NBOCC Shared Care Demonstration Project

Other - Breast

SMICS is participating in this Southern Health Breast Cancer Service project

 

About the Project

Southern Health, in conjunction with SMICS has recently been successful in its application to establish a demonstration site as part of the National Breast and Ovarian Cancer Centre's (NBOCC) national Shared Care Demonstration Project.

This exciting project aims to trial and evaluate approaches to the delivery of shared care between primary and specialist clinicians in the planned delivery of the follow-up of patients from three months after completion of hospital-based therapy for early breast cancer or ductal carcinoma in situ (DCIS).

Shared care has been successfully and safely implemented across a range of health settings including diabetes, paediatric oncology and obstetric care .
Shared care has the potential to promote and support planned continuity of cancer patient care, whole person care and equity of access to local evidence-based care.

 

Principles of shared care

The following Principles were developed in consultation with experts in the field and are based on key elements of a National Breast and Ovarian Cancer Centre literature review from 2008.

Patient Centred
The patient and their whole person care is the focus for all care providers

Coordination, communication and continuity of care
Care of the patient requires coordination through timely and effective communication, and clarification of the roles and responsibilities of the care providers.

Support for primary care providers
Primary care providers are supported in the delivery of shared follow-up care through early involvement, and through the provision of education, resources and protocols.

Support for specialist treatment team
Specialist care providers are supported in the delivery of shared folow-up care through the provision of resources and protocols which improve efficiency and support data collection.

Care is delivered according to best practice standards
Provision of care is in accordance with nationally agreed standards and is outcomes focused.

 

Follow-up purpose

The purpose of follow-up care after treatment for early breast cancer includes:
• early detection of local, regional or distant recurrence
• screening for a new primary breast cancer
• detection and management of psychosocial distress, anxiety or depression
• detection and management of treatment-related side effects
• reviewing and updating family history information
• observation of outcomes of therapy
• reviewing treatment, including new treatments that may be appropriate for the patient

 

Benefits to patients

• shared care promotes a model of wellness
• receive evidence based practice
• better coordination, communication and continuity of care

 

Benefits to GPs

• participation in a team based approach to breast cancer follow up
• support for GPs to engage in shared care for breast cancer follow-up through the provision of education, resources and protocols

 

Benefits to specialist teams

 • improved links between specialist teams and GPs
• support for specialist care providers in the delivery of shared care follow-up care through the provision of resources and protocols which improve efficiency and support data collection

 

Follow up guidelines

•  NBOCC Follow-up care for women with early breast cancer - a guide for general practitioners (March 2010)
•  NBOCC Recommendations for follow-up of women with early breast cancer (supplement)

Information for health professionals

•  Shared care demonstration project
•  Roles and responsibilities of the shared care clinical team
•  Rapid access request

Information for consumers

•  Shared care plan

 For further information about this project, please contact Heather Davis on (03) 9928 8602 or Sue Liersch on (03) 9928 8100.