BACKGROUND: Childhood cancer survivors face high risks of adverse late health effects. Long-term follow-up care for childhood cancer survivors is crucial to improve their health and quality of life. However, implementation remains a challenge. To support implementation of high-quality long-term follow-up care, we explored expected barriers and facilitators for establishing this follow-up care among healthcare providers from four European clinics. METHODS: A qualitative study was conducted using four focus groups comprising 30 healthcare providers in total. The semi-structured interview guide was developed based on the Grol and Wensing framework. Data was analyzed following a thematic analysis, combining both inductive and deductive approaches to identify barriers and facilitators across the six levels of Grol and Wensing: innovation, professional, patient, social, organizational and economic and political. RESULTS: Most barriers were identified on the organizational level, including insufficient staff, time, capacity and psychosocial support. Other main barriers included limited knowledge of late effects among healthcare providers outside the long-term follow-up care team, inability of some survivors to complete the survivor questionnaire and financial resources. Main facilitators included motivated healthcare providers and survivors, a skilled hospital team, collaborations with important stakeholders like general practitioners, and psychosocial care facilities, utilization of the international collaboration and reporting long-term follow-up care results to convince hospital managers. CONCLUSION: This study identified several factors for successful implementation of long-term follow-up care for childhood cancer survivors. Our findings showed that specific attention should be given to knowledge, capacity, and financial issues, along with addressing psychosocial issues of survivors.

Childhood Cancer International Europe Vienna Austria

Childhood Cancer Research Group Danish Cancer Society Research Centre Copenhagen Denmark

Department of Clinical Medicine Faculty of Health Aarhus University and Aarhus University Hospital Aarhus Denmark

Departments of Hematology and IQ Health Radboud University Medical Centre Nijmegen The Netherlands

Departments of Pediatric Hematology and Oncology and Oncology University Hospitals Leuven Leuven Belgium

Epidemiology and Biostatistics Unit and DOPO Clinic IRCCS Istituto Giannina Gaslini Genoa Italy

Faculty of Health Sciences and Medicine University of Lucerne Lucerne Switzerland

Faculty of Medical Sciences Newcastle University Royal Victoria Infirmary Newcastle UK

Great North Children's Hospital Newcastle UK

International Clinical Research Centre at St Anne's University Hospital Masaryk University Brno The Czech Republic

Pediatrics Department of Clinical Sciences Lund Lund University Skåne University Hospital Lund Sweden

Princess Máxima Centre for Pediatric Oncology Utrecht The Netherlands

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