Optimising referral practices for cancer survivors to dietary and exercise services


Cancer survivors often face both short-term and long-term challenges that affect their physical and mental wellbeing, finances, and social/family life. These challenges can make it difficult for them to lead a healthy lifestyle. This has led to a growing need for dietary and exercise interventions that can help prevent, lessen, or even reverse the various physical and psychosocial effects of cancer and its treatment. Such interventions can also have a positive impact on other chronic health issues like heart disease or obesity. 

In Australia, accessing specialised dietary and exercise support requires cancer survivors to be referred to dietitians and exercise professionals by their specialist team or through their GP. Despite strong evidence supporting the importance of these interventions for cancer survivors, the current healthcare system doesn’t effectively provide seamless access to these services. This means that although these services can greatly improve the outcomes for cancer survivors, the current process falls short of offering a comprehensive and well-structured health-system response. 

To better understand referral practices to dietary and exercise services for cancer survivors in Australia, Ria Joseph investigated the challenges experienced by cancer survivors in accessing dietary and exercise support as part of her doctoral research at Flinders University’s College of Nursing and Health Sciences, supervised by Professor Raymond Chan, Dr Nicolas Hart, and Professor Natalie Bradford.  

The research began by reviewing the perspectives of medical and nursing health professionals about their roles in providing dietary and exercise advice and referring cancer survivors to appropriate services.  

“Despite general agreement on their significant role in offering guidance and referrals for such services, there was confusion about their exact responsibilities, ” Joseph explained.  

To address this, better guidance and structure is needed for these professionals on their role in providing advice and referrals. 

Following these results, a co-design method, Delphi approach was used to find agreement amongst essential element statements by involving an expert panel for discussion, including medical and nursing professionals, allied health experts, consumers, and Cancer Council representatives.  

These statements would help to define key elements which would guide medical and nursing professionals in advising and referring cancer survivors for dietary and exercise needs.  

“Twenty-four essential elements were agreed upon to assist with guiding both doctors and nurses. However, it was apparent that the implementation of these essential elements would be a challenge due to the complex nature of the health system,” Joseph said. 

A workshop involving 27 stakeholders representing consumers and industry experts was then held to understand and identify relevant factors in the healthcare system as a whole influencing dietary and exercise referral practices. 

The workshop resulted in a set of 15 innovative strategies, endorsed by key stakeholders, that leverage existing strengths while overcoming obstacles to offer health professionals practical guidance. A causal loop diagram was also used to visually represent how system factors interact to address policy-level strategies.  

“This research has the potential to significantly improve how dietary and exercise referrals are managed in Australia across the survivorship trajectory by assisting medical and nursing health professionals to provide better support in these areas by using a consistent, systemised approach.” Joseph said.   

Moving forward, it’s crucial to validate these findings across various participant groups and make necessary adjustments. This ongoing process ensures the strategies are effective in diverse healthcare scenarios. Additionally, continued research ensures that these enhancements are integrated throughout healthcare, benefiting individual patient care and larger health systems.

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Cancer Care