Organizational barriers and recommendations for colorectal cancer survivorship care in Thailand: A qualitative study using the consolidated framework for implementation research

Abstract

Purpose: Colorectal cancer survivors often face complex, long-term healthcare needs that are not adequately addressed, especially in low- and middle-income countries. Organizational barriers can significantly impede the delivery of survivorship care, but these challenges remain underexplored. This study aimed to explore healthcare providers’ perspectives on organizational barriers and offer recommendations for improving colorectal cancer survivorship care in Thailand. Methods: A qualitative descriptive study was conducted through semi-structured interviews with healthcare providers (N = 21) at a public tertiary university hospital in Bangkok. Data were analyzed using both deductive and inductive content analysis. Themes were linked to the Consolidated Framework for Implementation Research (CFIR) Inner Setting domain to identify organizational characteristics that influence care and to develop actionable recommendations. Results: Eleven themes were identified as barriers across five CFIR Inner Setting constructs: limited physical infrastructure; high patient volume and an understaffed workforce; uncoordinated multidisciplinary collaboration; fragmented documentation systems; insufficient information exchange; absence of a survivorship care culture; low institutional prioritization; lack of compensation mechanisms; leadership disengagement; inadequate systems and resource support; and limited survivorship-specific training and clinical guidelines. Participants recommended redesigning care delivery, developing survivorship care tools (e.g., treatment summaries and care plans), and expanding national infrastructure to support decentralized and coordinated care. Conclusions: This study highlights the critical organizational challenges in survivorship care and stresses the urgent need for coordinated efforts at both the institutional and policy levels. Investing in infrastructure, securing leadership commitment, and implementing innovative care models are crucial steps toward creating sustainable, patient-centered survivorship services in resource-constrained settings.