Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Developing an intervention logic model for ‘Engage’: a novel, multi-disciplinary program for survivors of childhood cancer     (#450)

Joseph Elias 1 , Jordana K McLoone 2 3 , Christina Signorelli 2 3 , Carolyn Mazariego 4 , Skye McKay 1 , Claire E Wakefield 2 3 , Richard J Cohn 2 3 , Natalie J Taylor 1
  1. School of Population Health, UNSW Medicine & Health, Ranwick, NSW, Australia
  2. Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
  3. Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Randwick, NSW, Australia
  4. The Daffodil Centre, a join venture with Cancer Council NSW, The University of Sydney, Woolloomooloo, NSW, Australia

Aims: Many survivors of childhood brain cancer are left to endure the long-term health problems caused by cancer and its treatments, necessitating lifelong survivorship care.1 Despite this, there are few long-term survivorship services available in Australia for survivors to access.2 ‘Engage’ is a new program that aims to overcome these barriers by providing survivors with distance-delivered, multi-disciplinary care.3 This complex intervention has many dynamic components, resources, and underlying mechanisms of change. A logic model, which is defined by the Medical Research Council as a “diagrammatic representation of an intervention”, describes an interventions components, delivery mechanisms, mechanisms of impact, and intended outcomes.4 The aim of our study will be to create a logic model for ‘Engage’ to better understand these inter-related factors and how they contribute to this program’s effectiveness.5, 6

Methods: Study investigator (JE) developed a logic model for ‘Engage’ by retrospectively reviewing outcomes from the pilot study as well as the revised trial protocol. A participatory approach was then undertaken with input received from the initial program developers (trial team) and implementers (implementation team).

Results: The logic model described the following outputs and corresponding clinical outcomes (in brackets), which include: the provision of (a) consolidated and up-to-date health information to survivors/GPs (to decrease unmet health-related information needs), (b) personalised treatment recommendations (to decrease unmet health-related information needs and increase satisfaction with survivorship care), and (c) distance-delivered consultations (to increase participation and satisfaction with survivorship care). The results from the ‘Engage’ evaluation study were then mapped to these outputs and outcomes.

Conclusions: The development of this logic model now provides ‘Engage’ investigators with an explicit theoretical basis, which can be tested and refined during subsequent effectiveness evaluations. Ultimately, this process has helped clarify the active ingredients and intended mechanisms of 'Engage', and will further inform its implementation across different settings.

  1. Tonorezos E.S., Cohn R.J., Glaser A.W., Lewin J., Poon E., Wakefield C.E., & Oeffinger K.C. (2022). Long-term care for people treated for cancer during childhood and adolescence. The Lancet, 399(10334), 1561–1572.
  2. Signorelli C, Wakefield C, McLoone JK, et al. Childhood cancer survivorship: barriers and preferences. BMJ Supportive and Palliative Care. [published online November 11 2019]
  3. Signorelli C, Wakefield CE, Johnston, K., et al Re-Engage: A Novel Nurse-Led Program for Survivors of Childhood Cancer Who Are Disengaged From Cancer-Related Care. Journal of National Comprehensive Cancer Network. 2020; 8(8):1067–1074.
  4. Moore G F, Audrey S, Barker M, Bond L, Bonell C, Hardeman W et al. Process evaluation of complex interventions: Medical Research Council guidance BMJ 2015; 350 :h1258
  5. Skivington, K., Matthews, L., Simpson, S. A., Craig, P., Baird, J., Blazeby, J. M., Boyd, K. A., Craig, N., French, D. P., McIntosh, E., Petticrew, M., Rycroft-Malone, J., White, M., & Moore, L. (2021). A new framework for developing and evaluating complex interventions: Update of Medical Research Council guidance. BMJ, 374, n2061.
  6. De Silva, M. J., Breuer, E., Lee, L., Asher, L., Chowdhary, N., Lund, C., & Patel, V. (2014). Theory of Change: A theory-driven approach to enhance the Medical Research Council’s framework for complex interventions. Trials, 15(1), 1–13.