The document summarizes findings from a survey of GPs in NSW, Australia that was part of an international cancer benchmarking study. Key findings included:
- GPs expressed strong support for timely cancer diagnosis but less so for lung cancer. Nearly half saw gatekeeping as important.
- There were differences in access to diagnostic tests and specialists between urban and rural GPs, and between public and private systems.
- Waiting times heavily influenced referral pathways.
- The findings can help improve coordination between primary and specialist cancer care and provide a baseline for monitoring changes over time.
Implementing a shared care model to prevent liver cancer and improve chronic ...Cancer Institute NSW
Hepatocellular cancer (HCC) is among the top 10 causes of cancer death in Australia, with ~80% of cases attributable to chronic viral hepatitis. Although 60-80% of HCCs are preventable by antiviral therapies, multiple barriers exist in the diagnostic and treatment continuum. Chronic hepatitis B (CHB) is the main cause for rising HCC rates in Western Sydney, where the greatest burden of disease is among people born in hepatitis B endemic countries.
Improving Aboriginal and Torres Strait Islander cancer screening rates in NNS...Cancer Institute NSW
Northern NSW (NNSW) LHD was awarded a $20,000 grant from the Cancer Institute NSW to increase breast and cervical cancer screening in Aboriginal women and cancer screening in Aboriginal men in the Northern NSW region.
Secondary Cancers, Health Behaviour and Cancer Screening Adherence in survivo...Cancer Institute NSW
Over 50% of patients undergoing allogeneic BMT can now be expected to become long-term survivors. Unfortunately many survivors experience an increased risk of secondary cancers, infections and chronic diseases.
The experience of survival following Blood and Marrow Transplant in NSW, Aust...Cancer Institute NSW
Over 50% of patients undergoing allogeneic BMT can now be expected to become long-term survivors. Unfortunately many experience significant late morbidity and mortality.
Cancer patients’ experiences in one tertiary referral emergency department (E...Cancer Institute NSW
The demand on Australian EDs has increased by an average of 4.2% each year while the cancer incidence rate has doubled since 1991. Many patients with cancer present to EDs but may be better managed using alternative healthcare models.
Anti-cancer therapy is big business. In Australia alone between 2000 and 2009, cancer-related pharmaceutical expenditure has risen over 200% to over half a billion dollars per annum.
Don't miss our upcoming webinars! Subscribe today.
In this webinar:
Our presenters will talk about the work the LAO does, provide information about the causes and symptoms of lymphedema, and inform lymphedema patients on how to access help and support. They will also include the physiotherapist perspective and discuss what treatments are available.
View the YouTube video: https://youtu.be/Wg1dzEOBPEA
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Implementing a shared care model to prevent liver cancer and improve chronic ...Cancer Institute NSW
Hepatocellular cancer (HCC) is among the top 10 causes of cancer death in Australia, with ~80% of cases attributable to chronic viral hepatitis. Although 60-80% of HCCs are preventable by antiviral therapies, multiple barriers exist in the diagnostic and treatment continuum. Chronic hepatitis B (CHB) is the main cause for rising HCC rates in Western Sydney, where the greatest burden of disease is among people born in hepatitis B endemic countries.
Improving Aboriginal and Torres Strait Islander cancer screening rates in NNS...Cancer Institute NSW
Northern NSW (NNSW) LHD was awarded a $20,000 grant from the Cancer Institute NSW to increase breast and cervical cancer screening in Aboriginal women and cancer screening in Aboriginal men in the Northern NSW region.
Secondary Cancers, Health Behaviour and Cancer Screening Adherence in survivo...Cancer Institute NSW
Over 50% of patients undergoing allogeneic BMT can now be expected to become long-term survivors. Unfortunately many survivors experience an increased risk of secondary cancers, infections and chronic diseases.
The experience of survival following Blood and Marrow Transplant in NSW, Aust...Cancer Institute NSW
Over 50% of patients undergoing allogeneic BMT can now be expected to become long-term survivors. Unfortunately many experience significant late morbidity and mortality.
Cancer patients’ experiences in one tertiary referral emergency department (E...Cancer Institute NSW
The demand on Australian EDs has increased by an average of 4.2% each year while the cancer incidence rate has doubled since 1991. Many patients with cancer present to EDs but may be better managed using alternative healthcare models.
Anti-cancer therapy is big business. In Australia alone between 2000 and 2009, cancer-related pharmaceutical expenditure has risen over 200% to over half a billion dollars per annum.
Don't miss our upcoming webinars! Subscribe today.
In this webinar:
Our presenters will talk about the work the LAO does, provide information about the causes and symptoms of lymphedema, and inform lymphedema patients on how to access help and support. They will also include the physiotherapist perspective and discuss what treatments are available.
View the YouTube video: https://youtu.be/Wg1dzEOBPEA
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
The Lung Cancer Demonstration Project: Implementation and evaluation of a lun...Cancer Institute NSW
The Royal Prince Alfred Hospital lung MDT was established in 1984. Historically, information about MDT decision making was captured as free text in the electronic medical record, including patient investigation and staging. This information was accessible to clinical staff; however, it was not routinely distributed to GPs involved in the patient's care. We identified a potential gap in the current reporting and communication processes.
Providing coordinated cancer care: a population-based survey of patients' exp...Cancer Institute NSW
Improving cancer care coordination is a key priority for health services. Understanding the patient experience and who is at risk of receiving poorly coordinated care is crucial to underpin service improvement. However, there is little understanding of the adequacy of care coordination within Australia.
Don't miss our upcoming webinars. Subscribe today!
In this webinar:
Attendees will learn about the role of exercise in the cancer care pathway, and the potential benefits from building a habit of moving more. We will also discuss the EXCEL study: EXercise for Cancer to Enhance Living Well, and how it is providing a sustainable exercise and behaviour change program to those living with cancer in rural and remote regions across Canada. Learn what is involved in this exercise research program and how to get involved online now!
View the YouTube video: https://youtu.be/BIOviCzESwA
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Pathways to smoking care for cancer patients (P-SCIP): Stage 1Cancer Institute NSW
As survival from cancer has improved over time, the potential impact of cigarette smoking on cancer patients and survivors is of increasing relevance. In addition to increased risk of chronic disease such as cardiovascular and respiratory disease, continued smoking after a cancer diagnosis increases the risk of second primary cancer, cancer recurrence and is a cause of treatment complications. As well the profound adverse impact of continued smoking on health outcomes in cancer patients, continued smoking among people with cancer incurs significant cost to the health system.
Predictors of MDT review and the impact on lung cancer survival for HNELHD re...Cancer Institute NSW
Review by a Multidisciplinary Team (MDT) has been shown to lead to increased rates of surgical resection, radiotherapy, chemotherapy and timeliness of care. Most recently, the Victorian lung cancer patterns of care study have found that MDT review is an independent predictor of lung cancer survival.
One in five women who survive breast cancer will develop lymphoedema of the upper body at some point in their life. Following breast surgery, women are recommended to follow strategies to minimise their lymphoedema risk (e.g., limiting exposure of the at-risk arm to trauma). Adherence to these strategies is typically less than optimal.
Don't miss our upcoming webinars. Subscribe today!
This presentation will highlight the promising new therapeutic strategies in the treatment of gliomas, with a focus on trials or therapies that will soon be available for Canadian patients.
View the YouTube video: https://youtu.be/ibbEuvSF7xY
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Defining and assessing a delineation uncertainty margin for modern radiotherapyCancer Institute NSW
The implementation of image-guided technology and progressively conformal techniques in modern radiotherapy for the treatment of cancer, ensure the planned distribution of dose is well matched to the clinician-defined target volume. However, this precision relies on the target volume including all malignant tissue, with delineation uncertainty resulting in potential normal tissue toxicities and insufficient dose to the cancer. Methods need to be implemented to minimise delineation uncertainty, and subsequently improve local control and patient outcomes.
Don’t miss our upcoming webinars: Subscribe today!
The CanRehab Team brings together a large group of patients, researchers, and clinicians at four Canadian centres and includes three concurrent projects focused on improving access to effective, appropriate, and timely cancer rehabilitation (CanRehab Team).
The objectives of the presentation are: 1) to provide a background on cancer rehabilitation; 2) to introduce the CanRehab Team projects; and 3) to provide an overview of the team structure including a call for interest to the Patient Advisory Committee.
View the YouTube video: https://youtu.be/B2tcIsrw4WE
To learn more about CCSN, visit us at survivornet.ca
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
An integrated model of psychosocial cancer care: a work in progress…Cancer Institute NSW
Cancer patients are faced with a multitude of stressors, from diagnosis, through treatment, at recurrence, in the stages following treatment completion, and in the terminal phase. Psychosocial care has been highlighted as a critical aspect of providing comprehensive patient-focused care. Specifically, one of the goals of The NSW Cancer Plan 2011-2015 is to improve the quality of life of people with cancer and their carers. This project was initiated to improve the current psychosocial model of care at The Kinghorn Cancer Centre (TKCC), to better reflect an integrated, holistic and comprehensive model of patient-centred care.
Comparative Effectiveness of a Multifaceted Intervention to Improve Adherence to Annual Colorectal Cancer Screening in Community Health Centers (RCT)
Présentation de David W. Baker au colloque "Recherche interventionnelle contre le cancer : Réunir chercheurs, décideurs et acteurs de terrain » - 17 et 18 novembre 2014, BnF, Paris
Building the bridge from discovery-to-delivery: A Community of Practice in Ca...Cancer Institute NSW
A research breakthrough is said to take approximately 17 years to translate into clinical practice. This time lag can have considerable implications for patients, their carers, health services, and public funds. To address this time lag, the Cancer Institute NSW and the Translational Cancer Research Centres (TCRCs) across the state developed a community of practice (CoP) to increase knowledge, skills, and capacity in implementation science.
Retention of Graduates in NB from the N.B. Medical Training Centre: Demograph...DataNB
The number and retention of physicians practicing in New Brunswick is a major issue in the province. This webinar aims to present demographic data to explore the factors linked to the retention of CFMNB medical graduates. Among the factors discussed are medical specializations, as well as graduates’ gender and place of origin (urban vs rural). This communication also discusses physicians from New Brunswick who have studied at the Université Laval or Université de Montréal through the NB – Québec Agreement.
Don’t miss our upcoming webinars: Subscribe today!
In this webinar:
Join CCSN and Marjut Huotari, VP-Healthcare Insights at Leger, as we present the results of the COVID-19 and Cancer Care Disruption in Canada Survey and hear from members of the cancer community about how the pandemic has directly impacted them.
View the video:
https://youtu.be/6ub1ot806-A
To learn more about CCSN, visit us at survivornet.ca
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Don't miss our upcoming webinars: Subscribe today!
In this webinar:
Dr. Paula Gordon will share information on when individuals should start screening for breast cancer, and how often to screen - in order for cancer to be found as early as possible, and to allow the least aggressive options for treatment. Dr. Gordon will also discuss how to screen for recurrence in women who’ve had cancer, explain why these methods are not always offered, and suggest what you can do to improve access to optimal screening.
View the video: https://youtu.be/7uFksz6_4Zk
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Implementing online mental health supports into community-based survivorship ...Cancer Institute NSW
The intersection of developmental vulnerabilities and cancer-related stressors means that adolescents and young adults (AYAs) with cancer show more complex distress relative to other age groups.
A strategy for cancer in england over the next five years, pop up uni, 11am, ...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
The Lung Cancer Demonstration Project: Implementation and evaluation of a lun...Cancer Institute NSW
The Royal Prince Alfred Hospital lung MDT was established in 1984. Historically, information about MDT decision making was captured as free text in the electronic medical record, including patient investigation and staging. This information was accessible to clinical staff; however, it was not routinely distributed to GPs involved in the patient's care. We identified a potential gap in the current reporting and communication processes.
Providing coordinated cancer care: a population-based survey of patients' exp...Cancer Institute NSW
Improving cancer care coordination is a key priority for health services. Understanding the patient experience and who is at risk of receiving poorly coordinated care is crucial to underpin service improvement. However, there is little understanding of the adequacy of care coordination within Australia.
Don't miss our upcoming webinars. Subscribe today!
In this webinar:
Attendees will learn about the role of exercise in the cancer care pathway, and the potential benefits from building a habit of moving more. We will also discuss the EXCEL study: EXercise for Cancer to Enhance Living Well, and how it is providing a sustainable exercise and behaviour change program to those living with cancer in rural and remote regions across Canada. Learn what is involved in this exercise research program and how to get involved online now!
View the YouTube video: https://youtu.be/BIOviCzESwA
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Pathways to smoking care for cancer patients (P-SCIP): Stage 1Cancer Institute NSW
As survival from cancer has improved over time, the potential impact of cigarette smoking on cancer patients and survivors is of increasing relevance. In addition to increased risk of chronic disease such as cardiovascular and respiratory disease, continued smoking after a cancer diagnosis increases the risk of second primary cancer, cancer recurrence and is a cause of treatment complications. As well the profound adverse impact of continued smoking on health outcomes in cancer patients, continued smoking among people with cancer incurs significant cost to the health system.
Predictors of MDT review and the impact on lung cancer survival for HNELHD re...Cancer Institute NSW
Review by a Multidisciplinary Team (MDT) has been shown to lead to increased rates of surgical resection, radiotherapy, chemotherapy and timeliness of care. Most recently, the Victorian lung cancer patterns of care study have found that MDT review is an independent predictor of lung cancer survival.
One in five women who survive breast cancer will develop lymphoedema of the upper body at some point in their life. Following breast surgery, women are recommended to follow strategies to minimise their lymphoedema risk (e.g., limiting exposure of the at-risk arm to trauma). Adherence to these strategies is typically less than optimal.
Don't miss our upcoming webinars. Subscribe today!
This presentation will highlight the promising new therapeutic strategies in the treatment of gliomas, with a focus on trials or therapies that will soon be available for Canadian patients.
View the YouTube video: https://youtu.be/ibbEuvSF7xY
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Defining and assessing a delineation uncertainty margin for modern radiotherapyCancer Institute NSW
The implementation of image-guided technology and progressively conformal techniques in modern radiotherapy for the treatment of cancer, ensure the planned distribution of dose is well matched to the clinician-defined target volume. However, this precision relies on the target volume including all malignant tissue, with delineation uncertainty resulting in potential normal tissue toxicities and insufficient dose to the cancer. Methods need to be implemented to minimise delineation uncertainty, and subsequently improve local control and patient outcomes.
Don’t miss our upcoming webinars: Subscribe today!
The CanRehab Team brings together a large group of patients, researchers, and clinicians at four Canadian centres and includes three concurrent projects focused on improving access to effective, appropriate, and timely cancer rehabilitation (CanRehab Team).
The objectives of the presentation are: 1) to provide a background on cancer rehabilitation; 2) to introduce the CanRehab Team projects; and 3) to provide an overview of the team structure including a call for interest to the Patient Advisory Committee.
View the YouTube video: https://youtu.be/B2tcIsrw4WE
To learn more about CCSN, visit us at survivornet.ca
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
An integrated model of psychosocial cancer care: a work in progress…Cancer Institute NSW
Cancer patients are faced with a multitude of stressors, from diagnosis, through treatment, at recurrence, in the stages following treatment completion, and in the terminal phase. Psychosocial care has been highlighted as a critical aspect of providing comprehensive patient-focused care. Specifically, one of the goals of The NSW Cancer Plan 2011-2015 is to improve the quality of life of people with cancer and their carers. This project was initiated to improve the current psychosocial model of care at The Kinghorn Cancer Centre (TKCC), to better reflect an integrated, holistic and comprehensive model of patient-centred care.
Comparative Effectiveness of a Multifaceted Intervention to Improve Adherence to Annual Colorectal Cancer Screening in Community Health Centers (RCT)
Présentation de David W. Baker au colloque "Recherche interventionnelle contre le cancer : Réunir chercheurs, décideurs et acteurs de terrain » - 17 et 18 novembre 2014, BnF, Paris
Building the bridge from discovery-to-delivery: A Community of Practice in Ca...Cancer Institute NSW
A research breakthrough is said to take approximately 17 years to translate into clinical practice. This time lag can have considerable implications for patients, their carers, health services, and public funds. To address this time lag, the Cancer Institute NSW and the Translational Cancer Research Centres (TCRCs) across the state developed a community of practice (CoP) to increase knowledge, skills, and capacity in implementation science.
Retention of Graduates in NB from the N.B. Medical Training Centre: Demograph...DataNB
The number and retention of physicians practicing in New Brunswick is a major issue in the province. This webinar aims to present demographic data to explore the factors linked to the retention of CFMNB medical graduates. Among the factors discussed are medical specializations, as well as graduates’ gender and place of origin (urban vs rural). This communication also discusses physicians from New Brunswick who have studied at the Université Laval or Université de Montréal through the NB – Québec Agreement.
Don’t miss our upcoming webinars: Subscribe today!
In this webinar:
Join CCSN and Marjut Huotari, VP-Healthcare Insights at Leger, as we present the results of the COVID-19 and Cancer Care Disruption in Canada Survey and hear from members of the cancer community about how the pandemic has directly impacted them.
View the video:
https://youtu.be/6ub1ot806-A
To learn more about CCSN, visit us at survivornet.ca
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Don't miss our upcoming webinars: Subscribe today!
In this webinar:
Dr. Paula Gordon will share information on when individuals should start screening for breast cancer, and how often to screen - in order for cancer to be found as early as possible, and to allow the least aggressive options for treatment. Dr. Gordon will also discuss how to screen for recurrence in women who’ve had cancer, explain why these methods are not always offered, and suggest what you can do to improve access to optimal screening.
View the video: https://youtu.be/7uFksz6_4Zk
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Implementing online mental health supports into community-based survivorship ...Cancer Institute NSW
The intersection of developmental vulnerabilities and cancer-related stressors means that adolescents and young adults (AYAs) with cancer show more complex distress relative to other age groups.
A strategy for cancer in england over the next five years, pop up uni, 11am, ...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Colorectal screening evidence & colonoscopy screening guidelines Health Evidence™
Health Evidence hosted a 90 minute webinar examining colorectal cancer screening: benefits and harms, effective screening methods, and screening guidelines.Click here for access to the audio recording for this webinar: https://www.youtube.com/watch?v=JqOV-KHCBq8
Donna Fitzpatrick-Lewis, MSW, Senior Research Coordinator at the McMaster Evidence Review and Synthesis Centre and Dr. Maria Bacchus, Associate Professor of Medicine, Faculty of Medicine University of Calgary, and member of the Canadian Task Force on Preventive Health Care led the session. Donna presented the findings of the Synthesis Centre’s latest review and Dr. Bacchus presented findings from the Task Force’s latest guidelines:
Fitzpatrick-Lewis, D., Usman, A., Warren, R., Kenny, M., Rice, M., Bayer, A., Ciliska, D., Sherifali, D., Raina, P. Screening for colorectal cancer. Ottawa: Canadian Task Force on Preventive Health Care; 2015. Available: http://canadiantaskforce.ca/files/crc-screeningfinal2.pdf
Bacchus, C. M., Dunfield, L., Gorber, S. C., Holmes, N. M., Birtwhistle, R., Dickinson, J. A., Lewin, G., Singh, H., Klarenbach, S., Mai, V., Tonelli, M. (2016). Recommendations on screening for colorectal cancer in primary care. Canadian Medical Association Journal, cmaj-151125.
Among men and women, colorectal cancer is the second and third most common cause of cancer related death, respectively. Colorectal cancer screening guidelines, developed by the Canadian Task Force on Preventive Health Care, are based on a systematic review synthesizing evidence on the benefits and harms of screening, and the characteristics of effective screening tests. The guidelines, developed from the review, outline screening recommendations for adults aged 50 and older who are asymptomatic and not at high risk for colorectal cancer. This webinar provided a high level overview of the systematic review that informed these recommendations, followed by an overview of the recent Canadian screening guidelines.
How general internists can participate in the continuum of care for patients with cancer. (Talk given at Internal Medicine Grand Rounds, St. Elizabeth Hospital, General Santos City, 10 Feb 2021.)
Aldo Rolfo, National Clinical Development Manager, Genesis Cancer Care, Austr...GenesisCareUK
A program that seeks to redefine best practice across the drivers of the GenesisCare business (Quality, Access and Efficiency) in order to deliver on their vision of “Innovating Healthcare. Transforming Lives.”
The Value of Targeted Sequencing in Advanced Cancer: DCE to Elicit the Public...Office of Health Economics
This project seeks to elicit the public’s preferences for different features of a genomic test to sequence advanced solid cancer tumours. Understanding the relative preferences for various attributes of targeted testing are useful for determining the value of sequencing approaches, and informing technology adoption decisions. A discrete choice experiment (DCE) survey was designed to assess the preferences of members of the Australian general public for targeted sequencing in advanced cancer. The survey presented respondents with 12 questions in which they had to choose between two unlabelled tests (Test A and Test B). Tests were specified in terms of five attributes: time to receive the test result; cost of the test; likelihood that the test result will lead to a change in treatment; length of time health care professionals spend describing the test; and type of health care team who explains the test result. Respondents were sampled from an online panel and also completed questions related to demographic and socio-economic factors, experiences of cancer and familial history. We found that cost, timeliness, expertise/location and likeliness of changing treatment regimes were identified as attributes of genomic sequencing that are most valuable to a sample of the public. These results will ultimately be compared with the results of an ongoing DCE being conducted with patients with advanced cancer who are undergoing sequencing.
Author(s) and affiliation(s): Paula Lorgelly (OHE), Grace Hampson (OHE), James Buchanan (Oxford), Melissa Martyn (MGHA), Jayesh Desai (PeterMac), Clara Gaff (MGHA), and iPREDICT MGHA Flagship collaborators
Conference/meeting: EuHEA 2018
Location: Maastricht, the Netherlands
Date: 12/07/2018
Bea Brown | a locally tailored intervention to improve adherence to a clinica...Sax Institute
Bea Brown gave a presentation on her research for the Sax Institute at the University of Sydney for the School of Public Health's 2013 research presentation day.
Research on consequences of cancer and its treatment on quality of life, symp...Nata Chalanskaya
Susanne Oksbjerg Dalton, Group Head, consultant, Danish Cancer Society Research Center, Danish Cancer Society, presentation at the Second International Scientific and Practical Conference «Improving the quality of life of cancer patients through the development of cooperation between state, commercial and non-profit organizations». 2018-01-23, Minsk. Belarus.
Understanding The Principles Multi-Disciplinary Approach To Cancer Treatment ...flasco_org
Providing a course that is relevant, practical and patient-centered that will positively impact the speed in which entry-level oncology specialists integrate into the oncology practice setting.
Similar to Innovations conference 2014 building a quality cancer system concurrent session presentations freshwater 1 and 2 (20)
Cervical screening – taking care of your health flipchart (Farsi)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Farsi women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Khmer)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Khmer women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Dari)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Dari women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Nepali)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Nepalese women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Nepali)
Cervical screening – taking care of your health flipchart (Turkish)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Turkish women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Thai)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Thai women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Korean)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to Korean women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to women, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Arabic)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to women of a Arabic background, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Vietnamese)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to women of a Vietnamese background, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Thai)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to women of a Thai background, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Bengali))Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to women from different cultural backgrounds, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Cervical screening – taking care of your health flipchart (Tibetan)Cancer Institute NSW
The flipchart has been developed by the Cancer Institute NSW as a tool to assist in providing information on cervical cancer and cervical screening to women from different cultural backgrounds, particularly those eligible to participate in the National Cervical Screening Program (NCSP).
Staying well and preventing cancer: Community education flipchartCancer Institute NSW
One in three cancers can be prevented through healthy living behaviours.
The Cancer Institute NSW developed the Staying well and preventing cancer flipchart to support health or community workers/educators working with multicultural communities.
The flipchart uses simple text and illustrations to provide information about cancer prevention and healthy living behaviours.
3. Beliefs, behaviours and systems in primary care:
NSW findings from the International Cancer
Benchmarking Partnership
Jane Young, Claire McAulay, Ingrid Stacey, Megan Varlow, David Currow
SYDNEY MEDICAL SCHOOL
Jane Young | University of Sydney
Cancer Epidemiology and Cancer Services Research Group
Sydney School of Public Health
4. Background to ICBP
• Evidence of variations in cancer survival between different
European countries
• Example – rectal cancer : 5-year age-standardised relative
survival
– Switzerland 61%
– England 52%
– Poland 39%
Sant et al, Eu J Cancer 2009
• ICBP formed to try to answer these questions
• Focus on lung, colorectal, breast and ovarian cancer
4
5. ICBP Module 3 aims
• To explore whether differences in primary care systems might
explain variations in cancer survival between countries
• In NSW, to investigate GPs’:
• beliefs about early diagnosis of cancer and their role in the cancer system
• access to diagnostic tests and specialists in the public and private sectors
• self reported practices for patients presenting with suspicious symptoms
• views of resources that could improve the interface between primary and
specialist care
• To compare responses for urban and rural GPs
5
6. Methods
• Online survey of GPs in
– UK (England, Wales, Northern Ireland)
– Scandinavia (Norway, Sweden, Denmark)
– Canada (British Columbia, Manitoba, Ontario)
– Australia (Victoria and NSW)
• GPs’ behaviours measured using case scenarios
• GPs’ beliefs and systems measured using direct questions
• Additional questions in NSW and Victoria:
– access to services in the public and private sectors
– out-of-pocket expenses for patients
– influences on referral practices
– preferences for resources to improve the interface between primary and specialist care
6
7. NSW sample and recruitment
• Random sample of GPs identified from a commercial
list (AMPCo)
• Stratified by urban or regional/rural location based
on ARIA+ classification of practice postcode
• Primer letter, invitation and up to 3 mailed
reminders
• GPs were ineligible if:
– not working primarily in clinical general practice
– provided locum services only
– had died, retired, on extended leave
– no longer in NSW
7
9. Characteristics of respondents
9
Characteristic Rural (N = 140) Urban (N= 133)
n (%) n (%)
Female 61 (44) 62 (47)
Age (years) < 35 14 (10) 13 (10)
35–44 28 (20) 22 (17)
45–54 42 (30) 44 (33)
55–64 52 (37) 39 (29)
≥ 65 4 (3) 15 (11)
GP registrar 10 (7) 8 (6)
Sole practitioner 13 (9) 21 (16)
Part time 44 (31) 54 (41)
Years in general practice
< 3 11 (8) 8 (6)
3–5 18 (13) 10 (8)
6–10 12 (9) 21 (16)
11 + 99 (71) 94 (71)
10. Beliefs about timely diagnosis
10
More timely diagnosis of cancer is important to ensure better outcomes
Agree or Strongly agree
Rural (%) Urban (%)
Colorectal 97 98
Melanoma 96 98
Breast 94 96
Ovarian 89 95
Lung 83 89
Prostate 51 56
11. Beliefs about role in cancer system
11
Agree or strongly agree
Rural (%) Urban (%)
I like to wait until I am sure of a diagnosis before referring to a
specialist
21 17
I am often unclear about when I should refer to a specialist when
I suspect cancer
6 4
Protecting patients from over-investigation is an important part
of my role
44 39
Preventing secondary/specialist care cancer services from being
overloaded is an important part of my role
44 39
12. Influences on management decisions
12
Agree or strongly agree
Rural (%) Urban (%)
Fear of litigation sometimes influences my decisions to order
investigations
38 48
Fear of litigation sometimes influences my decisions to refer 35 43
I sometimes order cancer investigations that I don’t feel are
36 40
indicated due to patient pressure
I sometimes refer patients due to patient pressure rather than
clinical indication
29 31
13. Access to specialist advice within 48
hours regarding investigations for
suspected cancer
13
Agree or strongly agree
Rural (%) Urban (%)
Public system 51 51
Private system 76 89
14. Specialist referral within 48 hours for
patient with suspected cancer
14
Agree or strongly agree
Rural (%) Urban (%)
Public system 36 50
Private system 69 82
15. Proportion of GPs reporting direct
access to GI diagnostic tests (no
specialist referral required)
15
NSW
rural
NSW
urban
VIC rural VIC urban
Upper GI endoscopy 21 30 53 9
Flexible sigmoidoscopy 14 21 29 43
Colonoscopy 21 31 47 78
16. Access to colonoscopy
16
Proportion of GPs reporting average waiting time of 4 weeks or less:
NSW rural NSW urban VIC rural VIC urban
Public system 14 23 24 18
Private
system
79 88 84 96
Proportion of GPs receiving colonoscopy results within 1 week:
NSW rural NSW urban VIC rural VIC urban
37 40 67 68
17. Proportion of GPs who can arrange
colonoscopy with no out of pocket
expenses
17
Rural Urban
Yes, this is easy to organise 25 25
Yes, but with difficulty 51 56
No 19 18
Don’t know 4 2
18. Proportion of GPs reporting time to
specialist appointment within 2
weeks
18
Rural Urban
General surgeon Public
Private
46
85
58
94
Gastroenterologist Public
Private
31
68
52
92
Colorectal surgeon Public
Private
38
69
50
91
Respiratory physician Public
Private
36
66
55
87
Thoracic surgeon Public
Private
29
57
46
84
Gynaecologist Public
Private
46
77
56
90
Gynaecologic oncologist Public
Private
27
52
48
77
19. GPs’ perceived importance of various factors for selecting a specialist
Factor Rural Urban
Previous experience referring patients to this specialist 84.3 90.2
Length of wait for appointment 70 68.4
Patient preference 49.3 52.6
Colleague recommendation 52.1 48.9
Specialist's hospital has good reputation for cancer care 32.1 57.9
Specialist is member of MDT 33.6 51.1
Specialists’ relevant cancer caseload 29.3 43.6
Know specialist personally 32.9 38.3
Out of pocket costs for patients 32.9 34.6
Distance patient must travel 33.6 26.3
Specialist's hospital has good published outcomes/low complication
17.1 41.4
rates for cancer patients
Specialist is in directory of cancer specialists 6.4 19.5
Specialist is involved in clinical trials 3.6 11.3
19
20. Perceived usefulness of resources for
informing about cancer services and
referral pathways
20
Factor Percentage responding “very important”
Rural Urban
Discussion with colleagues 82 76
GP meetings or seminars 60 63
Feedback from patients 41 44
Mailed brochures or info from
36 40
hospitals/specialists
GP publications and newsletters 25 41
Directory of specialists/services 26 39
Internet searches 24 29
Cancer Institute NSW CanRefer
14 19
website
21. Limitations
• Very low response rate
• Participating GPs more positive towards cancer
care than non-responders
• Scope of questions limited due to requirements
of standardised instrument
21
22. Summary
• GPs expressed strong support for timely diagnosis to improve
patient outcomes for breast, colorectal and melanoma skin
cancer, but less for other cancer types
• Almost half of GPs considered that gatekeeping was an
important part of their role
• There were marked differences in access to diagnostic tests
and specialist services between urban and regional/rural GPs
and for patients in the public and private sectors
• Waiting times were one of the most important factors
influencing referral pathways
• These findings can inform future programs to enhance the
interface between primary and specialist care and provide a
baseline to monitor change
22
23. Acknowledgements
• We thank the GPs who participated in the survey, the ICBP
Module 3 team who developed the core questionnaire and
Sigmer UK who developed and managed the online database
• The study was funded by the Cancer Institute NSW
• JY is supported by Academic Leader in Cancer Epidemiology
award number 08/EPC/1-01 from the Cancer Institute NSW
and CM was employed through this award
• Paper reporting embedded RCT of financial incentives to
improve response rate will be published in Journal of Clinical
Epidemiology (in press)
23
26. Team Members
• Sandra Turley Cancer Care Coordinator (CCC)
Project Lead
•Melissa Cumming Director Cancer & Palliative
Care
•Previous Members:
• Jennifer Carter Psycho-Oncology Counsellor
•Ruby Hooke Psycho-Oncology Counsellor
27. Background
•2008 Loss of visiting Medical Oncology Service
to Broken Hill
•Patients referred directly from GP to metro
centres
•Local cancer services not accessed
•Decreased referrals to CCC
•Poor coordination of care
28. Background ctd
•Fragmented care
•Increased presentations to ED
•Increased patient & carer stress
•Poor communication between service providers
•Patients lost in the system
29. What now?
• Improve integration of care
• Promote role CCC – first point of contact
• Improve communication between providers
• Maintain profile of Cancer Services in BH
• Identify barriers to referral
• Develop and implement Cancer Care Referral
Pathway (CCRP)
30. Method
•Multi step approach undertaken over a 4 year
period
•Step 1 (2009) – successful recipients Innovation
Scholarship NAMO
•Scoping study – service mapping, consultations
with stakeholders, focus groups, consumer
interviews, health advisory board members,
community support groups
31. Findings from Scoping Study
9 findings in total – most significant being:
•Loss of Specialist Oncology Services had a
profound impact upon cancer care
•Lack of awareness of the role of the CCC
•Lack of knowledge of how to access CCC
•High turnover of medical staff and GPs in BH
•People affected by cancer were not aware of
supports available
32. Next Step
• (2011)- Applied for funding to develop and
implement recommendations outlined in
scoping study - application declined
•(2012)– Successful Innovation Grant CINSW
Develop Cancer Care Referral Pathway
33. Developing the Cancer Care Referral Pathway
•Collaboration/consultation with GPs and
Practice Nurses designing both an
electronic/paper version
•Liaison with GP IT providers embedding trial
templates & accompanying referral criteria into
practices including Maari Ma (Aboriginal Health
Service) and Royal Flying Doctor Service (RFDS)
34. Development Ctd
•Development promotional material
•Designed & implemented TV commercial
•Feedback letter template
•Acknowledgement of referral
•Public Launch & implementation of pathway
35. The Pathway Look
•Simple & easy to use
•Located in one electronic folder
•Utilized existing referral letter templates
•Uploaded section B IPTAAS form
•Local pathology & radiology request forms
•External provider request forms
36. Referral Criteria (hard copy)
Criteria Rationale
New Cancer Diagnosis
or
Unclear diagnosis and
treatment plan
• Ensure patient and carers aware of service to
access education and support when needed
• Provide point of contact
• Provide continuity of care
• To access need for ongoing support
• Facilitate links with treating specialist via face to
face consultation of via telemedicine
Travel outside of FWLHD
to access treatment and
specialist intervention
• Provide coordination of appointments and tests
• Facilitate communication between clinicians,
patients and carers
• Provide continuity of care, referral to Metro CCC
• Assist with travel and accommodation
37. Referral Criteria (hard copy) ctd
Criteria Rationale
Unpredicted change in
condition or treatment
plan
• Facilitate new treatment plan with MDT
• Educate patient and carer
• Facilitate communication between clinicians
Admission to ED or
Hospital
• Provide support and continuity of care
• Facilitate communication between clinicians,
patient and carers
• Assess need for community services
Poorly controlled /
multiple comorbidities
• Ensure knowledge of services and
responsibilities of care
• Facilitate communication between clinicians,
patient and carers
40. Remembering the Aim of the Pathway
•Promote CCC as first point of contact after
cancer diagnosis
•Promote role across all sectors ensuring
integrated care coordination
•Raise community awareness of role
•Ongoing engagement with community and
health providers
41. Referrals prior to Pathway
Source Number
Patient/ family referrals 13
Public Hospital 13
GP referrals 6
Oncology referrals 2
Surgeon referrals 3
Community services 1
IPTAAS 5
7 sources of referrals
Total number of
referrals 43
42. Results post introduction of Pathway
Source Number
GP 15
Maari Ma 6
Plastic Surgeon 7
Gastro Surgeon 5
RFDS 3
Gynaecologist 3
Haematologist 2
Self-referral/ Family 40
Oncology 10
Wards 27
RAH 10
Pre-admission 9
IPTAAS 3
Source Number
Leukaemia
1
Foundation
Flinders Medical 2
Emergency 2
Theatre 1
Outreach 1
Breast Screen 1
19 sources of referral
Total number of Referrals
148
43. Outcomes
•Patients not ‘falling through gaps’ - being
referred at diagnosis / more timely manner
•Care is integrated and coordinated between care
providers (local and tertiary)
•CCC can ensure right care is provided in right
place at right time
•Patients/carers feel supported in navigating
cancer treatment system
44. Testimonial
•“…the cancer care coordinator …has given me a
lot more confidence about the process, my
feeling of being back in control of my body,
explaining the recent scan results in terms I can
understand and helped me to overcome
problems with pain, medication and side
effects”
(Heather-patient)
45. Sustainability
•Embedded referral pathway
•Ongoing collaboration/ education
•Backfill for CCC
•Advertising / printed resources continue
•Ownership of coordinated care (eg Maari Ma)
•Formal evaluation of CCRPP with UDRH
•New collaborative partnerships between sectors
46. Transferability
•Cancer Care Referral Pathway is transferable
across small ‘like’ rural / remote communities
• Promotion of the role within the community is
paramount to success
•Components of CCRPP (eg advertising /
electronic referral pathways) transferable to
larger settings
50. Tim Shaw
Sarah York
Nicole Rankin
Deborah McGregor
Sanchia Aranda
Kahren White
Jane Young
Shelley Rushton
Deb Baker
Megan Varlow
Tina Chen
Tracey Flanagan
51. Background
CI NSW looking to develop Key Performance
Indicators to measure coordinated care
University of Sydney Commissioned to
undertake a consultative approach to develop
and prioritise success factors as first step
52. Cancer care
workshop
Scoping lit
review
Stakeholder
survey
Consumer
input
Small group refinement
and testing
20 success factors
for coordinated care
Priority setting workshops
Priority factors
CI NSW develop KPIs
53. Coordinated Cancer Care
Success Factors
Success Factors - relatively broad statements
which collectively describe successfully
coordinated care from a systems, practitioner
and patient POV.
A number of indicators could sit under each
success factor
54. Example
Success Factor: Patients receive timely &
appropriate care on the pathway from first
presentation to diagnosis and to
commencement of treatment.
Indicator: Time from first presentation to
treatment is recorded and meets recognised
tumour specific benchmark
Indicator: Patient survey indicates time to
treatment acceptable'
55. Coordinated Cancer Care - Success Factors
1. Patients receive best practice care defined by clinical practice guidelines or a
clinical pathway for each tumour group.
2. Patients receive timely and appropriate care on the pathway from first
presentation to diagnosis and to commencement of treatment.
3. Patient care takes into account patient and carer needs and preferences (e.g.
service locations).
4. Patients at elevated risk of disjointed care and poorer outcomes (e.g. CALD,
Aboriginal & Torres Strait Islander) are identified and systems are in place to
ensure care is appropriately managed and coordinated.
5. All patients have a comprehensive care plan that is created jointly by
patients, family and health professionals and that is documented, accessible
by relevant care providers and patients and maintained over the course of
their care.
6. Transition of patients across each point of the care trajectory (e.g. from
diagnosis to treatment) is well managed and takes into consideration the
patient’s physical, social and emotional needs.
56. Coordinated Cancer Care - Success Factors
7. Transfer of patient information (e.g. test results) between members of the
multidisciplinary team is timely and well managed at each transition point.
8. Patients, families and carers receive timely, relevant and appropriate
information at key points along their care trajectory; this may include their
diagnosis, prognosis and intention of treatment (e.g. curative/palliative),
depending on cultural appropriateness
9. Patients have timely referral and allocation to a key contact person to assist
with the coordination of their care.
10. Transfer of information and care between primary and community care
providers and specialist services is timely and appropriate.
11. Patients, carers and families know who to contact for information at
different stages during their care trajectory.
12. All patients are considered for discussion at an MDT meeting in a timely
manner and exclusions are guided by protocols
13. All appropriate team members from core disciplines (including diagnostic,
oncology clinicians, GPs, allied health and supportive care) attend and
contribute at weekly/fortnightly MDT meetings.
57. Coordinated Cancer Care - Success Factors
14. MDT meeting members are made aware of patient concerns, preferences
and social circumstances and MDT meeting discussions consider a patient’s
medical and supportive care needs.
15. The roles and responsibilities of all health care professionals involved in
patients care are communicated and understood.
16. Side effects of disease and treatment are managed in a timely and
appropriate manner by the care team to reduce unnecessary visits to ED
and hospital admissions.
17. Patients are routinely screened for physical, psychological and supportive
care needs using validated tools and referred to required services in an
appropriate and timely manner.
18. Patients are aware of and have access to practical assistance and financial
entitlements as appropriate (e.g. transport and accommodation).
19. Patients receive clear follow-up care plans according to tumour specific
guidelines and appropriate survivorship information.
20. Patients receive timely screening and referral to palliative care services.
58. Priority Setting Workshop
Implement a process of selecting the
most significant and measurable
success factors for future KPI
development
Based on Sydney Catalyst
Methodology
59. Individual Matrix Activity
Significance Measurability
Criteria
Success Factor
Transfer of information
and care between
primary and community
care providers and
specialist services is
timely and appropriate.
Patients receive timely
screening and referral to
palliative care services.
Agree
Least
Agree
Most
1 2 3 4 5
60. Priority Setting Criteria
Significance Measurability
Most likely to impact on
patient outcomes
Could a KPI be developed that
could be feasibly measured and
reported on across the board?
Current data point or system in
place to allow for data collection
(or soon to be)
Data sources
- Electronic database (OMIS/RIS)
-Patient Reported
64. Next steps..
4 x priority setting workshops with
care coordinators
1 x priority setting workshop with
Cancer Council NSW consumer group
Develop initial set of indicators built
around success factors
65. Conclusion
First time success factors have been
identified
Good agreement on priorities across
workshops to date
Approach represents a constructive way
to begin to measure improvement across
the cancer system in NSW'
66.
67. A systematic approach to closing
evidence gaps in cancer care:
The Sydney Catalyst experience
Deb McGregor, Nicole Rankin, Tim Shaw, Sarah York,
Phyllis Butow, Kate White, Jane Phillips, Jane Young, Sallie
Pearson, Lyndal Trevena, & Puma Sundaresan
Sydney Catalyst Translational Cancer Research Centre
University of Sydney
68. Evidence into Practice (T2/T3) Working Group
Tim Shaw (Chair)
Nicole Rankin
Jane Young
Phyllis Butow
Kate White
Lyndal Trevena
Deb McGregor
Collaborating sites
Sarah York
Philip Beale
Sallie Pearson
Jane Phillips
John Simes
Puma Sundarasen
Western NSW LHD: Ruth Jones & team
St Vincent’s Hospital/Kinghorn: Emily Stone, Alan Spigelman & team
Royal Prince Alfred/Lifehouse: David Barnes, Philip Beale & team
69. Why Implementation Science?
Evidence Based Medicine 1990’s - present
Discovery Guidelines
69
Clinical
trials
Translate evidence into Practice –
implementation science
Gap
analysis
Apply/evaluate
interventions
Engage system
and clinicians
Data analytics
Research
30-40% of care
not evidence-based
Modest
impact on
safety metrics
70. Why lung cancer?
Burden of Illness
High incidence &
mortality in NSW
population
Poor outcomes; poor
survival: 14% after 5
years (2008)
Paucity of research
National and State
Priorities
Cancer Australia, Cancer
Institute NSW
Sydney Catalyst:
Local Context
Significant issue for
Catalyst catchment
Clinical leaders and
expertise within Catalyst
membership
71. IDENTIFY GAP
71
Flagship program
Literature
review (patterns
of care studies
previous data
linkages studies
etc)
New local data
analyses
eg MBS VA and
ClinCR
PRIORITISE GAPS AND ENGAGE TEAMS
Engage with
clinical sites
- understand
environment
Listing of
potential target
areas
•Prioritisation at
clinical sites
APPLY INTERVENTIONS
Intervention(s)
Gather baseline
data
Evaluate impact
Support Implementation studies
Link with local initiatives
72. Identifying evidence-practice gaps
• Patterns of Care Studies
• Data linkage studies – registry and administrative
datasets
• Clinical practice guidelines
• Systematic reviews and meta-analyses
• Peer reviewed publications
• Grey literature, including government publications
• Local sources of data: Clinical Cancer Registry data
for one Sydney Catalyst member hospital
73. Evidence-practice gaps
1. Not all people with lung cancer receive timely diagnosis and referral
for treatment; unnecessary delays at the patient, provider and service
levels have the potential to negatively impact on patient outcomes.
2. People with potentially curable lung cancer who will benefit from
active treatment do not always receive it; active treatments including
surgery, radiation therapy and chemotherapy are under-utilised.
3. People with advanced lung cancer who will benefit from palliative
treatment do not always receive it; palliative treatments including
palliative radiation therapy and chemotherapy are under-utilised.
74. Evidence-practice gaps
4. People with lung cancer who are of an older age or with co-morbidities
who may benefit from active treatment do not always receive treatment;
active treatments including surgery, radiation therapy and chemotherapy
are under-utilised.
5. People with lung cancer who would benefit from review at a
multidisciplinary team meeting are not always being reviewed.
6. People with lung cancer have high levels of psychosocial needs which
are not always being met, resulting in poorer outcomes and poorer quality
of life.
7. Not all people with lung cancer who would benefit from early referral
to palliative care services are offered this option, which may result in
poorer symptom control and poorer quality of life.
77. Priority gaps
Timely diagnosis and
referral for treatment
Early referral to palliative
care services
78. Flagship Phase II
• Mapping lung cancer care pathways
– Process mapping
– Qualitative interviews (Consumers, GPs and targeted physicians)
– Quantitative data audit (ClinCR and medical records)
• Pilot implementation project to reduce at least one evidence-practice
gap in lung cancer
Draft process map from Orange
Cancer Services meeting
79.
80. Fostering Integration of General Practices
with Cancer Services through Improved
Communication Pathways
Andrew Knight
Fairfield GP Unit
81. The Fairfield GP Unit
Andrew Knight, Siaw-Teng Liaw
SW Sydney LHD Cancer Services
Geoff Delaney
The Ingham Institute
Afaf Girgis
The SW Sydney Medicare Local
Rene Pennock/Keith McDonald
The Cancer Institute of NSW
82. 2 projects
1. Needs analysis semistructured interviews 22 GPs
across the region
– Like cancer services
– Want information/access
– Patient care letters not timely
2. Speed up letters
– Produce them quicker
– Transmit them better
83. Q1. What are we trying to achieve?
Letters in a week.
Q2. How will we know the change is an
improvement?
Mosaic – dictation to approval of letters
Q.3 What changes do we think will make a
difference?
Process map and PDSA/rapid improvement cycles
89. Currently mail.
Considered fax…
Digital
• The agenda
• Rapidly evolving environment
• Conversation begun
90. Our strategy
• Mosaic to Cerner
• Cerner to GPs
– “GP communications”
– Argus/Healthlink
– Health E Net
• GP communications
• Plug into what follows
91. Conclusion
• General practice and cancer services must work
together
• Partnerships required
• Timely communication necessary
• Possible to improve
• E health solutions required