Aims
To evaluate implementation of a multidisciplinary survivorship clinic for people living with multiple myeloma receiving maintenance therapy, including feasibility, fidelity, acceptability and determinants of implementation.
Methods
A mixed-methods implementation study was undertaken at a tertiary Australian cancer centre. Phase 1 involved multidisciplinary workshops to specify the model of care using the Action, Actor, Context, Target and Time (AACTT) framework. Phase 2 evaluated a 12-month pilot implementation. Feasibility outcomes included recruitment, retention, intervention fidelity and care delivery. Acceptability was explored through semi-structured interviews with patients and healthcare professionals and analysed deductively using the Theoretical Framework of Acceptability (TFA). Implementation determinants were examined using the Theoretical Domains Framework (TDF). Sample size was guided by information power, with recruitment continuing until sufficient depth and breadth of perspectives were achieved.
Results
Thirty-seven patients were approached, with 26 (70.3%) enrolled. All participants completed the nurse- and pharmacist-led clinic components and no participants withdrew. Survivorship care plans were completed within two weeks for 24/26 participants (92.3%) and patient-reported outcome measure completion was 96.2%. Twenty new referrals to supportive care services were generated, identifying previously unmet supportive care needs. Sixteen patient Interviews (16 patients & 15 healthcare professionals) demonstrated high acceptability, with patients and healthcare professionals valuing the holistic, coordinated model of care embedded within routine haematology practice. Key implementation enablers included trusted relationships with clinicians, multidisciplinary collaboration and integration into existing workflows. Major barriers related to workforce capacity, competing clinical demands and documentation burden.
Conclusions
The Living Better with Myeloma clinic demonstrated high feasibility, fidelity and acceptability when embedded within routine haematology practice. The findings identify key implementation considerations for integrating multidisciplinary survivorship care into routine cancer services and provide an evidence-informed model to support broader implementation across Australian cancer centres.