The Interface of Primary and Oncology Specialty Care: From Symptoms to Diagnosis

Toward Improving the Quality of Cancer Care: Addressing the Interfaces of Primary and Oncology-Related Subspecialty Care

“…In section II of the supplement, the authors consider the five questions as they address the major phases along the continuum of care and the interfaces between providers during each: Nekhlyudov and Latosinsky (25) address Symptoms through Diagnosis, and Sussman and Baldwin (26) consider Diagnosis through Treatment. Grunfeld and Earle (27) discuss Treatment through Survivorship, and Han and Rayson (28) examine End-of-Life Care.…”

Introduction: Understanding and Influencing Multilevel Factors Across the Cancer Care Continuum

“…This reductionist approach has led to improvements in specific technical aspects of care, such as new imaging or new diagnostic or treatment technology (3,11,12). However, these advances are slowly incorporated into care, and there is evidence for cancer care that the result may not be coordinated or supportive of patients (5,8,(13)(14)(15). The reductionist approach to improving care has brought many new advances, but the sum of these advances is less than the integrated care that is desired (16).…”

Interfaces Across the Cancer Continuum Offer Opportunities to Improve the Process of Care

“…Actions at the interfaces of care include appointment scheduling and communicating about test results, therapy, and/or the next step in care. The articles in section II summarize the challenges that arise at the interfaces of care during four major phases of the cancer care continuum-disease presentation to diagnosis, diagnosis through primary treatments, treatment through survivorship in curative settings or palliation in noncurative situations, and endof-life care (8,9,10,11). The articles in section III begin by exploring how the care environment affects the interfaces during cancer screening (12,13).…”

“…An overarching theme of this supplement is that progress along the cancer care continuum is affected by contextual factors, including provider characteristics, family structure, health-care organization composition, and national policy. Nekhlyudov and Latosinsky first raise the issue of environment when they point out the structure-process-outcome paradigm of Donabedian and apply it to the diagnosis to treatment phase of care (8). Anhang Price et al (12) return to this issue in section III where they link an ecological model of influences across the continuum through the description of predisposing, enabling, and reinforcing factors that influence the behavior of both providers and patients.…”