Doctor of Philosophy
School of Medical, Indigenous and Health Sciences
Background The increasing incidence of cancer, coupled with improved survivorship, has increased the demand for cancer follow-up care and the need to find alternative models of care. International and national guidelines advocate for including general practitioners (GP) in cancer follow-up care. Barriers to implementing shared care into practice include having clinical assessment protocols for GPs, and suitable health technology to allow two-way communication to enable oncologists to continue overseeing care. To address these barriers, this thesis aimed to develop and implement a novel shared cancer follow-up model of care, and evaluate the model's acceptability and feasibility to patients, GPs and radiation oncologists (RO).
Methods Following a systematic review, this research employed a concurrent triangulation mixed methods methodology. Participants were patients on radiotherapy follow-up care, their GP and RO. The intervention included patients’ visiting their GP twice and the GP completing a clinical assessment protocol, which was transferred with novel health technology to the RO in real-time to oversee care. The quantitative component included a cross-sectional population survey and two concordance studies. Data were analysed using frequencies, Cohen's Kappa, Fleiss Kappa, logistic regression, and odds ratio. The qualitative component included semi-structured interviews, which were analysed thematically using the Theoretical Framework of Acceptability. Results were then synthesised to answer the overarching thesis' aim.
Results Four-hundred and fourteen surveys were returned (45% response rate) for the population survey. Acceptance for radiation oncology shared cancer follow-up care was high (80%). High Intervention Coherence and a positive Affective Attitude were significant predictive factors in accepting shared care. Eighty-three patient-RO dyads completed the remote monitoring concordance study. The lower-than-ideal response rate and fair to moderate patient-RO concordance meant results could not be used to support the model. Fifteen GP-RO dyads completed the follow-up clinical assessment concordance study, with moderate to almost perfect agreement, indicating the feasibility of the clinical assessment tool. Thirty-two pre-intervention and 28 post-intervention interviews were performed. This shared cancer follow-up model of care was acceptable and feasible for patients, GPs and ROs. Central to the acceptance was the clinical assessment protocol with an in-built rapid referral option, the health technology used to transfer the results securely from the GP to allow the RO to oversee care in real-time and collect outcome data. Acceptability and feasibility rely on the patients' understanding of the benefits of shared care, the patients' relationship with their GP, the oncologists' endorsement of the model, the clinical assessments, and the health technology that allows the oncologist to continue to oversee care.
Conclusion This thesis has shown a novel shared cancer follow-up model of care that is acceptable to patients, GPs and ROs, and feasible in practice. To support implementing this shared cancer follow-up model of care into practice, there is a need to review funding models, have continued support for health technology interfaces, support to ensure GPs have adequate recall systems in place, initial and ongoing support for GPs and oncologists in the form of a shared care coordinator, and support normalising the model into practice for all agents.
Sandell, Tiffany, Development, implementation and evaluation of the acceptability and feasibility of a shared cancer follow-up model of care, Doctor of Philosophy thesis, School of Medical, Indigenous and Health Sciences, University of Wollongong, 2023. https://ro.uow.edu.au/theses1/1693
FoR codes (2020)
4203 Health services and systems, 4206 Public health
Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.