Elizabeth A. Johnston

Aims With increasing cancer incidence and survival, there is a growing demand on primary care clinicians, including dietitians, to support survivors. Primary care dietitians have identified a need for a centralised, evidence-based resource to guide the provision of cancer-related nutrition care. This study aimed to co-design an evidence-based resource to support primary care dietitians in delivering optimised cancer-related nutrition care. Methods Boyd’s six-step process ( Engage, Plan, Explore, Develop, Decide, Change ) was used to co-design the resource across three phases. Phase 1 ( Engage/Plan ) involved virtual workshops with stakeholders. Phase 2 ( Explore/Develop ) used a concept prioritisation survey with stakeholders to prioritise ideas to inform the development of a prototype. Phase 3 ( Decide/Change ) comprised individual interviews with stakeholders. Purposive sampling recruited key stakeholders for co-design (dietitians, health professionals involved in cancer care, cancer survivors, family carers). Results Twenty-eight stakeholders contributed across the four phases. Stakeholders prioritised practical, evidence-based content, clear guidance on cancer-related nutrition issues, and accessible digital formats. Their input informed two online resource prototypes, a 34-page Toolkit and a 5-page Checklist, to streamline consultations and support consistent, high-quality nutrition care. Conclusion This co-design process produced practical, co-designed prototypes that address a critical gap in resources for primary care dietitians supporting people affected by cancer. Equipping primary care dietitians with effective tools to optimise cancer nutrition care can strengthen community-based survivorship support for cancer survivors. Together, the Toolkit and Checklist have the potential to enhance dietitians’ confidence and consistency in providing nutrition care, warranting further evaluation in real-world settings.

Issue Addressed: For people in rural and remote areas, government‐funded travel subsidy schemes provide vital financial assistance and equitable access to specialist healthcare in city centres. However, few studies have examined users' experiences of these schemes. Methods: Adults travelling for healthcare in Queensland, Australia, completed an online survey capturing their most recent experience applying for the Patient Travel Subsidy Scheme (PTSS). Participants' responses were analysed using descriptive statistics and thematic analysis. Results: From 69 respondents (aged 29–80 years, 60% female, 88% most recent application for cancer‐related care), 57% agreed information about the scheme was easy to access, although only 39% found the initial registration process easy. Most indicated that local hospital staff and PTSS officers were knowledgeable and helpful (65%–70%). Less agreed that staff were available to assist (48%) or that processes were well‐coordinated across hospitals (42%). Of those who sought reimbursement for travel costs (75%), almost two‐thirds (63%) were out‐of‐pocket post‐reimbursement (mean = AU$725; range = AU$20–10 000). Delayed reimbursement was relatively common (60%) and contributed to financial hardship (36%). For some (13%), challenges accessing the scheme impacted treatment decisions. User feedback included improved visibility of online application and reimbursement status, and fast‐tracking of high‐risk, urgent and ongoing cases. Conclusions: While information about the scheme and interactions with frontline staff were viewed positively by most, several system‐level challenges remain. So What?: Substantial out‐of‐pocket costs and reimbursement delays contribute to financial hardship and can affect treatment decisions. Increased subsidy reflecting actual travel costs, timely reimbursement, fast‐tracking, and greater application assistance and coordination would improve user experiences.

Introduction: Family carers have a key role in supporting malnourished older adults; yet, intervention evidence is lacking in the rehabilitation setting. This study aimed to explore the preliminary effects and acceptability of a family‐centred, telehealth‐enhanced dietary counselling intervention for treating protein‐energy malnutrition (PEM) in rural‐living older adults transitioning from rehabilitation to home, compared with usual care, in matched patient‐carer dyads. Methods: A pragmatic, historically controlled, prospective, two‐arm non‐randomised controlled trial was conducted as a pilot study. Fifteen malnourished older adults admitted to rural rehabilitation units in New South Wales, Australia, and their family carers, were recruited and matched to 15 historical controls. The Patient‐Generated Subjective Global Assessment (PG‐SGA) was the primary outcome for nutrition status assessed at rehabilitation admission, discharge, and 3 months post‐discharge. Quality of life, physical function, length of stay, discharge location, institutionalisation, mortality, carer burden, and service satisfaction were secondary outcomes. The historical control group received usual care. The intervention group received a telehealth‐enhanced dietary counselling intervention developed with co‐design principles, which engaged the family carer as a partner in the nutrition care team, delivered during the rehabilitation admission and for 3 months post‐discharge. Results: The difference in PG‐SGA score from baseline to 3 months post‐discharge between the two groups was 3.46 (95%CI: −2.07, 9.01; p = 0.238). The intervention group had a higher proportion of patients who were well‐nourished at 3 months post‐discharge compared to controls (60% vs 13%). At 3 months post‐discharge, the intervention group had lower odds of being rated malnourished or with more severe malnutrition (i.e., moderate vs. well‐nourished, severe vs. moderate) on the PG‐SGA (OR 0.01, 95%CI: 0.00, 0.27; p = 0.005). There was a trend towards the intervention group having reduced odds of being discharged to a location other than home (OR 0.18, 95%CI: 0.03, 1.07; p = 0.06). The intervention was perceived as acceptable to patients and family carers. There were no differences between groups in other outcomes. Conclusion: Compared with usual care, the family‐centred telehealth‐enhanced dietary counselling intervention for the treatment of PEM in rural‐living older adults transitioning from rehabilitation to home demonstrated preliminary efficacy and was acceptable to both patients and family carers. Future research aiming to improve PEM should meaningfully engage family carers as partners in the nutrition care team.

Objective: To identify facilitators and barriers to improving communication of survivorship care information to rural cancer survivors from the perspective of healthcare professionals. Setting: Metropolitan and rural health services provide care to rural cancer survivors. Participants: Healthcare professionals ( n = 31), including cancer specialists, general practitioners, nurses, care coordinators and allied health practitioners. Design: Qualitative descriptive study using semi‐structured interviews to assess current practices for communicating survivorship care information, perspectives on how this information should be delivered and factors that may affect the implementation of a new method for delivering this information. Responses were categorised as a facilitator or barrier to improving information delivery. Barriers and facilitators were mapped to constructs of the Consolidated Framework for Implementation Research to identify the settings and contexts in which they occur. Results: Facilitators included the evidence base and relative advantage of improving survivorship care information delivery to rural cancer survivors, indicating that healthcare professionals perceive this initiative as important and valuable. Participants also reported a tension for change (i.e., current practices for information delivery are not sustainable) and mission alignment , meaning improving survivorship information to rural cancer survivors is within participants' organisations' goals . Barriers included local conditions, policies and laws and financing , including challenges accessing support services in rural settings and limited funding for post‐treatment care. Conclusions: Guiding principles and suggested actions for improving survivorship care information delivery to rural cancer survivors are proposed, including strategies for minimising burden on healthcare teams, formalising transitional practices, streamlining referral pathways, partnering with community services and including family carers.