Background

Self-management support (SMS) is a recommended component of cancer survivorship care that improves health-related quality of life and reduces healthcare utilisation. However, widespread implementation has been difficult to achieve, with a gap in the literature on system-wide implementation efforts. This study examines contextual factors perceived to influence SMS adoption and sustainment in cancer centres in the Republic of Ireland.

Method

Semistructured interviews were conducted with 47 key informants from 20 cancer organisations across community and hospital settings. Participants were asked to report the level of adoption and sustainment of SMS at their organisation. This information was used to categorise organisations as low, medium or high implementers. We conducted cross-case analysis following the principles of Framework Analysis. Using the Consolidated Framework for Implementation Research as a menu of constructs, we examined factors influencing adoption and sustainment and variation in levels of implementation.

Results

National policy, external accreditation, external financing opportunities and the presence of champions in organisations are influential early in the implementation process driving adoption. Healthcare provider-led programmes and evidence of SMS improving patient outcomes and aligning with an organisation’s priorities are necessary to secure buy-in, particularly among senior leadership. An organisational culture of entrepreneurship enables adoption and sustainment, with resources and a culture supporting staff well-being enabling sustainment.

Conclusion

While national policy is a driver, additional factors related to programme attributes and local contextual features such as the presence of champions, organisational readiness and culture influence implementation. The results may be used for future evaluations of SMS implementation in cancer survivorship care and to inform the development of tailored implementation strategies.

Introduction and aims

Women residing in lower socioeconomic status (SES) areas have lower breast cancer survival but it is not clear how differences in the quality of care received contribute to these disparities. We compared adherence to clinical practice guidelines (CPG) for the diagnosis and treatment of breast cancer and subsequent breast cancer survival between women residing in lower versus higher SES areas.

Methods

We conducted a multicentre population-based study of all new cases of invasive breast cancer in women diagnosed 2010–2014 in six Spanish provinces with population-based cancer registries (n=3206). Clinical data were extracted in the framework of the European Cancer High Resolution studies and vital status follow-up covered a minimum of 5 years. SES of the patient’s residence was measured with the 2011 Spanish Deprivation Index. Adherence to CPG was measured with 16 indicators based on European and Spanish guidelines. Relative survival was modelled using flexible parametric models.

Results

There were no differences in the type of treatment received but women living in the lowest SES areas were less likely to undergo a sentinel lymph node biopsy, reconstruction after mastectomy, surgery within 30 days after pathological diagnosis and adjuvant treatment within 6 weeks after surgery. After accounting for demographic and clinical factors, women residing in lower SES areas had higher risk of death, HR=1.57 (95% CI 1.04, 2.36). Further accounting for adherence to CPG in the model, in particular having undergone a sentinel lymph node biopsy, eliminated the significant effect of SES.

Conclusions

Despite the overall coverage of the Spanish health system, women living in more deprived areas were less likely to receive care in line with CPG and had shorter survival.

Introduction

QI education is essential for resident physicians with established requirements from the Accreditation Council for Graduate Medical Education outlining the necessary components. Literature supports the inclusion of both didactic and experiential learning, however, most studies review knowledge and attitude based assessments of residency QI programs. In 2012, our pediatric residency program identified a gap in resident engagement in QI, which led to the formalization of a QI education program grounded in the Institute for Healthcare Improvement (IHI) Model for improvement with objective measures of QI projects.

Methods

Over 13 years, our program implemented interative interventions across three phases to enchance QI training. Initial core interventions involved the structure of didactics to teach core principles of QI and with time focusing on more individualized mentorship. Our efforts were guided through a residency QI committee. Our aim was to (1) increase the percentage of resident QI projects with SMART aims, and (2) increase the use of QI graphs (run charts and SPC charts) of resident QI projects. We tracked graduating resident exit survey satisfaction with the QI program as a balancing measure.

Results

From 2012 through 2025, over 300 resident completed 390 QI projects that were reviewed. The percentage of of projects with SMART aims and QI graphs increased over time. The percentage of projects applying for American Board of Pediatrics Part IV applications and presenting at conferences also increased. Resident satisfaction remained with with an average "Poor" rating of only 2.6%.

Conclusions

Using the model for improvement to assess objective measures in a residency QI program is both feasible and effective. This 13-year intiative demonstrates how systematic, iterative improvement can improve the rigor of resident QI projects. Future goals including leveraging informatics to further support residents with their projects and track downstream patient outcomes.