How do the characteristics of breast cancer diagnostic assessment programmes influence service delivery: A mixed methods study

Gagliardi, Anna R.; Honein-AbouHaidar, Gladys; Stuart-McEwan, Terri; Smylie, Jennifer; Arnaout, Angel; Seely, Jean M.; Wright, Frances C.; Dobrow, Mark; Brouwers, Melissa; Bukhanov, Karina; McCready, David R.

doi:10.1111/ecc.12727

Cited by 5 publications

(3 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Efforts are also needed to ensure consistency in language across differing specialties. In other research, we found that multidisciplinary teamwork was enhanced when coordinated through integrated programs, staff were co‐located, patient navigators mediated patient transitions between clinicians, and other activities such as team meetings supported clinician efficiency . Future research could investigate whether these or other strategies could harmonize DCIS language.…”

Section: Discussionmentioning

confidence: 81%

Recommendations to improve patient‐centred care for ductal carcinoma in situ: Qualitative focus groups with women

Nyhof

Wright

Hong

et al. 2019

Health Expectations

Self Cite

View full text Add to dashboard Cite

Background Patient‐centred care (PCC) improves health‐care experiences and outcomes. Women with ductal carcinoma in situ (DCIS) and clinicians have reported communication difficulties. Little prior research has studied how to improve communication and PCC for DCIS. Objective This study explored how to achieve PCC for DCIS. Design Canadian women treated for DCIS from five provinces participated in semi‐structured focus groups based on a 6‐domain cancer‐specific PCC framework to discuss communication about DCIS. Data were analysed using constant comparative technique. Setting and Participants Thirty‐five women aged 30 to 86 participated in five focus groups at five hospitals. Results Women said their clinicians used multiple approaches for fostering a healing relationship; however, most described an absence of desired information or behaviour to exchange information, respond to emotions, manage uncertainty, make decisions and enable self‐management. Most women were confused by terminology, offered little information about the risks of progression/recurrence, uninformed about treatment benefits and risks, frustrated with lack of engagement in decision making, given little information about follow‐up plans or self‐care advice, and received no acknowledgement or offer of emotional support. Discussion and Conclusions By comparing the accounts of women with DCIS to a PCC framework, we identified limitations and inconsistencies in women's lived experience of communication about DCIS, and approaches by which clinicians can more consistently achieve PCC for DCIS. Future research should develop and evaluate informational tools to support PCC for DCIS.

show abstract

Section: Discussionmentioning

confidence: 81%

Recommendations to improve patient‐centred care for ductal carcinoma in situ: Qualitative focus groups with women

Nyhof

Wright

Hong

et al. 2019

Health Expectations

Self Cite

View full text Add to dashboard Cite

show abstract

“…Surgery is not integrated into most provincial cancer bodies and there are no explicit roles to oversee the systematic evaluation and regulation of cancer surgery in most provinces. As a result, there is clear variation in breast cancer outcomes across the country [ 1 , 2 , 3 , 4 , 5 ]. Recently, the Canadian Partnership Against Cancer (CPAC) published pan-Canadian evidence-based surgical standards for the care of the breast cancer patient [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of the Canadian National Standards in Breast Cancer Surgical Care: Gaps, Barriers, Enablers and Opportunities

et al. 2021

View full text Add to dashboard Cite

Background: Diagnosis and surgical treatment decision making for breast cancers has become increasingly complex. Recently, Canadian Partnership Against Cancer (CPAC) published pan-Canadian evidence-based surgical standards for the care of breast cancer patients. This study was undertaken to assess the degree to which these standards were currently met in practice and to further understand the determinants of their implementation nationally. Methods: This study was undertaken in two parts—(1) National survey of breast cancer surgeons to assess the perceived extent of implementation of these standards in their institution and province; (2) Formation of a focus group with a representative sample of breast surgeons across Canada to further understand the barriers and facilitators towards future breast standards implementation. Results: 35 surgeons participated in the survey: 66% were from community hospitals. There were four categories of standards that were the most significantly lacking across the country—(a) processes related to quality assurance, (b) turnaround time for pathology results (c) psychosocial and health-related support for the breast cancer patient and (d) breast reconstruction for patients undergoing mastectomy. The focus group included participants from all ten Canadian provinces. For each standard, the 134 determinants fell into three main categories—individual physician (n = 27, 20%); organizational (n = 46, 34%), and system (n = 61, 46%). While specific determinants were present for each category, surgical standards were more likely to be implemented in practice if (1) they aligned with organizational priorities standards; (2) the individual physicians or physician groups were accountable to the organization and/or cancer jurisdiction regarding compliance with the standard; and (3) if infrastructure or resources existed within the organization or system for the reliable collection of relevant, meaningful, practice changing data combined with the capability of benchmarking, peer–peer comparisons and timely feedback to the surgeons. Conclusion: The results of this study demonstrated variation, barriers and opportunities for the national implementation of CPAC’s breast cancer surgery standards and identified determinants of high-quality breast surgical care delivery.

show abstract

“…The present study is part of a larger study exploring whether and how dap characteristics influence diagnostic service delivery measures such as wait time from referral to confirmed diagnosis and number of visits 13 . We are equally interested in exploring whether daps are cost-effective.…”

Section: Introductionmentioning

confidence: 99%

Cost Analysis of Breast Cancer Diagnostic Assessment Programs

et al. 2017

Self Cite

View full text Add to dashboard Cite

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. ResultsFor 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. ConclusionsIt 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.

show abstract

How do the characteristics of breast cancer diagnostic assessment programmes influence service delivery: A mixed methods study

Cited by 5 publications

References 32 publications

Recommendations to improve patient‐centred care for ductal carcinoma in situ: Qualitative focus groups with women

Recommendations to improve patient‐centred care for ductal carcinoma in situ: Qualitative focus groups with women

Implementation of the Canadian National Standards in Breast Cancer Surgical Care: Gaps, Barriers, Enablers and Opportunities

Cost Analysis of Breast Cancer Diagnostic Assessment Programs

Contact Info

Product

Resources

About