The 2-week rule for patients with suspected breast cancer: what can be learnt by analysing policy documents?

Cornford, Charles S.; Oswald, Nigel

doi:10.1016/j.healthpol.2003.07.002

Cited by 3 publications

(4 citation statements)

References 7 publications

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“…Other reports from colon cancer centers suggested a standard period of maximally two weeks from diagnostic suspicion to specialist consultation [15,16], since any delay in diagnosis may impact the patient's well-being, mainly at the psychological level [17,18]. The reduction in the waiting time is assumed to entail a reduction in the possible psychosocial impact on the patient caused by a period of intense anxiety and a sensation of vulnerability intervening between suspicion of cancer, definitive diagnosis and the start of treatment, a relationship supported by a number of studies [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Effects of Implementation of a National Fast Track Clinical Pathway for Hepatocellular Carcinoma in Western Denmark

Villadsen

Simonsen

Ott

et al. 2019

JGLD

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Background & Aims: In 2009, the Danish Government instituted “Fast Track Clinical Pathways” (FTCP) to accelerate diagnosis and treatment of cancers including hepatocellular carcinoma (HCC). We examined how the implementation of FTCP affected the time from referral to diagnosis and treatment as well as the patient survival.Methods: 309 consecutive patients with suspected HCC were included, 79 referred during the period 2007- 2008 (before FTCP) and 230 during 2009-2011. Of those, 271 (88%) were diagnosed with HCC and 161 (60%) had cirrhosis, in most cases caused by alcohol.Results: The time from referral to the first visit was reduced from a mean 16.4 (11.5) to 5.4 (6) days (p<0.001) and the time from the first visit to the Multidisciplinary Tumour Conference (MDT) treatment decision from 34.9 (27.9) to 16.1 (14.4) days (p<0.001). The total time from referral to treatment was reduced from 53.2 (37.9) to 35.9 (23.1) days (p<0.001). There was a weak trend of improved survival after FTCP: 231 (147-368)vs. 293 (227-396) days (p=0.11).Conclusions: The implementation of FTCP reduced the total time from referral to treatment by three weeks; however, without significant effects on overall mortality. While shortened waiting time is a comfort for the patient, it remains to be elucidated whether it will change the prognosis.

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Section: Discussionmentioning

confidence: 99%

Effects of Implementation of a National Fast Track Clinical Pathway for Hepatocellular Carcinoma in Western Denmark

Villadsen

Simonsen

Ott

et al. 2019

JGLD

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“…There is evidence in other cancers that suggests high levels of anxiety and distress for those suspected of cancers. 5,6,7 Thus, in terms of patient experience, as the majority referred don't have cancer, the sooner they can be reassured the better. This current study is novel in oral cancer referrals and provides evidence regarding the referral characteristics and levels of worry and concern.…”

Section: Table 3 How Many Times a Patient Spoke With The Gp/dentist B...mentioning

confidence: 99%

“…Communications have been highlighted as an issue in suspected breast cancer and colorectal cancer. 6,7 The UK NICE referral guidelines emphasise that the patient should be involved in the decision-making process and be informed of the reasons for referral. 10…”

Section: Table 3 How Many Times a Patient Spoke With The Gp/dentist B...mentioning

confidence: 99%

“…5 Cornford and co-workers reported that patients experienced significant distress while waiting to be seen within the 'twoweek rule' for suspected breast carcinoma. 6 For those referred on the two-week rule for suspected colorectal cancer, participants reported anxiety, fear and vulnerability. 7 As part of this pathway, general practitioners are advised to inform their patients that they are being referred on the 2WW.…”

Section: Introductionmentioning

confidence: 99%

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Patient worry and concern associated with referral on the two-week suspected head and neck pathway

et al. 2022

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Demand management for planned care: a realist synthesis

Pawson

Greenhalgh

Brennan

2016

Health Serv Deliv Res

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BackgroundThe task of matching fluctuating demand with available capacity is one of the basic challenges in all large-scale service industries. It is a particularly pressing concern in modern health-care systems, as increasing demand (ageing populations, availability of new treatments, increased patient knowledge, etc.) meets stagnating supply (capacity and funding restrictions on staff and services, etc.). As a consequence, a very large portfolio of demand management strategies has developed based on quite different assumptions about the source of the problem and about the means of its resolution.MethodsThis report presents a substantial review of the effectiveness of main strategies designed to alleviate demand pressures in the area of planned care. The study commences with an overview of the key ideas about the genesis of demand and capacity problems for health services. Many different diagnoses were uncovered: fluctuating demand meeting stationary capacity; turf protection between different providers; social rather than clinical pressures on referral decisions; self-propelling diagnostic cascades; supplier-induced demand; demographic pressures on treatment; and the informed patient and demand inflation. We then conducted a review of the key ideas (programme theories) underlying interventions designed to address demand imbalance. We discovered that there was no close alignment between purported problems and advocated solutions. Demand management interventions take their starting point in seeking reforms at the levels of strategic decision-making, organisational re-engineering, procedural modifications and behavioural change. In mapping the ideas for reform, we also noted a tendency for programme theories to become ‘whole-system’ models; over time policy-makers have advocated the need for concerted action on all of these fronts.FindingsThe remainder and core of the report contains a realist synthesis of the empirical evidence on the effectiveness on a spanning subset of four major demand management interventions: referral management centres (RMCs); using general practitioners with special interests (GPwSIs) at the interface between primary and secondary care; general practitioner (GP) direct access to clinical tests; and referral guidelines. In all cases we encountered a chequered pattern of success and failure. The primary literature is replete with accounts of unanticipated problems and unintended effects. These programmes ‘work’ only in highly circumscribed conditions. To give brief examples, we found that the success of RMCs depends crucially on the balance of control in their governance structures; GPwSIs influence demand only after close negotiations on an agreed and intermediate case mix; significant efficiencies are created by direct GP access to tests mainly when there is low diagnostic yield and high ‘rule-out’ rates; and referral guidelines are more likely to work when implemented by staff with responsibility for their creation.ConclusionsThe report concludes that there is no ‘preferred intervention’ that has the capacity to outperform all others. Instead, the review found many, diverse, hard-won, local and adaptive solutions. Whatever the starting point, success in demand management depends on synchronising a complex array of strategic, organisational, procedural and motivational changes. The final chapter offers practitioners some guidance on how they might ‘think through’ all of the interdependencies, which bring demand and capacity into equilibrium. A close analysis of the implementation of different configurations of demand management interventions in different local contexts using mixed methods would be valuable to understand the processes through which such interventions are tailored to local circumstances. There is also scope for further evidence synthesis. The substitution theory is ubiquitous in health and social care and a realist synthesis to compare the fortunes of different practitioners placed at different professional boundaries (e.g. nurses/doctors, dentists/dental care practitioners, radiologists/radiographers and so on) would be valuable to identify the contexts and mechanisms through which substitution, support or short-circuit occurs.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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The 2-week rule for patients with suspected breast cancer: what can be learnt by analysing policy documents?

Cited by 3 publications

References 7 publications

Effects of Implementation of a National Fast Track Clinical Pathway for Hepatocellular Carcinoma in Western Denmark

Effects of Implementation of a National Fast Track Clinical Pathway for Hepatocellular Carcinoma in Western Denmark

Patient worry and concern associated with referral on the two-week suspected head and neck pathway

Demand management for planned care: a realist synthesis

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