Impact of an Interprofessional Primary Care Training on Fear of Cancer Recurrence on Clinicians' Knowledge, Self-Efficacy, Anticipated Practice Behaviors, and Attitudes Toward Survivorship Care

Step-by-step: A clinical pathway for stepped care management of fear of cancer recurrence-results of a three-round online delphi consensus process with Australian health professionals and researchers

PURPOSE

Fear of cancer recurrence (FCR) is not routinely addressed in clinical practice, meaning many cancer survivors forego effective interventions. We established expert consensus on a clinical pathway to help health professionals identify and manage FCR in early-stage cancer survivors.

METHODS

Australian health professionals and researchers working with adult cancer survivors participated in a three-round Delphi study promoted via oncology professional bodies and social media. The Round 1 online survey presented 38 items regarding FCR screening, triage, assessment, referral, and stepped care, based on a literature review, related pathways/guidelines, and expert input. Participants rated how representative of best-practice items were on a 5-point scale (strongly disagree-strongly agree), with optional qualitative feedback. Consensus was defined as ≥ 80% of participants strongly/agreeing with items. Items not reaching consensus were re-presented to Round 1 participants in two subsequent rounds with new items, derived from content analysis of qualitative feedback.

RESULTS

From 94 participants in Round 1 (89% health professionals), 26/38 (68%) items reached consensus. By round 3, 35/38 (92%) items, including 8 new items, reached consensus. Routine FCR screening and triage conversations and stepped care management (i.e. tailored and staged treatment) were endorsed. However, the timing of FCR screening/triage did not reach consensus.

CONCLUSIONS

This world-first FCR clinical pathway incorporating contemporary evidence and expert opinion recommends routine screening and triage to stepped care management of FCR. Some pathway components, such as screening or triage timing, may need tailoring for different contexts.

IMPLICATIONS FOR CANCER SURVIVORS

Implementation of the pathway could aid routine identification and management of FCR, reducing its burden on cancer survivors and the healthcare system.

Exploring Fear of Cancer Recurrence (FCR) in cancer survivors from a medical social work perspective: A qualitative study of medical social workers in South Korea

BACKGROUND

Fear of Cancer Recurrence (FCR) in cancer survivors has been insufficiently addressed despite its imperativeness in cancer journey. Although several studies have investigated healthcare professionals' experience with FCR in cancer survivors, a medical social work perspective has rarely been reflected. This study aimed to explore Korean medical social workers' experience with intervening FCR in cancer survivors.

METHODS

Snowball sampling recruited 12 experienced medical social workers intervening with cancer survivors at tertiary or university cancer hospitals in South Korea. Individual and focus-group interviews (FGI) were conducted with the medical social workers. The interviews were recorded, transcribed, and analyzed by using an inductive qualitative content analysis.

RESULTS

Content analysis of the interviews extracted the following major themes regarding FCR in cancer survivors. First, when and how FCR among cancer survivors emerged at the early stage of medical social work interventions was identified. Second, how medical social workers dealt with FCR in cancer survivors was illustrated. Third, the responses of cancer survivors to medical social work interventions for FCR were assessed. Finally, the internal and external issues underlying the medical social work interventions for FCR among cancer survivors were revealed and discussed.

CONCLUSION

Based on the results, this study suggested the implications on dealing with FCR in cancer survivors in the realm of medial social work profession. Furthermore, it expanded the discussion about FCR in cancer survivors from cancer hospitals to community.

The effect of continuing interprofessional education on improving learners' self-efficacy and attitude toward interprofessional learning and collaboration

We aimed to assess the effect of continuing interprofessional education on collaborative self-efficacy, attitude toward the team, and interprofessional learning in workplace-based learning situations. This was a quasi-experimental study conducted in two educational hospitals. Two hundred and ten participants including nursing and medicine from general medicine, internal medicine, and emergency medicine, entered the study and were categorized in the census's intervention group (n = 97) and control group (n = 113). Continuing interprofessional education interventions included interprofessional rounds and workshops. Attitudes toward the team and interprofessional learning and collaborative self-efficacy were assessed using the Readiness for Interprofessional Learning, Attitudes Toward Health Care Teams, and Interprofessional Collaborator Assessment. Participants' attitude toward the team (p-value <.001), attitude toward interprofessional learning (p-value <.001), and interprofessional collaborative self-efficacy (p-value <.001) were significantly improved compared to participants' scores in the control group. Integrating the principles of continuing education, interprofessional education, and workplace-based learning provided an effective learning situation through interactive relationships and active collaboration of participants. The findings revealed a significant educational effect of the intervention on attitude toward interprofessional learning and the team, and a small effect on self-efficacy of interprofessional collaboration.

Outcomes of cancer survivorship education and training for primary care providers: a systematic review

PURPOSE

To identify published literature regarding cancer survivorship education programs for primary care providers (PCPs) and assess their outcomes.

METHODS

PubMed, Embase, and CINAHL databases were searched between January 2005 and September 2020. The Quality of Cancer Survivorship Care Framework and Kirkpatrick's 4-level evaluation model were used to summarize program content and outcomes, respectively. Data extraction and critical appraisal were conducted by two authors.

RESULTS

Twenty-one studies were included, describing self-directed online courses (n=4), presentations (n=2), workshops and training sessions (n=6), placement programs (n=3), a live webinar, a fellowship program, a referral program, a survivorship conference, a dual in-person workshop and webinar, and an in-person seminar and online webinar series. Eight studies described the use of a learner framework or theory to guide program development. All 21 programs were generally beneficial to PCP learners (e.g., increased confidence, knowledge, behavior change); however, methodological bias suggests caution in accepting claims. Three studies reported positive outcomes at the patient level (i.e., satisfaction with care) and organizational level (i.e., increased screening referrals, changes to institution practice standards).

CONCLUSIONS

A range of cancer survivorship PCP education programs exist. Evidence for clinical effectiveness was rarely reported. Future educational programs should be tailored to PCPs, utilize an evidence-based survivorship framework, and evaluate patient- and system-level outcomes.

IMPLICATIONS FOR CANCER SURVIVORS

PCPs have an important role in addressing the diverse health care needs of cancer survivors. Improving the content, approach, and evaluation of PCP-focused cancer survivorship education programs could have a positive impact on health outcomes among cancer survivors.

Feasibility and Acceptability of Fear-Less: A Stepped-Care Program to Manage Fear of Cancer Recurrence in People with Metastatic Melanoma

Immunotherapies and targeted therapies have revolutionised treatment of metastatic melanoma and improved survival rates. However, survivors treated with novel therapies are vulnerable to high levels of fear of cancer recurrence or progression (FCR). Existing FCR interventions have rarely been trialled in people with advanced cancer. The current study aimed to evaluate the acceptability and feasibility of Fear-Less: a stepped-care model to treat FCR in people with metastatic melanoma treated with immunotherapy or targeted therapy. Sixty-one outpatients with metastatic melanoma were screened using the Fear of Cancer Recurrence Inventory Short Form (FCRI-SF) and Fear of Progression Questionnaire Short Form (FoP-Q-SF). Survivors with subthreshold FCR were stratified to a self-management intervention while those with clinical levels of FCR were provided with an individual therapy, Conquer Fear. Survivor experience surveys and rescreening were administered post-intervention completion. Results indicated that Fear-Less was an acceptable and feasible FCR intervention. Results provided preliminary support for the potential impact of Fear-Less in reducing FCR. Fear-Less is a promising first step in providing an acceptable and feasible stepped-care model to treat FCR in survivors with metastatic disease.

Study protocol of the BLANKET trial: a cluster randomised controlled trial on the (cost-) effectiveness of a primary care intervention for fear of cancer recurrence in cancer survivors

INTRODUCTION

Many successfully treated patients with cancer suffer from fear of cancer recurrence (FCR), affecting their quality of life and their physical, emotional, cognitive and social functioning. Effective psychological interventions for FCR exist but are not widely available, as they are typically offered by specialised psycho-oncology professionals and institutes. Concurrently, the role of primary care in cancer and survivorship care is increasing. Therefore, there could be a role for general practitioners (GPs) and mental health workers (MHWs) working in primary care in supporting patients with FCR. In the current study, the effectiveness of a primary care delivered FCR intervention will be evaluated.

METHODS AND ANALYSIS

A two-armed cluster randomised trial will be conducted. The primary outcome will be FCR severity; secondary outcomes will be FCR-related distress, healthcare uptake and healthcare costs. Primary care practices in the Netherlands will be invited to participate in the study. Participating practices will be stratified by size and socioeconomic status and randomised. In the control arm, practices will provide care as usual. In the intervention arm, practices will offer the cognitive-behavioural FCR intervention that is being studied, which consists of an intake with the GP and five sessions with the MHW. Patients who have finished successful curative treatment for cancer between 3 months and 10 years ago will be invited to participate in the study by invitation letter from their GPs. Participating patients will fill out questionnaires at baseline, after 3 months and after 12 months. Data on healthcare use will be collected from their electronic health records. Qualitative interviews are held at T1 with patients and practitioners in the intervention group.

ETHICS AND DISSEMINATION

The Medical Research Ethics Committee (METC) Utrecht has reviewed the study in accordance with the Dutch Medical Research Involving Human Subjects Act (WMO) and other applicable Dutch and European regulations. Based on the requirements of the WMO, the METC Utrecht has issued an approval of the above-mentioned study. Any protocol amendments will be communicated to all relevant parties. Written consent is obtained from study participants. Results will be dispersed through peer-reviewed publications and scientific presentations.

TRIAL REGISTRATION NUMBER

NL7573 in the Netherlands Trial Register on 25-02-2019.

Understanding Long-Term Cancer Survivors' Preferences for Ongoing Medical Care

BACKGROUND

Due to risk for treatment-related late effects and concerns about cancer recurrence, long-term cancer survivors have unique medical needs. Survivors' preferences for care may influence adherence and care utilization.

OBJECTIVE

To describe survivors' preferences for care and factors associated with preferred and actual care.

DESIGN

Cross-sectional analysis of participants in a longitudinal study using mailed questionnaires.

PARTICIPANTS

Survivors of ten common cancers (n = 2,107, mean years from diagnosis 8.9).

MAIN MEASURES

(1) Survivors' preferences for primary care physician (PCP) and oncologist responsibilities across four types of care: cancer follow-up, cancer screening, preventive health, and comorbid conditions. (2) Survivor-reported visits to PCPs and oncologists.

KEY RESULTS

The response rate was 42.1%. Most long-term survivors preferred PCPs and oncologists share care for cancer follow-up (63%) and subsequent screening (65%), while preferring PCP-led preventive health (77%) and comorbid condition (83%) care. Most survivors (88%) preferred oncologists involved in cancer follow-up care, but only 60% reported an oncologist visit in the previous 4 years, and 96% reported a PCP visit in the previous 4 years. In multivariable regressions, those with higher fear of cancer recurrence were less likely to prefer PCP-led cancer follow-up care (OR = 0.96, CI = 0.93-0.98), as did survivors with advanced cancer stage (OR = 0.56, CI = 0.39-0.79). Those with higher fear of recurrence (OR = 1.03, CI = 1.01-1.04) or who preferred oncologist-led cancer follow-up care (OR = 2.08, CI = 1.63-2.65) had greater odds of seeing an oncologist in the last 4 years.

CONCLUSIONS

Most cancer survivors preferred PCPs and oncologists share care for cancer follow-up and screening, yet many had not seen an oncologist recently. Survivors preferred PCP-led care for other preventive services and management of comorbid conditions. These findings highlight the important role PCPs could play in survivor care, suggesting the need for PCP-oriented education and health system policies that support high-quality PCP-led survivor care.