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

Siri Christine K Næss

doi:10.1177/10497323211020708

Abstract

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.

Highlights

Despite the absence of a clear connection between a timely cancer diagnosis and survival, there is a growing body of evidence suggesting that early detection and treatment of cancer are likely to influence the prognosis positively (Neal, 2009)
In Norway, as well as Denmark and Sweden, the notion that time can be used as an essential strategy to fight cancer inspired the development of a policy titled cancer patient pathways (CPPs), implemented in 2015
Findings suggest that there are different interpretations of how the process of referring patients to a CPP is best realized, a key question being, at what point is a reasonable suspicion of cancer achieved? Physicians have different perceptions of how close to a final diagnosis a patient should be before it is appropriate to start a CPP

Summary

Introduction

Despite the absence of a clear connection between a timely cancer diagnosis and survival, there is a growing body of evidence suggesting that early detection and treatment of cancer are likely to influence the prognosis positively (Neal, 2009). In Norway, as well as Denmark and Sweden, the notion that time can be used as an essential strategy to fight cancer inspired the development of a policy titled cancer patient pathways (CPPs), implemented in 2015. The intention is to improve the quality of cancer care by providing all potential cancer patients with a standardized set of time frames, from suspicion of cancer to diagnosis and the start of treatment. The CPPs are anchored in the clinical practice guidelines, which provide recommendations for diagnostic procedures but are concerned with the logistics (Norwegian Directorate of Health, 2016). I examine how primary and specialist physicians, balancing diverse demands, work with the referral of patients to CPPs

Results

Discussion

Conclusion