Advancing implementation of shared care for cancer survivors using a systems thinking approach (the SEAMLESS study)

Purpose: The aims of this study were to (1) understand the interactions between system-level factors and key leverage points impacting the implementation of shared care models in Australia and (2) develop strategies and actions targeting these leverage points. 

Methods: A systems thinking approach was applied through two facilitated workshops (online and face-to-face) using group model building and the nominal group technique to guide discussions. 

Results: Twenty-four stakeholders participated in either one or both workshops (18 in workshop one and 15 in workshop two), including patient advocates (n = 4), oncology specialists (n = 3), primary care providers (i.e., general practitioners (GPs) and practice nurses) (n = 5), oncology nursing professionals (n = 6), cancer care researchers (n = 3), and policymakers (n = 3). A causal loop diagram was developed following workshop one, informed by stakeholder discussions and existing literature. In workshop two, stakeholders prioritised 10 key leverage points in terms of importance, with the top three being (i) funding and resource allocation; (ii) healthcare interoperability, health information exchange, and information technology; and (iii) collaborative relationships. In response to these prioritised leverage points, stakeholders identified 12 potential strategies and 55 corresponding actions to address the challenges. 

Conclusions: A systems thinking lens enabled stakeholders to prioritise key leverage points and develop targeted strategies to enhance shared care implementation. These strategies can be used to address key areas for change in policy planning and practice in Australia. 

Implications for Cancer Survivors: This study highlights key areas in the health system where targeted changes can improve follow-up and survivorship care for cancer survivors.