Barriers and enablers impacting health professionals' referral to supportive care services for patients with pancreatic & oesophagogastric cancer

**$5,000 Scholarship on Offer to Successful Honours Candidate** Early identification and referral of patients with unmet needs to supportive care services has demonstrated tangible benefit to patients. It has been shown to result in improved patient experiences, and lead to better prognosis, improved quality of life (QOL) and, in some cases, prolonged survival. The Optimal Care Pathways, developed by the Victorian Department of Health and Cancer Council Victoria as a national strategy to improve cancer care, highlight the importance of supportive care at every step of the pathway. Despite this, more than two-thirds of patients with upper gastrointestinal (UGI) cancer have been reported to have a “tsunami of unmet needs”. It is unclear why unmet needs persist in patients with UGI cancer who have such high needs. Under-reporting of cancer-related symptoms is common, with severe, distressing or bothersome symptoms not reported by the majority of patients with advanced cancer. Under-reporting can stem from patient beliefs that nothing can be done about their symptoms or reluctance to ‘bother’ their busy doctor about their problems, which may account for poor referral patterns to services. Furthermore, Australian studies have shown that only a minority of patients with pancreatic cancer have consulted a dietician or a psychologist/psychiatrist. Furthermore, despite research signifying the importance of early referral to palliative care, even in patients with localised disease, less than half of patients accessed palliative care. Not taking action to address unmet needs could be due to a lack of available services/resources, long wait times, or perception of some clinicians and patients that services such as physiotherapy, dietetics, psychotherapy or palliative care won’t make much difference. Project Aims: The aim of this study is to understand what factors impact health professionals’ (HPs) referral to supportive care services in Victoria for patients with pancreatic and oesophagogastric cancer. It will also explore compliance with the Optimal Care Pathways that highlight the importance of supportive care at every step of the cancer pathway. We hypothesise that referral to supportive care services will be dependent on the resources available and access to the services at the treating health service site. A mixed-methods study will be undertaken to identify the barriers and enablers to referral to supportive care services. This project will involve: 1) Development of a questionnaire, with key stakeholders, to understand current practice with regard to supportive care and identify variation in practice according to the Optimal Care Pathway; 2) Administration of questionnaire to HPs who manage and/or treat patients with pancreatic and oesophagogastric cancer; 3) Focus groups with HPs in order to develop an interview schedule, guided by the Theoretical Domains Framework, to understand the reasons for variation and identify the barriers and enablers associated with these practices. 4) Interviews will be held with clinicians and allied health professionals from a range of disciplines who practice at regional, metropolitan, public and private sites participating in the PROpatient trial in Victoria. **$5,000 Scholarship on Offer to Successful Honours Candidate**