Limitations
cancer, breast cancer
LATE EFFECTS, BREAST CANCER, CANCER, RECRUITMENT, PCP
We encountered several challenges and limitations. First, we did not reach our patient recruitment target in the treatment phase. Over the course of patient recruitment, it became increasingly difficult to recruit new participants, as PCPs could only have 1 patient participating in the trial to minimize the potential for contamination between study groups (ie, if a patient was interested in participating and their PCP already had another patient in the trial, they were ineligible to enroll). In addition, only PCPs who had already signed up for eConsult could participate, thus further reducing the number of potential patients that could be enrolled. The COVID-19 pandemic caused further difficulties in patient recruitment.There was no mechanism to ensure that patients were blinded to their group allocation; however, we learned that most patients were unaware of the communication between their health care providers, suggesting that they likely did not know whether they were randomized to the intervention or control group.Within the context of the survivorship phase, the eOncoNote discussion lasted for 1 year after the patient was discharged to their PCP. Patients may experience late effects beyond that period, and questions may arise when patients visit their PCP (clinical guidelines recommend that the frequency of visits be adjusted to the individual needs of breast cancer survivors [Some limitations were specific to the eOncoNote system setup. The eOncoNote system did not support EMR integration, which may have impacted uptake among health care providers. Although ideally, the discussion between health care providers would follow a patient across the cancer care continuum, we were unable to examine communication longitudinally because of the current functionality of eOncoNote. The eOncoNote system was not designed to be a managed service, which would require a case manager to support a longitudinal discussion and was beyond the scope of this study.