Improving the implementation of self-management support in cancer survivorship care

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dc.check.chapterOfThesisI would like an embargo on the following three sections please, while I publish this material from my thesis: Chapter 7: DESIGN OF AN IMPLEMENTATION INTERVENTION TO IMPROVE ONCOLOGY HEALTHCARE PROVIDER SIGNPOSTING TO SELF-MANAGEMENT SUPPORT SERVICES Chapter 8: DISCUSSION Appendix 5: Supplementary files for chapter 7en
dc.check.date2026-12-31
dc.contributor.advisorBrowne, John P.
dc.contributor.advisorMchugh, Sheena
dc.contributor.advisorConnolly, Roisin
dc.contributor.authorPallin, Nickola Danielleen
dc.contributor.funderHealth Research Boarden
dc.date.accessioned2025-05-20T15:45:30Z
dc.date.available2025-05-20T15:45:30Z
dc.date.issued2024
dc.date.submitted2024
dc.description.abstractBackground 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.en
dc.description.statusNot peer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationPallin, N. D. 2024. Improving the implementation of self-management support in cancer survivorship care. PhD Thesis, University College Cork.
dc.identifier.endpage399
dc.identifier.urihttps://hdl.handle.net/10468/17548
dc.language.isoenen
dc.publisherUniversity College Corken
dc.relation.projectHealth Research Board (Award reference SPHeRE/2018/1)
dc.rights© 2024, Nickola Danielle Pallin.
dc.rights.urihttps://creativecommons.org/licenses/by-nd/4.0/
dc.subjectSelf-management support
dc.subjectImplementation science
dc.subjectCancer
dc.subjectCancer survivors
dc.titleImproving the implementation of self-management support in cancer survivorship care
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhD - Doctor of Philosophyen
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