Challenges, Strengths and Opportunities Related to Implementing Comprehensive Evidence-Based Guidelines on Breast Cancer Survivorship Care by Primary Care Physicians and Nurse Practitioners in Southeastern Ontario

Background Many breast cancer survivors continue to have a broad range of physical and psychosocial problems after breast cancer treatment. As cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up it is important that comprehensive evidence-based breast cancer survivorship care is implemented to effectively address these needs. Research suggests primary care providers are willing to provide breast cancer survivorship care but many lack the knowledge and confidence to provide evidence-based care. Purpose The overall purpose of this thesis was to determine the challenges, strengths and opportunities related to implementing comprehensive evidence-based breast cancer survivorship guidelines by primary care physicians and nurse practitioners in southeastern Ontario. Methods This mixed-methods research was conducted in three phases: (1) synthesis and appraisal of clinical practice guidelines relevant to provision of breast cancer survivorship care within the primary care practice setting; (2) a brief quantitative survey of primary care providers to determine actual practices related to provision of evidence-based breast cancer survivorship care; and (3) individual interviews with primary care providers about the challenges, strengths and opportunities related to provision of comprehensive evidence-based breast cancer survivorship care. Results and Conclusions In the first phase, a comprehensive clinical practice framework was created to guide provision of breast cancer survivorship care and consisted of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations, and a one-page list of guideline sources. The second phase identified several knowledge and practice gaps, and it was determined that guideline implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care and lowest related to screening for and management of long-term effects. The third phase identified three major challenges to providing breast cancer survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden; and three major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles. A better understanding of these challenges, strengths and opportunities will inform development of targeted knowledge translation interventions to provide support and education to primary care providers.

Zahhak consults the physicians at court from a Shahnama (Book of kings) by Firdawsi

9 9/16 in.x 7 3/4 in.; ink, opaque watercolor, gold and silver on paper

Early American fiction, 1774-1830 : a compilation of the titles of works of fiction written by writers born or residing in North America, and printed previous to 1931.

"The edition of this work is limited to one hundred and two copies."

A Cheap, sure, and ready guide to health, or, acure for a disease call'd the doctor : : instructing how to prevent being cheated and destroyed by the exactions and unmerciful usage of ognoratn adn oppressive physicians and apothecaries.

Mode of access: Internet.

Catalogue and report of obstetrical and other instruments exhibited at the conversazione of the Obstetrical Society of London : held, by permission, at the Royal College of Physicians, March 28th. 1866.

Mode of access: Internet.

Distribution of physicians by medical service areas.

"Map supplement to Bulletin 94, [by] Frank G. Dickinson and Charles E. Bradley" (64 p. maps), issued in 1953.

The Cottage physician : for individual and family use. Prevention, symptoms and treatment. Best known methods in all diseases, accidents and emergencies of the home, prepared by the best physicians and surgeons of modern practice. Allopathy, Homœopathy, etc., etc. /

"Complete hand book of medical knowledge for the home."

Register of physicians in Pennsylvania : by counties, from July 1, 1881 to December 1, 1888. Taken from the Fourth annual report of the State board of health.

Mode of access: Internet.

History of medicine and surgery and physicians and surgeons of Chicago, endorsed by and published under the supervision of the council of the Chicago Medical Society.

Mode of access: Internet.

Official register of physicians and midwives now in practice : to whom certificates have been issued by the State Board of Health of Illinois, 1877-1886.

Revised and corrected to February 10, 1886.

Devotional somnium, or, A Collection of prayers and exhortations : uttered by Miss Rachel Baker, in the City of New York, in the winter of 1815, during her abstracted and unconscious state ; to which ... is prefixed, an account of her life ... the facts, attested by the most respectable divines, physicians, and literary gentlemen; and the discourses, correctly noted by clerical stenographers / by several medical gentlemen.

Shaw and Shoemaker

Burritt, our alma mater : an attractive little book of facts and fiction, bringing up memories that cluster round Spencer's hills [with] letters from abroad by the late president, W. N. Billingsley /

Mode of access: Internet.

Regulation of physicians by law ..

Mode of access: Internet.