Table 3.

Summary of Themes From Key Informant Major Interview Questions.

Themes	Summary of Comments
Perceived surveillance roles and behaviors with colorectal survivors by physician specialty	PCPs generally saw no more than 1 to 6 new CRC cases annually. They reported following recommendations of the other specialists, perceiving them as responsible for surveillance. One PCP did colonoscopies, with abnormal findings referred to the cancer center.
	GIs saw themselves as technical consultants, as recipients of oncologists’ and surgeons’ orders. They reported doing thousands of colonoscopies, had from 1–2 to 4–5 positive cases a month and hundreds of adenomas.
	Surgeons reported a wide variability in CRC patients seen, from 2 to 7 per week to 1 per month to 1–10 per year. They varied in their surveillance roles depending on whether an oncologist was also involved. Some surgeons performed colonoscopies.
	Oncologists reported playing a major role in surveillance care with variability by level of surgeon involvement and cancer stage.
Perceived surveillance care roles of other physicians	PCPs considered other specialists responsible for course of surveillance care with particular specialists for respective tests.
	One oncologist reported that the PCP should be the gatekeeper, while another felt that the oncologist is in charge of surveillance. Several described specific timelines for the involvement of other specialists in surveillance care (e.g., PCP, GIs).
	GIs tended to rely on the oncologists for direction. One noted being “unsure” about what each one should be doing; “I think there are a lot of unnecessary visits.”
	Surgeons commented on the importance of oncologists and PCPs depending on severity (e.g., stage and treatment type).
Common patient concerns and barriers at the end of treatment	All physicians commented on patient fear of recurrence.
	Several PCPs and surgeons noted concern regarding ostomy care, side effects (e.g., diarrhea); one PCP noted “relationship” issues.
	One PCP mentioned emotional issues—for example, facing mortality.
	Two oncologists noted financial concerns, insurance, copays, and travel to treatment location.
Barriers to adherence to recommended surveillance care	Patient-related barriers: Education, aversion to colonoscopy, perceptions of cancer as the “brown ribbon,” lack of insurance and ability to pay copayment charges, transportation in rural areas. One African American (AA) GI noted that AA have fears of tests and the system and worry more about stigma. One GI commented on “babysitting patients too much.” They need to take care of themselves, while admitting “we don’t empower patients with good education.”
	Health system or provider-related barriers: Lack of EMR capability to share information, inconsistent interaction/ reporting between PCP/patient and specialists, lack of reminders, providers’ lack of guideline knowledge.
	One PCP emphasized that guidelines are always in flux and not evidence based; some testing may not be cost-effective.
	A surgeon stressed the lack of agreement on national care guidelines.
Physician practices/behaviors for posttreatment surveillance	PCPs generally followed guidelines. PCPs reported addressing routine health issues and continuing CEAs once survivors were “cut loose” by the oncologist.
	Recommendations for colonoscopy periodicity and follow-up visits varied considerably within and between the three specialist groups. CT scan ordering was consistently done on a regular basis by surgeons and oncologists.
	About half of the non-PCP specialists reported making lifestyle recommendations; several noted this as an important role for PCPs.
	One surgeon reported referring all CRC patients to oncologists, whereas others reported overseeing follow-up care themselves.
	Reported surveillance care discussions with survivors varied significantly; few reported providing comprehensive care plans, that is, many reported limited written materials such as descriptions of treatment options.
Surveillance care resources and training	All GIs reported having reminder systems to assure patients’ adherence.
	One oncologist noted that he had a navigator in-training.
	Few other specialists reported surveillance support systems, but several had reminder systems.
Communication patterns among physicians	All PCPs reported receiving reports from specialists albeit variable mode and frequency. One PCP noted that she had to “track information down.”
	Specialists reported variable communication with PCPs by phone, email/fax, or in writing.
	GIs noted frequent communication about needed tests and results. Four noted always sending test results to PCPs.
	Surgeons noted variable mode and frequency of communication with oncologist based on the case.
	Oncologists mentioned getting back with referring PCP, particularly surgeon, and GI regarding testing.
Suggestions for improvements to surveillance care quality	Need better interspecialty communication, free colonoscopies, patient tracking systems, and more PCPs to oversee the patient-centered medical home, pay for performance regarding surveillance care, and get written plans with checklists.
	EMR issues were emphasized by all specialties but surgeons.
	Surgeons emphasized the need for MD education and adherence to National Comprehensive Cancer Network guidelines.
	Patient education is key; patients need to become more proactive.
	Almost no mention was specifically made of “care plans.”
	Support systems were highlighted, for example, navigators, support from volunteers, community education.

Note. PCP = primary care physician; CRC = colorectal cancer; GI = gastroenterologist; EMR = electronic medical record; CEA = carcinoembryonic antigen; CT = computed tomography.