Enhancing Cancer Survivorship Care Knowledge among Primary Care Clinicians in Community Health Centers
Introduction
Community Health Centers (CHCs) serve as safety-net systems for patients with a history of cancer living in underserved communities. In these settings, primary care clinicians (PCCs) are expected to provide health care for all of the patient’s conditions, including common chronic conditions like diabetes or hypertension and cancer follow-up care. However, many PCCs lack formal medical training in cancer survivorship care, leaving a critical gap in their ability to provide comprehensive and coordinated care to cancer survivors. To address this gap, we implemented and evaluated an interactive tele-mentoring survivorship care education program for PCCs working in CHCs utilizing the Project ECHO (Extension for Community Healthcare Outcomes) model.
Methods
Qualitative in-depth interviews conducted with 10 PCCs from two Texas CHCs and four urban clinics assessed barriers and facilitators in providing survivorship care and their experiences participating in ECHO sessions. A pilot project consisting of nine ECHO sessions was implemented at two CHC clinics from October 2022 to June 2023. The sessions included principles of cancer survivorship; survivorship care plans; breast, lung, and prostate cancers; early childhood cancers; late and long-term effects of cancer and its treatments; and psychosocial distress. Each ECHO session included a case-based presentation by participating PCCs followed by a didactic presentation from oncology and primary care content experts. Surveys before and after ECHO program evaluated PCC cancer survivorship knowledge and experience.
Results
PCC interviews revealed barriers providing high-quality care to cancer survivors in primary care. These included lack of accessible survivorship care guidelines and management resources in the electronic medical records and means to quickly communicate with oncologists. PCCs also shared the need for survivorship training to assist with managing their patient's side effects from the late and long-term effects of cancer. Preliminary findings from pre-ECHO surveys (58.3% response rate) revealed that 83.3% of PCCs reported a lack of training in cancer survivorship. Additionally, the post-ECHO session surveys found that 86% will likely apply practices learned during the ECHO session in their work and 95% found the case presentations useful. After the ECHO sessions, PCCs reported a positive impact and relevance of ECHO case-based presentation sessions in fostering survivorship knowledge and training to deliver high-quality cancer survivorship care.
Conclusion
Enhancing cancer survivorship care knowledge among PCCs is crucial for improving the delivery of comprehensive and coordinated care in underserved patient populations. ECHO-based telementoring approaches have the potential to engage PCCs collaboratively, addressing the knowledge gap. This, along with practice changes, can enhance patient outcomes. The findings of this study highlight the importance of implementing innovative educational interventions to enhance survivorship care in underserved settings.