A pilot oncology outreach clinic involving training of local staff to administer chemotherapy, in partnership with ACT medical oncologists and the local GPs was established in Cooma. The need for this service was community driven.

A Cancer Institute Innovation Grant application was successful and collaboration between ACT Health, local GPs and Greater Southern Area Health Service (GSAHS) saw the development of a model of shared care to ensure the provision of a quality service that meets the standards of care consistent with other oncology sites across Australia.

An evaluation of the model will determine the quality of the service and assess the suitability for implementation across other rural sites.

To establish a shared care oncology outreach service providing local cancer treatments to reduce the burden associated with travel.

Community consultation was conducted by the MCCR, providing GSAHS with a report supporting the need for an oncology service.

Data was collected to identify the number of new cancers diagnosed in the Cooma region and the possible number of patients who would benefit from this service. The data indicated that:

1. there would be in excess of 122 patients from the Cooma region requiring cancer treatments per year and that over half would meet the criteria for treatment administration in the Cooma clinic.
2. 77 new cancers were diagnosed in 2004 in the Cooma-Monaro and Snowy River regions.
3. there is an expected increase of 24% in the incidence of new cancers by 2011. (Cancer Institute NSW Cancer Plan.)
4. there is an expected population increase of 1.17% by 2011 in the Cooma region.
5. there were 2,464 oncology chemotherapy treatments for NSW residents referred to The Canberra Hospital in 2004.

Reducing the burden of travel and the associated costs factored as an issue to patients accessing cancer services. In 2006, there were 82 IPTAAS claims for travel reimbursements to the ACT for 17 oncology patients from the Cooma region. In addition, there were an unidentified number of patients who were eligible to apply for assistance who did not.

The establishment of this service supports the goals and strategic direction of the NSW Health Plan to create better experiences for people accessing health services and ensuring services are of a high quality and are coordinated to meet the needs of the patient. (State Health Plan p16.) Formalising and developing the existing partnerships between the local GPs and the medical oncologists in the ACT improves care coordination and assists the patient in navigating the complex treatment pathways involved in cancer care. (State Health Plan p17 & 25). This partnership supports patients and carers being informed of healthcare decisions.

GSAHS used a collaborative approach in consultation with ACT Health, the local area health service, GPs, the MCCR and representatives from the Cooma community to implement this service. The approach was to use the buy in of key stakeholders and the experience of the clinicians to build on the existing framework of oncology services in GSAHS.

The project plan included the design, implementation and evaluation of the Shared Care Model. The model was chosen due to the inability of the medical oncologists to travel to provide face to face consultation. It was proposed that patients would travel to the ACT for the initial consultation and then referred back to Cooma for chemotherapy administration. The model aims to facilitate effective communication and collaboration between the oncologists, GPs and oncology nurses to manage patients jointly. A mentoring program with the oncology specialists has been established.

Ascertaining the location and the required refurbishment of the Oncology service was an early focus of the project. The location was given careful consideration in terms of ease of access, standards, links to other services and patient privacy issues. The MCCR funded much of the required equipment.

Recruiting and training the nursing staff was a major component of the project. An agreement was established to train the nurses at The Canberra Hospital (TCH) Oncology Day Unit. The nurses worked for six weeks under the guidance of expert oncology nurses and completed the required local theoretical packages during this time. A valuable partnership for ongoing support has been formed between the local nurses and TCH.

Referral pathways and treatment parameters were developed and implemented to ensure the treatments offered were appropriate to the skill level of the nursing staff and were achievable in a three day service. These parameters have the ability to expand as the knowledge and skill level of the nurse’s and the clinic demands increase.

Independent evaluation is being undertaken at predetermined stages of the project. It is through the evaluation that the success of the project will be measured and will determine the viability and sustainability of the oncology service in Cooma. Sustainability will be measured from a demand, financial, resource and skilled workforce perspective.

Patient satisfaction is a key component to the success of the model. This will be measured through the evaluation process.

The establishment of a cancer service locally will reduce the burden placed on patients and families by reducing the financial pressures associated with travel, accommodation and having to access a metropolitan treatment centre.

Training staff to administer chemotherapy will give patients access to cancer treatments within their local facility and will lessen the need for patients to travel to access oncology services.

Data collection has been a focus of the service in determining the numbers of patients accessing the service and the types of treatments being administered.
The evaluation will be finalised in June 2008, involving face to face interviews with patients and carers, nursing staff, GPs, MCCR members, specialist oncologists and the area health service.

Staff training and support from the area Clinical Nurse Consultant is ongoing. The oncology nurses are now enrolled in the College of Nursing Graduate Certificate in Cancer Nursing, funded by the MCCR. An invitation to attend oncology education days has been extended to GSAHS oncology staff at TCH. Two additional nurses have been identified and are undergoing training to support the clinic.

The established partnership between the various clinicians is pivotal in supporting the long term sustainability of the shared care model. Potentially the model can be transferred to other health settings to improve access to quality services for rural patients.

The shared care model has been implemented and documented in other health settings, such as paediatric oncology, mental health and obstetric services. This is the first time the model has been used in the adult oncology setting. The model draws on the knowledge and skill of a wide group of health care professionals to communicate and share the responsibility of a patient’s treatment.

This model could be applied to any specialty provided relationships between all care providers are defined and agreed upon in service level agreements and cross area health service relationships where required.

• A direction for NSW. State Health Plan. Towards 2010.
• NSW Cancer Plan 2007 - 2010. Cancer Institute NSW. November 2006.

Communications and Publications Coordinator, Development Unit
Greater Southern Area Health Service
Phone: 02 6933 9184