Background
Guidelines recommend long term follow-up for women after breast cancer treatment1. In Australia follow-up care is carried out mostly in tertiary settings by specialist clinicians. As breast cancer incidence increases and survival rates improve2, more women will require long-term follow-up. New models of care are required to address the increasing demand on the specialist workforce, and deliver best-practice patient care.
Shared follow-up care between the specialist and primary care team has the potential to promote and support continuity of cancer patient care, whole person care and equity of access to local evidence-based care. A shared-care model promotes optimal use of the specialist workforce.
Methods
Cancer Australia identified Principles for shared-care and demonstrated and evaluated shared-care through the Shared-care demonstration project (2009-2011). Further evaluation to assess the extent to which the model supports best practice (2013-15) and an economic evaluation (2014-15) are currently underway.
Results
Shared-care was implemented for 1,046 patients over four demonstration sites. Findings from the evaluation indicate that shared-care is a feasible model of follow-up care for early breast cancer. Overall acceptance of the shared-care model was demonstrated through agreement to participate of nearly 80% of patients approached. Of participating health professionals surveyed, 68% of GPs and 92% of specialists agreed that they would continue to provide shared-care. Critical success factors for the sustainability of shared-care were identified. These included clinical leadership, appropriate infrastructure, accurate and accessible electronic medical records, patients having a regular GP and care coordination.
Conclusions
A framework for shared early breast cancer care that defines best practice and includes key elements of success, would promote a nationally consistent approach to implementing shared-care which addresses the issues of access, workforce and sustainability of the model. Furthermore, there is potential for applicability of the shared follow-up care model across other cancer groups.
References
National Breast and Ovarian Cancer Centre. Recommendations for follow-up of early breast cancer. Surry Hills. NBOCC, 2010.
AIHW Breast cancer in Australia: an overview. Canberra: AIHW, 2012