South Australia (SA) is developing a Statewide Survivorship Framework to enable equity of access to survivorship care that is sustainable within current services. To gain insight on contextual elements of implementation, pilots were conducted of three core survivorship initiatives; standardised treatment summary, needs assessment, and care plan across SA Local Health Networks (LHNs).
Sites were selected following calls for expression of interest (three metro and one rural). A continuous improvement process was used considering the direct inputs (workforce and tools), outputs (reach, number of treatment summaries and care plans produced) and outcomes (impact on service delivery and sustainability). Implementation, evaluation and planning cycles included fortnightly debrief meetings (Champions and Project Officer); maintaining an outcomes and actions log; review of de-identified treatment summaries and care plans; quantitative and qualitative data collection and analysis.
Four Champion Teams (Nurse Practitioner (NP)/ NP Candidate and Medical Oncologist) participated across four sites. Number of care plans developed was 43 (median 4.5). Evaluation and planning initiatives led to the refinement of tools and templates; creation of key phrases and resource list and an identified unmet need for upskilling in survivorship care and motivational interviewing.
Contextual enablers to local implementation identified included strong interrelationships within and between Champion Teams and other Specialists; existing survivorship clinic; established survivorship referral pathways and dedicated time to deliver.
Challenges identified included a need for creation or re-orientation of clinics and referral pathways; low numbers of survivors completing treatment during pilot; competing demands and higher service priorities.
Whilst Champion Teams were willing to engage in this initiative, the number of care plans produced varied considerably. Contextual enablers and challenges highlight the need to consider strategies relating to awareness raising, capacity building (services and workforce) and opportunistic referral pathways as well as policy driven embedding the Statewide Survivorship Framework into strategic plans and policies.