Electronic shared care plan for long term care of cancer patients

A feasibility study to develop and determine how best to engage GPs and patients in a cancer shared e-care plan and assess how specialists, GPs and patients use the e-care planA feasibility study to develop and determine how best to engage GPs and patients in a cancer shared e-care plan and assess how specialists, GPs and patients use the e-care plan

Project Number

PS50364

Chief Investigator

Mark Harris

Project Coordinator

Jane Taggart, Melvin Chin (POW), Winston Liauw (St George)

Project Rationale

The prevalence of cancer is increasing due to the increasing survival of patients with cancer.  Current models of cancer follow-up care involve either specialist services continuing to provide routine care for long periods or transfer of care to general practice with little or no specialist involvement.  Our previous research has demonstrated that this places increasing demands on specialist cancer services and are not acceptable to patients or providers. There is currently no model of shared care between the cancer service and primary health care. Communication between the Cancer Service and GPs is limited and usually one way. 

Resources for Colorectal Cancer Shared Care

Below are links to the resources for Colorectal Cancer Shared Care which include:

For GPs:

Inca GP training video

Inca GP Guide – GP led

For Cancer Specialists:

Inca Specialist traiing video 

Inca Specialist Guide – GP Led

Project Aim/s

To establish and evaluate a web-based cancer shared care plan that supports long term integrated care of cancer patients for colorectal, breast and lung cancers.  

Project Design and Method

Pilot evaluation studies of shared e-care planning for the follow-up care of colorectal, breast and lung cancers are being conducted between Cancer Service specialists, GPs and patients in the South Eastern Sydney Local Health District.

The intervention is a model of shared care that uses an e-care plan for sharing the tasks and responsibilities and for communicating results and monitoring care between the care team, including the patient. The e-care plan is integrated with GP clinical information systems.

The care pathway is shown in the figure below.

Publication

•  Taggart J, Chin M, Liauw W, Goldstein D, Dolezal A, Plahn J, Harris MF. Challenges and solutions to sharing a cancer follow-up e-care plan between a cancer service and general practice. Public Health Res Pract. 2021;31(2):e31122108. First published 30 April 2021. https://doi.org/10.17061/phrp31122108

Contact

Jane Taggart Phone: 02 9385 1511 Email: J.Taggart@unsw.edu.au

Key Partners

Translational Cancer Research Network (TCRN)

Funding

Translational Cancer Research Network, SESLHD The Inspiring Ideas Challenge Program, Cancer Institute NSW Innovation, Avant Grant Foundation