Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr;17(2):509-517.
doi: 10.1007/s11764-022-01304-x. Epub 2022 Nov 28.

Implementing and sustaining a breast cancer prospective surveillance rehabilitation program: an institutional perspective

Nicole L Stout  1   2   3 , Ralph Utzman  4 , Hannah Hazard Jenkins  5   6 , Megan Burkart  5   4 , Anne K Swisher  5   4
Affiliations

Implementing and sustaining a breast cancer prospective surveillance rehabilitation program: an institutional perspective

Nicole L Stout et al. J Cancer Surviv. 2023 Apr.

Abstract

Background: The prospective surveillance model (PSM) is an evidence-based rehabilitation care delivery model that facilitates functional screening and intervention for individuals undergoing cancer treatment. While PSM is empirically validated and feasible in practice, implementation into cancer care delivery has languished. The purpose of this manuscript is to characterize the barriers and facilitators to implementing PSM in a breast cancer center and to share policy and process outcomes that have sustained the model in practice.

Methods: The PSM implementation was undertaken as a quality improvement initiative of our cancer center. We retrospectively assessed barriers to implementation and define those according to the Consolidated Framework for Implementation Research (CFIR). Implementation strategies are defined based on the Expert Recommendations for Implementation Change (ERIC) taxonomy. Breast center policy changes and stakeholder-reported process improvement outcomes at the clinic and system level are described.

Results: PSM implementation facilitation was driven primarily by adapting the model to align with the cancer center workflow, engaging interdisciplinary stakeholders as program champions, enhancing knowledge and awareness among cancer care providers, and changing infrastructure to support the model. System and clinic-level policy and process changes included the development of clinical pathways, EHR order sets and automated referrals, new staffing models, and adapted clinical workflows.

Conclusion: Our report provides insight on implementing the PSM at a single institution in a cancer care delivery setting. Successful implementation strategies addressed individual, clinic, and system-level barriers and facilitated process and policy changes that have enabled PSM sustainment. Improving integration of rehabilitation services into oncology care has significant implications for survivorship care by enhancing proactive management of functional morbidity.

Implications for cancer survivors: Improving integration of rehabilitation services into oncology care has significant implications for survivorship care by enhancing proactive management of functional morbidity.

Keywords: Breast cancer; Cancer care delivery; Functional morbidity; Implementation science; Rehabilitation.

PubMed Disclaimer

References

    1. Cheville AL, McLaughlin SA, Haddad TC, Lyons KD, Newman R, Ruddy KJ. Integrated rehabilitation for breast cancer survivors. Am J Phys Med Rehabil. 2019;98(2):154–64. https://doi.org/10.1097/PHM.0000000000001017 . - DOI - PubMed
    1. Runowicz CD, Leach CR, Henry NL, et al. American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline. Cancer J Clin. 2016;66(1):43–73. https://doi.org/10.3322/caac.21319 . - DOI
    1. Springer BA, Levy E, McGarvey C, et al. Pre-operative assessment enables early diagnosis and recovery of shoulder function in patients with breast cancer. Breast Cancer Res Treat. 2010;120(1):135–47. https://doi.org/10.1007/s10549-009-0710-9 . - DOI - PubMed - PMC
    1. Stout Gergich NL, Pfalzer LA, McGarvey C, Springer B, Gerber LH, Soballe P. Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer. 2008;112(12):2809–19. https://doi.org/10.1002/cncr.23494 . - DOI - PubMed
    1. Levy EW, Pfalzer LA, Danoff J, et al. Predictors of functional shoulder recovery at 1 and 12 months after breast cancer surgery. Breast Cancer Res Treat. 2012;134(1):315–24. https://doi.org/10.1007/s10549-012-2061-1 . - DOI - PubMed

LinkOut - more resources