Feasibility study of a colorectal cancer e-care plan for shared follow-up survivorship care

There is a need for more integrated and coordinated follow-up care for long-term cancer survivors that involves both oncologists and primary health care providers in ongoing, accessible and equitable care. This requires effective information sharing and communication.

This feasibility study introduced a colorectal cancer e-care plan for shared follow-up survivorship care and evaluated the perceptions of medical oncologists (3), cancer nurse coordinators (3), general practitioners (GPs) (7) and colorectal cancer patients (9). Interviews were conducted at three timepoints and were thematically coded. Normalisation Process Theory guided the analysis.

Participants could make sense of shared care and the potential of e-care plans for sharing information. There was high engagement with the e-care plan by GPs and varied engagement by patients. The limited or no engagement by cancer services significantly impacted the enactment of care plans. There was poor communication between cancer services and GPs, which affected their appraisal of the benefits, although GPs and patients assessed shared e-care planning as worthwhile and an improvement on regular follow-up care. Barriers included the lack of interoperability between cancer services and primary care clinical information systems, workload pressures on cancer services and GPs and the work practice changes required for a small proportion of patients.

The introduction of an e-care plan was not effective in supporting interpersonal communication. Implementing shared e-care plans into routine practice requires interoperable health information systems, strategies to improve interpersonal communication and investment of time in both general practices and cancer services.