scholarly journals Speedy, predictable and secure cancer care? Introducing cancer patient pathways in Norway

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
L Melby ◽  
E Håland
Keyword(s):  
Cancer Patient ◽  
Cancer Care ◽  
Waiting Times ◽  
Hospital Staff ◽  
Cancer Diagnostics ◽  
Cross Sectional ◽  
Clerical Workers ◽  
Time Limits ◽  
Assessment Period ◽  
Patient Pathways

Abstract Norway introduced cancer patient pathways (CPPs) in 2015. CPPs are standardised patient pathways, based on current guidelines for cancer diagnostics and treatment. The aim is to speed up patient assessments and start of treatment and minimise waiting times, in order to make the assessment period as predictable as possible. Each CPP are divided into phases, and each phase should be completed within a defined time period. The aim of this paper is to describe and discuss how healthcare professionals work to realise the objectives of the CPPs and how they reflect upon them as tools for achieving predictable and secure cancer care. The paper departs from an ongoing study (2017-2020) investigating the introduction of CPPs in Norway. The study has a qualitative cross-sectional design and focuses on four CPPs: breast-, prostate, and lung cancer, and malign melanoma. Data are mainly collected through interviews. The study setting is four hospitals, and study participants are hospital staff, including physicians, nurses, clerical workers and managers (N = 60). Preliminary results show that keeping the waiting times has become a major concern, and national statistics are published showing if the hospitals keep the defined time limits. From the perspective of healthcare workers, CPPs may contribute to a predictable assessment period for patients, and thereby creating a more secure experience. However, predictability and security rest on patients being informed about receiving care organised through a CPP. We found that in many instances this was not the case. Our study indicates that most effort in hospitals is directed towards reducing waiting times, and we argue that publishing of statistics may be an incentive for hospitals to reorganise their resources and prioritize cancer patients before other (elective) patients. Further development of the CPPs should encourage informing and supporting patients so they can have the most predictable and secure experience as possible. Key messages Patient pathways is an incentive to reorganise resources to reach defined time limits in cancer diagnostics. Short waiting times are positive for patients, even if survival rate is not necessarily affected.

scholarly journals Keeping up with the codes; accounting for quality in cancer patient pathways (CPPs) in Norway

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
E Håland ◽  
L Melby
Keyword(s):  
Cancer Patient ◽  
Patient Experience ◽  
Health Personnel ◽  
Waiting Times ◽  
Administrative Staff ◽  
Measuring Time ◽  
Clerical Workers ◽  
Patient Pathways ◽  
Coding Manual ◽  
Standardised Patient

Abstract Background Standardised cancer patient pathways (CPPs) were introduced in Norway in 2015. CPPs are national standardised patient pathways which are discipline- and target-based (28 cancer diagnoses), aiming to minimize waiting times and make cancer care more predictable and secure for patients. One important part of the CPPs are different codes aimed at measuring time in the different phases of the pathway. These codes are reported to the Norwegian directorate for health and are made public on a national web site. On the basis of these reports hospitals across the country can be compared regarding compliance to timescales. From a political and bureaucratic level, the codes are seen as signs of quality, and hence very important. Methods In this paper, we present preliminary results from a project which is evaluating the introduction of CPPs. Based on interviews with administrative staff responsible for coding and with other health personnel (physicians, nurses, clerical workers and managers) in different hospitals, we present experiences with and perceptions of coding practices. Results We find that even though the coding manual is presented as a universal tool implying standardised coding practices, there is a multitude of coding practices (which makes comparison between hospitals challenging). The coding represents a massive bureaucratic workload for the dedicated staff, raising concerns if their time is spent on the most important issues. Conclusions The codes are seen as timescales set according to logistics and not according to what is medically safe - and some of the health personnel argue that these timescales have nothing to do with quality. However, they still recognize that keeping the timescales might be important for the patient experience. Key messages Standardised coding are often not standardised, but contains a multitude of practices. These practices need to be explored in order to understand if and how codes can be seen as signs of quality.

scholarly journals When time matters: a qualitative study on hospital staff’s strategies for meeting the target times in cancer patient pathways

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Line Melby ◽  
Erna Håland
Keyword(s):  
Cancer Patient ◽  
Hospital Staff ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Next Of Kin ◽  
Cross Sectional ◽  
Treatment Pathways ◽  
Frontline Workers ◽  
Patient Pathways ◽  
Future Care

Abstract Background Cancer patient pathways (CPPs) were introduced in Norway in 2015. CPPs are time-bound standardised care pathways that describe the organisation of and responsibilities for diagnostics and treatment, as well as communication with the patient and next of kin. The aim is to ensure that cancer patients experience a well-organised, coherent and predictable pathway without any delays in assessment and diagnostics caused by non-medical reasons. Preventing delays in diagnostics by meeting specific target times is central to the successful implementation of CPPs. The aim of this paper is to describe how hospital staff cope with the increased focus on meeting CPP target times and the measures and strategies implemented by hospitals and their staff. Methods Data for this paper were collected in a larger study on implementation and experiences with CPPs among hospital staff, general practitioners, and patients in Norway (2017–2020). The study had a qualitative cross-sectional design, and data were collected through interviews. This article is based on semi-structured interviews with hospital staff (N = 60) in five hospitals. Results Hospital staff are highly aware of the target times, and try to comply with them, in the interest of both the patients and the hospitals. The implementation of CPPs was not accompanied by the allocation of additional resources; therefore, hospitals could not simply increase capacity to meet the target times. Instead, they had to develop other strategies. Four categories of strategies were identified: (i) introducing new roles and more staff, (ii) reorganising the workflow, (iii) gaming the system and (iv) outsourcing services. Conclusions Hospital staff are torn between meeting the target times and a lack of resources and capacity. This is not unusual in the current healthcare context, where staff face organisational reforms and increasing demands on a regular basis. It is important to recognise frontline workers’ efforts towards realising new organisational changes. Therefore, carefully weighing the benefits against the costs and undertaking the necessary planning are important in the design and implementation of future care and treatment pathways for patients.

Cancer Patient Pathways shortens waiting times and accelerates the diagnostic process of suspected sarcoma patients in Denmark

Health Policy ◽  
2013 ◽  
Vol 113 (1-2) ◽  
pp. 110-117 ◽  
Author(s):  
Heidi Buvarp Dyrop ◽  
Akmal Safwat ◽  
Peter Vedsted ◽  
Katja Maretty-Nielsen ◽  
Bjarne Hauge Hansen ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Waiting Times ◽  
Diagnostic Process ◽  
Patient Pathways

scholarly journals Computer-assisted textual analysis of free-text comments in the Swiss Cancer Patient Experiences (SCAPE) survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chantal Arditi ◽  
Diana Walther ◽  
Ingrid Gilles ◽  
Saphir Lesage ◽  
Anne-Claude Griesser ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Cancer Care ◽  
Textual Analysis ◽  
Questionnaire Development ◽  
Patient Experiences ◽  
Computer Assisted ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Patient Reported

Abstract Background Patient experience surveys are increasingly conducted in cancer care as they provide important results to consider in future development of cancer care and health policymaking. These surveys usually include closed-ended questions (patient-reported experience measures (PREMs)) and space for free-text comments, but published results are mostly based on PREMs. We aimed to identify the underlying themes of patients’ experiences as shared in their own words in the Swiss Cancer Patient Experiences (SCAPE) survey and compare these themes with those assessed with PREMs to investigate how the textual analysis of free-text comments contributes to the understanding of patients’ experiences of care. Methods SCAPE is a multicenter cross-sectional survey that was conducted between October 2018 and March 2019 in French-speaking parts of Switzerland. Patients were invited to rate their care in 65 closed-ended questions (PREMs) and to add free-text comments regarding their cancer-related experiences at the end of the survey. We conducted computer-assisted textual analysis using the IRaMuTeQ software on the comments provided by 31% (n = 844) of SCAPE survey respondents (n = 2755). Results We identified five main thematic classes, two of which consisting of a detailed description of ‘cancer care pathways’. The remaining three classes were related to ‘medical care’, ‘gratitude and praise’, and the way patients lived with cancer (‘cancer and me’). Further analysis of this last class showed that patients’ comments related to the following themes: ‘initial shock’, ‘loneliness’, ‘understanding and acceptance’, ‘cancer repercussions’, and ‘information and communication’. While closed-ended questions related mainly to factual aspects of experiences of care, free-text comments related primarily to the personal and emotional experiences and consequences of having cancer and receiving care. Conclusions A computer-assisted textual analysis of free-text in our patient survey allowed a time-efficient classification of free-text data that provided insights on the personal experience of living with cancer and additional information on patient experiences that had not been collected with the closed-ended questions, underlining the importance of offering space for comments. Such results can be useful to inform questionnaire development, provide feedback to professional teams, and guide patient-centered initiatives to improve the quality and safety of cancer care.

scholarly journals The effects of cancer care pathways on waiting times

2019 ◽  
Vol 11 (2) ◽  
pp. 204-216 ◽  
Author(s):  
Magdalena Smeds ◽  
Bozena Bonnie Poksinska
Keyword(s):  
Cancer Care ◽  
Waiting Times ◽  
County Council ◽  
Cancer Diagnostics ◽  
Crowding Out ◽  
Care Pathways ◽  
Negative Effects ◽  
Content Type ◽  
Swedish Health Care ◽  
Vulnerable Patients

Purpose The Swedish health-care system currently implements cancer care pathways (CCPs) for better and more timely cancer diagnostics. The purpose of this paper is to elucidate and define “crowding out” effects associated with the CCP implementation. Design/methodology/approach A document study based on implementation reports and action plans from Swedish county councils (n = 21) and a case study in one county council were conducted. Qualitative data collection and analysis were used to acquire more knowledge about the “crowding out” effects associated with the CCP implementation. Findings Three effects discussed under “crowding out” were defined. The first effect, called the push-out effect, occurs when other patients have to wait for care longer in favour of CCP patients. Another effect is the inclusion effect, whereby “crowding out” is reduced for vulnerable patients due to the standardised procedures and criteria in the referral process. The final effect is the exclusion effect, where patients in need of cancer diagnostics are, for some reason, not referred to CCP. These patients are either not diagnosed at all or diagnosed outside CCP by a non-standard process, with the risk of longer waiting times. Originality/value “Crowding out” effects are an urgent topic related to CCP implementation. While these effects have been reported in international research studies, no shared definition has been established to describe them. The present paper creates a common base to measure the “crowding out” effects and support further development of CCPs to avoid the negative effects on waiting times.

scholarly journals Patient experiences of waiting times in standardised cancer patient pathways in Norway – a qualitative interview study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marit Solbjør ◽  
Kari Sand ◽  
Bente Ervik ◽  
Line Melby
Keyword(s):  
Cancer Patient ◽  
Waiting Times ◽  
Qualitative Interview ◽  
Patient Experiences ◽  
Rapid Diagnosis ◽  
Patient Needs ◽  
Structured Interviews ◽  
Patient Pathways ◽  
Qualitative Interview Study ◽  
Urgent Action

Abstract Objective Standardised cancer patient pathways (CPP) are implemented within cancer care with an aim to ensure standardised waiting times for diagnosis and treatment. This article investigates how patients in Norway experience waiting times within a CPP. Methods Qualitative semi-structured interviews with 19 patients who had been through CPP for breast cancer, prostate cancer or malignant melanoma in Norway. Results Few patients knew about the term CPP but trusted that waiting times were standardised to decrease mortality. Their experiences of waiting depended on their expectations as much as the period they waited. Patients generally felt safe about the timing of treatment, but not all expectations of a rapid response from health services were met. Short waiting times were interpreted as a sign of urgency, and a change of pace between urgent action and prolonged periods of waiting were disturbing. Conclusions Patients are comforted by knowing they are within a structured CPP that ensures rapid diagnosis and start of treatment. CPPs still need to be improved to avoid delays, allow for adaptions to patient needs, and include more information to avoid stress.

THE RELATION OF COPPING STRATEGY BY LOOKING SOCIAL SUPPORT WITH STRESS LEVEL OF BREAST CANCER PATIENT WHO GONE TROUGH CHEMOTHERAPY

2018 ◽  
Vol 1 (1) ◽  
pp. 51-54
Author(s):  
Sri Burhani Putri
Keyword(s):  
Breast Cancer ◽  
Social Support ◽  
Cancer Patient ◽  
Breast Cancer Patient ◽  
Cross Sectional Study ◽  
P Value ◽  
Spiritual Support ◽  
Cross Sectional ◽  
Breast Cancer Chemotherapy ◽  
Patient Stress

Breast cancer is one of the most common illness that killed woman. One of the therapy to cure breast cancer is chemotherapy. Chemotherapy has side effect either physical and psychology, that caused people who’s in chemo therapy, prone to stress. Stress effected by many factors, such as characteristic and chopping strategy that patient has been using. The aim of this research is to get a perspective about the relation of characteristic and chopping strategy with breast cancer patient stress, whose in chemo therapy. This research using cross sectional study and taking sample by using accidental sampling method. The data analyzed by using bavariat and multivariat with variable result shows that breast cancer patient stress who has chemo therapy realted to age characteristic (p value = 0.00) the time since they diagnosed with cancer (pvalue = 0.03), how long they have chemo therapy (pvalue = 0.00) and chopping strategyby looking social support (pvalue = 0.00) looking for spiritual (pvalue = 0.00) with dominan variable which related to stress is chopping strategy to looking spiritual support (coeffecients B = -1.139).   Key words : Breast cancer, chemotherapy, stress  

scholarly journals Evaluating Barriers and Opportunities in Delivering High-Quality Oncology Care in a Resource-Limited Setting Using a Comprehensive Needs Assessment Tool

2018 ◽  
pp. 1-9
Author(s):  
Chika R. Nwachukwu ◽  
Omobola Mudasiru ◽  
Lynn Million ◽  
Shruti Sheth ◽  
Hope Qamoos ◽  
...  
Keyword(s):  
Palliative Care ◽  
Needs Assessment ◽  
Cancer Care ◽  
Assessment Tool ◽  
Hospital Staff ◽  
Teaching Hospitals ◽  
High Quality ◽  
Middle Income ◽  
Quality Cancer Care ◽  
Oncology Care

Purpose Despite recognition of both the growing cancer burden in low- and middle-income countries and the disproportionately high mortality rates in these settings, delivery of high-quality cancer care remains a challenge. The disparities in cancer care outcomes for many geographic regions result from barriers that are likely complex and understudied. This study describes the development and use of a streamlined needs assessment questionnaire (NAQ) to understand the barriers to providing quality cancer care, identifies areas for improvement, and formulates recommendations for implementation. Methods Using a comprehensive NAQ, in-depth interviews were conducted with 17 hospital staff involved in cancer care at two teaching hospitals in Nigeria. Data were analyzed using content analysis and organized into a framework with preset codes and emergent codes, where applicable. Results Data from the interviews were organized into six broad themes: staff, stuff, system, space, lack of palliative care, and provider bias, with key barriers within themes including: financial, infrastructural, lack of awareness, limited human capacity resources, lack of palliative care, and provider perspective on patient-related barriers to cancer care. Specific solutions based on ability to reasonably implement were subcategorized into short-, medium-, and long-term goals. Conclusion This study provides a framework for a streamlined initial needs assessment and a unique discussion on the barriers to high-quality oncology care that are prevalent in resource-constrained settings. We report the feasibility of collecting and organizing data using a streamlined NAQ and provide a thorough and in-depth understanding of the challenges in this setting. Knowledge gained from the assessments will inform steps to improve oncology cancer in these settings.

scholarly journals Infection control practices and challenges in Pakistan during the COVID-19 pandemic: a multicentre cross-sectional study

2021 ◽  
pp. 175717742110127
Author(s):  
Salma Abbas ◽  
Faisal Sultan
Keyword(s):  
Personal Protective Equipment ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Hospital Staff ◽  
Cross Sectional Study ◽  
Infection Prevention And Control ◽  
Protective Equipment ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
And Control

Background: Patient and staff safety at healthcare facilities during outbreaks hinges on a prompt infection prevention and control response. Physicians leading these programmes have encountered numerous obstacles during the pandemic. Aim/objective: The aim of this study was to evaluate infection prevention and control practices and explore the challenges in Pakistan during the coronavirus disease 2019 pandemic. Methods: We conducted a cross-sectional study and administered a survey to physicians leading infection prevention and control programmes at 18 hospitals in Pakistan. Results: All participants implemented universal masking, limited the intake of patients and designated separate triage areas, wards and intensive care units for coronavirus disease 2019 patients at their hospitals. Eleven (61%) physicians reported personal protective equipment shortages. Staff at three (17%) hospitals worked without the appropriate personal protective equipment due to limited supplies. All participants felt overworked and 17 (94%) reported stress. Physicians identified the lack of negative pressure rooms, fear and anxiety among hospital staff, rapidly evolving guidelines, personal protective equipment shortages and opposition from hospital staff regarding the choice of recommended personal protective equipment as major challenges during the pandemic. Discussion: The results of this study highlight the challenges faced by physicians leading infection prevention and control programmes in Pakistan. It is essential to support infection prevention and control personnel and bridge the identified gaps to ensure patient and staff safety at healthcare facilities.

scholarly journals Obstetric anesthesia services in Israel snapshot (OASIS) study: a 72 hour cross-sectional observational study of workforce supply and demand

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gal Schtrechman-Levi ◽  
Alexander Ioscovich ◽  
Jacob Hart ◽  
Jacob Bar ◽  
Ronit Calderon-Margalit ◽  
...  
Keyword(s):  
Observational Study ◽  
General Anesthesia ◽  
Activity Index ◽  
Supply And Demand ◽  
Waiting Times ◽  
Obstetric Anesthesia ◽  
Quality And Safety ◽  
Cross Sectional ◽  
Vaginal Deliveries ◽  
Safety Outcomes

Abstract Background We planned an observational study to assess obstetric anesthesia services nationwide. We aimed to assess the effect of the anesthesia workload/workforce ratio on quality and safety outcomes of obstetric anesthesia care. Methods Observers prospectively collected data from labor units over 72 h (Wednesday, Thursday and Friday). Independent variables were workload (WL) and workforce (WF). WL was assessed by the Obstetric Anesthesia Activity Index (OAAI), which is the estimated time in a 24-h period spent on epidurals and all cesarean deliveries. Workforce (WF) was assessed by the number of anesthesiologists dedicated to the labor ward per week. Dependent variables were the time until anesthesiologist arrival for epidural (quality measure) and the occurrence of general anesthesia for urgent Cesarean section, CS, (safety measure). This census included vaginal deliveries and unscheduled (but not elective) CS. Results Data on 575 deliveries are from 12 maternity units only, primarily because a major hospital chain chose not to participate; eight other hospitals lacked institutional review board approval. The epidural response rate was 94.4%; 321 of 340 parturients who requested epidural analgesia (EA) received it. Of the 19 women who requested EA but gave birth without it, 14 (77%) were due to late arrival of the anesthesiologist. Median waiting times for anesthesiologist arrival ranged from 5 to 28 min. The OAAI varied from 4.6 to 25.1 and WF ranged from 0 to 2 per shift. Request rates for EA in hospitals serving predominantly orthodox Jewish communities and in peripheral hospitals were similar to those of the entire sample. More than a fifth (13/62; 21%) of the unscheduled CS received general anesthesia, and of these almost a quarter (3/13; 23%) were attributed to delayed anesthesiologist arrival. Conclusions Inadequate WF allocations may impair quality and safety outcomes in obstetric anesthesia services. OAAI is a better predictor of WL than delivery numbers alone, especially concerning WF shortage. To assess the quality and safety of anesthetic services to labor units nationally, observational data on workforce, workload, and clinical outcomes should be collected prospectively in all labor units in Israel.

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