Developing a 21st century model of nurse-led follow-up after curative germ cell tumour treatment

Title: Developing a 21st century model of nurse-led follow-up after curative germ cell tumour treatment Background: Due to improved medical treatments, demand for follow-up care for people living after cancer is growing. This needs integrating into a stretched NHS. Germ cell tumour (GCT) treatment is very successful, meaning almost all patients receive follow-up care.

The current model for delivering follow-up is burdensome on patients and services, not tailored to patients' needs4 and often inequitable3. Changing this model of care to become more patient-centred is mandated by existing policy6. There are approaches that may overcome this, that have been successfully tested in some UK locations20,21.

The NHS Long Term Plan emphasises utilising technology well, to deliver easily and conveniently accessible care17.Telemedicine practices within cancer follow-up are becoming more commonplace, however these are often patient-initiated or symptom-based, making them unsuitable for GCT patients.

The COVID-19 pandemic necessitated adopting telemedicine approaches in GCT to deliver safe care, leading to an increased desire for structured telemedicine.

However, no consensus exists as to how and what works, to widen the use of telemedicine in GCT equitably and tailored to patients' and stakeholders' needs. To do this well requires an implementation science approach.

Research questions RQ1: What are the key components of optimal telemedicine follow-up care in GCT as perceived by patients and HCPs and what factors aid/prevent their delivery?

RQ2: What tools, resources, knowledge, and skills do specialist GCT nurses need to deliver this new model of follow-up care?

RQ3: How can GCT telemedicine follow-up care be redesigned and evaluated, to better meet the needs of patients, healthcare professionals and health service?

Aim: This project aims to improve patients' outcomes and reduce the strain on clinical services, by developing a nurse-led telemedicine follow-up system in GCT and an implementation through evaluation toolkit for this model of service and patient group.

Methods: The project will be informed by the new framework for developing and evaluating complex interventions35, consisting of 4 interconnected workstreams: Qualitative analysis of patients' needs of follow-up Mixed method systematic review on efficacy, key components of cancer telemedicine, utilisation of PROMs within cancer telemedicine, models of change that apply to implementing telemedicine and the role nurses play in telemedicine models of follow-up.

Developing consensus and training needs analysis on key components of nurse-led telemedicine follow-up Finalisation of the toolkit through stakeholder workshops, to design future implementation studies of telemedicine in GCT follow-up. Timelines for delivery: the project will be developed over 3-years with workstreams 1-3 running concurrently.

Workstream 4 will be completed in year 4 of the PhD.

Anticipated impact and dissemination: The project will impact patients and the NHS through the production of an implementation and evaluation toolkit for novel, nurse-led GCT follow-up: creating a personalised follow-up pathway for patients, reducing waiting times and increase medical capacity for patients with the most active or complex medical post-treatment needs.

Results will be presented at conferences and submitted for publication in high impact peer reviewed journals.