Table 3.
Contextual factors for survivorship care planning.
| CFIR domains | Contextual factors | Exemplar quotes |
| Outer settings | Accreditation requirements | "We are a COC-accredited organization, COC recognizes how many patients were treated and completed their active treatment with a curative intent in the hospital. So they actually have a list of patients that you have to cover 50 percent of those patients." (ONC#1) |
| Reimbursement | "Because right now there is no way— no ICD-10 code or there's no billing mechanism to bill for a survivorship care visit as such." (ONC#2) | |
| Inner setting | Clinic workflow | "for providers, it wasn't a priority for them, because their priority was to check up on people who were more on active treatment. Like they were more prioritizing their time for people doing chemo." (LPN#2) |
| "a dedicated time that's just dedicated, an appointment or clinic, to survivorship so that they would come back to a special clinic that addresses that rather than trying to do it in an interdisciplinary clinic that's addressing surgical and oncology things." (LPN#1) | ||
| Electronic medical records | "sometimes it got uploaded in EMR under documents, or sometimes it got uploaded under labs." (ONC#2) | |
| “I only went on one visit and I know I emailed the provider but she didn't know where it was. Like, she knew it existed, but she didn't know where it was." (LPN#4) | ||
| Lack of time | "For me, actually, I don't think I did a great job explaining it. I think I filled it out and I told them what it was. I never went through it in great detail. I don't think I went over the last page with all the different lifestyle things.” (ONC#1) | |
| "They were frustrated because it is time-consuming and it wasn't quite their—on their agenda, right." (LPN#3) | ||
| "Or making a brand-new PCP appointment just to go over the survivorship care plan wasn't good use of the PCP's time or the patient's time or the navigator's time." (LPN#4) | ||
| Primary care clinic appointments | "Getting to a PCP visit if it's not in the hospital is a challenge. Getting an appointment is a challenge" (LPN#2). | |
| Embedded LPN | "We have patient navigators also who refer patients to different programs that they need to be referred to. And so, there is a system to provide survivorship care that was happening even before the survivorship care planning was introduced.” (ONC#1) | |
| Integrated survivorship resources | "I think in general; our patients don't ask for too many things. But we do have certain things built up in our own clinic. So we—for example, we have a lymphedema program so patients are evaluated by a person who educates patients about lymphedema and also refers patients who need to see physical therapy, for example." (ONC#2) | |
| Participants’ characteristics | Symptom related needs of BCS | “I have a lot going on, and I don't like to keep taking pain killers constantly because, you know, _____ can affect your stomach and stuff and, you know, I don't like – so I have the creams and patches I do put on to ease the pain, the cream _____ help.” (EBCS#3) |
| "It's like we automatically had that because we have that connection, we felt obligated, and sort of we wanted to give a full picture for the patient to see, 'This is important.'" (LPN #2) | ||
| Need for dedicated resources for diverse BCS | "—To me, the most helpful part was to go to _____ support group. I mean my friends are all cancer survivors. Due to the fact that a lot of people out there discriminate us who have cancer.” (CBCS#1) | |
| "Yeah, and I think the only other thing I would add to that is the educational resources. I think they are available sometimes in English and Spanish. Like for example, we—if patients want to know more about, for example, insomnia or something, and then most of the resources are only available in English. They're at a higher literacy level. And some of them might be available. Some places may have it in Spanish but finding it in Chinese is even harder." (ONC#2) | ||
| BCS engagement | "So, some patients are very involved in their care and some patients are not, and it's not dependent on what language they speak or other things. It really depends on individual patients. For example, one of my patients I think after maybe one or two years after I gave her the survivorship care plan actually brought a copy this week and wanted me to go over it again." (ONC#1) | |
| "It was a mix—for the clients who I helped with I had a mix of Chinese—Cantonese-speaking clients and some English-speaking clients. Some of them were sort of grateful to have something documented from the hospital to give to them, but there were some people who, when I went to the primary care, they didn't really prioritize that as a discussion with their primary care. It was just another paper—I have it, but I don't really think I'm gonna bring it, but you could bring it for me if you want as a navigator." (LPN#2) | ||
| Implementation Process | Buy-in | "But I think buy-in from the providers was very hit or miss. It was very hit or miss." (LPN#4) |
| Lack of planning and ongoing support | "To get an extra visit, it would make other patients not be able to get in because they were—and they need—that would just be a nightmare, I think, on the scheduling." (ONC#3) | |
| Intervention characteristics | SCP as an imperfect tool | "The most helpful, I guess the initial information. When was your surgery, what was going on so you have like this whole this was going on if I would tell somebody else or a different doctor? You also have it on paper so it's not like oh, I had this and this or you can make anything up in the end. But you have like a piece of paper where it's all like here, yes, I have that treatment?" (EBCS#1) |
| "I think if you look at it like a patient gets admitted, they get a discharge summary, and you really want two different things for the patient and provider. You know, your patient wants to know what—they should take these antibiotics for six days and then if there's any problem, they should go to the doctor, while doctor should hear about, you know, this _____ gave this patient antibiotics for six days and if he's still symptomatic when they come and see you, then maybe you wanna consider something else.” (ONC#1) | ||
| Evidence of usefulness for SCP | "So, when we started implementing the survivorship care plan, we were aware of some of the data that had been published before that because we did some reading before implementation. And one of the things was that maybe it was not as helpful to the patient, and probably also as a communication tool with the providers." (ONC #2) |
Abbreviations: ONC, oncologist; CBCS, cantonese speaking BCS; EBCS, english speaking BCS; LPN, lay patient navigator.