For adolescent and young adult (AYA) cancer patients, clinical practice guidelines recommend specialised cancer care and timely engagement of supportive and palliative care, no matter the AYA’s cancer trajectory. Despite this, our comprehensive cancer centre had no AYA-dedicated cancer service, and of the 884 AYA referrals between January 2016 and January 2022, only 8.4% were referred for palliative care input.

Our quality improvement (QI) project’s primary aim was to increase referrals to our AYA Supportive and Palliative Care (SPC) Service from an average of one a month, to four a month, with secondary aims of increasing referral pathway confidence, and improving AYA health outcomes.

Methods:
The project was selected for the SPHERE-Stanford Quality Improvement Programme, which provided our multidisciplinary team with mentorship and evidence-based QI methodology training.

The project was run in a comprehensive cancer centre, over 18 weeks from June to November, 2022. A data manager provided AYA referral numbers to the centre at baseline and post-project commencement, and referrals to the AYA SPC Service were monitored by the project lead.

Using the intuitive A3 QI framework, the team identified simple interventions to achieve and sustain our target. These included collaborating with and educating stakeholders, improving centre-wide awareness of specialised AYA cancer care and the benefits of an AYA SPC referral, a streamlined referral process and a responsive model of care for AYAs.

Results:
Over 18 weeks, AYA SPC Service referrals exceeded the target, averaging five a month, with eight in the final month. Additionally, clinicians expressed greater confidence in referring to our service and collaborating in AYA care, and the project stimulated organizational level AYA advocacy.

Conclusions:
In a short timeframe and complex clinical environment, QI methodology helped articulate an innovative, sustainable approach to improving AYA cancer patients’ outcomes through better supportive and palliative care access.