Table 4 Qualitative interviews: clinician key themes

Feasible, appropriate, and useful

Overall, health professionals felt that the list of 16 Quality Indicators cover all key areas pertaining to cancer supportive care.

Clarifying responsibility for undertaking supportive care activities will help ensure indicators can be implemented and result in tangible action.

“I think you have actually covered everything and they’re all quite valuable in its own right” Site A, Health Professional, 02

Investment is prioritised

Implementation of the indicators requires adequate investment, resourcing and staffing to be feasible.

Current supportive care needs screening is hampered by lack of adequate funding, undermining ability of healthcare. Professionals to meet optimal requirements.

Health professionals lack adequate time for meaningful conversations with patients at regular intervals throughout their cancer trajectory.

Funding liaison nurses or nurse consultants is a priority to help address this deficit.

Supportive care training and education is an area for funding to ensure indicators are feasible to implement.

“And it needs to have allocated funds around that, we’re funded in health services for activity, you know… giving chemotherapy, but we’re not funded for supportive care that’s sort of supposed to be all bundled up in one package” Site A, Health Professional, 01.

An integrated approach is needed

Supportive care indicators must be implemented in the context of comprehensive, integrated care delivery.

Patients need to understand the reason for a referral and how that service can assist them in the broader context of their care, to prevent patients declining referrals.

A minimum but comprehensive set of services available for referral must be specified and there needs to be adequate resource to deliver them.

“Sometimes people think: ‘oh I’m not ready for palliative care not understanding what we can offer’. So I think maybe sometimes patients refuse, when if it had been explained properly maybe they wouldn’t. ‘Cause a lot of people think palliative care is end of life where it’s so much more than that.” Site B, Health Professional, 05.

System alignment is essential

System limitations impede regular repeat screening for patients across their experience of care. Implementing screening quality indicators wil help overcome this if specified as part of documented processes.

In the absence of standardised approaches different referral processes between and within different units at both health services have emerged. Consequently, clinicians need to operate outside of standard protocols to ensure that people have access to the services they need.

When there is lack of access to in-house services or knowledge about external services available, clinical staff may avoid completing referrals altogether.

Having quality indicator documented and standardised approaches for identifying, making, processing and recording internal and external referrals is important to enable supportive care in acute health services.

Locating screening data within complex health records is problematic. For example, when scanning completed screening tools into the health record is part of a documented process, finding these tools becomes challenging. Policies documenting standardised data storage and usage will be important for effective implementation of the quality indicators.

“Screening might be done – there’s a form that can get filled out that gets filed in the record, but it’s not acted on because there’s then no services to refer on to” – Site B, Health Profesional, 03.

“So if someone does need physio we actually have to tell them to go to their GP and get a referral from their GP. Or if they really desperately need it we actually have to admit them to the hospital to get them reviewed” Site B, Health Professional, 04.

“When it gets scanned in at the moment in the EMR, unless you know what date the tool was done on to look for where in the episode it would’ve scanned in they’re almost impossible to find. It doesn’t have like a dedicated place of where it goes to, it just gets scanned in on whatever day the label is stuck on the form... So if you put the wrong label on it could go anywhere. [laughs] -another reason why nobody looks at it ‘cause they can’t find it.” Site B, Health Professional, 04.

Cultural Safety and inclusive care

Both health services had mandatory and documented processes associated with cultural competency, cultural sensitivity, and interpreter services. However, neither had a documented or formal processes for ensuring that information, or screening tools were available in languages other than English.

Where screening tools are only available in a few languages they are inadequate to deliver quality supportive care.

Involving interpreters in supportive care screening can be challenging due to the time required and complexity of organising interpreter availability to meet clinical appointment times.

“The distress thermometer’s not translated so, you know, there’s that definite barrier to people actually filling it in and then supportive care being indicated for referrals to be generated and follow up to occur” Site B, Health Professional, 08.