Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Systems-thinking to optimise dietary and exercise advice and referral practices for cancer survivors in Australia. (#365)

Ria Joseph 1 , Nicolas H Hart 1 2 3 4 5 , Natalie Bradford 2 , Fiona Crawford-Williams 1 2 , Matthew P Wallen 1 6 , Matthew Tieu 1 , Reegan Knowles 1 , Chad Y Han 1 , Vivienne Milch 1 7 8 , Justin J Holland 9 , Raymond J Chan 1 2 10
  1. Caring Futures Institute, Flinders University, Adelaide, SA, Australia
  2. Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
  3. Faculty of Health, Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Sydney, NSW, Australia
  4. Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia
  5. Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia
  6. School of Science, Psychology and Sport, Federation University Australia, Ballarat, VIC, Australia
  7. Cancer Australia, Sydney, NSW, Australia
  8. The University of Notre Dame, Sydney, NSW, Australia
  9. School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
  10. Division of Cancer Services, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia

Background: Service referrals are required for cancer survivors to adequately access dietitians and exercise professionals (i.e., exercise physiologists and physiotherapists) for specialist dietary and exercise care. Many system-level factors influence the quality and effectiveness of existing referral practices within the healthcare system in Australia. Understanding how those factors are interconnected, and leveraging existing and promoting new synergies between them, can help to identify strategies to enhance facilitators and overcome barriers to referral. The aim of this study was to pioneer a systems-thinking approach to identify system-level factors and innovative strategies for optimising dietary and exercise referral practices.

Methods: A workshop involving national stakeholders by invitation was held to explore these system-level factors. Facilitated group work and discussion were employed to identify barriers and facilitators to referral practices based on the six World Health Organisation building blocks. The systems-thinking approach involved using six cognitive maps, each representing a building block. The characteristics and interactions of the healthcare system that may impact dietary and exercise referral practices for cancer survivors were mapped, highlighting the relationships between system-level factors. A causal loop diagram was developed to enable visualisation of the factors that influence dietary and exercise referral practices. Strategies were identified by leveraging system-level facilitators and addressing system-level barriers. 

Results: 27 stakeholders participated in the workshop, including consumers, cancer specialists, researchers, and representatives of peak bodies, not-for-profit organisations, and government agencies. Common system-level factors included funding, accessibility, knowledge and education, workforce capacity, and infrastructure. A total of 15 system-level strategies to improve referral practices were also identified.

Conclusions: This study is the first to use a systems-thinking approach to identify system-level factors impacting referral practices for cancer survivors in Australia. Future research and policy efforts should leverage existing system-level factors to optimise dietary and exercise advice and improve referral practices for cancer survivors.