• Our program theory describes how survivor and provider characteristics and facilitators/barriers may interact to produce intermediate and final outcomes and the potential role of models and resources in these interactions.
• The program theory variables seen most consistently in the literature include oncology care versus primary care, survivor and provider knowledge (e.g., survivor risks and needs), provider comfort treating childhood cancer survivors, communication and coordination between and among providers and survivors, and delivery/receipt of prevention and surveillance of late effects of original cancer treatment.
• We developed seven hypotheses about the relationships between context, mechanism, and outcomes (CMO) that could be associated with effective survivorship care models that include primary care.
• Care delivered outside of the specialty setting needs to include communication of knowledge to both survivors and primary care providers; our program theory provides guidance on the ways this knowledge could be shared.

Objectives. We had two aims: (1) identify and analyze models of survivorship care for adult survivors of childhood cancer that include primary care, and (2) identify available tools, training, and other resources for adult survivors of childhood cancer.

Methods. For each aim, we used realist synthesis to provide insights on how and for whom, in what contexts, and via what mechanisms the models of care and resources we identified can be effective for adult survivors of childhood cancer. We developed an initial program theory through searches of the literature and discussions with Stakeholders. We then identified and summarized quantitative evidence that supported or refuted the theory and developed specific hypotheses about how contexts and mechanisms may interact to produce outcomes (i.e., “CMO” hypotheses). The final program theory and CMO hypotheses were presented to Stakeholders for feedback.

Results. Our final refined theory describes how, within the overall environment, survivor and provider characteristics and facilitators/barriers interact to produce intermediate and final outcomes. We focus on the role of models of care and resources (e.g., care plans) in these interactions. The program theory variables seen most consistently in the literature include oncology care versus primary care, survivor and provider knowledge (i.e., survivor risks and needs), provider comfort treating childhood cancer survivors, communication and coordination between and among providers and survivors, and delivery/receipt of prevention and surveillance of late effects of original cancer treatment. In turn, these variables played the most prominent role in the seven CMO hypotheses (4 focused on survivors and 3 focused on providers) regarding what works for whom and in what circumstances.

Conclusions. To enable models of care that include primary care for adult survivors of childhood cancer, there needs to be communication of knowledge to both survivors and primary care providers. Our program theory provides guidance on the ways this knowledge could be shared, including the role of resources in doing so, and our CMO hypotheses suggest how the relationships illustrated in our theory could be associated with survivors living longer and feeling better through high-value care.

Snyder C, Choi Y, Smith KC, et al. Realist Review of Care Models That Include Primary Care for Adult Childhood Cancer Survivors. JNCI Cancer Spectrum. 2022 Apr;6(2):pkac012. Epub 16 February 2022. DOI: https://doi.org/10.1093/jncics/pkac012.

Snyder C, Yuan CT, Wilson RF, Smith K, Choi Y, Nathan PC, Zhang A, Robinson KA. Models of Care That Include Primary Care for Adult Survivors of Childhood Cancer: A Realist Review. Evidence Report. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 75Q80120D00003.) AHRQ Publication No. 22-EHC003. Rockville, MD: Agency for Healthcare Research and Quality; February 2022. DOI: 10.23970/AHRQEPCREALISTMODELSOFCARE. Posted final reports are located on the Effective Health Care Program search page.