Addressing Cancer Survivors' Fear of Recurrence: Testing a Social Work Intervention Targeting Interprofessional Teams in Primary Care (WITHDRAWN)

Background: Oncology practices no longer have the capacity to provide healthcare to growing numbers of cancer survivors. Therefore, survivors are increasingly receiving their care through primary care practitioners, who often lack cancer-specific expertise, especially regarding psychosocial issues. The demand for this expertise is increasing as the population of survivors in the US is expanding exponentially due to advances in early detection and treatment.  In addition to the multiple physical and psychosocial long-term effects from cancer, survivor populations tend to be older with multiple chronic conditions, often leaving psychosocial issues such as fear of cancer recurrence (FCR) unaddressed.  Continuing education training is an established and effective means to impart new knowledge to primary care providers. This study reports the development and testing of a social work intervention to train primary care practitioners to identify and address the psychosocial concern of FCR.

Methods: The training was developed through key informant interviews with 42 health care professionals, health care researchers, and cancer survivors. The 30 minute training was then delivered by a social work clinician and pilot tested with a total of 46 participants, including physicians, physician’s assistants, (PA)s, nurse practitioners (NP)s, nurses, and social workers in six discrete primary care practices. A one group pre-test, post-test design was used to evaluate the effectiveness of the training.  Participants completed self-report questionnaires consisting of 5 domains developed from Social Cognitive Theory and Kirkpatrick’s Evaluation of Training Programs model. Domains included: socio-demographics, FCR knowledge, self-efficacy, reaction to training/ anticipated practice behaviors, and attitudes about survivorship issues. Data were analyzed using descriptive statistics, paired-sample t-tests, and ANOVA/Welch’s F.

Results: The majority of participants (N = 46) were physicians (61%), followed by nurses (17%), PAs (11%), NPs (7%) and social workers (4%).  The average number of years of professional experiences was 16.8 + 10.9. Descriptive statistics indicated that the participants reported high levels of confidence that the training would change their practice, although they also identified barriers to action. Results of bivariate analyses indicated that the training increased knowledge and self-efficacy of providers in identifying and addressing FCR. No statistically significant differences were found between groups of health care professionals at the multivariate level.

Implications: This study demonstrated that a brief, on-site interprofessional training is feasible in a range of primary care practices, well-received by participants, and achieved goals of improved knowledge, self-efficacy and confidence to implement anticipated practice behavior changes. Such training efforts are important, as quality healthcare for increasing numbers of cancer survivors can be improved through continuing education efforts for their interdisciplinary primary care providers.