Aim: To optimise dietary and exercise referral practices of medical and nursing health professionals in providing dietary and exercise guidance to, and referrals for cancer survivors.
Methods: First, an integrative review was conducted to examine the perspectives of medical and nurse health professionals on their roles in providing referrals to cancer survivors. Second, a four-round Delphi study was conducted to draft essential elements based on Cancer Australia’s Principles of Cancer Survivorship and distributed to a panel to establish consensus by rating the importance of each statement. Finally, a systems-thinking workshop based on the six WHO building blocks was conducted with six facilitated focus groups, including consumers, cancer specialists, researchers, and representatives of peak bodies, Cancer Council and Cancer Australia.
Results: Although medical and nursing professionals agree they have an important role in providing guidance and referrals for exercise and dietary services, there is a lack of role clarity and standardised referral pathways to facilitate such practices. The Delphi consensus study produced 24 essential elements of care. Through the systems-thinking workshop, cognitive diagrams demonstrated inter-related factors that can influence referral practices across the WHO building blocks. Respective strategies related to the WHO building blocks were identified to further advance practices in health professionals’ guidance and referrals for exercise and dietary services.
Conclusions: This research resulted in a consensus framework of essential elements of care to guide practice. Using a systems-thinking approach enabled identification of strategies at a policy level. Future implementation research will be required to ensure successful translation at the micro- (persons and clinician level), meso- (organisational level) and macro- (policy and system level).