Defining timeliness in care for patients with lung cancer: a scoping review

Abstract

ObjectivesEarly diagnosis and reducing the time taken to achieve each step of lung cancer care is essential. This scoping review aimed to examine time points and intervals used to measure timeliness and to critically assess how they are defined by existing studies of the care seeking pathway for lung cancer.MethodsThis scoping review was guided by the methodological framework for scoping reviews by Arksey and O’Malley. MEDLINE, EMBASE, CINAHL and PsycINFO electronic databases were searched for articles published between 1999 and 2019. After duplicate removal, all publications went through title and abstract screening followed by full text review and inclusion of articles in the review against the selection criteria. A narrative synthesis describes the time points, intervals and measurement guidelines used by the included articles.ResultsA total of 2113 articles were identified from the initial search. Finally, 68 articles were included for data charting process. Eight time points and 14 intervals were identified as the most common events researched by the articles. Eighteen different lung cancer care guidelines were used to benchmark intervals in the included articles; all were developed in Western countries. The British Thoracic Society guideline was the most frequently used guideline (20%). Western guidelines were used by the studies in Asian countries despite differences in the health system structure.ConclusionThis review identified substantial variations in definitions of some of the intervals used to describe timeliness of care for lung cancer. The differences in healthcare delivery systems of Asian and Western countries, and between high-income countries and low-income-middle-income countries may suggest different sets of time points and intervals need to be developed.

Time is of the Essence: Why Goals-of-Care Conversations and Prognosis Documentation Matters in Advanced Cancer Patients in an Integrated Health System

“…Timeliness and appropriateness are two quality measures used to evaluate outcomes in cancer care. 32 Appropriateness is an intervention or service in which the expected benefits significantly exceed the expected risks. 33 Timeliness is defined as the time between two events that supports the best outcome for the patient.…”

“…33 Timeliness is defined as the time between two events that supports the best outcome for the patient. 32 Despite the association of early diagnosis and management with improved outcomes, including survival and mortality, in cancer patients, 32,34 optimal time intervals of diagnosis and treatment have not been established or incorporated into national guidelines, yet time-to-treatment beyond 90 days is considered delayed. 35,36 Timeliness was determined by mean time-to-interventions and calculated for aspects of diagnosis and treatment, with extrapolation of findings from earlier stage analysis by Cole et al 37…”

“…33 Timeliness is defined as the time between two events that supports the best outcome for the patient. 32 Despite the association of early diagnosis and management with improved outcomes, including survival and mortality, in cancer patients, 32,34 optimal time intervals of diagnosis and treatment have not been established or incorporated into national guidelines, yet time-to-treatment beyond 90 days is considered delayed. 35,36 Timeliness was determined by mean time-to-interventions and calculated for aspects of diagnosis and treatment, with extrapolation of findings from earlier stage analysis by Cole et al 37 Management appropriateness was based on the medical team's selection of specific diagnostic tests and therapy options with relation to application of National Comprehensive Cancer Network guidelines for the benefit of patients and determined through expert review of each case by a panel of three oncology providers (AL, FM, AA) and 1 hospital-based internal medicine physician (KH).…”