Equitable access to cancer patient pathways in Norway – a national registry-based study

Abstract Background In 2015, cancer patient pathways (CPP) were implemented in Norway to reduce unnecessary non-medical delay in the diagnostic process and start of treatment. The main aim of this study was to investigate the equality in access to CPPs for patients with either lung, colorectal, breast or prostate cancer in Norway. Methods National population-based data on individual level from 2015 to 2017 were used to study two proportions; i) patients in CPPs without the cancer diagnosis, and ii) cancer patients included in CPPs. Logistic regression was applied to examine the associations between these proportions and place of residence (hospital referral area), age, education, income, comorbidity and travel time to hospital. Results Age and place of residence were the two most important factors for describing the variation in proportions. For the CPP patients, inconsistent differences were found for income and education, while for the cancer patients the probability of being included in a CPP increased with income. Conclusions The age effect can be related to both the increasing risk of cancer and increasing number of GP and hospital contacts with age. The non-systematic results for CPP patients according to income and education can be interpreted as equitable access, as opposed to the systematic differences found among cancer patients in different income groups. The inequalities between income groups among cancer patients and the inequalities based on the patients’ place of residence, for both CPP and cancer patients, are unwarranted and need to be addressed.

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

Health Policy ◽

10.1016/j.healthpol.2013.09.012 ◽

2013 ◽

Vol 113 (1-2) ◽

pp. 110-117 ◽

Cited By ~ 18

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

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Patient and tumour characteristics associated with inclusion in Cancer patient pathways in Norway in 2015–2016

BMC Cancer ◽

10.1186/s12885-020-06979-y ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Yngvar Nilssen ◽

Odd Terje Brustugun ◽

Morten Tandberg Eriksen ◽

Erik Skaaheim Haug ◽

Bjørn Naume ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Patient ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Waiting Time ◽

Low Income ◽

Breast Cancer Patients ◽

Prostate Cancer Diagnosis ◽

Patient Pathways ◽

Region Of Residence

Abstract Background Cancer patient pathways (CPPs) were implemented in 2015 to reduce waiting time, regional variation in waiting time, and to increase the predictability of cancer care for the patients. The aims of this study were to see if the national target of 70% of all cancer patients being included in a CPP was met, and to identify factors associated with CPP inclusion. Methods All patients registered with a colorectal, lung, breast or prostate cancer diagnosis at the Cancer Registry of Norway in the period 2015–2016 were linked with the Norwegian Patient Registry for CPP information and with Statistics Norway for sociodemographic variables. Multivariable logistic regression examined if the odds of not being included in a CPP were associated with year of diagnosis, age, sex, tumour stage, marital status, education, income, region of residence and comorbidity. Results From 2015 to 2016, 30,747 patients were diagnosed with colorectal, lung, breast or prostate cancer, of whom 24,429 (79.5%) were included in a CPP. Significant increases in the probability of being included in a CPP were observed for colorectal (79.1 to 86.2%), lung (79.0 to 87.3%), breast (91.5 to 97.2%) and prostate cancer (62.2 to 76.2%) patients (p < 0.001). Increasing age was associated with an increased odds of not being included in a CPP for lung (p < 0.001) and prostate cancer (p < 0.001) patients. Colorectal cancer patients < 50 years of age had a two-fold increase (OR = 2.23, 95% CI: 1.70–2.91) in the odds of not being included in a CPP. The odds of no CPP inclusion were significantly increased for low income colorectal (OR = 1.24, 95%CI: 1.00–1.54) and lung (OR = 1.52, 95%CI: 1.16–1.99) cancer patients. Region of residence was significantly associated with CPP inclusion (p < 0.001) and the probability, adjusted for case-mix ranged from 62.4% in region West among prostate cancer patients to 97.6% in region North among breast cancer patients. Conclusions The national target of 70% was met within 1 year of CPP implementation in Norway. Although all patients should have equal access to CPPs, a prostate cancer diagnosis, older age, high level of comorbidity or low income were significantly associated with an increased odds of not being included in a CPP.

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Prognostic consequences of implementing cancer patient pathways in Denmark: a comparative cohort study of symptomatic cancer patients in primary care

BMC Cancer ◽

10.1186/s12885-017-3623-8 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 12

Author(s):

Henry Jensen ◽

Marie Louise Tørring ◽

Peter Vedsted

Keyword(s):

Primary Care ◽

Cohort Study ◽

Cancer Patient ◽

Cancer Patients ◽

Patient Pathways ◽

Comparative Cohort Study ◽

Symptomatic Cancer

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Cancer patients’ experiences with urgent referrals to cancer patient pathways

European Journal of Cancer Care ◽

10.1111/ecc.12927 ◽

2018 ◽

Vol 28 (1) ◽

pp. e12927 ◽

Cited By ~ 5

Author(s):

Mette Sandager ◽

Henry Jensen ◽

Henriette Lipczak ◽

Cecilie Dyg Sperling ◽

Peter Vedsted

Keyword(s):

Cancer Patient ◽

Cancer Patients ◽

Patient Pathways

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Cancer suspicion, referral to cancer patient pathway and primary care interval: a survey and register study exploring 10 different types of abdominal cancer

Family Practice ◽

10.1093/fampra/cmab025 ◽

2021 ◽

Author(s):

Nanna H Jessen ◽

Henry Jensen ◽

Charles W Helsper ◽

Alina Z Falborg ◽

Henning Glerup ◽

...

Keyword(s):

Primary Care ◽

Cancer Patient ◽

Cancer Patients ◽

Kidney Cancer ◽

Cancer Type ◽

Diagnostic Strategies ◽

Patient Pathways ◽

Different Types ◽

Cancer Types ◽

Serious Disease

Abstract Background Abdominal cancers represent 30% of all diagnosed cancers. Nevertheless, it is unknown if the general practitioner’s (GP’s) initial cancer suspicion varies for different abdominal cancer types and how this is associated with referrals to standardized cancer patient pathways (CPPs). Objectives To explore initial cancer suspicion in GPs and to investigate how this was associated with GP referrals to CPPs and the duration of the primary care interval (PCI) in 10 different abdominal cancer types. Methods We conducted a cohort study on 1104 incident abdominal cancer patients diagnosed in Denmark in 2016 using a combination of survey and register-based data. Poisson regression was used to estimate associations between GP cancer suspicion, CPP referral and PCI duration. Results The GPs initially suspected cancer or other serious disease in 46–78% of cases, lowest in kidney cancer, and referred 35–65% to a CPP, lowest in oesophageal cancer. The GP’s suspicion at the first presentation was strongly associated with referral to a CPP. The median (0–11 days) and 75th percentile (3–32 days) PCIs varied between the abdominal cancer types. The likelihood of a long PCI was more than 3-fold higher when the GP did not initially suspect cancer. Conclusion In up to half of abdominal cancer patients, there is no initial suspicion of cancer or serious disease. CPPs were used in only one-third to two-thirds of patients, depending on cancer type. For kidney cancer, as well as several abdominal cancers, we need better diagnostic strategies to support GPs to enable effective and efficient referral.

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Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care

BMC Health Services Research ◽

10.1186/s12913-020-4893-4 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Cecilia Hultstrand ◽

Anna-Britt Coe ◽

Mikael Lilja ◽

Senada Hajdarevic

Keyword(s):

Primary Care ◽

Cancer Patient ◽

Primary Healthcare ◽

Social Processes ◽

Diagnostic Process ◽

Care Seeking ◽

Cancer Symptoms ◽

Grounded Theory Method ◽

Patient Pathways ◽

Bodily Sensations

Abstract Background How interactions during patient-provider encounters in Swedish primary care construct access to further care is rarely explored. This is especially relevant nowadays since Standardized Cancer Patient Pathways have been implemented as an organizational tool for standardizing the diagnostic process and increase equity in access. Most patients with symptoms indicating serious illness as cancer initially start their diagnostic trajectory in primary care. Furthermore, cancer symptoms are diverse and puts high demands on general practitioners (GPs). Hence, we aim to explore how presentation of bodily sensations were constructed and legitimized in primary care encounters within the context of Standardized Cancer Patient Pathways (CPPs). Methods Participant observations of patient-provider encounters (n = 18, on 18 unique patients and 13 GPs) were carried out at primary healthcare centres in one county in northern Sweden. Participants were consecutively sampled and inclusion criteria were i) patients (≥18 years) seeking care for sensations/symptoms that could indicate cancer, or had worries about cancer, Swedish speaking and with no cognitive disabilities, and ii) GPs who met with these patients during the encounter. A constructivist approach of grounded theory method guided the data collection and was used as a method for analysis, and the COREQ-checklist for qualitative studies (Equator guidelines) were employed. Results One conceptual model emerged from the analysis, consisting of one core category Negotiating bodily sensations to legitimize access, and four categories i) Justifying care-seeking, ii) Transmitting credibility, iii) Seeking and giving recognition, and iv) Balancing expectations with needs. We interpret the four categories as social processes that the patient and GP constructed interactively using different strategies to negotiate. Combined, these four processes illuminate how access was legitimized by negotiating bodily sensations. Conclusions Patients and GPs seem to be mutually dependent on each other and both patients’ expertise and GPs’ medical expertise need to be reconciled during the encounter. The four social processes reported in this study acknowledge the challenging task which both patients and primary healthcare face. Namely, negotiating sensations signaling possible cancer and further identifying and matching them with the best pathway for investigations corresponding as well to patients’ needs as to standardized routines as CPPs.

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CPP or Not, That Is the Question: Physicians’ Work With Activating CPPs

Qualitative Health Research ◽

10.1177/10497323211020708 ◽

2021 ◽

pp. 104973232110207

Author(s):

Siri Christine K. Næss

Keyword(s):

Cancer Patient ◽

Cancer Patients ◽

Secondary Care ◽

Institutional Ethnography ◽

Qualitative Interviews ◽

Diagnostic Investigation ◽

Clear Cut ◽

Patient Pathways ◽

Starting Point ◽

Potential Cancer

The Norwegian government has launched a policy titled cancer patient pathways (CPPs), which assigns maximum deadlines to the various phases of the diagnostic investigation. In this article, I examine the starting point of CPPs through the lens of institutional ethnography—that is, how physicians work with the referral of patients in the context of CPPs. Based on qualitative interviews with physicians in both primary and secondary care across Norway ( N = 37), the findings reveal that the distinction between CPP or not is by no means clear-cut for either primary or specialist physicians. The starting point of CPPs is mediated by the interaction between physicians and patients and how the referral is composed, as well as how and by whom the referral is interpreted, in conjunction with overarching discourses, policies, and guidelines for practice. The findings challenge the notion that all potential cancer patients can and should be equally prioritized.

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The acceptance and applicability of a patient-reported experience measurement tool in oncological care: a descriptive feasibility study in northern Germany

BMC Health Services Research ◽

10.1186/s12913-019-4646-4 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Christiane Rudolph ◽

Gitte Stentebjerg Petersen ◽

Ron Pritzkuleit ◽

Hans Storm ◽

Alexander Katalinic

Keyword(s):

Health Care ◽

Cancer Patient ◽

Cancer Patients ◽

Diagnostic Process ◽

Patient Questionnaire ◽

Response Patterns ◽

Response Behaviour ◽

Oncological Care ◽

Patient Reported ◽

German Adaptation

Abstract Background Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are tools for assessing outcomes of and experiences with health care from the patient’s perspective. In Germany, PROMs are widely used in research for evaluating patient outcomes and quality of care. However, the application of PREMs is rather scant, especially in oncology. The study aimed to assess the feasibility of patient-centred quality evaluation in oncological care in Germany using the German adaptation of the Danish National Cancer Patient Questionnaire. This questionnaire is a PREM/PROM-tool addressing patients of all cancer sites and covering the entire cancer patient pathway. Methods The Danish National Cancer Patient Questionnaire was translated into German via forward-backward translation. Face-validity was tested among three cancer patients in a conventional pre-test. The German adaptation contains 99 questions. A pilot test was carried out among 245 newly diagnosed breast and colorectal cancer patients in the German federal state Schleswig-Holstein. Patients were recruited via clinics participating in the Oncological Care Registry (12 specialised units in seven hospitals) and contacted six to nine months after diagnosis. Response behaviour and response patterns were compared to the Danish study population (n = 1964). Results The willingness among clinicians to support patient recruitment as well as the response rate of patients to the questionnaire was high (65%). Moreover, response behaviour and response patterns of German and Danish patients were consistent. Despite the generally good response behaviour of patients to the single items, the authors observed that questions assessing the diagnostic process did not fully capture German pathways. Only 19.3% of the German patients stated that their diagnostic process was initiated by a visit to a general practitioner (GP) in contrast to 52% in Denmark. The assessment of patient experiences in the diagnostic phase heavily focuses on experiences in general practice, which does not seem appropriate in the German health care setting. Conclusion The translation was successful, and the feasibility of a future large-scale study within existing structures is given. However, some modifications of questions heavily related to the Danish health care system, especially referring to the diagnostic phase, are necessary.

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