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.

2. SYDNEY MEDICAL SCHOOL
Providing coordinated cancer care:
A population-based survey of patients’
experiences and preferences
Ms Ivana Durcinoska
Prof Jane Young, Prof Michael Solomon
Sydney School of Public Health
Surgical Outcomes Research Centre

3. Why Care Coordination?
Priority for health service improvement and fundamental to high-quality
cancer care1-5
Challenge for services due to growing demands and care complexity
Little understanding of adequacy of care coordination

4. Objectives
Assess experiences of cancer care coordination in a population-based
sample of patients with colorectal cancer
• Quantify patients’ experience of cancer care coordination
• Investigate patient- & system-related predictors of poor care coordination
• Identify patient preferences for resources to assist care coordination
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5. Methods
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NSW Central Cancer Registry (NSWCCR)
CRC notifications Oct 2012 – Mar 2013
(n= 2637)
Potentially eligible cases
Clinician consent requested
(n=1381)
Patients invited to participate
6 months post diagnosis
(n=1007)
Returned questionnaire
(n=560)
Excluded by registry (n=1256)
Deceased n=13
Ineligible n=1243
Excluded (n=374)
Clinician Refusal n=77
Unable to assign Clinician n=209
Deceased n=88
Excluded (n=447)
Refusal n=205
Unable to contact n=5
Non-response n=237

6. Participant Characteristics
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n %
Age – mean(SD) 68.19 (11.91)
Sex (male) 335 60
Single/separated/widowed 184 33
Country of birth (outside Australia) 143 26
Health insurance (private) 298 53
Received adjuvant therapy 255 46
Tumour site (rectum) 205 37
Spread
Localised 170 30
Regional 156 28
Distant metastasis 106 19
Remoteness (ARIA)
Major City 359 64
Inner Regional 134 24
Outer Regional, Remote 67 12

7. Predictors of Poorer Care Coordination
Patient-related factors n (%) coef. p-value
Little/no understanding of health system 333 (60%) -4.34 <0.001
Comorbidities 0.01
none* 167 (30%)
1-2 312 (56%) -0.79 0.45
>2 81 (14%) -4.57 0.002
No regular general practitioner (GP) 30 (6%) -4.09 0.05
System-related factors
Didn’t receive written plan before start of treatment 318 (58%) -4.15 <0.001
Didn’t see a care coordinator/specialist cancer
nurse
397 (71%) -3.29 0.001
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 Mean care coordination experience 76.1(10.9) (range 20-100)

8. What do patients’ want?
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9. Summary
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Wide variation in experience of care coordination across NSW
Patient groups at greater risk of poor care coordination:
o More comorbid conditions
o Poor understanding of health system
o No regular general practitioner (GP)
Strategies that increase the use of pre-treatment plans and access to
care coordinators or specialist cancer nurses may improve patients’
experience
Strategies should be rigorously tested, particularly for patients with
other risk factors of experiencing poor care coordination

10. References
1. Institute of Medicine. Delivering high quality cancer care charting a new course for a system in
crisis. Washington DC, National Academy Press: 2013
2. National Health Priority Action Council. National Service Improvement Framework for Cancer.
Canberra: National Health Priority Action Council, 2004
3. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century.
Washington DC, National Academy Press: 2001
4. NSW CI, NSW Cancer Plan 2011-2015. Cancer Institute NSW, 2010
5. Health Q, Queensland Statewide Cancer Treatment Services Plan2010-2017. Queensland
Government, 2009
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11. Acknowledgements
Study participants who completed the survey
Cancer Institute NSW, Translational Health Services Research Grant
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