Abstract
BackgroundInter-professional collaborative care (ICC) for cancer leads to multiple system, organizational, professional, and patient benefits, but is limited by numerous challenges. Empirical research on interventions that promote or enable ICC is sparse so guidance on how to achieve ICC is lacking. Research shows that ICC for diagnosis could be improved. Diagnostic assessment programs (DAPs) appear to be a promising model for enabling ICC. The purpose of this study was to explore how DAP structure and function enable ICC, and whether that may be associated with organizational and clinical outcomes.MethodsA case study approach will be used to explore ICC among eight DAPs that vary by type of cancer (lung, breast), academic status, and geographic region. To describe DAP function and outcomes, and gather information that will enable costing, recommendations expressed in DAP standards and clinical guidelines will be assessed through retrospective observational study. Data will be acquired from databases maintained by participating DAPs and the provincial cancer agency, and confirmed by and supplemented with review of medical records. We will conduct a pilot study to explore the feasibility of estimating the incremental cost-effectiveness ratio using person-level data from medical records and other sources. Interviews will be conducted with health professionals, staff, and referring physicians from each DAP to learn about barriers and facilitators of ICC. Qualitative methods based on a grounded approach will be used to guide sampling, data collection and analysis.DiscussionFindings may reveal opportunities for unique structures, interventions or tools that enable ICC that could be developed, implemented, and evaluated through future research. This information will serve as a formative needs assessment to identify the nature of ongoing or required improvements, which can be directly used by our decision maker collaborators, and as a framework by policy makers, cancer system managers, and DAP managers elsewhere to strategically plan for and implement diagnostic cancer services.
Highlights
Inter-professional collaborative care (ICC) for cancer leads to multiple system, organizational, professional, and patient benefits, but is limited by numerous challenges
The proposed study constitutes phase one of a longitudinal research program that will evaluate existing and alternative interventions to support ICC for cancer. It represents the phase in the evaluation of Diagnostic assessment programs (DAPs) as a model by which to enable ICC following evaluation of diagnostic wait times for pilot program implemented across Ontario
Medical record review will not be comprehensive of all cases at all DAPs across Ontario, and clinical measures are limited to wait times and receipt of basic diagnostic tests
Summary
Inter-professional collaborative care (ICC) for cancer leads to multiple system, organizational, professional, and patient benefits, but is limited by numerous challenges. Patient needs vary as they undergo stay, readmission) and patient-reported (i.e., satisfaction, health related quality of life) outcomes for a variety of acute and chronic conditions including cancer [1,4,5]. This concept of inter-professional collaborative care (ICC) requires ongoing interaction among various types of health professionals to assess, plan, negotiate, provide, and review care for individual patients [6]. Further understanding of how various ICC models lead to beneficial patient, provider, institutional, and health system outcomes will provide insight on when and in what way to implement these models
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