Optimising proton therapy referral pathways for lung and oesophageal cancer in a Dutch interorganisational referral network: A canonical action research study.

BACKGROUND AND PURPOSE: Proton therapy (PT) offers enhanced treatment precision and potentially fewer adverse effects than photon therapy. Despite national referral guidelines, many eligible patients are not referred for PT. This study aims to 1) identify and address barriers within the interorganisational care pathway (including the patient journey), and 2) implement stakeholder co-developed interventions, supported by Canonical Action Research (CAR).

MATERIAL AND

METHODS

Two referring radiotherapy (RT) centres and one PT-centre participated, focusing on lung and oesophageal cancer patients. We applied the five-phase CAR approach as a structured implementation method. Phase 1 (diagnosis) mapped the interorganisational care pathway through interviews, workshops, and data collection. Phase 2 (action planning) involved co-development of pathway improvements, followed by implementation (phase-3:action taking). Outcomes were evaluated (phase-4: assessment) and reflected upon (phase-5: learning).

RESULTS

The diagnosis phase identified barriers in the interorganisational care pathway/patient journey, including limited knowledge, experience, and coordination in PT-referral. Implementation of pathway-targeted interventions (e.g., logistics improvements, addition of a patient accompanist) was associated with increased referral rates and numbers of patients treated with PT from one referring RT-centre. Stakeholder perceptions of pathway design and intervention appropriateness improved, while patient satisfaction remained stable.

CONCLUSION

We identified barriers in the PT care pathway and co-developed and implemented stakeholder-informed interventions. Improvements in referral processes and stakeholder perceptions highlight the importance of addressing professional, contextual and pathway-related factors when optimising complex interorganisational care pathways. CAR supported stakeholder engagement and collaboration across organisational boundaries, contributing to the delivery of the right care in the right place.