Contextual assessment of health system alignment with National Standards for Cancer Survivorship Care in the American Southeast.

Purpose: We assessed alignment of a large health system in the American Southeast with the National Standards for Cancer Survivorship Care. Methods: We engaged key partners and distributed an electronic survey to oncology practices within the system. In parallel, in four representative clinics we collected qualitative data including four clinic observations and 12 semi structured interviews informed by the Consolidated Framework for Implementation Research (CFIR). Results: Of the 51 key informants at practices who received the survey, 16 consented, and 10 completed at least one item. On average, informants reported meeting 55% of the survivorship care National Standards at least some of the time. Facilitators and barriers for National Standards implementation were identified in these CFIR Domains: Characteristics of the Individuals (e.g., believed to be beneficial for improving and standardizing care), Outer Setting (e.g., need to be linked to an incentive), Inner Setting (e.g., need for more provider training on what is available), Intervention Characteristics (e.g., difficult to understand), and Process (e.g., important decision-makers). Conclusions: While most informants reported meeting at least half of the National Standards, there was variability in how consistently these were applied across practices. Further, there was likely bias with more favorable responses from those who chose to complete the survey than those who did not. Implications for Cancer Survivors: These data demonstrate a systematic process for assessing alignment with National Standards and identifying opportunities for improving survivorship care with a balance of having both consistent services and adaptation to local demands.