FIG 1.

Conceptual model inset: Barriers to timely, guideline-adherent postoperative radiation therapy (PORT) after surgery for head and neck cancer occur at multiple levels (intrapersonal, interpersonal, team, organizational, and community). Because cancer delivery occurs in a multilevel system in which behavior is affected by multiple levels of reciprocal interactions, key themes of barriers to the delivery of timely PORT reflect (1) individual behaviors of patients and providers (blue box), (2) reciprocal interactions between patients and providers and patients and caregivers (green box), (3) clinicians embedded within and across numerous health care teams (red boxes), (4) teams situated within and across multiple health care systems (purple boxes), and (5) health care systems located within communities across a geographic space (orange box). (*) Although the conceptual model depicts only 2 teams (surgical and radiation oncology), additional teams within and across organizations that routinely participate in the delivery of (and thus barriers to) timely PORT include medical oncology, dental, oral surgery, maxillofacial prosthodontics, speech language pathology, general surgery/gastroenterology/interventional radiology, and primary care.