Barriers and facilitators to establishing survivorship care at an NCI-designated cancer center.

491 Background: Cancer survivorship care has evolved over the past 20 years and there continues to be no model of care suitable for all the various cancer types and settings of cancer care delivery. As part of a larger project to understand the current state of cancer survivorship within the University of Wisconsin Carbone Cancer Center (UWCCC), we assessed barriers and facilitators to survivorship care among disease-specific clinics. Methods: This project was conducted as a quality improvement initiative. An electronic survey asking about the current approach to survivorship care was sent to cancer care providers including physicians and Advanced Practice Providers (APPs). The survey contained questions about ongoing survivorship practices and barriers to survivorship care. Interested survey participants had the opportunity to participate in structured virtual interviews. The interviews were recorded, transcribed, and organized with the software NVivo, and analyzed to identify barriers and facilitators to establishing survivorship care. Results: 51 of 195 (26.2%) of polled UWCCC providers responded to the survey, 35 of which reported barriers to survivorship care. Regarding system-level barriers, 77.1% reported missing or insufficient support systems in place, 54.3% reported no leadership (internal champion), and 48.6% reported a lack of standardized guidance and metrics. The top 2 provider-level barriers included lack of time, reported by 77.1% of providers and inadequate training, knowledge, or experience in survivorship care reported by 40%. Regarding patient-level barriers, practical barriers (time, cost, travel time, childcare) were reported by 60% in addition to emotional stress or fear of clinic due to past cancer diagnosis/treatment, reported by 31.4%. We conducted 11 interviews. Among facilitators of survivorship care, providers reported training on survivorship, multidisciplinary clinic, and utilizing a survivorship document (care plan or comprehensive summary). As barriers, providers reported being unsure of appropriate time for survivorship transition, challenges to address the needs of survivors with life-long indolent disease and challenges with transitioning patients to primary care providers. Conclusions: In order to build a comprehensive survivorship clinical program, perceived barriers to survivorship care must be addressed. While disease-specific clinics have particular needs based on disease characteristics and prognosis, there are care provision commonalities (e.g. development of care workflow, identifying champion providers, providing education on survivorship) that can be supported by cancer center leadership to expand the provision of survivorship care across all disease-specific clinics.