Cancer Diagnostic Assessment Programs: Standards for the Organization of Care in Ontario

Abstract

BackgroundImproving access to better, more efficient, and rapid cancer diagnosis is a necessary component of a highquality cancer system. How diagnostic services ought to be organized, structured, and evaluated is less understood and studied. Our objective was to address this gap. MethodsAs 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health service researchers, and methodologists, conducted a systematic review and a targeted environmental scan of the unpublished literature.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. ResultsThe body of evidence consists of thirty-five published studies and fifteen unpublished guidance documents.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

How can diagnostic assessment programs be implemented to enhance inter-professional collaborative care for cancer?

“…A case study approach was chosen to explore multiple factors that influence ICC including DAP structure, processes and outcomes [ 31 ]. These will be assessed according to DAP standards and guideline recommendations for staging and diagnosis of breast [ 32 - 34 ] and lung cancer [ 27 , 28 ]. This will enable comparison between ‘cases’ (DAPs) that vary by type of cancer, academic status, and geographic region.…”

“…This generated core components and enablers of ICC that were common across the models. Organizational standards for DAPs that are described in Table 1 [ 27 , 28 ] were mapped onto this preliminary framework. The conceptual framework was expanded by adding challenges [ 10 - 26 ] and beneficial outcomes [ 9 - 21 ] identified in our background review of the literature.…”

“…Clinicians and managers suggested the need to improve ICC earlier in the cancer trajectory given barriers of access to, and coordination of diagnosis and staging, and recommended centralized diagnostic facilities [ 14 - 19 ]. An expert panel assembled by the provincial cancer agency issued organizational standards for Diagnostic Assessment Programs (DAPs) to coordinate diagnostic tests and integrate multidisciplinary expertise [ 27 , 28 ]. A summary of recommended DAP features appears in Table 1 .…”

Using Lean to Improve Wait Time Performance in Diagnostic Assessment for Lung Cancer

“…The provision of accurate and rapid cancer diagnosis is a necessary component of a high-quality cancer system (Brouwers et al 2009). Prolonged time intervals between symptom onset and treatment initiation increase the risk of poor clinical outcomes and worse patient experience of care (Koo et al 2015).…”

Regional Process Redesign of Lung Cancer Care: A Learning Health System Pilot Project

“…The challenge is to build the operational systems that deliver such care in a timely manner. Lung cancer presents a series of clinical management and institutional challenges for both operational and therapeutic delivery of care 5,6 . Such challenges include the requirement for a series of diagnostic and staging tests to be performed and collectively interpreted and the patient triaged, in a timely fashion, to the most appropriate initial providers, such as surgical oncology, medical oncology, radiation oncology, and palliative services.…”