The effects of cancer care pathways on waiting times

Abstract

Purpose The Swedish health-care system currently implements cancer care pathways (CCPs) for better and more timely cancer diagnostics. The purpose of this paper is to elucidate and define “crowding out” effects associated with the CCP implementation. Design/methodology/approach A document study based on implementation reports and action plans from Swedish county councils (n = 21) and a case study in one county council were conducted. Qualitative data collection and analysis were used to acquire more knowledge about the “crowding out” effects associated with the CCP implementation. Findings Three effects discussed under “crowding out” were defined. The first effect, called the push-out effect, occurs when other patients have to wait for care longer in favour of CCP patients. Another effect is the inclusion effect, whereby “crowding out” is reduced for vulnerable patients due to the standardised procedures and criteria in the referral process. The final effect is the exclusion effect, where patients in need of cancer diagnostics are, for some reason, not referred to CCP. These patients are either not diagnosed at all or diagnosed outside CCP by a non-standard process, with the risk of longer waiting times. Originality/value “Crowding out” effects are an urgent topic related to CCP implementation. While these effects have been reported in international research studies, no shared definition has been established to describe them. The present paper creates a common base to measure the “crowding out” effects and support further development of CCPs to avoid the negative effects on waiting times.

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

“…The effects of CPPs on non-cancer patients has not been a focus of this article, but informants in the study explained that when cancer diagnostics is prioritised, other patient groups without diagnostic target times are given less priority. This is in line with other studies that focus on crowding-out effects as unintended, or at least unwanted, consequences of prioritising certain patient groups [ 22 , 35 , 36 ]. More extensive use of private providers may, however, be a remedy for low-priority patients, that is, patients with less serious, not life-threating conditions.…”

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“…Recognising challenges in diagnosing cancers with varied symptomatology, different diagnostic pathways have been pioneered in Denmark, with urgent referrals for both alarm symptoms and serious, non-specific symptoms (GP triage is required for the latter—with direct access to investigations) and the use of diagnostic centres (also with direct access) for vague symptoms [ 111 ]. Similar approaches have been adopted in Norway and Sweden [ 112 , 113 ], and tested in England as part of the “Accelerate, Coordinate, Evaluate” (ACE) programme [ 114 – 116 ]. Informed by ACE results, the 2019 National Health Service (NHS) long-term plan stipulates the creation of Rapid Diagnostic Centres (RDCs).…”

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“…The effects of re-allocation of resources in a healthcare system are rarely straightforward or easy to predict, 62 as made evident by the study on the introduction of cancer care pathways on waiting times for cancer patients in Sweden and the study of the effect of a reduction in bed numbers in an emergency ward on the number of cancellations of elective surgery in a British hospital. 63,64 The issue relates partly to the cost-effectiveness issues and the fact that cost-effectiveness may vary depending on the scale of the antimicrobial resistance issue locally. But cost-effectiveness evaluations alone do not capture the issue in full.…”

“…The effects of re-allocation of resources in a healthcare system are rarely straightforward or easy to predict, 62 as made evident by the study on the introduction of cancer care pathways on waiting times for cancer patients in Sweden and the study of the effect of a reduction in bed numbers in an emergency ward on the number of cancellations of elective surgery in a British hospital. 63,64…”