Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2017

Optimal cancer care pathway in breast cancer diagnosis and surveillance: A qualitative study of health care provider perspectives in North Queensland. (#336)

Abhishek Joshi 1 , Sabe Sabesan 1 , Sarah Larkins 2 , Rebecca Evans 2
  1. Medical Oncology, Townsville Hospital & James Cook University, Townsville, Queensland, Australia
  2. College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia


Pathways to breast cancer (BC) diagnosis and surveillance are complex as they involve multiple providers (general practitioners i.e GPs, public and private specialists, allied health etc.) across different health systems. Optimal cancer care pathway (OCCP) framework calls for collaboration and integration between these various providers. Qualitative research investigating breast cancer diagnosis and surveillance rarely considers all providers view simultaneously.


To describe the BC diagnosis and surveillance pathway in Townsville region, focusing on the perspective of health care providers.


This study design used a focused group approach in which invited participants responded to a structured questionnaire using electronic voting pads and documenting experiences of the diagnostic and surveillance pathway. Using the questionnaire, current BC diagnostic and surveillance pathway within Townsville Health District was mapped. The questionnaire elicited data for thematic content analysis.


A total of 51 different providers participated in the study of which majority (36) were GPs. The study revealed varied diagnostic practices within the GPs based on factors like financial status of patient, remoteness of practice, GPs knowledge about BC etc. Qualitative questions revealed multiple themes like completeness of triple T (USS+Mammo+Biopsy) testing, cost of biopsy, patient advocacy, patterns of referral, communication within GPs and specialists, coordination of care, co-shared model of surveillance etc. Around 15% of GPs would refer patients to surgical clinics without a biopsy. Most GPs (70%) felt that they should actively remain involved during acute cancer treatment transitioning to early involvement during surveillance. 


All providers expressed similar experiences across BC diagnostic and surveillance pathway. Cost of testing resulting in incomplete triple T test requests, delayed communication from surgeons back to GPs etc were some of the identified important themes. Interventions aimed at these themes could result in optimization of BC diagnostic and surveillance pathway.