Supportive Care Service Availability for Cancer Caregivers in Community Oncology Practices

The primary goals of this study are to: 1) estimate the prevalence of: a) caregiver
identification practices, b) psychosocial and/or needs assessment practices for caregivers,
and c) the availability of and funding models for supportive care services for caregivers at
community oncology practices (Objective 1), and 2) assess the perspectives of
multi-disciplinary oncology health care providers regarding: a) perceived responsibility for,
and barriers to, assessing and supporting caregivers, b) the importance of and self-efficacy
in communicating with caregivers, and c) preferences regarding systems approaches to assess
and meet caregivers' needs (Objective 2). Additionally, we will explore various practice and
provider -level factors that are associated with the listed outcomes in objectives 1 and 2
respectively (Objective 3a and 3b). This study is estimated to enroll 138 Supportive Care
Leaders (e.g., Director of Psychosocial Oncology, Supportive Care Services, or Cancer Patient
Support) and 690 multidisciplinary Oncology Providers including physicians, nurses, and
physician assistants/nurse practitioners. Participants will complete a one-time web-based
survey (estimated at 15-20 minutes to complete). The supportive care leader survey will
capture: (1) practice characteristics including caregiver identification and psychosocial
assessment practices and preferences; supportive care resources; practice structure; practice
technology resources; and status of the Caregiver Advise Record and Enable (CARE) Act. The
oncology provider survey will capture: (1) provider skills in caregiver communication;
perceived responsibility, knowledge and skills, and awareness of resources for meeting
caregiver needs; barriers to meeting caregiver needs; provider characteristics; and system
intervention preferences.

For data capture regarding supportive care leaders (Objective 1 and 3a), this will be a
convenience sample of responders from all WF NCORP sites, therefore no randomization or
stratification is necessary.

Regarding objectives pertaining to oncology providers (Objective 2 and 3b), participating
sites with corresponding supportive care leaders will identify an appropriate supportive care
leader to generate 3 lists of providers: 1) physicians, 2) nurses, and 3) physician
assistants/nurse practitioners who routinely provide cancer care (Oncology Care Provider
Identification Form, Appendix B). Using previous Landscape data regarding oncology
physicians, we estimate that 50% of practice groups have 1-9 oncology physicians, 25% have
10-20, and 25% have 20+ physicians. After practices respond with lists of physicians, nurses,
and physician assistants/nurse practitioners, we will classify each site as small, medium,
and large using the criteria for physicians listed above. Assuming similar distributions as
seen in Landscape, we will randomly sample 4, 12, and 20 total providers at small, medium,
and large sites respectively. With approximately 50% of practices participating, we plan to
target a weighted average of 10 providers per practice with the goal of a weighted average of
5 completed provider surveys (50% response/practice) for a total of 690 providers included in
objective 2 (sample size justification follows in section 9.3). In addition, we will stratify
and proportionally allocate by provider types identified at each site using self-weighting
samples supplied in their lists of providers. Therefore of those randomly sampled, we will
target roughly the same proportion of physicians, nurses, and PA/nurse practitioners as
identified from their site administrator. Coordinators at each NCORP practice will provide
e-mail addresses only for randomly selected providers (selected numbers from a numbered
list), based on the size of the center and stratified proportional to provider types.

Inclusion Criteria:

- NCI Community Oncology Research Program (NCORP) components/subcomponents providing
care to adult oncology patients.

- NCORP components/subcomponents willing to: a) identify a supportive care leader
knowledgeable about supportive care services that may be available to the practice and
b) assist with the identification and recruitment of oncology providers for a brief
provider survey.

- NCORP components/subcomponents who share staff and supportive care services may
participate as a single practice group

- A staff member at each site who is most knowledgeable about supportive care services
for adult oncology patients (e.g., Director of Manger of Psychosocial Oncology,
Supportive Care Services, or Cancer Patient Support). If an administrator or leader
cannot be identified, the nurse manager or clinic director will be asked to identify a
staff member most knowledgeable about psychosocial or supportive care services for
adult oncology patients or complete the survey himself or herself.

- Must be a physician, nurse, or physician assistant/nurse practitioner, who routinely
provides cancer care to adult oncology patients, including medical, radiation and
surgical oncologists or physician assistants (PAs), nurse practitioners (NPs), and
nurses who work in oncology settings.

- Must have been in practice at component/subcomponent for at least 6 months.

Exclusion Criteria:

- Component/subcomponent exclusively care for pediatric oncology patients. Given the
distinct caregiver experience and needs of caregivers of pediatric oncology patients,
we are not including components/sub-components that exclusively provide care for
pediatric oncology patients.

- Providers in practice less than 6 months.