From active treatment to surveillance: how the barriers and facilitators of implementing survivorship care planning could be an opportunity for telehealth in oncology care for rural patients

Jennifer Alford-Teaster; Danielle Vaclavik; Inger Imset; Jenna Schiffelbein; Kathleen Lyons; Nirav Kapadia; Ardis Olson; Elizabeth B McGrath; Karen Schifferdecker; Tracy Onega

doi:10.1007/s11764-023-01447-5

From active treatment to surveillance: how the barriers and facilitators of implementing survivorship care planning could be an opportunity for telehealth in oncology care for rural patients

J Cancer Surviv. 2023 Dec 8. doi: 10.1007/s11764-023-01447-5. Online ahead of print.

Authors

Jennifer Alford-Teaster^{1

2}, Danielle Vaclavik³, Inger Imset⁴, Jenna Schiffelbein⁵, Kathleen Lyons⁶, Nirav Kapadia^{5

7

8}, Ardis Olson⁵, Elizabeth B McGrath⁵, Karen Schifferdecker³, Tracy Onega⁹

Affiliations

¹ Dartmouth Cancer Center, Lebanon, NH, 03756, USA. Jennifer.A.Alford-Teaster@dartmouth.edu.
² Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. Jennifer.A.Alford-Teaster@dartmouth.edu.
³ Center for Program Design and Evaluation (CPDE) at the Dartmouth Institute for Health Policy and Clinical Practice (TDI), Lebanon, NH, USA.
⁴ Population Health, Dartmouth Health, Lebanon, NH, USA.
⁵ Dartmouth Cancer Center, Lebanon, NH, 03756, USA.
⁶ MGH Institute of Health Professions, Boston, MA, USA.
⁷ Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
⁸ Department of Radiation Oncology, Dartmouth Health, Lebanon, NH, USA.
⁹ Department of Population Health Sciences, University of Utah and Huntsman Cancer Institute, Salt Lake City, UT, USA.

PMID: 38066227
DOI: 10.1007/s11764-023-01447-5

Abstract

Purpose: Cancer survivorship care planning is a recognized yet underutilized aspect of care delivery, and the opportunity for telehealth in cancer survivorship is examined.

Methods: We conducted a mixed-methods study in Vermont and New Hampshire to characterize perceptions of rural cancer providers and survivors regarding survivorship transitions in care, consisting of (a) key informant interviews with primary care and oncology clinicians, (b) a broader survey of clinicians, and (c) surveys and focus group discussions with cancer survivors. In these interactions, we also explored the use of a shared telehealth survivorship care planning appointment between oncology clinicians, primary care clinicians, and survivors.

Results: Results from surveys and interviews clustered around several themes, namely (1) infrequent care transitioning back to primary care, (2) lack of mental health services, (3) lack of side effect education, (4) low perceived utility of survivorship care plans, (5) clinicians exclusively communicate using the EMR and finding it imperfect, and (6) clinicians and survivors reported conflicting perceptions regarding survivors' access to telehealth options.

Conclusions: Our results suggest that telehealth has the potential to augment the delivery of survivorship care planning; however, key technical and logistical concerns need to be addressed, particularly enhanced coordination across clinician scheduling and ensuring payment parity for various telehealth implementation strategies.

Implications for cancer survivors: Cancer survivorship care planning is a recognized yet underutilized aspect of care delivery. There is an opportunity for the application of telehealth for supportive care in survivorship care planning, which should be a focus of further research.

Keywords: Survivorship; Tele-oncology; Telehealth.