The Opportunity Realistic Optimism

Clearly, major funding from government and private organizations is critical but so is getting the stakeholders to the table and focusing on the right questions. If you ask three researchers or three clinicians or three employers what are the top priorities or what is the "right" approach to take they most likely will give you nine different answers. For example, one recommendation of the IOM was the use of evidence-based guidelines for cancer survivor care. While most cannot argue with this recommendation, it is easier said than done. We know that even when evidence-based guidelines are available most clinicians don't follow them. Why? Also, in many areas of cancer survivorship at this point we don't even have sufficient results from RCTs to create these evidence-based clinical practice guidelines.

Will response to the recommendation simply show compliance is poor or quality is poor or can we build on the knowledge of health services research in other areas of care and work on ways to operationalize the implementation of these so cancer survivors receive what they really need. Will we study ways to maximize provider adherence which should result in more survivors with positive outcomes? Does adherence to the few guidelines available at this point truly improve outcomes? Some providers do not think so. Also some employers are uncertain as well. A shift in the question for an employer might be not, "Is this going to cost me more if my employees follow these evidence-based guidelines? but rather how might following this guideline improve my employees work productivity and what is the economic value of this outcome? "While it is certainly a logical assumption that the development and use of guidelines are somehow better, we still do not know this for many clinical practice guidelines that have been generated over the past decade. The point is that we need to be realistic in our optimism, pursuit of knowledge, and quality care in this area. We need to step back and question some of our basic assumptions related to how we approach cancer survivorship so that we don't make the same errors in health care we now know about. We need to stop and think armed with new knowledge regarding health care services and ask the right questions. We need a sense of optimism to move forward, however, we also need a sense of realism based on what we know are current challenges in the delivery of quality health care in the United States and throughout the world.

As we have read many survivors experience a pattern of societal, health care, symptom, interpersonal, and health behavior challenges. They deserve quality health care. They have been through much already. They do not need to be subjected to approaches that are ineffective, redundant, senseless, or even harmful.

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