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Home » Products » Models of Care That Include Primary Care for Adult Survivors of Childhood Cancer » Models of Care that Include Primary Care for Adult Survivors of Childhood Cancer: A Realist Review

Models of Care that Include Primary Care for Adult Survivors of Childhood Cancer: A Realist Review

Systematic Review Draft

Open for comment through Jun 18, 2021

This draft report is available in electronic format only (Draft Report, [PDF, 1.25 MB]; Draft Appendixes [PDF, 848.6 KB]). For additional assistance, please contact us.

Main Points

  • Our program theory describes how survivor and provider characteristics and facilitators/barriers may interact to produce intermediate and final outcomes and the potential role of models and resources in these interactions.
  • We developed seven hypotheses about the relationships between context, mechanism, and outcome (CMO) that could be associated with effective survivorship care models that include primary care.
  • The program theory variables seen most consistently in the literature include oncology versus primary care, survivor and provider knowledge, provider comfort treating childhood cancer survivors, communication and coordination between and among providers and survivors, and delivery/receipt of prevention and surveillance of late effects. In turn, these variables played the most prominent role in the CMO hypotheses.
  • Care delivered outside of the specialty setting needs to include communication of knowledge to both survivors and primary care providers; our program theory provides guidance on the ways this knowledge could be shared.

Structured Abstract

Objectives. We had two aims: (1) identify and analyze models of survivorship care for adult survivors of childhood cancer that include primary care, and (2) identify available tools, training, and survivorship resources for adult survivors of childhood cancer. For each aim, we used realist synthesis to provide insights on how and for whom, in what contexts, and via what mechanisms the models of care and resources we identified can be effective for adult survivors of childhood cancer.

Methods. We conducted a realist review. We developed an initial program theory through searches of the literature and discussions with Stakeholders. We then identified and summarized empiric evidence that supported or refuted the theory and developed specific hypotheses about how contexts and mechanisms may interact to produce outcomes ("CMO" hypotheses). The final program theory and CMO hypotheses were presented to Stakeholders for feedback.

Results. Our final refined theory describes how, within the overall environment, survivor and provider characteristics and facilitators/barriers interact to produce intermediate and final outcomes. We focus, in particular, on the role of models of care and resources in these interactions. From the theory, we developed seven CMO hypotheses (four focused on survivors and three focused on providers). The program theory variables seen most consistently in the literature include oncology versus primary care, survivor and provider knowledge, provider comfort treating childhood cancer survivors, communication and coordination between and among providers and survivors, and delivery/receipt of prevention and surveillance of late effects. In turn, these variables played the most prominent role in the CMO hypotheses.

Conclusions. To enable models of care that include primary care for adult survivors of childhood cancer, there needs to be communication of knowledge to both survivors and primary care providers. Our program theory provides guidance on the ways this knowledge could be shared, including the role of resources in doing so, and our CMO hypotheses suggest how the relationships illustrated in our theory could be associated with survivors living longer and feeling better through high-value care.