English summary

From vision to action – innovation and implementation of an integrated cancer rehabilitation within clinical practice

P. Göransson E. Börjesson B.Wahlgren

Hallands Hospital, Halmstad, Halland, Sweden


A government funded pilot project was finalized in the beginning of 2013. The aim was an integrated cancer rehabilitation addressing, assessing and meeting the physical, psychological, social and existential needs of cancer patients and their significant others independent of cancer site and stage of the disease.

The innovational process, which included the active participation of patients, significant others and medical staff, have delivered new services, resources routines and a plan for implementation and continuing development.


Within one hospital, with different processes for cancer care based on diagnosis, a project group with the mission to develop services, resources, routines and support to foster integrated cancer rehabilitation was created. Through the active use of social media channels and reference group’s patients, significant others and medical staff was made an active part of the development.

In the model doctors and nurses routinely address, assess and meet patients different needs of cancer rehabilitation through the whole care process. A multi-professional cancer rehabilitation team supports the medical staff. The model was tested and evaluated in small scale.


After evaluation in reference groups, clinical practice and focus groups run by innovation science researchers the model was adjusted and, together with an implementation plan, presented to the Hallands Hospital’s board of directors. Following the positive response the next step is to implement the model across the regions three hospitals. This should be conducted as an implementation study. The following has been developed:

• Multi-professional cancer rehabilitation team

• Routines for addressing and assessing patient’s needs

• Routines for providing cancer rehabilitation

• Routines for documentation

• Educational resources

• Individual care plans

• Quality indicators for evaluation and further development of the model


There’s a need for research from the multi-scientific approach of innovational sciences to draw forth organizational, social and technical innovations concerning cancer rehabilitation. The development and implementation of these innovations needs to be conducted close to clinical practice and include stakeholders as active parts of the innovation process.

Through national guidelines we can define the ”what” shall be done when it comes to cancer rehabilitation. When it comes to put guidelines into practice the next step is to define the ”how”, ”when” and ”who” and this should to be done within the context where it shall thrive.

Research Implications

How can we create working models for integrated services that really can put science and policy into practice? This project has been initiated and conducted within clinical practice but has evolved into a model which gives a perfect platform for research on the innovation and implementation of integrated cancer rehabilitation services.

Clinical Implications

How can clinicians get policies and guidelines to work in their unique context? How can cancer care work together with cancer survivors to facilitate an innovational process that will evolve cancer care services that can face the needs of cancer survivors that today stand as unmet needs?


Project Manager Patrik Göransson MSc


Phone: +46(0)35-134693