Implementing And Sustaining A Breast Cancer Prospective Surveillance Rehabilitation Program An Institutional Perspective

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.

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Authors and Affiliations
1. Department of Hematology Oncology, West Virginia University School of Medicine, Morgantown, WV, USA Nicole L. Stout

2. Department of Health Policy, Management, and Leadership, West Virginia University School of Public Health, Morgantown, WV, USA Nicole L. Stout

3. West Virginia University Cancer Institute, Morgantown, WV, USA Nicole L. Stout, Hannah Hazard Jenkins, Megan Burkart & Anne K. Swisher

4. Division of Physical Therapy, West Virginia University School of Medicine, Morgantown, WV, USA Ralph Utzman, Megan Burkart & Anne K. Swisher

5. Department of Surgery, West Virginia University School of Medicine, Morgantown, WV, USA Hannah Hazard Jenkins

Authors 1. Nicole L. StoutYou can also search for this author in PubMedGoogle Scholar

2. Ralph UtzmanYou can also search for this author in PubMedGoogle Scholar

3. Hannah Hazard JenkinsYou can also search for this author in PubMedGoogle Scholar

4. Megan BurkartYou can also search for this author in PubMedGoogle Scholar

5. Anne K. SwisherYou can also search for this author in PubMedGoogle Scholar

Contributions
Concept and design: AS, NS, RU. Acquisition, analysis, or interpretation of data: NS, RU, AS, MB, HHJ. Drafting of the manuscript: NS, AS, RU. Critical revision of the manuscript: NS, RU, AS, MB, HHJ. Statistical analysis: N/A. Obtained funding: N/A. Administrative, technical, or material support: NS, RU, AS, MB, HHJ. Supervision: N/A.

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Conflict of interest
NS: consultant/speakers bureau: MedBridge Inc., Survivorship Solutions LLC. RU: none. HHJ: none. MB: none. AS: none.

Data availability
This narrative review did not collect a data set for this report.

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Stout, N.L., Utzman, R., Jenkins, H.H. et al. Implementing and sustaining a breast cancer prospective surveillance rehabilitation program: an institutional perspective. J Cancer Surviv (2022). /10.1007/s x

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* Received: 18 May * Accepted: 12 November * Published: 28 November * DOI: /10.1007/s x

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Keywords
* Breast cancer
* Cancer care delivery
* Implementation science
* Functional morbidity
* Rehabilitation