Abstract:BackgroundImproving access to better, more efficient, and rapid cancer diagnosis is a necessary component of a highquality cancer system. How diagnostic services ought to be organized, structured, and evaluated is less understood and studied. Our objective was to address this gap.
MethodsAs a quality initiative of Cancer Care Ontario's Program in Evidence-Based Care, the Diagnostic Assessment Standards Panel, with representation from clinical oncology experts, institutional and clinical administrative leaders,… Show more
“…A case study approach was chosen to explore multiple factors that influence ICC including DAP structure, processes and outcomes [ 31 ]. These will be assessed according to DAP standards and guideline recommendations for staging and diagnosis of breast [ 32 - 34 ] and lung cancer [ 27 , 28 ]. This will enable comparison between ‘cases’ (DAPs) that vary by type of cancer, academic status, and geographic region.…”
Section: Methodsmentioning
confidence: 99%
“…This generated core components and enablers of ICC that were common across the models. Organizational standards for DAPs that are described in Table 1 [ 27 , 28 ] were mapped onto this preliminary framework. The conceptual framework was expanded by adding challenges [ 10 - 26 ] and beneficial outcomes [ 9 - 21 ] identified in our background review of the literature.…”
Section: Methodsmentioning
confidence: 99%
“…Clinicians and managers suggested the need to improve ICC earlier in the cancer trajectory given barriers of access to, and coordination of diagnosis and staging, and recommended centralized diagnostic facilities [ 14 - 19 ]. An expert panel assembled by the provincial cancer agency issued organizational standards for Diagnostic Assessment Programs (DAPs) to coordinate diagnostic tests and integrate multidisciplinary expertise [ 27 , 28 ]. A summary of recommended DAP features appears in Table 1 .…”
BackgroundInter-professional collaborative care (ICC) for cancer leads to multiple system, organizational, professional, and patient benefits, but is limited by numerous challenges. Empirical research on interventions that promote or enable ICC is sparse so guidance on how to achieve ICC is lacking. Research shows that ICC for diagnosis could be improved. Diagnostic assessment programs (DAPs) appear to be a promising model for enabling ICC. The purpose of this study was to explore how DAP structure and function enable ICC, and whether that may be associated with organizational and clinical outcomes.MethodsA case study approach will be used to explore ICC among eight DAPs that vary by type of cancer (lung, breast), academic status, and geographic region. To describe DAP function and outcomes, and gather information that will enable costing, recommendations expressed in DAP standards and clinical guidelines will be assessed through retrospective observational study. Data will be acquired from databases maintained by participating DAPs and the provincial cancer agency, and confirmed by and supplemented with review of medical records. We will conduct a pilot study to explore the feasibility of estimating the incremental cost-effectiveness ratio using person-level data from medical records and other sources. Interviews will be conducted with health professionals, staff, and referring physicians from each DAP to learn about barriers and facilitators of ICC. Qualitative methods based on a grounded approach will be used to guide sampling, data collection and analysis.DiscussionFindings may reveal opportunities for unique structures, interventions or tools that enable ICC that could be developed, implemented, and evaluated through future research. This information will serve as a formative needs assessment to identify the nature of ongoing or required improvements, which can be directly used by our decision maker collaborators, and as a framework by policy makers, cancer system managers, and DAP managers elsewhere to strategically plan for and implement diagnostic cancer services.
“…A case study approach was chosen to explore multiple factors that influence ICC including DAP structure, processes and outcomes [ 31 ]. These will be assessed according to DAP standards and guideline recommendations for staging and diagnosis of breast [ 32 - 34 ] and lung cancer [ 27 , 28 ]. This will enable comparison between ‘cases’ (DAPs) that vary by type of cancer, academic status, and geographic region.…”
Section: Methodsmentioning
confidence: 99%
“…This generated core components and enablers of ICC that were common across the models. Organizational standards for DAPs that are described in Table 1 [ 27 , 28 ] were mapped onto this preliminary framework. The conceptual framework was expanded by adding challenges [ 10 - 26 ] and beneficial outcomes [ 9 - 21 ] identified in our background review of the literature.…”
Section: Methodsmentioning
confidence: 99%
“…Clinicians and managers suggested the need to improve ICC earlier in the cancer trajectory given barriers of access to, and coordination of diagnosis and staging, and recommended centralized diagnostic facilities [ 14 - 19 ]. An expert panel assembled by the provincial cancer agency issued organizational standards for Diagnostic Assessment Programs (DAPs) to coordinate diagnostic tests and integrate multidisciplinary expertise [ 27 , 28 ]. A summary of recommended DAP features appears in Table 1 .…”
BackgroundInter-professional collaborative care (ICC) for cancer leads to multiple system, organizational, professional, and patient benefits, but is limited by numerous challenges. Empirical research on interventions that promote or enable ICC is sparse so guidance on how to achieve ICC is lacking. Research shows that ICC for diagnosis could be improved. Diagnostic assessment programs (DAPs) appear to be a promising model for enabling ICC. The purpose of this study was to explore how DAP structure and function enable ICC, and whether that may be associated with organizational and clinical outcomes.MethodsA case study approach will be used to explore ICC among eight DAPs that vary by type of cancer (lung, breast), academic status, and geographic region. To describe DAP function and outcomes, and gather information that will enable costing, recommendations expressed in DAP standards and clinical guidelines will be assessed through retrospective observational study. Data will be acquired from databases maintained by participating DAPs and the provincial cancer agency, and confirmed by and supplemented with review of medical records. We will conduct a pilot study to explore the feasibility of estimating the incremental cost-effectiveness ratio using person-level data from medical records and other sources. Interviews will be conducted with health professionals, staff, and referring physicians from each DAP to learn about barriers and facilitators of ICC. Qualitative methods based on a grounded approach will be used to guide sampling, data collection and analysis.DiscussionFindings may reveal opportunities for unique structures, interventions or tools that enable ICC that could be developed, implemented, and evaluated through future research. This information will serve as a formative needs assessment to identify the nature of ongoing or required improvements, which can be directly used by our decision maker collaborators, and as a framework by policy makers, cancer system managers, and DAP managers elsewhere to strategically plan for and implement diagnostic cancer services.
“…The provision of accurate and rapid cancer diagnosis is a necessary component of a high-quality cancer system (Brouwers et al 2009). Prolonged time intervals between symptom onset and treatment initiation increase the risk of poor clinical outcomes and worse patient experience of care (Koo et al 2015).…”
Cancer Care Ontario developed a diagnostic assessment program (DAP) to improve patients' experience in the diagnostic phase of their cancer journey and improve health system efficiency and effectiveness. The Stronach Regional Cancer Centre Lung DAP (at Southlake Regional Health Centre) used learnings from a Lean improvement event to increase capacity to meet patient demand for service and to achieve/ improve upon the provincial wait time target from consultation to diagnosis for lung cancer patients (65% within 28 days), improving overall patient experience of care. Monthly patient volumes have increased by 65%, and wait time has improved by 60%.
“…The challenge is to build the operational systems that deliver such care in a timely manner. Lung cancer presents a series of clinical management and institutional challenges for both operational and therapeutic delivery of care 5,6 . Such challenges include the requirement for a series of diagnostic and staging tests to be performed and collectively interpreted and the patient triaged, in a timely fashion, to the most appropriate initial providers, such as surgical oncology, medical oncology, radiation oncology, and palliative services.…”
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