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Clinic Reported Facilitators and Barriers to Pediatric Cancer Survivor Care Delivery among Survivorship Clinics: A Fishbone Analysis
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  • Victoria Krauss,
  • Ann Mertens,
  • Jordan Marchak,
  • Regine Haardörfer,
  • Lillian Meacham,
  • Rebecca Williamson Lewis,
  • Robert Wright,
  • Oyinda Adisa,
  • Apoorva Kommajosula,
  • Cam Escoffery
Victoria Krauss
Emory University School of Public Health

Corresponding Author:[email protected]

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Ann Mertens
Children's Healthcare of Atlanta Inc Aflac Cancer and Blood Disorders Center
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Jordan Marchak
Children's Healthcare of Atlanta Inc Aflac Cancer and Blood Disorders Center
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Regine Haardörfer
Emory University School of Public Health
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Lillian Meacham
Children's Healthcare of Atlanta Inc Aflac Cancer and Blood Disorders Center
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Rebecca Williamson Lewis
Children's Healthcare of Atlanta Inc Aflac Cancer and Blood Disorders Center
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Robert Wright
Emory University School of Public Health
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Oyinda Adisa
Emory University School of Public Health
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Apoorva Kommajosula
Emory University School of Public Health
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Cam Escoffery
Emory University School of Public Health
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Abstract

Background: Childhood cancer survivors need regular, long-term survivor care. The Children’s Oncology Group (COG) recommends that pediatric cancer patients receive ongoing, evidence-based surveillance for late-effects beginning two years after cancer therapy completion. A third of survivors are not engaging in long-term survivorship care. This study assessed barriers and facilitators to follow-up survivorship care through the perspectives of pediatric cancer clinic representatives. Methods: As part of a hybrid implementation-effectiveness trial, a representative from 12 participating pediatric cancer survivor clinics completed a survey about site characteristics, and a semi-structured interview on barriers and facilitators to survivor care delivery at their institution. Interviews were grounded in the socio-ecological model (SEM) framework and utilized a Fishbone diagram to identify the root causes of a problem. We ran descriptive statistics and conducted thematic analyses of the interview transcripts to create two meta-Fishbone diagrams. Results: Participating clinics (n=12) have existed for at least five years (mean=30, range= 5-97), and half (50%) report seeing 100-200 survivors annually. In the Fishbone diagram, top facilitators were in the SEM domain of Organization, specifically with familiar staff (100%), resource utilization (92%), survivorship-exclusive staff (83%), and clinic processes (83%). Common barriers were in the domains of Organization, Community, and Policy which included technology limits (92%), scheduling issues (92%), insufficient funding/insurance (92%), and distance/transportation (100%). Conclusion: Using the Fishbone diagram was instrumental in understanding multilevel contextual issues related to survivor care delivery for pediatric cancer clinics. Future efforts can develop education, processes, and services to promote cancer follow-up care.
23 Dec 2022Submitted to Pediatric Blood & Cancer
23 Dec 2022Submission Checks Completed
23 Dec 2022Assigned to Editor
26 Dec 2022Review(s) Completed, Editorial Evaluation Pending
26 Dec 2022Reviewer(s) Assigned
23 Jan 2023Editorial Decision: Revise Major
14 Mar 2023Submission Checks Completed
14 Mar 2023Assigned to Editor
14 Mar 20231st Revision Received
14 Mar 2023Review(s) Completed, Editorial Evaluation Pending
14 Mar 2023Reviewer(s) Assigned
15 Apr 2023Editorial Decision: Revise Minor
17 May 20232nd Revision Received
17 May 2023Submission Checks Completed
17 May 2023Assigned to Editor
17 May 2023Review(s) Completed, Editorial Evaluation Pending
18 May 2023Editorial Decision: Accept