Making shared care work: A national qualitative case study on collaborative practice in pediatric oncology

Background: In 2018, the Netherlands centralized all pediatric oncology care at the Prinses Máxima Center (Máxima), supported by a national network of 14 Shared Care centers. These centers deliver non-intensive treatment and supportive care closer to home, enabling a hybrid model of centralized expertise and regional accessibility. While structurally in place, little is known about how regional pediatricians experience this collaboration or which factors they consider essential to its success. Methods: This national qualitative multiple case study explored interprofessional collaboration between the Máxima and its Shared Care partners, from the perspective of pediatricians in all 14 regional centers. Semi-structured interviews were conducted, transcribed, and analyzed inductively using ATLAS.ti. Analysis was informed by Kaats & Opheij's collaboration framework, encompassing shared ambition, mutual interests, interpersonal relationships, structured collaboration, and meaningful processes. Peer debriefing was used to enhance trustworthiness and ensure clinical relevance. Results: Participants emphasized that close collaboration is indispensable for delivering safe, high-quality pediatric oncology care. Enabling factors included mutual trust, personal familiarity, timely and clear communication, and professional recognition. Challenges were identified in areas such as inconsistent policy implementation, opaque decision-making, and insufficient acknowledgment of local expertise. Many called for differentiated, context-sensitive care agreements rather than one-size-fits-all approaches. Conclusion: Effective shared care requires more than structural alignment: it demands investment in professional relationships, shared goals, and adaptive processes. These findings offer actionable insights to improve collaboration within the Dutch model and provide transferable lessons for other countries navigating centralized care in highcomplex, low-volume pediatric specialties.