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Principles of shared follow-up care for early breast cancer

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Cancer Australia’s Principles of shared follow-up care for early breast cancer underpin the delivery of shared follow-up and survivorship care for early breast cancer by health professionals and health services. These principles were informed by evidence and developed in consultation with experts.

  • Person-centred care
    The individual and their whole person care is the focus for all care providers.Care is respectful and responsive to the individual’s needs, preferences, circumstances and values. The individual is supported to participate in shared decision making and self-management.
  • Care is delivered according to best practice
    Provision of care is in accordance with nationally agreed standards and is outcome focused. Individual follow-up care includes identified pathways for timely access to specialist providers as required.
  • Coordination of care
    Care coordination is enhanced through timely and effective communication, and clarification of the roles and responsibilities of the care providers. The collection and sharing of appropriate clinical data and information supports continuity of care and integration across treatment modalities, providers and health settings.
  • Support for living well
    Individuals are supported to make positive lifestyle choices which promote health, reduce risk of disease and prevent distress. The individual’s supportive care needs (physical, psychological, social, cultural, informational and spiritual) are assessed with appropriate referrals and management to promote optimal health and quality of life.
  • Support for primary care providers
    The role of primary care in the delivery of safe and effective follow-up care is supported. Primary care providers are supported in the delivery of shared follow-up and survivorship care through early involvement, and through the provision of education, resources, information for people affected by cancer and pathways for access to specialist advice.
  • Support for specialist treatment team
    The role of specialist care providers in the delivery of safe and effective follow-up care is supported.Specialist care providers are supported in the delivery of shared follow-up and survivorship care through the provision of resources, information for people affected by cancer and pathways for communication with primary care providers.
  • Care is informed and improved by data
    Improvements in shared care are data-driven.The collection and utilisation of key cancer data, including consumer experience and outcome data, supports the delivery of holistic patient care and continuous improvement in care.

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Related resources:

  • Principles of cancer survivorship
    Cancer Australia’s Principles of Cancer Survivorship aim to guide national approaches to reduce the impact of cancer and improve the health and wellbeing of people affected by cancer across the cancer care continuum.