Rapid Fire Presentations 2025 National Cancer Survivorship Conference

Advancing implementation of shared care for cancer survivors using a systems-thinking approach (#27)

Ria Joseph 1 , Fiona Crawford-Williams 1 , Imogen Ramsey 1 , Chad Y Han 1 , Andi Agbejule 1 , Adam G Elshaug 2 , Bogda Koczwara 3 , Carolyn Ee 1 4 , Jon Emery 5 , Lillian Leigh 6 , Michael Jefford 7 , Vivienne Milch 1 8 , Raymond Chan 1 9
  1. Caring Futures Institute, Flinders University, Adelaide, SA, Australia
  2. Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia
  3. Flinders Medical Centre and Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
  4. NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
  5. Centre for Cancer Research and Department of General Practice and Primary Care, University of Melbourne, Melbourne, VIC, Australia
  6. Rare Cancers Australia, Bowral, NSW, Australia
  7. Department of Health Services Research; Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre; Australian Cancer Survivorship Centre; University of Melbourne, Melbourne, VIC, Australia
  8. Cancer Australia, Sydney, NSW, Australia
  9. Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia

Background: Shared care between oncology specialists and primary care, is an appropriate model for many cancer survivors, but is rarely implemented.

Aim: This study aimed to understand the interactions between system-level factors and leverage points in the Australian healthcare system that impact implementation of shared-care models.

Methods: A systems-thinking approach, which involved facilitated group discussion using the nominal group technique, was used to identify system-level factors impacting implementation of shared care and the relationships between factors. Two workshops (online and face-to-face) were held with stakeholders (healthcare providers, policymakers, primary care researchers, government and non-government representatives, and consumers). Following workshop one, we used group model building (GMB) to generate a causal loop diagram with key leverage points, based on stakeholder discussions and the existing literature. In workshop two, stakeholders prioritised the leverage points in terms of importance and identified strategies to address them.

Conclusion: Stakeholders identified 18 potential strategies to address these, including (i) leadership buy-in and champions at a policy level; (ii) establishing a single unique patient identifier that is accessible by all specialists; and (iii) involving GPs in survivorship care at the point of diagnosis. Twenty-four stakeholders participated in either one or both workshops (18 in workshop one and 15 in workshop two), including consumers (n=4), oncologists (n=3), primary care providers (i.e., general practitioners (GPs) and practice nurses) (n=5), nurses (n=4), cancer care researchers (n=3), representatives from not-for-profit organisations (n=3), and government agencies (n=2). Stakeholders identified 10 key leverage points, with the top three being (i) funding and resource allocation; (ii) healthcare interoperability, health information exchange, and information technology; and (iii) collaborative relationships. A systems-thinking lens enabled our stakeholders to generate innovative strategies to optimise the implementation of shared care. These strategies can be used to address key areas for change in policy planning and practice in Australia.