P30 Administrative Supplement for Assessing and Enhancing Survivorship Care

PROJECT ABSTRACT The complexity of childhood cancer survivorship care delivery necessitates systematic optimization, especially as the U.S. survivor population approaches 580,000. The St. Jude Comprehensive Cancer Center's Cancer Control and Survivorship Program aims to enhance care through multidisciplinary approaches, yet significant barriers persist, particularly in non- specialized clinics. Existing guidelines require detailed cancer histories and treatment risk factors, challenging to obtain in community settings where providers often manage few, diverse survivors. Currently, most survivorship follow-up care is provided by primary care providers who often lack the necessary expertise and resources. Different models of survivorship care have been developed to aid in this process, such as community-based shared-care and comprehensive survivor programs. However, these continue to face unique challenges and have not proven universally effective. Qualitative interviews about survivorship care have begun to identify important barriers and highlight healthcare systems challenges survivors and providers face when attempting to deliver effective care to survivors. This study seeks to address gaps in survivorship care delivery by employing system dynamics and group model building to explore barriers and interconnections within the care process. The proposal will generate a qualitative model of survivorship care developed in collaboration with patients, families, and clinicians involved in their care. This involves two primary aims. We will conduct sequential group model building workshops with clinical teams (Aim 1) as well as survivors and their families (Aim 2). This work will result in the development of causal loop diagrams to describe the complex system of care and will be used to identify leverage points. Participants include primary care providers, subspecialists, oncology teams, and survivors/families. This research is significant for its potential to elucidate the complexities of survivorship care, enhancing accessibility and equity beyond highly resourced settings. The innovative participatory modeling approach will generate qualitative models considering multimorbidity, health-related quality of life, psychosocial adversity, geographic constraints, and genetic predisposition. This comprehensive model will guide the design, dissemination, and implementation of effective survivorship care solutions, ensuring sustainable and high-quality care delivery for childhood cancer survivors across diverse settings. The insights gained will contribute to better health outcomes and quality of life for the growing population of pediatric cancer survivors.