Understanding stakeholder misalignments in cancer follow-up surveillance care : a multi-stakeholder study

Context Cancer follow-up surveillance care (e.g. scans or blood tests), involves multiple stakeholders, including patients, relatives, clinicians and administrative staff, whose journeys intersect in complex ways. Yet, most research focuses on the focal patient journey, overlooking the dynamic interplay between multiple stakeholders and the impact on experience outcomes. This gap is critical in healthcare, where coordination failures can exacerbate distress. This study examines how misalignment across stakeholder journeys shapes experiences and how alignment can improve them. It reframes experience as being shaped by multi-stakeholder systems rather than by isolated dyadic interactions. Methodology We adopted an ethnographic, multi-methods design across eight hospital departments and four cancer types. Data collection involved observations, semi-structured interviews, patient and relative diaries, and Photovoice exercises. Sixteen stakeholder journey maps were developed to capture the interdependencies between actors and touchpoints. Analysis followed constant comparison techniques and was validated through the involvement of participant co-researchers to ensure credibility. We build upon interdependence theory, which explains how outcomes in relationships are shaped by patterns of mutual dependence and interaction structures, influencing cooperation, conflict, and adaptation, with insights from psychosocial oncology. This theoretical framework underpins our interpretation and guides the development of a conceptual model for alignment across stakeholder journeys. Results Our preliminary analysis indicates that experiences during cancer follow-up surveillance care are influenced by interactions among various stakeholders. Organisational and stakeholder contexts often disrupt patient journeys, with misalignments arising from control asymmetry and fragmented information flow. One case illustrated how a “no news is good news” communication approach heightened uncertainty. The clinician said that she would only call if abnormalities were found, which was contrary to the patient's wishes. However, the patient remained anxious about potentially overlooked results, reinforcing distress and vulnerability. Conversely, we observed situations where stakeholders aligned more with patient needs. An oncologist asked patients whether they preferred preliminary results on the same day, even if not fully confirmed, and coordinated to enable this. Both the organisation and oncologist facilitated this faster procedure. Moments of transparency and collaboration were perceived as reassuring and gave patients a sense of agency. This demonstrates how aligning stakeholder journeys reduced surveillance-related anxiety. Discussion & Contributions This study reframes patient experience in cancer follow-up surveillance care as being shaped by the coordination of multiple stakeholders, rather than isolated patient–provider interactions. Using Hollebeek et al.’s (2022) stakeholder journey perspective, we extend theory by identifying conditions that influence alignment across healthcare journeys and propose a conceptual model outlining mechanisms for better coordination and connection between stakeholders in cancer care. Our findings offer practical strategies to better align stakeholders in cancer follow-up surveillance care. These include transparent communication protocols and collaborative scheduling mechanisms that reduce uncertainty and foster trust. By improving coordination across stakeholder journeys, these strategies aim to enhance psychological support, alleviate anxiety, and create more integrated, patient-centered pathways. While applicable to other complex service settings, their immediate value lies in guiding healthcare organisations toward more cohesive and supportive follow-up care