MySurvivorCare: Stepped-Care Pathway for Improving Wellbeing for Women with Cancer
A key challenge in translating research into practice is overcoming the barriers – competing clinical priorities, lack of time, and a lack of reliable ways to identify patients in need. Current services for cancer survivors are fragmented and struggle to meet demand. Creative solutions are needed to enable more women to access high-quality information about appropriate and effective treatments. Evidence-based treatments exist for the management of the long-term side-effects of cancer treatment, such as psychological interventions for menopausal symptoms, sexual dysfunction, and mood disturbance. However, there is no centralized platform to access these interventions, and no system to ensure women receive the appropriate level of care. Without intervention, female cancer survivors experience worse QoL, and, as side-effects can compromise adherence to therapy, potentially higher morbidity and mortality. MySurvivorCare will be a central online platform to access interventions to manage the most common and troublesome consequences of cancer treatment using a stepped-care approach (i.e. a hierarchy of interventions, from least to most intensive, matched to individual need), an effective and low-cost model for delivering health interventions to large populations. This body of work aims to develop a novel online service delivery platform (MySurvivorCare) and to evaluate its impact on health-related quality of life (HRQoL).
 
The project will consist of a few stages:
Stage 1: A scoping survey to assess prevalence, bother, interference, severity and distress from menopausal symptoms (vasomotor, mood disturbance, sleep disturbance, vulvovaginal dryness, vulvovaginal discomfort or irritation, pain with sex and discomfort or pain whilst urinating) in female cancer survivors across tumour streams. It will also explore menopause-related quality of life, management of symptoms, satisfaction with treatment and unmet needs for management of symptoms in female cancer survivors across tumour streams. The main outcome is to have data collected using the same PROMs across tumour streams so symptoms can be compared. And to compare data from Menopause Symptoms After Cancer (MSAC) clinic participants against community-based participants.
 
From this patient-driven stepped care model and platform will be developed to delivery effective menopausal symptom management. To do this, three additional stages will be conducted:
  • Stage 2: Exploring the enablers and barriers to using a patient-driven stepped-care model and platform. This will be a qualitative study with patients and clinicians that will explore current pathways to care and focus on whether women would use the platform if available; whether they would be proactive in taking the provided clinical guidelines and referral pathways to their GPs and the barriers and enablers of this process (including access to care for rural and remote populations); whether they would recommend use of the platform to others in a similar situation. With clinicians (GPs, Nurses, and specialists), interviews will focus on whether they would recommend use of the platform to patients, if they would be willing to use clinical guidelines if presented to them by patients, and whether they would utilise the referral pathways. The outcome will be implementation strategies to inform the development of the severity-stratification tool, stepped-care model and online platform. 
  • Stage 3 – Development of the stepped-care severity-stratification model and assessment of user experience and feasibility of use in patients (and GP sub-study). This will be a pre/post single-arm feasibility study of a digital prototype platform, with the primary hypothesis of at least 80% of participants will comply or ‘use’ the care that they are allocated to (i.e. use the online CBT, take the guidelines to their GP, or attend a specialist service). GPs will also be interviewed about engagement with the process, whether they would support use of this platform if more patients presented with guidelines/ referral pathways, and barriers and enablers to providing optimal care according to clinical practice guidelines. The outcome is to have evidence that this novel stepped-care model is feasible to use in practice, acceptable to patients and GPs and preliminary data on efficacy (reduces troublesome symptoms, improves QoL). 
  • Stage 4: Further development of the online platform. The β-platform will be developed using participatory co-design methods (qualitative). The outcome, an online stepped-care platform for menopausal symptoms after cancer.

Working party:
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​A/Prof Michelle Peate, Ms Nipuni Susanto, Ms Dorcas Serwaa, Prof Michael Jefford, Prof Martha Hickey, A/Prof Carolyn Ee, Prof Paul Cohen, Prof Christobel Saunders, Kate Rolshoven, Mr Lewis Gauci