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Improving the implementation of self-management support in cancer survivorship care
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Date
2024
Authors
Pallin, Nickola Danielle
Journal Title
Journal ISSN
Volume Title
Publisher
University College Cork
Published Version
Abstract
Background and aim
Globally cancer incidence is on the rise, and while survival outcomes of those diagnosed with cancer have improved many experience physical and psychological morbidity following the acute phase of treatment. Self-management support (SMS) can improve health related quality of life and reduce health care utilisation among those living with and beyond cancer. However, widespread implementation of SMS as part of routine cancer care has been difficult to achieve. Few studies have examined national implementation efforts, and few have tailored strategies to address known barriers to implementation. Therefore, this thesis aimed to understand how to improve the implementation of SMS in cancer survivorship care.
Methods
This thesis followed a multi-phase design process consisting of four consecutive qualitative studies. Interviews were conducted with twenty-six people living with and beyond cancer to identify enablers and barriers to accessing SMS, and with ten survivors of low-grade non-Hodgkin's lymphoma to examine their views on self-management and preferences for SMS. The third qualitative study explored forty seven healthcare providers’ perspectives on the contextual factors perceived to influence SMS adoption and sustainment in cancer centres. The findings from these three studies informed the fourth study which used input from thirteen oncology healthcare providers to design an implementation intervention to improve healthcare provider signposting to SMS services.
Results
Interviews with individuals living with and beyond cancer revealed multiple factors influencing access to SMS services, including a lack of knowledge and emotional factors, such as fear and lack of confidence. Although some participants were aware of SMS programmes and psychosocial care delivered by community providers, participants hesitated to utilise these resources and noted limited healthcare provider signposting to SMS. Interviews with healthcare providers highlighted that national policy, external accreditation, funding opportunities, and the presence of champions within organisations influence the adoption of SMS. An entrepreneurial organisational culture, combined with resources such as funding, protected time, administrative support, and staff well-being initiatives, were identified as a key enabler of SMS sustainment. The final study produced an implementation intervention, which included an information leaflet, hospital champions, educational meetings led by SMS providers and champions, audits with feedback on patient uptake following signposting, and local opinion leaders emphasising the priority of signposting.
Conclusions
The findings highlight the patient, healthcare providers and organisational level factors that influence the implementation of SMS. These findings provide a basis to inform the tailoring of strategies to increase reach of SMS programmes. For example, to support SMS implementation at the healthcare provider and organisational level, national leadership should prioritise SMS, with accreditation bodies integrating it into accreditation standards, alongside setting performance benchmarks and fostering a supportive culture through strong leadership and governance. Engaging local champions and providing ongoing professional development in relation to SMS are also key to sustaining SMS. To improve uptake at the patient level, strategies could focus on raising awareness of existing psychosocial and SMS services, reducing stigma, establishing effective referral systems, and improving service accessibility. Direct patient contact from SMS services and addressing logistical barriers, such as location and timing, could also increase participation.
Description
Keywords
Self-management support , Implementation science , Cancer , Cancer survivors
Citation
Pallin, N. D. 2024. Improving the implementation of self-management support in cancer survivorship care. PhD Thesis, University College Cork.