Using Pragmatic Co‐Design Processes in a Resource‐Constrained Regional Health Service: Insights From the TROPICAL ‐ VIC Early Referral to Palliative Care Project

Objective To describe an evidence‐informed, experience‐based co‐design process used to adapt metropolitan early palliative care referral models for implementation in a regional Australian health service. Methods A scoping review of palliative care delivery and early referral models to inform evidence‐informed, experience‐based co‐design workshops involving consumers, clinicians, and health service staff. Design Sequential mixed‐methods development study comprising evidence synthesis to identify model components, followed by two iterative workshops to construct and refine a context‐appropriate outpatient early referral model. Setting A regional public health service in Victoria, Australia, seeking to establish an outpatient early referral palliative care clinic for people with advanced cancer. Participants Purposefully sampled stakeholders (patients/carers, oncologists, palliative care clinicians, cancer care coordinators, Aboriginal health worker, managers, and researchers) took part in two online workshops. Main Outcome Measures Co‐designed model structure and components, perceived feasibility in a resource‐constrained regional context, and agreed service scope and patient eligibility. Results The process generated a regionally tailored early referral pathway incorporating needs‐based screening, prioritisation to manage limited capacity, and staged roll‐out initially focused on selected cancer groups. These adaptations, while pragmatic, highlight the resourcing disparities faced by rural and regional services and the equity implications of resource‐driven variation in care delivery. Conclusions Evidence‐informed co‐design enabled pragmatic adaptation of metropolitan palliative care models to a regional setting and offers a transferable approach for other rural and regional services.