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Bergin RJ, O'Sullivan D, Dixon-Suen S, Emery JD, English DR, Milne RL, White VM. Time to Diagnosis and Treatment for Ovarian Cancer and Associations with Outcomes: A Systematic Review. J Womens Health (Larchmt) 2024; 33:1185-1197. [PMID: 38976232 DOI: 10.1089/jwh.2023.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background: Ovarian cancer is commonly diagnosed symptomatically at an advanced stage. Better survival for early disease suggests improving diagnostic pathways may increase survival. This study examines literature assessing diagnostic intervals and their association with clinical and psychological outcomes. Methods: Medline, EMBASE, and EmCare databases were searched for studies including quantitative measures of at least one interval, published between January 1, 2000 and August 9, 2022. Interval measures and associations (interval, outcomes, analytic strategy) were synthesized. Risk of bias of association studies was assessed using the Aarhus Checklist and ROBINS-E tool. Results: In total, 65 papers (20 association studies) were included and 26 unique intervals were identified. Interval estimates varied widely and were impacted by summary statistic used (mean or median) and group focused on. Of Aarhus-defined intervals, patient (symptom to presentation, n = 23; range [median]: 7-168 days) and diagnostic (presentation to diagnosis, n = 22; range [median]: 7-270 days) were most common. Nineteen association studies examined survival or stage outcomes with most, including five low risk-of-bias studies, finding no association. Conclusions: Studies reporting intervals for ovarian cancer diagnosis are limited by inconsistent definitions and reporting. Greater utilization of the Aarhus statement to define intervals and appropriate analytic methods is needed to strengthen findings from future studies.
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Affiliation(s)
- Rebecca J Bergin
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Department of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Deirdre O'Sullivan
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Suzanne Dixon-Suen
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- School of Exercise & Nutrition Sciences, Deakin University, Burwood, Australia
| | - Jon D Emery
- Department of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Victoria M White
- School of Psychology, Deakin University, Burwood, Australia
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
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Davis LE, Strumpf EC, Patel SV, Mahar AL. Income differences in time to colon cancer diagnosis. Cancer Med 2024; 13:e6999. [PMID: 39096087 PMCID: PMC11297540 DOI: 10.1002/cam4.6999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION People with low income have worse outcomes throughout the cancer care continuum; however, little is known about income and the diagnostic interval. We described diagnostic pathways by neighborhood income and investigated the association between income and the diagnostic interval. METHODS This was a retrospective cohort study of colon cancer patients diagnosed 2007-2019 in Ontario using routinely collected data. The diagnostic interval was defined as the number of days from the first colon cancer encounter to diagnosis. Asymptomatic pathways were defined as first encounter with a colonoscopy or guaiac fecal occult blood test not occurring in the emergency department and were examined separately from symptomatic pathways. Quantile regression was used to determine the association between neighborhood income quintile and the conditional 50th and 90th percentile diagnostic interval controlling for age, sex, rural residence, and year of diagnosis. RESULTS A total of 64,303 colon cancer patients were included. Patients residing in the lowest income neighborhoods were more likely to be diagnosed through symptomatic pathways and in the emergency department. Living in low-income neighborhoods was associated with longer 50th and 90th-percentile symptomatic diagnostic intervals compared to patients living in the highest income neighborhoods. For example, the 90th percentile diagnostic interval was 15 days (95% CI 6-23) longer in patients living in the lowest income neighborhoods compared to the highest. CONCLUSION These findings reveal income inequities during the diagnostic phase of colon cancer. Future work should determine pathways to reducing inequalities along the diagnostic interval and evaluate screening and diagnostic assessment programs from an equity perspective.
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Affiliation(s)
- Laura E. Davis
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealCanada
- ICESTorontoCanada
| | - Erin C. Strumpf
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealCanada
- Department of EconomicsMcGill UniversityMontrealCanada
| | | | - Alyson L. Mahar
- ICESTorontoCanada
- School of NursingQueen's UniversityKingstonCanada
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Quality Indicators for the Diagnosis and Management of Sudden Sensorineural Hearing Loss. Otol Neurotol 2021; 42:e991-e1000. [PMID: 34049327 DOI: 10.1097/mao.0000000000003205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sudden sensorineural hearing loss (SSNHL) is an ideal entity for quality indicator (QI) development, providing treatment challenges resulting in variable or substandard care. The American Academy of Otolaryngology-Head and Neck Surgery recently updated their SSNHL guidelines. With SSNHL demonstrating a large burden of illness, this study sought to leverage the updated guidelines and develop QIs that support quality improvement initiatives at an individual, institutional, and systems level. METHODS Candidate indicators (CIs) were extracted from high-quality SSNHL guidelines that were evaluated using the Appraisal of Guidelines for Research and Evaluation II tool. Each CI and its supporting evidence were summarized and reviewed by a nine-member expert panel based on validity, reliability, and feasibility of measurement. Final QIs were selected from CIs using the modified RAND Corporation-University of California, Los Angeles appropriateness methodology. RESULTS Fifteen CIs were identified after literature review. After the first round of evaluations, the panel agreed on 11 candidate indicators as appropriate QIs with 2 additional CIs suggested for consideration. An expert panel meeting provided a platform to discuss areas of disagreement before final evaluations. The expert panel subsequently agreed upon 11 final QIs as appropriate measures of high-quality care for SSNHL. CONCLUSION The 11 proposed QIs from this study are supported by evidence and expert consensus, facilitating measurement across a wide breadth of quality domains. With the recently updated SSNHL guidelines, and a greater focus on quality improvement opportunities, these QIs may be used by healthcare providers for targeted quality improvement initiatives.
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Vasilakis C, Forte P. Setting up a rapid diagnostic clinic for patients with vague symptoms of cancer: a mixed method process evaluation study. BMC Health Serv Res 2021; 21:357. [PMID: 33865373 PMCID: PMC8052708 DOI: 10.1186/s12913-021-06360-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background The study sought to evaluate the impact of a Rapid Diagnostic Clinic (RDC) service designed to improve general practitioner (GP) referral processes for patients who do not meet existing referral criteria yet present with vague - but potentially concerning - symptoms of cancer. We sought to investigate how well the RDC has performed in the views of local GPs and patients, and through analysis of its activity and performance in the first two years of operation. Methods The study setting was a single, hospital-based RDC clinic in a University Health Board in South Wales. We used a mixed-method process evaluation study, including routinely collected activity and diagnosis data. All GPs were invited to participate in an online survey (34/165 responded), and a smaller group (n = 8) were interviewed individually. Two focus groups with patients and their carers (n = 7) provided in-depth personal accounts of their experiences. Results The focus groups revealed high rates of patient satisfaction with the RDC. GPs were also overwhelmingly positive about the value of the RDC to their practice. There were 574 clinic attendances between July 2017 and March 2019; the mean age of attendees was 68, 57% were female, and approximately 30% had three or more vague symptoms. Of those attending, we estimated between 42 to 71 (7.3 and 12.3%) received preliminary cancer diagnoses. Median time from GP referral to RDC appointment was 12 days; from GP referral to cancer diagnosis was 34 days. Overall, 73% of RDC patients received either a new diagnosis (suspected cancer 23.2%, non-cancer 35.9%) or an onward referral to secondary care for further investigation with no new diagnosis (13.9%), and 27% were referred to primary care with no new diagnosis. Conclusions The RDC appears to enable a good patient experience in cancer diagnosis. Patients are seen in timely fashion, and the service is highly regarded by them, their carers, and referring GPs. Although too early to draw conclusions about long-term patient outcomes, there are strong indications to suggest that this model of service provision can set higher standards for a strongly patient-centred service. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06360-0.
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Affiliation(s)
- Christos Vasilakis
- Centre for Healthcare Innovation and Improvement (CHI2), School of Management, University of Bath, Bath, UK.
| | - Paul Forte
- Centre for Healthcare Innovation and Improvement (CHI2), School of Management, University of Bath, Bath, UK
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5
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Sung MR, Leighl NB. Improving lung cancer diagnosis: the evolving role of patients and care providers. J Thorac Dis 2019; 11:S422-S424. [PMID: 30997237 DOI: 10.21037/jtd.2018.11.68] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Mike R Sung
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Basta YL, Tytgat KMAJ, Greuter HH, Klinkenbijl JHG, Fockens P, Strikwerda J. Organizing and implementing a multidisciplinary fast track oncology clinic. Int J Qual Health Care 2018; 29:966-971. [PMID: 29177408 DOI: 10.1093/intqhc/mzx143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 10/22/2017] [Indexed: 11/15/2022] Open
Abstract
Quality problem Patients with gastrointestinal malignancies often need multiple appointments with different medical specialists, causing waiting times to accrue. Initial assessment In our hospital, care is organized in a sequential manner, causing long waiting times. To reduce this, a fast track outpatient clinic (FTC) was implemented. Choice of solution The FTC was organized within the hospital's existing structure. Patient centered care was achieved by ensuring that the medical specialists visit the patient, implementing nurse coordinators and considering patient wishes and co-morbidities when formulating a treatment plan. Implementation A mandate from the board (Top-down), ensured cooperation between different medical departments and a change in resource allocation (i.e. medical staff); a horizontal clinic across a vertical departmental structure. Brainstorm sessions between the departments led by two physicians who were going to work at the FTC (Bottom-up), assured a swift implementation of the FTC. Evaluation Since implementation in 2009, patient influx has tripled. Waiting time for an appointment and start of treatment was reduced from 2-4 weeks to 6 working days and from 12-14 weeks to 17 working days, respectively. This was achieved by re-allocating recourses, but without increasing existing resources. Lessons learned The combination of a top-down and bottom-up strategy ensured participation from all involved departments, a strong foundation and a shared vision on patient centered care. The FTC facilitates sharing information between different medical specialists through both proximity and a shared electronic patient record. The implementation of the FTC comprises a change in organization, but not a change in structure.
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Affiliation(s)
- Y L Basta
- Department of Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, the Netherlands.,Gastro Intestinal Oncology Center, Academic Medical Center, Amsterdam, the Netherlands
| | - K M A J Tytgat
- Department of Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, the Netherlands.,Gastro Intestinal Oncology Center, Academic Medical Center, Amsterdam, the Netherlands
| | - H H Greuter
- Department of Quality and Process innovation, Academic Medical Center, Amsterdam, the Netherlands
| | - J H G Klinkenbijl
- Gastro Intestinal Oncology Center, Academic Medical Center, Amsterdam, the Netherlands.,Department of Surgery, Gelre Ziekenhuizen, Apeldoorn, the Netherlands
| | - P Fockens
- Department of Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, the Netherlands.,Gastro Intestinal Oncology Center, Academic Medical Center, Amsterdam, the Netherlands
| | - J Strikwerda
- Amsterdam Business School - Faculty of Economics and Business, Amsterdam, the Netherlands
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Gagliardi A, Honein‐AbouHaidar G, Stuart‐McEwan T, Smylie J, Arnaout A, Seely J, Wright F, Dobrow M, Brouwers M, Bukhanov K, McCready D. How do the characteristics of breast cancer diagnostic assessment programmes influence service delivery: A mixed methods study. Eur J Cancer Care (Engl) 2018; 27:e12727. [PMID: 28639355 PMCID: PMC5900983 DOI: 10.1111/ecc.12727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 12/01/2022]
Abstract
Diagnostic assessment programmes (DAPs) coordinate multidisciplinary teamwork (MDT), and improve wait times and patient satisfaction. No research has established optimal DAP design. This study explored how DAP characteristics influence service delivery. A mixed methods case study of four breast cancer DAPs was conducted including qualitative interviews with health-care providers and retrospective chart review. Data were integrated using multiple approaches. Twenty-three providers were interviewed; 411 medical records were reviewed. The number of visits and wait times from referral to diagnosis and consultation were lowest at a one-stop model. DAP characteristics (rural-remote region, human resources, referral volume, organisation of services, adherence to service delivery targets and one-stop model) may influence service delivery (number of visits, wait times). MDT, influenced by other DAP characteristics (co-location of staff, patient navigators, team functioning), may also influence service delivery. While the one-stop model may be ideal, all sites experienced similar and unique challenges. Further research is needed to understand how to optimise the organisation and delivery of DAP services. Measures reflecting individual, team and patient-reported outcomes should be used to assess the effectiveness and impact of DAPs in addition to more traditional measures such as wait times.
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Affiliation(s)
| | | | | | | | | | | | - F.C. Wright
- Sunnybrook Health Sciences CentreTorontoCanada
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8
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Honein-AbouHaidar GN, Hoch JS, Dobrow MJ, Stuart-McEwan T, McCready DR, Gagliardi AR. Cost analysis of breast cancer diagnostic assessment programs. ACTA ACUST UNITED AC 2017; 24:e354-e360. [PMID: 29089805 DOI: 10.3747/co.24.3608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Diagnostic assessment programs (daps) appear to improve the diagnosis of cancer, but evidence of their cost-effectiveness is lacking. Given that no earlier study used secondary financial data to estimate the cost of diagnostic tests in the province of Ontario, we explored how to use secondary financial data to retrieve the cost of key diagnostic test services in daps, and we tested the reliability of that cost-retrieving method with hospital-reported costs in preparation for future cost-effectiveness studies. METHODS We powered our sample at an alpha of 0.05, a power of 80%, and a margin of error of ±5%, and randomly selected a sample of eligible patients referred to a dap for suspected breast cancer during 1 January-31 December 2012. Confirmatory diagnostic tests received by each patient were identified in medical records. Canadian Classification of Health Intervention procedure codes were used to search the secondary financial data Web portal at the Ontario Case Costing Initiative for an estimate of the direct, indirect, and total costs of each test. The hospital-reported cost of each test received was obtained from the host-hospital's finance department. Descriptive statistics were used to calculate the cost of individual or group confirmatory diagnostic tests, and the Wilcoxon signed-rank test or the paired t-test was used to compare the Ontario Case Costing Initiative and hospital-reported costs. RESULTS For the 191 identified patients with suspected breast cancer, the estimated total cost of $72,195.50 was not significantly different from the hospital-reported total cost of $72,035.52 (p = 0.24). Costs differed significantly when multiple tests to confirm the diagnosis were completed during one patient visit and when confirmatory tests reported in hospital data and in medical records were discrepant. The additional estimated cost for non-salaried physicians delivering diagnostic services was $28,387.50. CONCLUSIONS It was feasible to use secondary financial data to retrieve the cost of key diagnostic tests in a breast cancer dap and to compare the reliability of the costs obtained by that estimation method with hospital-reported costs. We identified the strengths and challenges of each approach. Lessons learned from this study have to be taken into consideration in future cost-effectiveness studies.
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Affiliation(s)
- G N Honein-AbouHaidar
- Toronto General Research Institute, University Health Network, Toronto, ON.,Hariri School of Nursing, American University of Beirut, Lebanon
| | - J S Hoch
- St. Michael's Hospital, Cancer Care Ontario, and Canadian Centre for Applied Research in Cancer Control, Toronto, ON.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - M J Dobrow
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - T Stuart-McEwan
- Gattuso Rapid Diagnostic Centre, University Health Network, Toronto, ON
| | - D R McCready
- Surgical Oncology, University Health Network, Toronto, ON
| | - A R Gagliardi
- Toronto General Research Institute, University Health Network, Toronto, ON
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9
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Singh M, Maheu C, Brady T, Farah R. Centres de diagnostic rapide du cancer et conséquences psychologiques : une analyse systématique. Can Oncol Nurs J 2017; 27:356-364. [PMID: 31148778 DOI: 10.5737/23688076274356364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Mina Singh
- Professeure agrégée, École des sciences infirmières, Faculté des sciences de la santé, Université York, Toronto (Ontario)
| | - Christine Maheu
- Professeure agrégée, École des sciences infirmières Ingram, Faculté de médecine, Université McGill, Montréal (Québec) H3A 2A7
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10
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Singh M, Maheu C, Brady T, Farah R. The psychological impact of the rapid diagnostic centres in cancer screening: A systematic review. Can Oncol Nurs J 2017; 27:348-355. [PMID: 31148761 DOI: 10.5737/23688076274348355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this review is to assess the state of the literature and identify implications for nursing practice and future research on the psychological impact of rapid diagnostic centres (RDC) for women related to breast cancer. A systematic literature review was conducted on the topic and six studies were identified for data extraction and analysis. There is evidence that RDCs decrease short-term anxiety in women undergoing further cancer tests after cancer screening, and who receive a benign diagnosis. There is limited available research on the impact of anxiety on women who receive a diagnosis of cancer in RDCs, but some evidence showed that this sub-group had higher depression in the long term. Nurses need to be aware of the different needs of women undergoing further cancer screening tests after a cancer diagnosis and receiving these results in the same day.
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Affiliation(s)
- Mina Singh
- Associate Professor, School of Nursing, Faculty of Health, York University, Toronto, ON
| | - Christine Maheu
- Associate Professor, Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC
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11
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Effect of specialized diagnostic assessment units on the time to diagnosis in screen-detected breast cancer patients. Br J Cancer 2015; 112:1744-50. [PMID: 25942395 PMCID: PMC4647239 DOI: 10.1038/bjc.2015.147] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/27/2015] [Accepted: 04/06/2015] [Indexed: 01/07/2023] Open
Abstract
Background: The duration of the cancer diagnostic process has considerable influence on patients' psychosocial well-being. Breast diagnostic assessment units (DAUs) in Ontario, Canada are designed to improve the quality and timeliness of care during a breast cancer diagnosis. We compared the diagnostic duration of patients diagnosed through a DAU vs usual care (UC). Methods: Retrospective population-based cohort study of 2499 screen-detected breast cancers (2011) using administrative health-care databases linked to the Ontario Cancer Registry. The diagnostic interval was measured from the initial screen to cancer diagnosis. Diagnostic assessment unit use was based on the biopsy and/or surgery hospital. We compared the length of the diagnostic interval between the DAU groups using multivariable quantile regression. Results: Diagnostic assessment units had a higher proportion of patients diagnosed within the 7-week target compared with UC (79.1% vs 70.2%, P<0.001). The median time to diagnosis at DAUs was 26 days, which was 9 days shorter compared with UC (95% CI: 6.4–11.6). This effect was reduced to 8.3 days after adjusting for all study covariates. Adjusted DAU differences were similar at the 75th and 90th percentiles of the diagnostic interval distribution. Conclusions: Diagnosis through an Ontario DAU was associated with a reduced time to diagnosis for screen-detected breast cancer patients, which likely reduces the anxiety and distress associated with waiting for a diagnosis.
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12
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Brocken P, van der Heijden EHFM, Oud KTM, Bootsma G, Groen HJM, Donders ART, Dekhuijzen PNR, Prins JB. Distress in suspected lung cancer patients following rapid and standard diagnostic programs: a prospective observational study. Psychooncology 2014; 24:433-41. [DOI: 10.1002/pon.3660] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 07/14/2014] [Accepted: 08/01/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Pepijn Brocken
- Dept. of Pulmonary Diseases; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | | | - Karen T. M. Oud
- Dept. of Pulmonary Diseases; Gelderse Vallei Medical Centre; Ede The Netherlands
| | - Gerben Bootsma
- Dept. of Pulmonary Diseases; Atrium Medical Centre; Heerlen The Netherlands
| | - Harry J. M. Groen
- Dept. of Pulmonary Diseases; University Medical Centre Groningen and University of Groningen; Groningen The Netherlands
| | - A. Rogier T. Donders
- Dept. of Epidemiology, Biostatistics and Health Technology Assessment; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - P. N. Richard Dekhuijzen
- Dept. of Pulmonary Diseases; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Judith B. Prins
- Dept. of Medical Psychology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
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13
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Faber MJ, Grande S, Wollersheim H, Hermens R, Elwyn G. Narrowing the gap between organisational demands and the quest for patient involvement: The case for coordinated care pathways. INTERNATIONAL JOURNAL OF CARE COORDINATION 2014. [DOI: 10.1177/2053435414540616] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
To improve healthcare, we currently observe two major developments. On the one hand, there is an increasing emphasis on including the patients’ perspective, for example in treatment decision making, during development of clinical guidelines and evaluation of care delivery services. On the other hand, healthcare providers are moving towards evidence-based care and standardising operating procedures, exemplified by the development of documented coordinated care pathways. These pathways typically focus on organisational and system requirements, which usually do not refer to patient involvement, nor indicate the need to be sensitive to differing patient needs. As a result, the structured process of developing and documenting care pathways seems to be at odds with the call to personalise care around the needs and preferences of the individual patient. The purpose of this paper is to illustrate the conspicuous mismatch and show promising opportunities to address it.
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Affiliation(s)
| | - Stuart Grande
- The Dartmouth Center for Health Care Delivery Science, USA
| | | | | | - Glyn Elwyn
- The Dartmouth Center for Health Care Delivery Science, USA
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14
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Astalos Chism L, Magnan MA, Helmer SR. The Environment of care model: a paradigm shift in comprehensive breast care. J Interprof Care 2014; 29:76-8. [PMID: 24865994 DOI: 10.3109/13561820.2014.922530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The delivery of comprehensive breast care seems to be undergoing a paradigm shift driven by advances in technology, interprofessional collaboration and patient dissatisfaction with interruptions in care. This paradigm shift includes the emergence of new models of care that optimize the use of embedded radiology services and encourage greater interprofessional collaboration. This paper briefly reviews the three drivers (advances in technology, expectations regarding interprofessional collaboration and patient dissatisfaction with interrupted care) underlying the paradigm shift in comprehensive breast care as well as introduces the environment of care model, which describes the proximity of radiology services and interprofessional collaboration between the Women's Wellness Clinic (WWC) and Radiology at the Karmanos Cancer Institute (KCI) - both based in the United States. In addition, this model is proposed as a way to facilitate improved patient satisfaction and early appropriate referral. Finally, plans for evaluating the effectiveness of this model are presented.
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Mersov A, Mersov G, Al-Ebraheem A, Cornacchi S, Gohla G, Lovrics P, Farquharson M. The differentiation of malignant and benign human breast tissue at surgical margins and biopsy using x-ray interaction data and Bayesian classification. Radiat Phys Chem Oxf Engl 1993 2014. [DOI: 10.1016/j.radphyschem.2012.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Gagliardi AR, Stuart-McEwan T, Gilbert J, Wright FC, Hoch J, Brouwers MC, Dobrow MJ, Waddell TK, McCready DR. How can diagnostic assessment programs be implemented to enhance inter-professional collaborative care for cancer? Implement Sci 2014; 9:4. [PMID: 24383742 PMCID: PMC3884012 DOI: 10.1186/1748-5908-9-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inter-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. METHODS A 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. DISCUSSION Findings 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.
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Affiliation(s)
- Anna R Gagliardi
- Toronto General Research Institute, University Health Network, Toronto, Canada.
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Abstract
The survival of patients with lung cancer remains low in most developed countries, which is largely attributable to the advanced stage of the disease when it presents. It seems obvious that if lung cancer could be found at an earlier stage, the prognosis of patients would be improved. The evidence from the medical literature on this point is conflicting; most studies suggest that delays in diagnosis are not prognostically important. When strategies are in place to expedite the investigation of individuals suspected of having lung cancer, the stage of disease typically shifts toward earlier-stage disease and resection rates increase.
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Affiliation(s)
- William K Evans
- Juravinski Cancer Centre, 699 Concession Street, Hamilton, Ontario L8V 5C2, Canada.
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Brocken P, Prins JB, Dekhuijzen PNR, van der Heijden HFM. The faster the better?—A systematic review on distress in the diagnostic phase of suspected cancer, and the influence of rapid diagnostic pathways. Psychooncology 2012; 21:1-10. [PMID: 22905349 DOI: 10.1002/pon.1929] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To perform a systematic review of articles published in the last 25 years on prevalence and course of distress and quality of life surrounding the diagnostic process of suspected cancer, and the influence of rapid diagnostic programs. METHODS Twenty-three articles were identified via Pubmed, PsycINFO, and reference lists of articles. Except for three randomized clinical trials and one case control study all studies were uncontrolled cohort studies. RESULTS Most studies involved patients with suspected breast cancer and therefore had a sex selection bias. Four studies on the effect of rapid outpatient diagnostic programs were found.Studies showed very high prevalence of anxiety, decreasing in case of a benign diagnosis but increasing or sustaining in patients waiting for results or after cancer diagnosis though not significantly more in rapid programs. Quality of life was low and showed varying patterns. CONCLUSIONS Distress in the diagnostic phase of cancer is a major problem and the rapid decrease of anxiety in patients eventually not diagnosed with cancer suggests a benefit of rapid diagnostic programs. The available evidence however is limited and shows some inconsistencies. Studies differ in subjects, objective and are limited by quality and quantity. Conflicting results prohibit a conclusion on patients ultimately diagnosed with cancer.
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Affiliation(s)
- Pepijn Brocken
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Ellis PM, Vandermeer R. Delays in the diagnosis of lung cancer. J Thorac Dis 2012; 3:183-8. [PMID: 22263086 DOI: 10.3978/j.issn.2072-1439.2011.01.01] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 01/05/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND Many patients with lung cancer report delays in diagnosing their disease. This may contribute to advanced stage at diagnosis and poor long term survival. This study explores the delays experienced by patients referred to a regional cancer centre with lung cancer. METHODS A prospective cohort of patients referred with newly diagnosed lung cancer were surveyed over a 3 month period to assess delays in diagnosis. Patients were asked when they first experienced symptoms, saw their doctor, what tests were done, when they saw a specialist and when they started treatment. Descriptive statistics were used to summarize the different time intervals. RESULTS 56 of 73 patients consented (RR 77%). However only 52 patients (30M, 22F) were interviewed as 2 died before being interviewed and two could not be contacted. The mean age was 68yrs. Stage distribution was as follows (IB/IIA 10%, stage IIIA 20%, IIIB/IV 70%). Patients waited a median of 21 days (iqr 7-51d) before seeing a doctor and a further 22d (iqr 0-38d) to complete any investigations. The median time from presentation to specialist referral was 27d (iqr 12-49d) and a further 23.5d (iqr 10-56d) to complete investigations. The median wait to start treatment once patients were seen at the cancer centre was 10d (iqr 2-28d). The overall time from development of first symptoms to starting treatment was 138d (iqr 79-175d). CONCLUSIONS Lung cancer patients experience substantial delays from development of symptoms to first initiating treatment. There is a need to promote awareness of lung cancer symptoms and develop and evaluate rapid assessment clinics for patients with suspected lung cancers.
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Ellis P. The importance of multidisciplinary team management of patients with non-small-cell lung cancer. Curr Oncol 2012; 19:S7-S15. [PMID: 22787414 PMCID: PMC3377758 DOI: 10.3747/co.19.1069] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Historically, a simple approach to the treatment of non-small-cell lung cancer (nsclc) was applicable to nearly all patients. Recently, a more complex treatment algorithm has emerged, driven by both pathologic and molecular phenotype. This increasing complexity underscores the importance of a multidisciplinary team approach to the diagnosis, treatment, and supportive care of patients with nsclc. A team approach to management is important at all points: from diagnosis, through treatment, to end-of-life care. It also needs to be patient-centred and must involve the patient in decision-making concerning treatment. Multidisciplinary case conferencing is becoming an integral part of care. Early integration of palliative care into the team approach appears to contribute significantly to quality of life and potentially extends overall survival for these patients. Supportive approaches, including psychosocial and nutrition support, should be routinely incorporated into the team approach. Challenges to the implementation of multidisciplinary care require institutional commitment and support.
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Affiliation(s)
- P.M. Ellis
- Correspondence to: Peter M. Ellis, Juravinski Cancer Centre, 699 Concession Street, Hamilton, Ontario L8V 5C2. E-mail:
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21
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Brouwers M, Oliver TK, Crawford J, Ellison P, Evans WK, Gagliardi A, Lacourciere J, Lo D, Mai V, McNair S, Minuk T, Rabeneck L, Rand C, Ross J, Smylie J, Srigley J, Stern H, Trudeau M. Cancer diagnostic assessment programs: standards for the organization of care in Ontario. ACTA ACUST UNITED AC 2011; 16:29-41. [PMID: 20016744 PMCID: PMC2794680 DOI: 10.3747/co.v16i6.400] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Improving access to better, more efficient, and rapid cancer diagnosis is a necessary component of a high-quality cancer system. How diagnostic services ought to be organized, structured, and evaluated is less understood and studied. Our objective was to address this gap. Methods As 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, health service researchers, and methodologists, conducted a systematic review and a targeted environmental scan of the unpublished literature. Standards were developed based on expert consensus opinion informed by the identified evidence. Through external review, clinicians and administrators across Ontario were given the opportunity to provide feedback. Results The body of evidence consists of thirty-five published studies and fifteen unpublished guidance documents. The evidence and consensus opinion consistently favoured an organized, centralized system with multidisciplinary team membership as the optimal approach for the delivery of diagnostic cancer assessment services. Independent external stakeholders agreed (with higher mean values, maximum 5, indicating stronger agreement) that dap standards are needed (mean: 4.6), that standards should be formally approved (mean: 4.3), and importantly, that standards reflect an effective approach that will lead to quality improvements in the cancer system (mean: 4.5) and in patient care (mean: 4.3). Interpretation Based on the best available evidence, standards for the organization of daps are offered. There is clear need to integrate formal and comprehensive evaluation strategies with the implementation of the standards to advance this field.
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Affiliation(s)
- M Brouwers
- Program in Evidence-Based Care, Hamilton, ON.
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Gilbert JE, Green E, Lankshear S, Hughes E, Burkoski V, Sawka C. Nurses as patient navigators in cancer diagnosis: review, consultation and model design. Eur J Cancer Care (Engl) 2010; 20:228-36. [PMID: 20955374 DOI: 10.1111/j.1365-2354.2010.01231.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The diagnostic phase of cancer care is an anxious time for patients. Patient navigation is a way of assisting and supporting individuals during this time. The aim of this review is to explore patient navigation and its role in the diagnostic phase of cancer care. We reviewed the literature for definitions and models of navigation, preparation for the role and impact on patient outcomes, specifically addressing the role of the nurse in patient navigation. Interviews and focus groups with healthcare providers and managers provided further insight from these stakeholder groups. Common to most definitions of navigation is the navigator's multifaceted role in facilitating processes of care, assisting patients to overcome barriers and providing information and support. Navigation may be provided by laypersons, clerical staff and/or healthcare professionals. In the diagnostic phase it has the potential to affect efficiency of diagnostic testing, patients' experience during this time and preparation for decision-making around treatment options. Patient care during the diagnostic phase requires various levels of navigation, according to individual informational, physical and psychosocial needs. Identifying those individuals who require more support--whether physical or psychosocial--during the diagnostic phase is of critical importance.
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Affiliation(s)
- J E Gilbert
- Policy Research and Analysis, Division of Planning and Regional Programs, Cancer Care Ontario, 620 University Avenue, Toronto, Ontario, Canada.
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23
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Nothacker M, Langer T, Weinbrenner S. [Diagnostic imaging in oncology--evidence reviews for evidence based guidelines by the Agency of Quality for Medicine (ÄZQ)]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2010; 104:554-562. [PMID: 21095608 DOI: 10.1016/j.zefq.2010.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 08/02/2010] [Accepted: 08/17/2010] [Indexed: 05/30/2023]
Abstract
Within the context of the development of evidence-based oncology guidelines, the Agency for Quality in Medicine undertook evidence reviews for diagnostic imaging procedures. Systematic searches retrieved no randomised controlled trials, but only cohort studies and case series of mostly moderate quality. The identified studies provided only a restricted basis for the guideline recommendations as their validity was limited and only outcomes of diagnostic accuracy were examined. However, decision criteria for recommending diagnostic strategies significantly comprise judgements about required resources and availability of diagnostic imaging procedures. These criteria as well as patient out-comes were mostly implicit and should be explicated in future. In order to increase the relevance of evidence reviews for oncological diagnosis, high quality studies which examine resources and patient-centred outcomes for diagnostic strategies are required.
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Nekhlyudov L, Latosinsky S. The interface of primary and oncology specialty care: from symptoms to diagnosis. J Natl Cancer Inst Monogr 2010; 2010:11-7. [PMID: 20386049 DOI: 10.1093/jncimonographs/lgq001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Symptomatic individuals presenting to their primary care providers may need further evaluation and/or testing to determine whether a cancer is present. A number of issues arise in determining who needs further testing, what tests are needed, which specialists need to be involved, and how the testing can be organized and supported within a specific health-care system within a timely, coordinated, and cost-efficient manner. This article explores the challenges in the interface of primary care providers and specialists, includes evidence from prior research, and proposes research opportunities to understand and improve this phase of care.
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Affiliation(s)
- Larissa Nekhlyudov
- Department of Population Medicine, Harvard Medical School, 133 Brookline Ave, 6th Floor, Boston, MA 02215, USA.
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25
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Gagliardi AR, Wright FC, Davis D, McLeod RS, Urbach DR. Challenges in multidisciplinary cancer care among general surgeons in Canada. BMC Med Inform Decis Mak 2008; 8:59. [PMID: 19102761 PMCID: PMC2631026 DOI: 10.1186/1472-6947-8-59] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 12/22/2008] [Indexed: 12/04/2022] Open
Abstract
Background While many factors can influence the way that cancer care is delivered, including the way that evidence is packaged and disseminated, little research has evaluated how health care professionals who manage cancer patients seek and use this information to identify whether and how this could be supported. Through interviews we identified that general surgeons experience challenges in coordinating care for complex cancer patients whose management is not easily addressed by guidelines, and conducted a population-based survey of general surgeon information needs and information seeking practices to extend these findings. Methods General surgeons with privileges at acute care hospitals in Ontario, Canada were mailed a questionnaire to solicit information needs (task, importance), information seeking (source, frequency of and reasons for use), key challenges and suggested solutions. Non-responders received up to three reminder packages. Significant differences among sub-groups (age, setting) were examined statistically (Kruskal Wallis, Mann Whitney, Chi Square). Standard qualitative methods were used to thematically analyze open-ended responses. Results The response rate was 44.2% (170/385) representing all 14 health regions. System resource constraints (60.4%), comorbidities (56.4%) and physiologic factors (51.8%) were top-ranked issues creating information needs. Local surgical colleagues (84.6%), other local colleagues (82.2%) and the Internet (81.1%) were top-ranked sources of information, primarily due to familiarity and speed of access. No resources were considered to be highly applicable to patient care. Challenges were related to limitations in diagnostics and staging, operative resources, and systems to support multidisciplinary care, together accounting for 76.0% of all reported issues. Findings did not differ significantly by surgeon age or setting of care. Conclusion General surgeons appear to use a wide range of information resources but they may not address the complex needs of many cancer patients. Decision-making is challenged by informational and logistical issues related to the coordination of multidisciplinary care. This suggests that limitations in system capacity may, in part, contribute to variable guideline compliance. Further research is required to evaluate the appropriateness of information seeking, and both concurrent and consecutive mechanisms by which to achieve multidisciplinary care.
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Miller D, Frost A, Hall A, Barton C, Bhoora I, Kathuria V. A 'one-stop clinic' for the diagnosis and management of rotator cuff pathology: Getting the right diagnosis first time. Int J Clin Pract 2008; 62:750-3. [PMID: 18412933 DOI: 10.1111/j.1742-1241.2007.01682.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND We have introduced a one-stop clinic for the diagnosis and management of rotator cuff tears (RCTs). The aim of the study was to determine the effect of the one-stop clinic on the interval and delay in management for patients with suspected rotator cuff pathology. PATIENTS AND METHODS Seventy-four patients were reviewed retrospectively; 39 had an ultrasound of the shoulder before (group 1), and 35 patients after (group 2) the new protocol was introduced. Patients in group 2 had a shoulder ultrasound scan (USS) on the day of their clinic appointment or beforehand based upon the General Practitioners (GP) letter. Indications included patients over the age of 30, or patients with a history of trauma or a painful shoulder. RESULTS Twenty-four patients were diagnosed with RCTs on USS with an overall sensitivity of 93.75%, specificity 100% and accuracy of 91% for full thickness tears. Clinical detection alone had an overall sensitivity of 80%, a specificity of 91% and accuracy of 87%. Mean time from GP referral to definitive management plan was 6.49 months (SD 2.74) in group 1, compared with 4.63 months (SD 1.43) in group 2 with an overall reduction in half the number of clinic appointments. This was statistically significant (p < 0.001). CONCLUSIONS Ultrasound scan of the shoulder is an accurate and reliable method of detecting full thickness RCTs. The one-stop clinic significantly shortened the interval between GP referral and definitive management.
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Affiliation(s)
- D Miller
- Department of Trauma and Orthopaedic Surgery, Mid Staffordshire Hospitals, Stafford, UK
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Ouwens MMMTJ, Marres HAM, Hermens RRP, Hulscher MME, van den Hoogen FJA, Grol RP, Wollersheim HCH. Quality of integrated care for patients with head and neck cancer: Development and measurement of clinical indicators. Head Neck 2007; 29:378-86. [PMID: 17123308 DOI: 10.1002/hed.20532] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To improve the quality of integrated care, we developed indicators for assessing current practice in a large reference center for head and neck oncology. METHODS We defined a set of indicators based on integrated care literature, national evidence-based guidelines for patients with head and neck cancer, and the opinions of professionals and patients. We tested this set regarding assessment of current practice and clinimetric characteristics. RESULTS The final set consisted of 8 integrated care indicators and 23 specific indicators for patients with head and neck cancer. Current practice assessment produced high scores for the integrated care indicators, but the specific indicators showed room for improvement. The practice test showed that 9 indicators had good applicability. CONCLUSIONS The indicators, while based on evidence-based guidelines and the principles of integrated care, should incorporate patients' opinions and include a practice test. Our results show that the quality of integrated care for patients with head and neck cancer could be improved.
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Affiliation(s)
- Mariëlle M M T J Ouwens
- Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Toomey DP, Cahill RA, Birido N, Jeffers M, Loftus B, McInerney D, Rothwell J, Geraghty JG. Rapid assessment breast clinics – Evolution through audit. Eur J Cancer 2006; 42:2961-7. [PMID: 16956758 DOI: 10.1016/j.ejca.2006.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 06/15/2006] [Accepted: 06/29/2006] [Indexed: 10/24/2022]
Abstract
This observational, cohort study aimed to examine the potential utility of Rapid Assessment Breast Clinics (RABC) beyond cancer detection at presentation. One thousand four hundred and twenty nine women were studied over an 18 month period. 154 (10.7%) had breast cancer - 87.7% of whom were seen expediently with 92.9% being diagnosed at one attendance. One hundred and forty three (10%) of those with a benign diagnosis were found by routine questioning to have significant familial risk separate to their reason for referral. Despite careful triage, considerable contamination of appointment allotment occurred with many who were correctly triaged as non-urgent being seen 'urgently'. One hundred and seventy six attendees (12.3%) had neither the symptom that triggered referral, nor breast lump, nipple discharge nor family history of breast cancer, while 283 (19.8%) had no objective clinical or radiological abnormality. Although RABC reliably categorise malignant versus non-malignant diagnoses despite cluttering by low risk women, a significant proportion of non-cancer patients still require address of future risk rather than reassurance of their present status alone.
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Affiliation(s)
- D P Toomey
- Department of Surgery, Tallaght Breast Unit, Adelaide and Meath Hospitals incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland
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