Abstract for: Childhood Cancer Survivorship: Cultivating Shared Understanding of Complex Care Contexts Through Group Model Building

Historically, childhood cancer survival rates were low. Recent innovations in treatment are rapidly improving cure rates globally. Survivors are at increased risk for late effects. There are many survivorship care guidelines to respond to growing need for survivorship care, but most efforts have been largely reactive due to rapid treatment success. There is an opportunity to understand the complexity of survivorship care globally to inform care practices and supporting tools. We used group model building to engage clinicians from diverse contexts to characterize the structural diversity of survivorship care globally. The goal was to inform the development of contextually relevant and effective survivorship care. Our approach emphasized building system dynamics capabilities in a team of global childhood cancer and survivorship care experts to co-facilitate activities and synthesize outputs as leaders in the field. Practitioners from 12+ countries participated. Results included insights in three areas: care provision and capacity, survivor awareness and care-seeking, and policy. Time and resources to provide survivorship faces capacity trade-offs in contexts where providers must prioritize acute needs. Because survivorship is an emerging practice, survivors play a key role in seeking care and advocating for resources. Policy is leveraged in multiple ways, including nationally to support investment and institutional policies on training and guideline implementation. The approach shows promise to inform contextually relevant survivorship care practices and supporting tools in global settings. Despite diverse contexts, there are emerging sectors consistent in multiple countries. Additional research is needed to understand potential generic structures within each sector and any context-specific structures. Next this team will do additional modeling with practitioners from heterogenous settings to refine insights and investigate place-based specificity through additional GMB in two countries.