by Oncology Providers (ONCs) and Primary Care Providers (PCPs)
ONC PCP p-Value Amount of confidence in knowledge of cancer-related follow-up care for survivors: Order appropriate surveillance testing to detect recurrent cancer (%) Not at all confident 1.2 25.5 <0.001 Somewhat confident 20.9 49.1 Very confident 77.9 23.6 Don't know 0.0 1.8 Detect long-term and late physical adverse effects of cancer and cancer treatment (%) Not at all confident 2.3 25.5 <0.001 Somewhat confident 30.2 58.2 Very confident 67.4 16.4 Don't know 0.0 0.0 Address adverse psychosocial outcomes of cancer or its treatment (%) Not at all confident 2.3 12.7 0.052 Somewhat confident 50.0 43.6 Very confident 47.7 43.6 Don't know 0.0 0.0 To what extent do you agree/disagree with statements regarding patients who have completed active cancer treatment? PCPs have the skills needed to provide follow‐up care related to the effects of cancer or its treatment for survivors (%) Strongly disagree 22.6 2.4 <0.001 Somewhat disagree 41.7 7.3 Neither Agree nor disagree 9.5 34.1 Somewhat agree 19.0 34.1 Strongly agree 7.1 22.0 PCPs have the skills needed to initiate appropriate screening or diagnostic work‐ up to detect recurrent cancer (%) Strongly disagree 29.4 1.9 <0.001 Somewhat disagree 40.0 14.8 Neither Agree nor disagree 7.1 24.1 Somewhat agree 15.3 35.2 Strongly agree 8.2 24.1 PCPs should have primary responsibility for cancer‐related follow‐up for survivors (%) Strongly disagree 40.0 12.5 0.002 Somewhat disagree 42.4 37.5 Neither Agree nor disagree 4.7 17.5 Somewhat agree 10.6 25.0 Strongly agree 2.4 7.5 PCPs are better able than ONCs to provide psychosocial support for survivors (%) Strongly disagree 36.5 5.6 <0.001 Somewhat disagree 30.6 9.3 Neither Agree nor disagree 18.8 24.1 Somewhat agree 10.6 27.8 Strongly agree 3.5 33.3 - Table 4.
Oncology Provider (ONC) and Primary Care Provider (PCP) Perceived Role in Cancer Survivorship Care
ONC PCP p-Value For patients who have completed cancer treatment, how often take responsibility for… …screening for other new primary cancers (%) Never 10.8 2.6 <0.001 Rarely 20.5 0 Sometimes 22.9 5.1 Often 15.7 30.8 Almost/Almost Always 22.9 61.5 N/A 7.2 0.0 …evaluating patients for recurrence of cancer (%) Never 2.4 2.0 <0.001 Rarely 6.0 7.8 Sometimes 2.4 31.4 Often 13.3 45.1 Almost/Almost Always 67.5 13.7 N/A 8.4 0.0 …evaluating patients for adverse psychological effects of cancer or its treatment (%) Never 6.0 0 0.016 Rarely 13.3 0 Sometimes 27.7 33.3 Often 24.1 46.2 Almost/Almost Always 20.5 17.9 N/A 8.4 2.6 …evaluating patients for long-term and late physical adverse effects of cancer and cancer (%) Never 3.7 0 <0.001 Rarely 6.2 12.0 Sometimes 12.3 38.0 Often 32.1 38.0 Almost/Almost Always 37.0 12.0 N/A 8.6 0.0
