Skip to main content
Top
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Care | Research article

Implementing standardized cancer patient pathways (CPPs) – a qualitative study exploring the perspectives of health care professionals

Authors: Sara Delilovic, Henna Hasson, Mårten Åhström, Mia von Knorring

Published in: BMC Health Services Research | Issue 1/2019

Login to get access

Abstract

Background

Many countries have implemented standardized cancer patient pathways (CPPs) to reduce waiting times in cancer care and to ensure timely and quick diagnosis as well as treatment. Yet, no studies have explored the implementation process as perceived by the health care professionals working in the CPPs. The aim of this study is to explore the experiences of health care professionals (HPCs) involved in the CPPs.

Methods

A descriptive qualitative design was adopted. Thematic analysis was applied to individual interviews conducted in 2016–2017 with 58 participants working in six different CPPs in Sweden’s largest region, covering care for around 2.3 million inhabitants.

Results

In general, the health care professionals had a positive attitude towards the implementation of the CPPs. Our findings showed that the CPPs require close collaboration, both between and within different health care professional groups and units, something that was not always probable due to differences in resource capacity. Better dissemination to all relevant professionals, better conceptualization, and equivalent opportunities in terms of resources were identified by the respondents as being important yet lacking in practice. The analysis showed possible negative effects of the CPP, such as crowding-out on other patient groups.

Conclusion

The CPPs were introduced to address challenges with long waiting times and unequal cancer care. By exploring the experiences of health care professionals involved in the implementation of CPPs, our findings show challenges with multi-level coordination and collaboration, policy dissemination, and resource constraints. The analysis also showed that the implementation of CPPs risk being accompanied by unintended effects such as longer waiting times for other patients and patient groups in need of the same health care resources. The results shed light on and contribute to an understanding of the challenges, opportunities and ways forward.
Literature
2.
go back to reference Viberg N, Forsberg BC, Borowitz M, Molin R. International comparisons of waiting times in health care – Limitations and prospects. Health Policy. 2013;112(1–2):53–61.CrossRef Viberg N, Forsberg BC, Borowitz M, Molin R. International comparisons of waiting times in health care – Limitations and prospects. Health Policy. 2013;112(1–2):53–61.CrossRef
3.
go back to reference Coleman MP, Forman D, Bryant H, Butler J, Rachet B, Maringe C, et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): An analysis of population-based cancer registry data. Lancet. 2011;377(9760):127–38.CrossRef Coleman MP, Forman D, Bryant H, Butler J, Rachet B, Maringe C, et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): An analysis of population-based cancer registry data. Lancet. 2011;377(9760):127–38.CrossRef
4.
go back to reference Robertson S, Adolfsson J, Stattin P, Sjövall A, Winnersjö R, Hanning M, et al. Waiting times for cancer patients in Sweden: A nationwide population-based study. Scand J Public Health. 2017;45(3):230–7.CrossRef Robertson S, Adolfsson J, Stattin P, Sjövall A, Winnersjö R, Hanning M, et al. Waiting times for cancer patients in Sweden: A nationwide population-based study. Scand J Public Health. 2017;45(3):230–7.CrossRef
5.
go back to reference The National Board of Health and Welfare. Väntetider i cancervården [Waiting times in cancer care]: Socialstyrelsen; 2014. The National Board of Health and Welfare. Väntetider i cancervården [Waiting times in cancer care]: Socialstyrelsen; 2014.
6.
go back to reference The National Board of Health and Welfare. Standardiserade vårdförlopp i cancervården [Standardized patient pathways in cancer care]: Socialsyrelsen; 2016. The National Board of Health and Welfare. Standardiserade vårdförlopp i cancervården [Standardized patient pathways in cancer care]: Socialsyrelsen; 2016.
8.
go back to reference Wilkens J, Thulesius H, Schmidt I, Carlsson C. The 2015 National Cancer Program in Sweden: Introducing standardized care pathways in a decentralized system. Health Policy. 2016;120(12):1378–82.CrossRef Wilkens J, Thulesius H, Schmidt I, Carlsson C. The 2015 National Cancer Program in Sweden: Introducing standardized care pathways in a decentralized system. Health Policy. 2016;120(12):1378–82.CrossRef
9.
go back to reference Schmidt I, Thor J, Davidson T, Nilsson F, Carlsson C. The national program on standardized cancer care pathways in Sweden: Observations and findings half way through. Health Policy. 2018;122(9):945–8.CrossRef Schmidt I, Thor J, Davidson T, Nilsson F, Carlsson C. The national program on standardized cancer care pathways in Sweden: Observations and findings half way through. Health Policy. 2018;122(9):945–8.CrossRef
10.
go back to reference The Norweigan Directorate for Health. Implementering av pakkeforløp for kreft Nasjonal plan for implementering av pakkeforløp for kreft [Implementation of the patient pathways for cancer]. Oslo: Health Directorate; 2015. The Norweigan Directorate for Health. Implementering av pakkeforløp for kreft Nasjonal plan for implementering av pakkeforløp for kreft [Implementation of the patient pathways for cancer]. Oslo: Health Directorate; 2015.
11.
go back to reference Jensen H, Tørring ML, Olesen F, Overgaard J, Vedsted P. Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study. BMC Cancer. 2014;14(1):636.CrossRef Jensen H, Tørring ML, Olesen F, Overgaard J, Vedsted P. Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study. BMC Cancer. 2014;14(1):636.CrossRef
12.
go back to reference Ingeman ML, Christensen MB, Bro F, Knudsen ST, Vedsted P. The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer – A cross-sectional study of patient characteristics and cancer probability. BMC Cancer. 2015;15(1):421.CrossRef Ingeman ML, Christensen MB, Bro F, Knudsen ST, Vedsted P. The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer – A cross-sectional study of patient characteristics and cancer probability. BMC Cancer. 2015;15(1):421.CrossRef
13.
go back to reference Jensen H, Tørring ML, Vedsted P. Prognostic consequences of implementing cancer patient pathways in Denmark: A comparative cohort study of symptomatic cancer patients in primary care. BMC Cancer. 2017;17(1):627.CrossRef Jensen H, Tørring ML, Vedsted P. Prognostic consequences of implementing cancer patient pathways in Denmark: A comparative cohort study of symptomatic cancer patients in primary care. BMC Cancer. 2017;17(1):627.CrossRef
14.
go back to reference Probst HB, Hussain ZB, Andersen O. Cancer patient pathways in Denmark as a joint effort between bureaucrats, health professionals and politicians – A national Danish project. Health Policy. 2012;105(1):65–70.CrossRef Probst HB, Hussain ZB, Andersen O. Cancer patient pathways in Denmark as a joint effort between bureaucrats, health professionals and politicians – A national Danish project. Health Policy. 2012;105(1):65–70.CrossRef
15.
go back to reference Dodds W, Morgan M, Wolfe C, Raju KS. Implementing the 2-week wait rule for cancer referral in the UK: General practitioners’ views and practices. Eur J Cancer Care. 2004;13(1):82–7.CrossRef Dodds W, Morgan M, Wolfe C, Raju KS. Implementing the 2-week wait rule for cancer referral in the UK: General practitioners’ views and practices. Eur J Cancer Care. 2004;13(1):82–7.CrossRef
16.
go back to reference National Institute for Health and Clinical Excellence. Referral guidelines for suspected cancer. London: National Institute for Health and Clinical Excellence; 2005. ISBN 1-84629-053-8 National Institute for Health and Clinical Excellence. Referral guidelines for suspected cancer. London: National Institute for Health and Clinical Excellence; 2005. ISBN 1-84629-053-8
17.
go back to reference Jensen H, Vedsted P. Exploration of the possible effect on survival of lead-time associated with implementation of cancer patient pathways among symptomatic first-time cancer patients in Denmark. Cancer Epidemiol. 2017;49:195–201.CrossRef Jensen H, Vedsted P. Exploration of the possible effect on survival of lead-time associated with implementation of cancer patient pathways among symptomatic first-time cancer patients in Denmark. Cancer Epidemiol. 2017;49:195–201.CrossRef
20.
go back to reference Salamonsen A, Kiil MA, Kristoffersen AE, Stub T, Berntsen GR. “My cancer is not my deepest concern”: Life course disruption influencing patient pathways and health care needs among persons living with colorectal cancer. Patient Prefer Adherence. 2016;10:1591–600.CrossRef Salamonsen A, Kiil MA, Kristoffersen AE, Stub T, Berntsen GR. “My cancer is not my deepest concern”: Life course disruption influencing patient pathways and health care needs among persons living with colorectal cancer. Patient Prefer Adherence. 2016;10:1591–600.CrossRef
23.
go back to reference Kvale SBS. Interviews: Learning the craft of qualitative research interviewing. Los Angeles: Sage Publications; 2009. Kvale SBS. Interviews: Learning the craft of qualitative research interviewing. Los Angeles: Sage Publications; 2009.
24.
go back to reference Polit D, Beck C. Nursing research. Philadelphia, Pa: Lippincott Williams & Wilkins; 2004. Polit D, Beck C. Nursing research. Philadelphia, Pa: Lippincott Williams & Wilkins; 2004.
25.
go back to reference Koontz T, Newig J. From Planning to Implementation: Top-Down and Bottom-Up Approaches for Collaborative Watershed Management. Policy Stud J. 2014;42(3):416–42.CrossRef Koontz T, Newig J. From Planning to Implementation: Top-Down and Bottom-Up Approaches for Collaborative Watershed Management. Policy Stud J. 2014;42(3):416–42.CrossRef
29.
go back to reference Patton MQ. Qualitative research and evaluation methods. 3rd ed. Thousand Oaks, CA: Sage Publications; 2002. Patton MQ. Qualitative research and evaluation methods. 3rd ed. Thousand Oaks, CA: Sage Publications; 2002.
30.
go back to reference Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015;42(5):2–4.CrossRef Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015;42(5):2–4.CrossRef
31.
go back to reference Robinson OC. Sampling in interview-based qualitative research: A theoretical and practical guide. Qual Res Psychol. 2014;11(1):25–41.CrossRef Robinson OC. Sampling in interview-based qualitative research: A theoretical and practical guide. Qual Res Psychol. 2014;11(1):25–41.CrossRef
32.
go back to reference Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.CrossRef Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.CrossRef
33.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef
34.
go back to reference Strehlenert H, Richter-Sundberg L, Nyström ME, Hasson H. Evidence-informed policy formulation and implementation: A comparative case study of two national policies for improving health and social care in Sweden. Implement Sci. 2015;10(1):1–10.CrossRef Strehlenert H, Richter-Sundberg L, Nyström ME, Hasson H. Evidence-informed policy formulation and implementation: A comparative case study of two national policies for improving health and social care in Sweden. Implement Sci. 2015;10(1):1–10.CrossRef
35.
go back to reference Nyström ME, Strehlenert H, Hansson J, Hasson H. Strategies to facilitate implementation and sustainability of large system transformations: A case study of a national program for improving quality of care for elderly people. BMC Health Serv Res. 2014;14(1):1–15.CrossRef Nyström ME, Strehlenert H, Hansson J, Hasson H. Strategies to facilitate implementation and sustainability of large system transformations: A case study of a national program for improving quality of care for elderly people. BMC Health Serv Res. 2014;14(1):1–15.CrossRef
Metadata
Title
Implementing standardized cancer patient pathways (CPPs) – a qualitative study exploring the perspectives of health care professionals
Authors
Sara Delilovic
Henna Hasson
Mårten Åhström
Mia von Knorring
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4413-6

Other articles of this Issue 1/2019

BMC Health Services Research 1/2019 Go to the issue