Evaluation of primary care providers’ knowledge and self-efficacy in the management of cancer survivors
Introduction
Early screening, improved treatments, and other advancements in medicine have substantially increased the life expectancy of patients who receive a cancer diagnosis and the number of survivors living in the United States (U.S.). In the U.S. alone, there are currently 18.1 million survivors. This number is expected to grow exponentially beyond the capacity of oncologists. Primary care providers (PCPs) are in a unique position to deliver comprehensive care to survivors; however, cancer survivorship care is not a formal part of their training. We implemented a video-based curriculum developed by UTHealth MD Anderson Cancer Center (MDACC) on comprehensive cancer survivorship care, followed with monthly consultation sessions on the implementation of clinical services using Project ECHO™ (Extension for Community Healthcare Outcomes). This was a Quality Improvement Initiative at one UT Physicians community-based family practice to provide cancer survivorship care training.
Methods
We assessed PCPs’ knowledge and self-efficacy in providing survivorship care using the Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) via Qualtrics at baseline, at completion of the MDACC curriculum, and at completion of the ECHO™ consultation sessions. Pre-post analysis with means and frequency distributions and Wilcoxon signed rank test using recoded data were conducted to evaluate changes in PCP’s knowlege and self-efficacy. Graphs were also generated to describe the changes.
Results
All PCPs (N=17) completed the MDACC curriculum which consists of eight video-based, didactic CME-accredited training modules on topics such as late effects, psychosocial concerns of survivors, and individual modules on four cancer types (lung, colorectal, breast and prostate cancer). After completing the curriculum, the PCPs also attended at least two monthly consultation sessions. At baseline, 94% of PCPs have previously provided care for patients diagnosed with cancers. However, 24-41% PCPs felt “not at all” confident in their knowledge of cancer-related follow-up care for breast, colorectal, lung, and prostate cancer survivors. Only 6-18% felt “very” confident. The first post-training survey results (n=17) indicated considerable improvement in knowledge and self-efficacy among the PCPs with 18-29% reporting “very” confident and only 12% indicating they lacked confidence related to the management of long-term and late physical adverse effects. The second post-training survey results (n=14) showed a sustained level of confidence with 29-57% PCPs reporting “very” confident, an increase from 14-28% among the same PCPs who completed the first post-training survey. Test statistics among 14 PCPs who completed three assessments showed statistically significant improvement in PCP’s confidence in providing care for cancer survivors at post-training periods compared with the pre-training period.
Conclusion
The education and training program has demonstrated improvement in PCP’s knowledge, self-efficacy, and practices concerning survivorship care management. Regular training sessions are recommended to ensure the delivery of the most current information regarding survivorship care and to facilitate expansion of services to other clinic sites.