Background
Methods
Overview
Search
Eligibility criteria
Inclusion criteria
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Study designs: Systematic reviews published between 2005 and 2010. While the methodology is still evolving, this interval was chosen to align with best evidence suggesting median survival time of a systematic review is approximately five years [16].
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Outcomes: Systematic reviews that included at least one of the following outcomes: measurable clinical outcomes, observable behavior change, documented intention to behave, documented attitudes, documented knowledge uptake, or reported stakeholder satisfaction.
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KT interventions: Interventions that focused on at least one of the following target groupings: consumer, professional, organization, regulatory, and financial, as outlined in the CADTH-EPOC framework.
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Clinical scenarios:
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○ Diagnosis: Interventions that were tested in cancer-specific environments (any cancer diagnosis). Reviews that included cancer as part of the clinical context or that were generic/nonspecific to clinical condition were also considered.
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○ Stage of continuum of care: Diagnosis, treatment, follow-up, survivorship, end-of-life [17]a.
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Exclusion criteria
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Study designs: Any design other than systematic reviews.
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Language: Non-English language due to cost and availability of translations.
Data extraction
Quality control and critical appraisal
Interpretation of systematic reviews' results and research priorities/direction
Results
Overall
Intervention | Definition |
---|---|
Consumer interventions
| |
Education | interventions informing patients about their treatment and their health (education, information provision, promotion of health) |
Decision aids/shared decision-making interventions | interventions designed to assist patients make specific and deliberative choices among options by providing information on the options and outcomes relevant to a person's health status |
Interactive health communication application (IHCA) interventions | interventions aimed at enabling interactions between an individual and a communication technology to access or transmit health information, to receive guidance, or to receive support |
Contracts | a behavioral strategy aimed at improving patient adherence by setting out a set of rules regarding the behavior of interest and formalizing commitment to adhere to the rules |
Reminder packaging | interventions aimed to facilitate safe and appropriate medication use (e.g., monitored dose symptoms, multi-compartment aids) |
Multifaceted interventions | two or more interventions aimed at assisting patients with adherence to treatment/medications and improving the prescription process |
Professional interventions
| |
Educational outreach and audit and feedback | interventions whereby a trained person meets with providers in their practice setting to give information with the goal to change clinical behavior (also referred to as academic detailing) OR any summary of clinical performance (from health records, observation, computer systems) of healthcare over a specified time that may also include recommendations for clinical action |
Clinical decision support systems (IT/IM/informatics) | information system interventions that provide the clinician with decision support, including critical clinical data, reminders, advice on drug or care provision, etc. |
Computerized physician order entry (IT/IM/informatics) | computer-based systems for ordering medications with automated aspects to the ordering process, such as a list of possible medications for a physician to choose, drug interaction or contraindication prompts, reminders, etc. |
Tracker/reminder systems (IT/IM/informatics) | specific interventions that prompt healthcare providers with information specific to the patient or the encounter that would advise on action to do or action to avoid (interventions can be verbal, paper, or electronic) |
Local opinion leaders | educational leaders and influentials nominated by their colleagues |
Tailored interventions | identify barriers to change and subsequent design of an intervention that addresses identified barriers |
Clinical pathways | document-based tools that provide a link between best available evidence and clinical practice by providing recommendations, processes, and time-frames for the management of specific medical conditions or interventions |
Guidelines for professions allied to medicine | a systematic statement aimed at assisting in decisions by providers and patients for a specific clinical condition |
Discharge planning from hospital to home | interventions aimed at providing individualized plans as a patient is moved from hospital to home |
Organizational interventions
| |
Changing length of consultation | interventions designed to increase consult time between primary care provider and patient |
Routine standard assessment interventions | interventions designed to improve the assessment and documentation of patients (akin to pathology checklist concept in Ontario or surgical checklist concept in various provinces) |
Chronic care model interventions | interventions aimed at redesigning ambulatory care by modifying elements of the chronic care model (elements include self-management support, decision support, delivery system design, clinical information systems, healthcare organizations, and community resources) |
Shared-care interventions | any type of structured system that involves continuing collaborative clinical care between primary care and specialty care in the management of patients |
Shared-care tactic interventions | tactics aimed to facilitate information sharing between providers who provide care to a patient; include (i) liaison meetings--meetings between specialists and primary care teams whereby ongoing management of patients within the service is planned and discussed, (ii) shared-care record cards--a formal information-sharing arrangement where a set of data is agreed to, entered onto a record card, and usually carried by the patient, or (iii) computer-assisted shared care/email--a formal information-sharing arrangement whereby a data set is agreed to, entered onto a record card, and shared between two sectors on computer (can also include coordinated computer registration and patient recall) |
Health information technology interventions | switching the format or structure of the medical record, such as computerized medical records |
Cluster | Continuum-of-care stage | |||||||
---|---|---|---|---|---|---|---|---|
Prevention | Screening | Diagnosis | Treatment | Survivorship | Follow-up | Supportive care | Palliative end-of-life care | |
Professional | 5 | 7 | 7 | 10 | 1 | 2 | 2 | 2 |
Consumer | 4 | 2 | 8 | 16 | 1 | 3 | 8 | 4 |
Organizational | 1 | 3 | 6 | 8 | 1 | 3 | 4 | 3 |
Financial | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Regulatory | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Cluster | ||||||
---|---|---|---|---|---|---|
Professional | Consumer | Organizational | Financial | Regulatory | ||
Breast | 4 | 9 | 4 | 0 | 0 | |
Gastrointestinal | 2 | 2 | 2 | 0 | 0 | |
Genitourinary | 2 | 4 | 2 | 0 | 0 | |
Gynecological | 1 | 1 | 1 | 0 | 0 | |
Head and neck | 0 | 2 | 0 | 0 | 0 | |
Diagnosis
| Hematologic | 1 | 2 | 1 | 0 | 0 |
Lung | 0 | 3 | 0 | 0 | 0 | |
Melanoma | 1 | 1 | 1 | 0 | 0 | |
Neuro-oncology | 0 | 0 | 0 | 0 | 0 | |
Sarcoma | 1 | 0 | 1 | 0 | 0 | |
Not specified | 5 | 6 | 5 | 0 | 0 |
Type of intervention (number of evidence summaries) | Theory/framework | Study designs included | Outcomes included | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Y | N | NS | RCT only | Non-RCT only | Mixed | C | BO | BI | K | A | S | |
Consumer interventions
| ||||||||||||
Patient education/patient information (n = 8) | 2 | 0 | 6 | 2 | 0 | 6 | 4 | 3 | 6 | 6 | 4 | 5 |
Decision aids/shared decision making (n = 5) | 2 | 2 | 1 | 0 | 0 | 5 | 1 | 3 | 2 | 4 | 1 | 3 |
Interactive health communication applications (n = 1) | 0 | 0 | 1 | 1 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 0 |
Contracts (n = 1) | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 1 |
Reminder packaging (n = 1) | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 1 | 0 | 0 | 1 | 0 |
Multifaceted (n = 1) | 0 | 0 | 1 | 1 | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 0 |
Overall
|
5
|
2
|
10
|
6
|
0
|
11
|
7
|
10
|
8
|
12
|
6
|
9
|
Professional interventions
| ||||||||||||
Educational outreach visits & audit and feedback (n = 4) | 1 | 2 | 1 | 2 | 1 | 1 | 4 | 2 | 0 | 2 | 0 | 1 |
IT/IM/informatic interventions (n = 5) | 0 | 1 | 4 | 0 | 1 | 4 | 4 | 5 | 0 | 0 | 0 | 0 |
Local opinion leaders (n = 1) | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 |
Tailored interventions (n = 1) | 1 | 0 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 |
Clinical pathway interventions (n = 1) | -- | -- | -- | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 0 |
Guidelines for professions allied to medicine (n = 1) | -- | -- | -- | 0 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 |
Discharge planning from hospital to home (n = 1) | -- | -- | -- | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 |
Overall
|
2
|
3
|
6
|
5
|
2
|
7
|
11
|
10
|
0
|
2
|
0
|
2
|
Organizational interventions
| ||||||||||||
Changing length of consultation (n = 1) | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 1 |
Routine standardized assessment (n = 1) | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 1 | 0 | 1 | 1 | 1 |
Chronic care model interventions (n = 1) | 1 | 0 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 |
Models-of-care/integrated care-related interventions (n = 5) | 0 | 2 | 3 | 0 | 2 | 3 | 4 | 2 | 1 | 3 | 1 | 3 |
Shared-care tactic interventions (n = 1) | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 1 |
Health information technology (n = 1) | 1 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 1 |
Overall
|
2
|
3
|
5
|
0
|
2
|
8
|
8
|
7
|
1
|
4
|
2
|
7
|
Type of intervention (number of evidence summaries) | Context: Who delivered | Context: Where delivered | Context: How delivered | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Pt | Fam | Clin | Ad | PH | O | Home | Comm | ClE | O | Per | Paper | Phone | TI | TS | NS | |
Consumer interventions
| ||||||||||||||||
Patient education/patient information (n = 8) | 0 | 0 | 5 | 0 | 0 | 3 | 4 | 3 | 7 | 4 | 4 | 7 | 4 | 2 | 2 | 0 |
Decision aids/shared decision making (n = 5) | 0 | 0 | 5 | 0 | 0 | 0 | 2 | 0 | 3 | 2 | 2 | 5 | 1 | 4 | 2 | 0 |
Interactive health communication applications (n = 1) | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 0 |
Contracts (n = 1) | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 0 |
Reminder packaging (n = 1) | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 0 |
Multifaceted (n = 1) | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 |
Overall
|
2
|
2
|
13
|
0
|
0
|
6
|
10
|
6
|
14
|
8
|
10
|
15
|
6
|
8
|
7
|
0
|
Professional interventions
| ||||||||||||||||
Educational outreach visits & audit and feedback (n = 4) | 0 | 0 | 3 | 1 | 0 | 2 | 0 | 1 | 4 | 1 | 4 | 4 | 3 | 2 | 1 | 0 |
IT/IM/informatic interventions (n = 5) | 0 | 0 | 2 | 1 | 0 | 4 | 0 | 2 | 5 | 1 | 0 | 0 | 0 | 4 | 1 | 0 |
Local opinion leaders (n = 1) | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 |
Tailored interventions (n = 1) | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
Clinical pathway interventions (n = 1) | 0 | 0 | 1 | 0 | 0 | 0 | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
Guidelines for professions allied to medicine (n = 1) | 0 | 0 | 1 | 0 | 0 | 0 | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
Discharge planning from hospital to home (n = 1) | 0 | 0 | 1 | 0 | 0 | 0 | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
Overall
|
0
|
0
|
9
|
2
|
0
|
7
|
0
|
4
|
11
|
2
|
5
|
4
|
3
|
6
|
2
|
1
|
Organizational interventions
| ||||||||||||||||
Changing length of consultation (n = 1) | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 |
Routine standardized assessment (n = 1) | 0 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 1 | 0 | 1 | 1 | 0 | 0 | 0 | 0 |
Chronic care model interventions (n = 1) | 0 | 0 | 1 | 0 | 0 | 1 | 0 | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 1 |
Models-of-care/integrated care-related interventions (n = 5) | 0 | 0 | 5 | 0 | 0 | 0 | 1 | 2 | 5 | 1 | 5 | 4 | 2 | 2 | 0 | 0 |
Shared-care tactic interventions (n = 1) | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 |
Health information technology (n = 1) | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
Overall
|
0
|
0
|
10
|
1
|
0
|
2
|
2
|
4
|
10
|
2
|
9
|
6
|
3
|
4
|
0
|
1
|
Interventions aimed at consumers (Additional File 3)
Type of intervention | Total number of SRs | Number of SRs--cancer only | Number of SRs-- mixed | Number of SRs-- no cancer |
---|---|---|---|---|
Patient education and patient information
| 8 | 4 | 4 | 0 |
Patient decision aids
| 5 | 3 | 2 | 0 |
Interactive health communication applications
| 1 | 0 | 1 | 0 |
Contracts
| 1 | 0 | 0 | 1 |
Reminder packaging
| 1 | 0 | 0 | 1 |
Multifaceted
| 1 | 0 | 1 | 0 |
Intervention cluster and systematic review first author (year) | Scores and ratings | ||
---|---|---|---|
AMSTAR (1 to 11) | Research team ratings | ||
Mean | SD | ||
Patient education/patient information
| |||
Bennett (2009) [26] | 8 | 5.7 | 0.67 |
Gaston (2005a) [35] | 5 | 4.7 | 0.45 |
Gysels (2007) [37] | 5 | 3.0 | 1.00 |
Goldberg (2007a) [36] | 3 | 3.8 | 0.45 |
Wofford (2005) [56] | 7 | 4.3 | 0.84 |
Santo (2005) [47] | 7 | 4.6 | 0.89 |
Conn (2008) [30] | 10 | 4.3 | 1.79 |
Raynor (2007) [45] | 8 | 4.0 | 0.71 |
Overall mean score | 7 | 4.3 | |
Patient decision aids
| |||
Evans (2005) [33] | 7 | 4.4 | 1.14 |
Gaston (2005b) [35] | 5 | 4.3 | 0.97 |
Waljee (2007) [54] | 8 | 6.1 | 0.22 |
Edwards (2008) [32] | 5 | 3.8 | 0.45 |
Joosten (2008) [41] | 5 | 5.1 | 0.22 |
Overall mean score | 6 | 4.7 | |
Interactive health communication applications
| |||
Murray (2005) [43] | 11 | 6 | 1 |
Contracts
| |||
Bosch-Capblanch (2007) [27] | 9 | 3.8 | 0.84 |
Reminder packaging
| |||
Heneghan (2006) [39] | 10 | 5.1 | 0.74 |
Multifaceted
| |||
Haynes (2008) [38] | 10 | 4.6 | 0.89 |
Type of intervention | Research ideas |
---|---|
Patient education/patient information | Randomized studies directly comparing different intervention formats/modalities/techniques on satisfaction, adherence, and clinical outcomes (prioritize those interventions from which individual studies have shown greatest promise on clinical outcomes) (i.e., how to do it) |
Decision aids | Development, testing, and evaluation of cancer decision aids in understudied areas (e.g., role within personalized medicine, molecular-genetics) • |
Development, testing, and evaluation of cancer decision aids in understudied populations | |
Interactive health communication applications (IHCA) | What are the implications for IHCA on privacy policies and legislations? |
Contract interventions | Outside of cancer prevention, no role |
Reminder packaging | Research to identify if adherence to medication protocols is a problem for cancer patients (e.g., for which drugs, cancer diagnoses, complexity of drug regimen) • |
Generalize to other aspects of cancer care--What are effective strategies to remind cancer survivors of follow-up and monitoring regimens? (linked to discharge plan priorities) | |
Multifaceted intervention | Design and evaluate multifaceted consumer interventions for specific cancer control problems using Haynes et al. review as foundation (i.e., deconstruct systematic review to identify most promising intervention clusters for specific contexts) |
Systematic review priorities | Acquiring skills and competencies • |
Consumer system participation • | |
Minimizing risks or harms |
Interventions aimed at professionals (Additional File 4)
Type of intervention | Total number of SRs | Number of SRs--cancer only | Number of SRs-- mixed | Number of SRs-- no cancer |
---|---|---|---|---|
Educational outreach visits & audit and feedback
| 4 | 2 | 2 | 0 |
IT/IM/informatics
| 5 | 1 | 4 | 0 |
Local opinion leaders
| 1 | 0 | 1 | 0 |
Tailored interventions
| 1 | 0 | 0 | 1 |
Clinical pathways
| 1 | 0 | 1 | 0 |
Guidelines for professions allied to medicine
| 1 | 0 | 1 | 0 |
Discharge planning from hospital to home
| 1 | 0 | 1 | 0 |
Intervention cluster and systematic review first author (year) | Scores and ratings | ||
---|---|---|---|
AMSTAR (1 to 11) | Research team ratings | ||
Mean | SD | ||
Educational outreach visit & audit and feedback interventions
| |||
Goldberg (2007b) [36] | 3 | 4.6 | 0.89 |
O'Brien (2007) [44] | 8 | 4.8 | 1.17 |
Goldberg (2007c) [36] | 3 | 3.8 | 0.98 |
Jamtvedt (2006) [40] | 8 | 4.7 | 0.82 |
Overall mean score | 5.5 | 4.5 | |
IT/IM/informatic interventions
| |||
Goldberg (2007d) [36] | 3 | 3.7 | 0.52 |
Garg (2005) [34] | 5 | 5.3 | 0.52 |
Ammenwerth (2008) [23] | 6 | 5.7 | 0.52 |
Beach (2006a) [25] | 5 | 5.7 | 1.03 |
Shojania (2009) [50] | 8 | 4.7 | 0.52 |
Overall mean score | 5.4 | 5.0 | |
Local opinion leader interventions
| |||
Doumit (2007) [31] | 7 | 4.3 | 0.82 |
Tailored interventions
| |||
Baker (2010) [24] | 7 | 4.8 | 1.47 |
Clinical pathway interventions
| |||
Rotter (2010)a [46] | -- | NA | NA |
Guidelines for professions allied to medicine
| |||
Thomas (2009)a [53] | -- | NA | NA |
Discharge planning from hospital to home
| |||
Shepperd (2010)a [49] | -- | NA | NA |
Type of intervention | Research ideas |
---|---|
Educational outreach visits (EOV)/audit and feedback (AF) | Better quality trials directly evaluating specific modalities and methods of EOV (proper randomization, baseline data, variety of outcomes--including patient outcomes and costing) |
Better quality trials directly evaluating specific modalities and methods of methods of AF (as above) | |
For which clinicians, clinical conditions, and stage in the continuum is EOV most impactful? | |
For which clinicians, clinical conditions, and stage in the continuum is AF most impactful? | |
What is the impact of regional AF versus individual AF on changing patterns of practice? | |
IT/IM/informatic interventions | Better quality trials directly evaluating specific modalities and methods of informatic interventions (proper randomization |
For which clinicians, clinical conditions, and stage in the continuum are informatics interventions most impactful? | |
Develop methods to enable practice guidelines to be directly integrated into informatic interventions | |
What is the cost effectiveness of different informatic interventions? | |
Are informatic interventions effective in non-drug-prescribing aspects of cancer care? | |
Local opinion leader interventions | Methodological development in choosing local opinion leaders in a reliable manner |
Methodological development in understanding factors that increase and decrease sustainability of local opinion leader designation | |
Research to better understand for which provider groups and under what clinical contexts (cancer diagnosis, practice setting, stage of the cancer trajectory) local opinion leaders are most effective | |
Tailored interventions | Methodological analysis of the operational techniques of tailoring in existing high-quality primary studies |
Methodological development to determine when tailoring has or has not addressed identified barriers | |
Identification of defining factors of effective tailoring | |
Direct comparisons of different tailoring interventions (tactic and modality, etc.) on uptake of evidence, processes of care, and clinical outcomes | |
Clinical pathway interventions | Testing of clinical pathway interventions on different stages of continuum of cancer care |
Testing of clinical pathway interventions with different healthcare providers involved in cancer control | |
Methodological development to determine for which clinical problem (e.g., cancer diagnosis, complexity of care) clinical pathways are most effective | |
Direct comparisons of different clinical pathway strategies (methods and modality, etc.) on uptake of evidence, processes of care, and clinical outcomes | |
Is the introduction of clinical pathways cost effective in Ontario/Canada? | |
Guidelines | Compare and contrast use of and impact of guidelines on processes of care and clinical outcome as a function of cancer care provider |
Testing innovative strategies to disseminate guideline messages to different providers | |
Testing of innovative strategies to disseminate guideline messages to administrators | |
Testing of innovate strategies to disseminate guideline messages to policy makers | |
Discharge planning | What are the defining features/components to a discharge plan that are linked to patient satisfaction, provider satisfaction, process outcomes, and clinical outcomes? |
Determining the specific clinical components for discharge plans for different cancer diagnoses |
Interventions aimed at organizations (Additional File 5)
Type of intervention | Total number of SRs | Number of SRs--cancer only | Number of SRs-- cancer included | Number of SRs-- no cancer |
---|---|---|---|---|
Changing length of consultation
| 1 | 0 | 0 | 1 |
Routine standard assessment
| 1 | 1 | 0 | 0 |
Chronic care model
| 1 | 0 | 1 | 0 |
Models of care/integrated care
| 5 | 2 | 3 | 0 |
Shared-care tactic
| 1 | 0 | 1 | 0 |
Health information technology
| 1 | 0 | 1 | 0 |
Intervention cluster and relevant systematic review first author (year) | Scores and ratings | ||
---|---|---|---|
AMSTAR (1 to 11) | Research team ratings | ||
Mean | SD | ||
Changing length of consultation interventions
| |||
Wilson (2006) [55] | 7 | 3 | 0.71 |
Routine standard assessment interventions
| |||
Goldberg (2007e) [36] | 3 | 3.8 | 1.30 |
Chronic care model interventions
| |||
Coleman (2009) [29] | 2 | 4.4 | 0.55 |
Models-of-care/integrated care-related interventions
| |||
Lewis (2009) [42] | 7 | 3.8 | 1.10 |
Smith (2008) [52] | 8 | 3.2 | 1.30 |
Beach (2006b) [25] | 5 | 4.6 | 0.89 |
Goldberg (2007f) [36] | 3 | 3.6 | 0.89 |
Scheuner (2008) [48] | 4 | 2.6 | 0.55 |
Overall mean score | 5.4 | 3.6 | |
Shared-care tactic interventions
| |||
Smith (2007) [51] | 8 | 3 | 1.22 |
Health information technology interventions
| |||
Chaudhry (2006) [28] | 4 | 4.6 | 0.89 |
Type of intervention | Research ideas |
---|---|
Changing length of consultation | Does length of consultation influence patient satisfaction, clinician satisfaction, or patient outcomes in a clinical context? |
Modeling the clinical encounter to predict patient satisfaction, clinician satisfaction, and patient outcomes. Use length of consult time as one of the predictors (examples of others: types of information shared, type of clinician, diagnosis). | |
In what stages of the cancer continuum does the length of consultation impact patient satisfaction, clinician satisfaction, and patient outcomes? | |
What is the cost effectiveness of longer consultation times? | |
Routine assessment interventions | Conduct a high-quality systematic review examining the impact of routine standard assessment (across cancer care continuum) on delivery of cancer care, satisfaction (patient and clinician), and clinical outcomes |
What is the impact of routine standard assessment on other aspects of cancer care other than pain? | |
Conduct a well-designed randomized trial to evaluate the impact of routine standard assessments on delivery of care (fidelity), satisfaction of care (patient and clinician), and clinical outcomes | |
Compare and contrast methods used to determine and create tools to support implementation of routine standard assessments to ensure they are based on evidence and acceptable to clinicians and patients | |
Research examining how to implement routine standard assessments into an oncology practice setting (ambulatory or in-patient) so that it is acceptable (to management, clinicians, patients), effective, and cost effective | |
Chronic care model (CMM) interventions | Conduct a high-quality systematic review examining the impact of CMM on delivery of cancer control, satisfaction (patient, clinician, policy), and clinical outcomes |
Research (qualitative and/or scoping review) to assess whether CCM applies well to the cancer control context. Which components of the CCM (if any) are most relevant to cancer control? Which aspect of cancer control (e.g., diagnosis) lends itself to the CCM model? | |
Design, evaluate, and refine tools to support each of the six CCM components using high-quality methods | |
Models of care/integrated care interventions 1 | Research to better understand for what cancer diagnoses, cancer care options, stages in the continuum, and contexts (e.g., geography) are different models of care and integration of services most appropriate (e.g., systematic review, case study intervention) |
High-quality economic analysis comparing different models of care | |
Research aimed to analyze (and perhaps statistically model) existing models of care to better understand the mechanisms underlying the processes and the outcomes of different approaches | |
Deconstruction of existing systematic reviews to better understand the mechanisms underlying different models of care | |
Develop methods to better measure the concepts of shared care and integrated care | |
Models of care/integrated care interventions 2 | Development/identification, implementation, and evaluation (process, satisfaction, patient outcomes) of various models (care and service) aimed at the diagnostic stage of continuum and transition to treatment (e.g., systemic review, scoping review, or randomized trial) |
As above but focused on treatment only (e.g., systematic review or scoping review) | |
As above but aimed at the treatment stage of the continuum and transition to survivorship or palliative care | |
How to best introduce new models of care or new clinical roles into the care system | |
Research aimed to test effectiveness, safety, satisfaction (patient, providers, and system) and cost effectiveness of new clinical roles in cancer control by non-medical clinical professionals | |
Shared-care implementation tactic interventions | Using high-quality randomized methods, compare and contrast different existing tactics aimed to facilitate communication between healthcare providers |
Develop, test, and refine new tactics aimed at facilitating communication between different practitioners | |
Health information technology (HIT) interventions | What are the most effective and efficient strategies to implement an HIT solution? |
For what cancer-control contexts (e.g., continuum of care, diagnosis, practice setting) is an HIT solution most appropriate? | |
Does embedding evidence-based recommendations into the HIT solutions improve quality of care over HIT solutions alone? | |
Are HIT solutions cost effective? |