Provider perceptions and expectations of breast cancer posttreatment care: a University of California Athena Breast Health Network project - PubMed (original) (raw)

Provider perceptions and expectations of breast cancer posttreatment care: a University of California Athena Breast Health Network project

Erin E Hahn et al. J Cancer Surviv. 2013 Sep.

Abstract

Purpose: The Athena Breast Health Network collaboration is a University of California system-wide project initiated with the intent to drive innovation in breast cancer prevention, screening, and treatment. This qualitative research examines provider perceptions and expectations of posttreatment breast cancer care across five network sites with the goal of better understanding provider behavior during the posttreatment phase of the cancer care trajectory.

Methods: Investigators at each site conducted semi-structured interviews with oncology specialists and primary care providers (PCPs). Interviews used case study examples and open- and closed-ended questions on the delivery of posttreatment breast cancer care. Informant responses were manually recorded by the interviewer, compiled in a database, then coded and analyzed using NVivo 9 software.

Results: There were 39 key informants across the sites: 14 medical oncologists, 7 radiation oncologists, 11 surgeons, 3 oncology nurses, and 4 PCPs. Care coordination was a major unprompted theme identified in the interviews. There was a perceived need for greater care coordination across institutions in order to improve delivery of posttreatment health care services and a need for greater care coordination within oncology, particularly to help avoid duplication of follow-up care and services. Participants expect frequent follow-up visits and to use biomarker tests and advanced imaging services as part of routine surveillance care. Implementing survivorship care programs was perceived as a way to improve care delivery.

Conclusions: These results identify a need for increased focus on care coordination during the posttreatment phase of breast cancer care within the University of California system and the potential for system and provider-level interventions that could help increase coordination of posttreatment care.

Implications for cancer survivors: Breast cancer survivors do not always receive evidence-based care. This research helps to better understand what motivates provider behavior during the posttreatment phase and lays a foundation for targeted interventions to increase adherence to evidence-based recommendations.

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Figures

Figure 1

Figure 1

Concept map of themes, sub-themes, and relationships discovered and coded from the interview data. The size and shape of the text box is related to the number of mentions in the data. Ovals indicate the highest number of mentions, followed by rectangles, then squares; larger shapes indicate more mentions than a smaller size of the same shape. For example, care coordination was mentioned the most of any theme so it is the largest oval. The next most common mentions are follow-up care perceptions related to the case vignettes, followed by follow-up care perceptions.

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