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.

Symptom prevalence and clustering of symptoms in people living with chronic hepatitis C infection

Quality of life has been shown to be poor among people living with chronic hepatitis C However, it is not clear how this relates to the presence of symptoms and their severity. The aim of this study was to describe the typology of a broad array of symptoms that were attributed to hepatitis C virus (HCV) infection. Phase I used qualitative methods to identify symptoms. In Phase 2, 188 treatment-naive people living with HCV participated in a quantitative survey. The most prevalent symptom was physical tiredness (86%) followed by irritability (75%), depression (70%), mental tiredness (70%), and abdominal pain (68%). Temporal clustering of symptoms was reported in 62% of participants. Principal components analysis identified four symptom clusters: neuropsychiatric (mental tiredness, poor concentration, forgetfulness, depression, irritability, physical tiredness, and sleep problems); gastrointestinal (day sweats, nausea, food intolerance, night sweats, abdominal pain, poor appetite, and diarrhea); algesic (joint pain, muscle pain, and general body pain); and dysesthetic (noise sensitivity, light sensitivity, skin. problems, and headaches). These data demonstrate that symptoms are prevalent in treatment-naive people with HCV and support the hypothesis that symptom clustering occurs.

O ENSINO DO EMPREENDEDORISMO NA FORMAÇÃO DO DISCENTE DO CURSO DE ADMINISTRAÇÃO: UM ESTUDO EM INSTITUIÇÕES PRIVADAS DE ENSINO SUPERIOR DO ESTADO DE SÃO PAULO

Este estudo apresenta uma análise sobre o ensino do empreendedorismo na formação do discente no curso de Bacharelado em Administração. A pesquisa foi realizada em três instituições privadas de ensino superior, localizadas no estado de São Paulo, com aplicação de questionário para alunos de primeiro e último períodos do curso, com levantamento quantitativo de dados. Também utilizou informações fornecidas pelos coordenadores do curso, por meio de pesquisa qualitativa. Em relação à pesquisa bibliográfica foram mencionados estudos sobre o desenvolvimento do ensino do empreendedorismo, os diversos conceitos apresentados pelos estudiosos do assunto, o histórico da universidade brasileira e os caminhos percorridos pelo ensino do empreendedorismo. O referencial teórico foi finalizado com uma abordagem sobre a cultura organizacional, que englobou as diferenças entre culturas organizacionais tradicionais e empreendedoras. O estudo foi desenvolvido enfatizando-se a importância do estímulo na criação de empreendimentos próprios e no desenvolvimento e prática de atitudes empreendedoras, como modelo de projeção profissional e encarreiramento nas organizações. Quanto aos resultados, essa dissertação apresentou as variáveis que apontam a relação entre o ensino do empreendedorismo e as características empreendedoras do discente do curso de Administração, como fatores determinantes para o desenvolvimento empreendedor.

O IMPACTO DAS POLÍTICAS E PRÁTICAS DE RECURSOS HUMANOS SOBRE OS COMPORTAMENTOS DE CIDADANIA ORGANIZACIONAL

O objetivo deste estudo é investigar se as políticas e práticas de recursos humanos (PPRH) impactam os comportamentos de cidadania organizacional (CCO), a fim de proporcionar aos gestores uma compreensão de como os indivíduos, tão diferentes entre si, comportam-se dentro e fora da organização diante daquilo que lhes é estabelecido pela área de recursos humanos. No campo teórico, foram consideradas as obras de Milkovich e Boudreau (1994), Dessler (2002), Demo et al. (2012) entre outros para abordar a questão de PPRH e os trabalhos de Handy (1978), Organ (1990), Siqueira (2003) entre outros para a temática CCO. A metodologia utilizada nesse estudo trata-se de uma pesquisa quantitativa entre 156 trabalhadores de empresas públicas, privadas e mistas localizadas no Estado de São Paulo, sendo que para a captação dos dados foram aplicados questionários de autopreenchimento, composto por duas escalas, sendo uma voltada a PPRH (DEMO et al., 2012) e outra cujas questões são relacionadas a CCO (BASTOS et al., 2014). Como resultados, identificou-se que PPRH impacta de forma significativa CCO e que a política de envolvimento, que trata da criação de um vínculo afetivo entre a organização e seus colaboradores, contribuindo para o seu bem-estar em termos de reconhecimento, relacionamento, participação e comunicação (Demo et al., 2012, p.38), é a única que impacta de forma significativa CCO, se comparados aos impactos causados pelas políticas de recrutamento e seleção, treinamento e desenvolvimento, condições de trabalho, avaliação de desempenho e remuneração e recompensas. Conclui-se também que o conjunto de PPRH impacta com maior significância os fatores de CCO denominados divulgação da imagem organizacional e sugestões criativas. Não houve impacto significativo entre PPRH e o fator cooperação com os colegas.

COORDENADORES PEDAGÓGICOS: FORMADORES DE PROFESSORES OU SUPERVISORES DE AÇÕES POLÍTICO-PEDAGÓGICAS DA ESCOLA?

O sistema educacional vem sofrendo influência direta das modificações ocorridas na sociedade, que está cada vez mais exposta a uma gama de informações que nem sempre são transformadas em conhecimento. Essas transformações vão desde uma nova postura do professor em sala de aula até a própria função social da escola, que ainda não responde às necessidades da sociedade. Nesse novo cenário faz-se imprescindível um professor mais preparado para orientar o aluno, ajudando-o a interagir com o outro, a selecionar as informações a que está exposto e a transformá-las em conhecimento, bem como a interagir com seus semelhantes. É importante considerar que aprendizagem do aluno está diretamente relacionada aos métodos de ensino aos quais está submetido. E, para garantir tal aprendizagem é necessário haver uma equipe mais preparada, mais coesa, ciente do trabalho que está desenvolvendo. Por isso a parceria do trabalho entre a coordenação pedagógica e os professores se torna indispensável. Mas será que o coordenador tem esse olhar? Para saber como o coordenador pedagógico atua na formação continuada dos professores, a pesquisa foi desenvolvida com uma parte teórica e uma parte prática. No referencial teórico estão Álvaro Marchesi, Vitor Henrique Paro e José Carlos Libâneo, por sua grande contribuição na área da gestão; Antônio Nóvoa, Cleide Terzi, Laurinda Almeida e Vera Placco, por seus trabalhos sobre formação de professores e de coordenadores pedagógicos, além de dissertações de mestrado e teses de doutorado sobre o tema. Na parte prática a pesquisa se organiza na perspectiva da metodologia quali/quantitativa, com entrevistas com nove coordenadores pedagógicos. Como a ênfase da dissertação está na construção do perfil desse profissional, foram entrevistados coordenadores de diversos segmentos (Educação Infantil, Ensino Fundamental e Ensino Médio) de diferentes escolas (rede particular e pública). No aspecto quantitativo da pesquisa, foi aplicado um questionário a dezesseis professores, para saber da atuação do coordenador pedagógico no aspecto formador. Os resultados mostraram que o coordenador pedagógico também precisa de formação. Ele desempenha tarefas específicas e que não são tratadas nem nas universidades nem nos cursos de especialização; precisa haver a parceria entre o coordenador pedagógico e o diretor pedagógico, para juntos decidirem os caminhos a serem seguidos dentro da escola; precisa haver um olhar mais direcionado para a formação da equipe, com reuniões, encontros, leituras e atividades planejadas, intencionais; há necessidade de devolutivas aos professores com mais frequência, estar mais perto, mais atuante; o coordenador pedagógico precisa repensar o trabalho coletivo, dar a seus professores autonomia para atuarem, dentro do que for possível. Mesmo os coordenadores pedagógicos que não têm autonomia dentro da escola podem fazer algo para deixar o trabalho com a marca do seu direcionamento; somente com um trabalho de parceria será possível resolver os conflitos e as tensões existentes e fortalecer a liderança, a confiança de seus pares, o trabalho em equipe. Dessa forma, as limitações do trabalho pedagógico com certeza diminuirão.

Internal branding to influence employees' brand promise delivery:a case study in Thailand

Purpose – The purpose of this paper is to understand the internal branding process from the perspective of service providers in Thailand. It will reveal the key internal branding mechanisms and empirically assess the relationship between internal branding and employees' brand attitudes and performance. Design/methodology/approach – A case study representing the Thai hotel industry is adopted with mixed methodologies. In-depth interviews are first carried out with 30 customer-interface employees in six major hotels in Thailand. On a census basis, a quantitative survey with 699 respondents from five major hotels in Thailand follows. Findings – Internal branding coordinating marketing with human resource management has a statistically significant impact on attitudinal and behavioural aspects of employees in their delivery of the brand promise. As employees' brand commitment do not have a statistically significant relationship with employees' brand performance, it is not regarded as a mediator in the link between internal branding and employees' brand performance. Practical implications – A number of significant managerial implications are drawn from this study, for example using both internal communication and training to influence employees' brand-supporting attitudes and behaviours. Still, it should be noted that the effect of internal branding on employee behaviours could be dependent on the extent to which it influences their brand attitudes. Originality/value – The paper provides valuable insights, from the key internal audience's perspectives, into an internal branding process. It has empirically shown the relationship between internal branding and the behavioural outcome as well as the partial meditating effects of employees' brand identification, commitment and loyalty.

Internal branding: an enabler of employees' brand-supporting behaviours

Purpose – The purpose of this paper is to understand the internal branding process from the employees' perspective; it will empirically assess the relationship between internal branding and employees' delivery of the brand promise as well as the relationships among their brand identification, brand commitment and brand loyalty. Design/methodology/approach – On a census basis, a quantitative survey is carried out with 699 customer-interface employees from five major hotels. Findings – Internal branding is found to have a positive impact on attitudinal and behavioural aspects of employees in their delivery of the brand promise. As employees' brand commitment does not have a statistically significant relationship with employees' brand performance, it is not regarded as a mediator in the link between internal branding and employees' brand performance. Furthermore, the study shows that brand identification is a driver of brand commitment, which precedes brand loyalty of employees. Practical implications – A number of significant managerial implications are drawn from this study, for example using both internal communication and training to influence employees' brand-supporting attitudes and behaviours. Still, it should be noted that the effect of internal branding on the behaviours could be dependent on the extent to which it could effectively influence their brand attitudes. Originality/value – The results provide valuable insights from the key internal audience's perspectives into an internal branding process to ensure the delivery of the brand promise. It empirically shows the relationship between internal branding and the behavioural outcome as well as the meditational effects of employees' brand identification, commitment and loyalty.

The discretionary role of the line manager in inspiring work engagement and innovative behaviour:a study of social exchange and job resources in the public sector

This thesis is about the discretionary role of the line manager in inspiring the work engagement of staff and their resulting innovative behaviour examined through the lens of Social Exchange Theory (Blau, 1964) and the Job Demands-Resources theory (Bakker, Demerouti, Nachreiner & Schaufeli, 2001). The study is focused on a large British Public Sector organisation undergoing a major organisational shift in the way in which they operate as part of the public sector. It is often claimed that people do not leave organisations; they leave line managers (Kozlowski & Doherty, 1989). Regardless of the knowledge in the literature concerning the importance of the line manager in organisations (Purcell, 2003), the engagement literature in particular is lacking in the consideration of such a fundamental figure in organisational life. Further, the understanding of the black box of managerial discretion and its relationship to employee and organisation related outcomes would benefit from greater exploration (Purcell, 2003; Gerhart, 2005; Scott, et al, 2009). The purpose of this research is to address these gaps with relation to the innovative behaviour of employees in the public sector – an area that is not typically associated with the public sector (Bhatta, 2003; McGuire, Stoner & Mylona, 2008; Hughes, Moore & Kataria, 2011). The study is a CASE Award PhD thesis, requiring academic and practical elements to the research. The study is of one case organisation, focusing on one service characterised by a high level of adoption of Strategic Human Resource Management activities and operating in a rather unique manner for the public sector, having private sector competition for work. The study involved a mixed methods approach to data collection. Preliminary focus groups with 45 participants were conducted, followed by an ethnographic period of five months embedded into the service conducting interviews and observations. This culminated in a quantitative survey delivered within the wider directorate to approximately 500 staff members. The study used aspects of the Grounded Theory (Glaser & Strauss, 1967) approach to analyse the data and developed results that highlight the importance of the line manager in an area characterised by SHRM and organisational change for engaging employees and encouraging innovative behaviour. This survey was completed on behalf of the organisation and the findings of this are presented in appendix 1, in order to keep the focus of the PhD on theory development. Implications for theory and practice are discussed alongside the core finding. Line managers’ discretion surrounding the provision of job resources (in particular trust, autonomy and implementation and interpretation of combined bundles of SHRM policies and procedures) influenced the exchange process by which employees responded with work engagement and innovative behaviour. Limitations to the research are the limitations commonly attributed to cross-sectional data collection methods and those surrounding generalisability of the qualitative findings outside of the contextual factors characterising the service area. Suggestions for future research involve addressing these limitations and further exploration of the discretionary role with regards to extending our understanding of line manager discretion.

Foundations of an intervention package to improve communication in residential care settings:a mixed methods study

Background: The prevalence of hearing loss is considerably higher in individuals in residential care than in people within the community-dwelling population, and yet hearing aids and hearing services are relatively underused. Care staff have a key role in supporting access to services. Objectives: This study identifies staff perspectives on hearing loss and their views about potential hearing service improvements. Study design: A four-stage mixed methods study was used, made up of qualitative interviews, observation, a survey and a stakeholder involvement meeting. Results: The qualitative stages indicated that staff were concerned about their levels of interaction with residents. Staff considered maximizing communication as part of their professional role. The quantitative survey indicated that these views were widely held by staff, and the stakeholder stage identified the need for social support and dedicated staff training opportunities. Conclusion: Care home staff regard communication as a shared issue. Future interventions could enhance access to hearing services and provide care home staff with training in hearing loss and hearing aid management. © 2013 Informa Healthcare.

Interorganizational innovation and collaboration in the UK medical device sector

Interorganizational team research is a growing body of literature and research has started toexamine team related factors such as interorganizational trust (i.e. Stock, 2006) in theinterorganizational setting. This research applies insights from the intraorganizational teamfield into the interorganizational team setting in order to determine the team related factorspertaining to effective collaboration in medical device innovation projects.Interorganizational collaboration has been a persistent feature within the interorganizationalrelations literature, due to the added benefits that can come with working collaborativelytowards a common goal (Berg-Weger & Schnieder, 1998). While much research has exploredthe structures and performance outcomes of engaging in this cross-boundary working, theliterature is sparse with respect to interpersonal relationships, practices and processes leadingto effective collaboration (Bergenholtz & Waldstrom, 2011; Majchrzak, Jarvenpaa & Bargherz,2015). An interpretivist perspective has informed an exploratory mixed methods approach to datacollection, with contextual insights informing each phase of data collection. Three exploratoryphases of data collection have provided (1) qualitative ethnography data, (1i) qualitativeinterview data and (2) quantitative survey data. The NHS has recently set out agendas to increase innovative procurement (Department ofHealth, 2008), work more closely with industry and SMEs (Innovation and Procurement Plan:Department of Health, 2009) and to increase innovative practice (IHW: NHS, 2011). SMEsdeveloping novel medical devices require input from the NHS to ensure that their devices areclinically applicable and therefore will be adopted by the NHS. These contextual insightsprovide the backdrop for Studies 1i and 2. The findings suggest that the intraorganizational team literature can be extended into theinterorganizational collaboration literature, whilst also explaining the factors relating toeffectiveness and success of interorganizational team innovation.

Not getting by: Poverty management and homelessness in Miami

Urban inequality has emerged as one of the dominant themes of modern life and globalization. More than three million people experienced homelessness in the United States last year; in Miami-Dade, more than 15,000 individuals were homeless. Surviving extreme poverty, and exiting or avoiding homelessness, involves negotiating a complex mix of public and private assistance. However, a range of factors influence what types of help are available and how they can be accessed. Frequently, larger social structures determine which resource are available, leaving many choices entirely out of the individual's control. For single men, who are ineligible for many benefits, homelessness can be difficult to avoid and even harder to exit. My study seeks to better understand how adult, minority men living in extreme poverty in Miami-Dade negotiate their daily survival. Specific research questions address: Do black and Hispanic men who are homeless or at risk of homelessness have different personal characteristics and different experiences in avoiding or exiting homelessness? How does Miami's response to extreme poverty/homelessness, including availability of public benefits and public and private service organizations, either maximize or constrain the choices available to this population? And, what is the actual experience of single, adult men who are homeless or at risk of homelessness, in negotiating their daily survival? A mixed methods approach combines quantitative survey data from 7,605 homeless men, with qualitative data from 54 semi-structured interviews incorporating the visual ethnography techniques of Photo Elicitation Interviewing. Results show the differences experienced by black and Hispanic men who are poor and homeless in Miami. Findings also highlight how the community's official and unofficial responses to homelessness intersect with the actual experiences of the persons targeted by the policies and programs, challenging preconceived notions regarding the lives of persons living in extreme poverty. It adds to the existing body of literature by focusing on the urban Miami context, emphasizing disparities amongst racial and ethnic groups. Findings are intended to provide an empirically grounded thesis that humanizes the subjects and illuminates their personal experiences, helping to inform public policy around the needs of extremely poor populations.

Comunicação pública e acesso à informação: o interesse público presente nas produções da assessoria de imprensa da prefeitura de Santarém (PA)

Public communication is based on the public interest and the effective democratization of communication in publics agencies. Access to information is the base for this is materializes solidly, helping even in formation as an individual. The work of the press office is the instrument for the Public Communication and access to information is guaranteed to society , since one of the goals of the press officer is to be committed to media , providing it material quality and depth , benefiting so the citizen. The research the look exactly on reflections on the topics listed above. The purpose of this study was to analyze the news published in Fanpage and Santarem Town Hall site, in western Para, meet the demands of Public Communication and the precepts of the Access to Information Law (AIL), starting the questioning until point to Santarem Town Hall works to public communication. For this analysis, we developed a work using the techniques of bibliographic and descriptive research. Such referrals have served as a starting point for fieldwork and for exhibition on the concepts of Public Communication of Access to Information Law, Organizational Communication and Press office. The research was considered, also, because document was to identify and verify the documents with a specific purpose. This research was lifting a quantitative survey to support the qualitative analysis of the object. So considering its features is that it was monitor the Fanpage and the Town Hall site, through a specific tool and then the analysis of posts, searching to observe public communication accomplished in the Town Hall of Santarem, on the Internet, especially social media and corporate website. The methodology helped obtain indicators that allowed add knowledge about the production of the Town Hall press office, and identify if the press office productions meet AIL and Public Communication. Finally, it was suggested in this study the elaboration a strategic script of communication because it scales the actions and policies of the Santarem city, allowing citizen participation. For this, too, it suggested the training of Santarem municipal government communication team as a strategy. This training consists of speeches and wheels conversations with all the press officer of the town hall, including the secretariats.

Convergence and translation: attitudes to inter-professional learning and teaching of creative problem-solving among medical and engineering students and staff

Background: Healthcare worldwide needs translation of basic ideas from engineering into the clinic. Consequently, there is increasing demand for graduates equipped with the knowledge and skills to apply interdisciplinary medicine/engineering approaches to the development of novel solutions for healthcare. The literature provides little guidance regarding barriers to, and facilitators of, effective interdisciplinary learning for engineering and medical students in a team-based project context. Methods: A quantitative survey was distributed to engineering and medical students and staff in two universities, one in Ireland and one in Belgium, to chart knowledge and practice in interdisciplinary learning and teaching, and of the teaching of innovation. Results: We report important differences for staff and students between the disciplines regarding attitudes towards, and perceptions of, the relevance of interdisciplinary learning opportunities, and the role of creativity and innovation. There was agreement across groups concerning preferred learning, instructional styles, and module content. Medical students showed greater resistance to the use of structured creativity tools and interdisciplinary teams. Conclusions: The results of this international survey will help to define the optimal learning conditions under which undergraduate engineering and medicine students can learn to consider the diverse factors which determine the success or failure of a healthcare engineering solution.

Considering Efficacy of an Outdoor Environmental Education Program: Facilitating Elementary Students’ Environmental Knowledge, Attitudes, and Behaviours

Various sources have sought to consider the educational interventions that foster changes in perception of and attitudes toward nature, with the ultimate intent of understanding how education can be used to encourage environmentally responsible behaviours. With these in mind, the current study identified an outdoor environmental education program incorporating these empirically supported interventions, and assessed its ability to influence environmental knowledge, attitudes, and behaviours. Specifically, this study considered the following research questions: 1) To what degree can participation in this outdoor education program foster environmental knowledge and encourage pro-environmental attitudes and self-reported pro-environmental behaviours? 2) How is this effect different among students of different genders, and those who have different prior experiences in nature? Two motivational frameworks guided inquiry in the current study: the Value-Belief-Norm Model of Environmentalism (VBN) and the Theory of Planned Behaviour (TPB). The study employed a quantitative survey methodology, combining contemporary data measuring knowledge, attitudes, and behaviours with archived data collected by program staff, reflecting frequency of environmentally responsible behaviour. Further, a single qualitative item was included for which students provided “the first three words that [came] to mind when [they] think of the word nature.” Terms provided before and after the program were compared for differences in theme to detect subtle or underlying changes. Quantitative results indicated no significant change in student knowledge or attitudes through the outdoor environmental education program. However, a significant change in self-reported behaviour was identified from both the contemporary and archived data. This agreement in positive findings across the two data sets, collected using different measures and different participants, lends evidence of the program’s ability to encourage self-reported pro-environmental behaviour. Further, qualitative results showed some change in students’ perceptions of nature through the program, providing direction for future research. These findings suggest that this particular outdoor education program was successful in encouraging students’ self-reported environmentally responsible behaviour. This change was achieved without significant change in knowledge or environmental attitudes, suggesting that external factors not measured in this study might have played a role in affecting behaviour.

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.