Optimising prevention activities in primary care for cancer survivors: a novel socio-technical approach using the Functional Resonance Analysis Method

Background: Primary care provides comprehensive whole-of-person patient-centred care with important responsibilities in prevention among cancer survivors. This includes cancer surveillance, the management of other chronic diseases, health promotion and preventative care. However, there is inconsistent application of prevention activities. We explored the experiences of Australian general practitioners (GPs) and practice nurses to: (1) understand the delivery of prevention activities for cancer survivors; and (2) identify determinants to optimise disease prevention activities within the current general practice context. Colorectal cancer is the fourth most common cancer in Australia. However, each GP will likely diagnose only one new case of colorectal cancer per year. Colorectal cancer survivorship care was provided as an example to prompt discussion on the delivery of prevention activities for cancer survivors and determinants to optimise prevention. Methods: A qualitative study using semi-structured interviews with GPs and practice nurses from New South Wales and Queensland, Australia. Interviews were conducted between June 2021 and February 2022. Transcripts were reflexively analysed and mapped to the Functional Resonance Analysis Method framework. Results: We conducted 15 interviews with GPs (n = 11) and practice nurses (n = 4) from 12 practices. Three potential activities fundamental to disease prevention for cancer survivors were identified: risk assessment, partnering with the patient and co-planning prevention activities. Conclusions: Primary care is a complex and adaptive system. The Functional Resonance Analysis Method approach, by visualising the dynamic interactions and interdependencies between people, resources, time and system conditions involved in prevention activities, offers a pragmatic guide to develop acceptable, scalable and adaptable interventions for promoting disease risk estimation (cancer and other chronic diseases), therapeutic partnerships and co-planning activities within the socio-technological constraints of the system studied using the resources available. This approach represents a key paradigm shift in health system innovation for cancer survivors.