Barriers and facilitators to implementing the European code of cancer practice in a rural and coastal setting: a qualitative study

Abstract

Purpose The European Code of Cancer Practice (ECCP) is a patient-centred framework for good clinical cancer practice, to improve outcomes for all of Europe’s patients [1]. Given challenges with applications to rural regions, the study aimed to explore the barriers and facilitators to implementing the ECCP in a rural, coastal, and urban context. Methods We conducted semi-structured individual and group interviews with nine acute cancer professionals; nine non-clinical professionals; and four people with lived experience of cancer. Interviews were analysed using reflexive thematic analysis, underpinned by a constructivist approach. Results Three themes were developed across all groups. 1) ‘Fragmented communication pathways limits access’ to information-sharing between services, and about support and research, linked to workforce challenges. 2) ‘Geographic and infrastructural disparities between urban, rural, and coastal areas’ highlight barriers to accessing and delivering care, including transport issues, alongside place-specific facilitators to wellbeing. 3) ‘Unmet needs for living well during and after treatment’ denotes financial, work-related, and psychological challenges through treatment and survivorship. These barriers transcended across all ECCP domains. Conclusion Workforce challenges that limit information-sharing about support and research, and gaps in post-treatment support, must be addressed to meet the ECCP aim to ensure equitable cancer care across geographical locations.

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