Implementing standardized cancer patient pathways (CPPs) – a qualitative study exploring the perspectives of health care professionals

Abstract

Background Many countries have implemented standardized cancer patient pathways (CPPs) to reduce waiting times in cancer care and to ensure timely and quick diagnosis as well as treatment. Yet, no studies have explored the implementation process as perceived by the health care professionals working in the CPPs. The aim of this study is to explore the experiences of health care professionals (HPCs) involved in the CPPs. Methods A descriptive qualitative design was adopted. Thematic analysis was applied to individual interviews conducted in 2016–2017 with 58 participants working in six different CPPs in Sweden’s largest region, covering care for around 2.3 million inhabitants. Results In general, the health care professionals had a positive attitude towards the implementation of the CPPs. Our findings showed that the CPPs require close collaboration, both between and within different health care professional groups and units, something that was not always probable due to differences in resource capacity. Better dissemination to all relevant professionals, better conceptualization, and equivalent opportunities in terms of resources were identified by the respondents as being important yet lacking in practice. The analysis showed possible negative effects of the CPP, such as crowding-out on other patient groups. Conclusion The CPPs were introduced to address challenges with long waiting times and unequal cancer care. By exploring the experiences of health care professionals involved in the implementation of CPPs, our findings show challenges with multi-level coordination and collaboration, policy dissemination, and resource constraints. The analysis also showed that the implementation of CPPs risk being accompanied by unintended effects such as longer waiting times for other patients and patient groups in need of the same health care resources. The results shed light on and contribute to an understanding of the challenges, opportunities and ways forward.

When time matters: a qualitative study on hospital staff’s strategies for meeting the target times in cancer patient pathways

“…Studies on the implementation of clinical pathways agree that both reorganisation of current work processes on an organisation level [ 21 ] and behavioural changes on an individual level [ 30 ] are required to achieve the desired outcome. Implementation may also be expensive and, therefore, raises the question of financing the new activities [ 13 ].…”

“…Therefore, one of the aims of introducing CPPs was to create more equal access to healthcare services. This reason was particularly prominent in Sweden [ 21 , 22 ]; additionally, the NHS in the UK justifies the introduction of the cancer pathways with the goal of reducing variation in patient access to diagnostic and treatment options [ 15 ]. In Norway, too, the aim of reducing geographical variation was a motivation behind introducing CPPs.…”

“…With regard to studies that have explicitly investigated hospital staff’s experiences with trying to meet the target times, we have only identified one study that touches upon the subject. The identified study investigated the implementation of CPPs in Sweden [ 21 ]. The authors showed that even though strong efforts were made to achieve the target times in one part of the system (e.g.…”

GPs’ perspectives of the patient encounter – in the context of standardized cancer patient pathways

“…Green et al suggest that a supplementary option to CPPs could be beneficial, allowing patients to be urgently referred to secondary care in cases when cancer is not suspected, and when patients do not fit into the frame for CPPs [6]. Furthermore, a recent study from Sweden finds that healthcare professionals need improved information about CPPs [40], which also some GPs in our study expressed. These findings from previous research, in combination with ours, indicate that the implementation of CPPs, at least in the studied region, in primary care still needs to be supported and improved to be able to function optimally well.…”

Reorganizing the Multidisciplinary Team Meetings in a Tertiary Centre for Gastro-Intestinal Oncology Adds Value to the Internal and Regional Care Pathways. A Mixed Method Evaluation

“…Case managers believed that throughput times to get the treatment plan and throughput times to start treatment could be further reduced through stricter monitoring of the completeness of the diagnostic information needed to start treatment. The importance of strict monitoring has been identified elsewhere [ 53 54 ] but we noticed that the ‘circle of influence’ of a care coordinator or case manager is limited. The case manager has no control over or mandate for discipline-bounded capacities such as slots for diagnostic procedures.…”