Education to improve cancer care in rural South Australia

Abstract

Cancer management follows the overall trend of rural health disparities, with higher incidence rates of preventable cancers and lower survival rates in rural Australia. Cancer prevention and management has been identified as a priority area and Cancer Australia has funded a variety of innovations throughout Australia. The Rural Chemotherapy Mentoring Program (RCMP) forms part of this drive to improve access to chemotherapy for rural based cancer sufferers in South Australia (SA). The key strategy of this program was the provision of opportunities for rural health clinicians (nurses and GPs) to enhance their knowledge and skills in the delivery of chemotherapy and cancer care through clinical placements at metropolitan oncology units. The RCMP enrolled 43 current SA rural clinicians (five GPs and 38 nurses). This evaluation was undertaken at the end of RCMP's initial 18 months. It considered how those involved in the RCMP perceived development and delivery of the RCMP, identifying key aspects of the program that were successful. This report emphasises lessons learnt which may be of relevance more widely in the development of other rural health professional education. The evaluation used a mixed method approach, designed to accommodate different perspectives from the health professionals with different roles in the program. Quantitative and qualitative questionnaire data from clinician participants, their employers, and providers of education at metropolitan cancer units, were supplemented with qualitative interview data from these sample groups and from the program's steering committee. The analysis used interpretative methods to examine the key strengths, limitations and the potential for future development of the program. The vast majority of participants, employers, providers of training and the steering committee representatives expressed high levels of overall satisfaction about their involvement in RCMP. A clear identifiable need for increased knowledge and skills in cancer care was expressed by rural clinical participants pre-clinical placement. Technical aspects of the delivery of some chemotherapy protocols and the steps in safely preparing patients to receive chemotherapy were key areas where respondents lacked confidence prior to their clinical placement. Post-placement self-evaluation data highlighted improvements in participants' understandings and confidence about chemotherapy, and cancer care knowledge. Participants and their employers identified change in specific work activities resulting from their new knowledge. The program's limitations were identified. Knowledge acquisition was a key to the success of the program, and the transfer of experience between rural and urban based clinicians was an important aspect of this. Generalisable recommendations for further improvement of the RCMP include: (1) clearly define and articulate a precise learning objective of the program; (2) involve staff who will directly deliver mentoring in planning of the program; (3) allow time in the planning phase to resolve complex indemnity issues across workplaces; and (4) provide funding for a dedicated trainer (preferably a staff member within the unit) to supervise placements in busy urban oncology clinics.