All.Can Cancer Care Navigation Model of Care and Pilot Design

All.Can is an international not-for-profit seeking to improve the efficiency of cancer care by focusing on what matters to the patient. An international survey of cancer patients undertaken by All.Can in 2018 found that patients with access to cancer specialist nurses were better able to overcome barriers to care. As such, one of the aims of All.Can Australia is to:

‘increase national access to Cancer Care Navigators, which will relieve patients and their carers of the system-related stress and concern that they experience.’

Cancer Care Navigators are becoming a common way in which hospitals and treatment centres can help patients through their cancer journey. However, in Australia these roles are not universally available and are limited to certain cancer types and / or health service providers. All.Can Australia engaged Healthcare Management Advisors (HMA) to assess the optimal Cancer Care Navigator role for Australian cancer patients and their families.

In order to develop design principles for a pan-cancer care navigator, HMA considered peer-reviewed literature, examples of existing cancer-specific program in Australia and elsewhere, consultation with peak bodies, people with lived experience and consultation with the All.Can working group. Key design features of the proposed Cancer Care Navigator role included (but not limited to):

  • Use of oncology nurses (not tumour specific specialist nurses) and oncology experienced allied health staff (mainly social workers and psychologists).
  • Use of phone /video conference as the predominant delivery method, limiting in-person services to higher need populations.
  • Two tiers of navigation support, with the higher level for more complex cases.
  • Role focused on navigation, with the delivery of clinical care limited, predominately to psychosocial support. Use of referral processes for patients requiring medical or nursing clinical care outside the scope of the proposed Cancer Care Navigator role.
  • Support for the psychosocial needs of patients to be provided through access to educational resources regarding self-management and information on how to access existing support services.
  • Provision of information and education to patients, family and carers will be a core role.

HMA completed the model of care design in April 2021 and was recommissioned by All.Can in July 2021 to develop a pilot proposal for the service, including a line-item budget over a five-year period.


Download the report here.

Tags: Cancer, Care Coordination, Model of Care, Program Design