Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA.
Regional Oncology, Southern California Permanente Medical Group, Pasadena, CA, USA.
Support Care Cancer. 2019 May;27(5):1737-1745. doi: 10.1007/s00520-018-4425-5. Epub 2018 Aug 24.
Limited understanding of factors affecting uptake and outcomes of different cancer survivorship care models hampers implementation of best practices. We conducted a formative evaluation of stakeholder-perceived acceptability and feasibility of an embedded primary care provider (PCP) survivorship care model.
We identified clinical, operational, and patient stakeholders within Kaiser Permanente Southern California and conducted semi-structured interviews. Analyses were guided by the Consolidated Framework for Implementation Research (CFIR), an integrated framework from the field of implementation science. Deductive thematic categories were derived a priori from CFIR domains; thematic sub-categories were developed inductively.
We interviewed 12 stakeholders; multiple themes were identified. Acceptability: oncologists and operational leaders perceived that the model was an acceptable solution to issues of capacity and efficiency with the potential to improve quality; however, several oncologists perceived negative consequences including "[loss of] the joy of medicine." Patients were less enthusiastic, fearing the introduction of "[someone] who doesn't know me." Feasibility: confidence was high that this model can succeed, although there was concern about finding the right PCP and investment in training and staff support. Culture/climate: numerous system-level facilitators were identified, including encouragement of innovation and familiarity with developing new models.
Formative evaluation is a critical pre-implementation process. Acceptability and feasibility for this model were high among oncologists and operational leaders but patients were ambivalent. Keys to successful implementation include training and support of engaged PCPs and a patient transition plan introduced early in the care trajectory.
对影响不同癌症生存护理模式的接受度和结果的因素了解有限，这阻碍了最佳实践的实施。我们对一种嵌入式初级保健提供者（PCP）生存护理模式的利益相关者感知的可接受性和可行性进行了形成性评估。
我们在 Kaiser Permanente Southern California 确定了临床、运营和患者利益相关者，并进行了半结构化访谈。分析以实施研究综合框架（CFIR）为指导，该框架是实施科学领域的一个综合框架。从 CFIR 领域中预先确定了可接受性和可行性的演绎主题类别；主题子类别是通过归纳法开发的。
我们采访了 12 位利益相关者；确定了多个主题。可接受性：肿瘤学家和运营领导者认为该模型是解决能力和效率问题的一种可接受的解决方案，有可能提高质量；然而，一些肿瘤学家认为存在负面后果，包括“失去医学的乐趣”。患者不太热情，担心会引入“不了解我的人”。可行性：虽然有人担心找不到合适的 PCP，并担心在培训和人员支持方面的投资，但对该模型成功的信心很高。文化/氛围：确定了许多系统层面的促进因素，包括鼓励创新和熟悉开发新模式。
形成性评估是实施前的关键过程。该模型在肿瘤学家和运营领导者中具有较高的可接受性和可行性，但患者持矛盾态度。成功实施的关键包括对参与的 PCP 进行培训和支持，以及在护理轨迹的早期引入患者过渡计划。
