Background: Cancer survival rates in Australian have significantly increased from 46% to 67%. Yet, one third of cancer survivors have resultant service needs. Undetected (or untreated), these result in increased burden of disease, under and overuse of services, and increased and unnecessary costs to survivors and the health system. For rural cancer services already facing health service and workforce shortages, new models of care are needed.
Aim: To establish the processes, infrastructure needs and communication pathways to support the implementation of a cancer survivorship model of shared care in a large geographically dispersed area which aligns with chronic disease self-management frameworks.
Methods: This study was undertaken in Gippsland; Victoria, a geographically, economically and socially disadvantaged area. The Consolidated Framework for Implementation Research (CFIR) was used for implementation. Key stakeholders included three rural health services, the primary health network, the integrated cancer service and the University Department of Rural Health. Process outcomes and patient reported outcome measures were collected through validated questionnaires, interviews, meeting notes and clinical records. Thematic and quantitative descriptive analysis was employed.
Results: Nurse-led clinics were established in three areas (0.8TE), one available through videoconferencing. A total of 190 patients (71% RR) diagnosed with lymphoma, breast, prostate and colorectal cancer attended clinics. Regional Health Pathways for oncology specialists and General Practitioners (GP) were established. Survivorship care plans (SCP) were highly acceptable to patients (92%), and used for private records (81%) or to show family/friends (68%). GPs (n=26) wanted easy access and telehealth meetings with specialists and continued cancer updates. Disparate and incompatible electronic record systems were a barrier to sharing information and facilitating communication between practitioners and services.
Conclusion: The survivorship model of care was acceptable and feasible to patients, health professionals and administrators. Innovations in digital health technologies can facilitate improved information and communication pathways between stakeholders.