Managing interdependencies in cancer surveillance care : a multi-stakeholder perspective

Relevance of the Phenomenon Service systems are multi-actor ecosystems in which customer experiences emerge from the interactions of interdependent stakeholders. However, most research focuses on the customer journey itself, overlooking the dynamic interplay between stakeholders and its impact on experience outcomes. This is a particularly critical issue in healthcare, where coordination failures can exacerbate emotional distress. In this study, we address this issue in the context of surveillance-associated distress, which is the anxiety experienced by patients and their relatives between diagnostic tests and receiving results in cancer follow-up care. This study examines how misalignment across stakeholder journeys shapes experiences, and how alignment can improve them. Research Questions (1) How do conditions of interdependence across stakeholder journeys influence the experiences of patients and their relatives during the post-surveillance phase? (2) Under what circumstances can alignment across stakeholder journeys reduce distress and enhance the overall experience? Theoretical Foundations & Conceptual Framework Drawing on interdependence theory and literature on the stakeholder journey, we conceptualise care delivery as a multi-actor system in which experiences emerge from intersecting trajectories that are shaped by structural conditions such as asymmetry of control, mutual dependence, information flow and temporal structure. Misalignment across these journeys can amplify uncertainty and distress, whereas alignment through transparent communication and collaborative scheduling can enhance the quality of the experience. Our framework integrates interdependence theory, stakeholder journey literature and psychosocial oncology insights to offer a novel perspective on the systemic drivers of experience. Methodology An ethnographic, multi-methods design was employed for four types of cancer and eight hospitals. Data sources included observations, interviews, diaries and the Photovoice method. Sixteen stakeholder journey maps were developed and analysed using constant comparison techniques and validated through the involvement of participant co-researchers. Findings Preliminary insights suggest that power imbalances, disjointed communication and inflexible scheduling exacerbate vulnerability during the waiting period. Conversely, providing proactive updates and empathic touchpoints can reduce uncertainty. These findings highlight the systemic nature of distress and the requirement for coordination that extends beyond the patient-provider relationship. Discussion & Contributions This study reframes customer experience as an outcome of multi-stakeholder service ecosystems. By applying the stakeholder journey perspective of Hollebeek et al. to this service system, we demonstrate how conditions of interdependence, such as control asymmetry and information flow, influence experiences at various touchpoints. Conceptually, we present a model that links these conditions to experience outcomes, thereby extending service ecosystem theory to high-stakes healthcare contexts. From a managerial perspective, we provide actionable insights for designing psychologically supportive services through strategies such as transparent communication protocols and collaborative scheduling mechanisms. Beyond healthcare, our findings can inform the design of services in other complex, interdependent settings where customer experience depends on the coordination of multiple actors.