Implementing and Sustaining Early Cancer Diagnosis Initiatives in Canada: An Exploratory Qualitative Study.

BACKGROUND: The interval between suspected cancer and diagnosis for symptomatic patients is often fragmented, leading to diagnosis delays and increased patient stress. We conducted an exploratory qualitative study to explore barriers and facilitators to implementing and sustaining current initiatives across Canada that optimize early cancer diagnosis, with particular relevance for symptomatic patients. METHODS: The national study included a document review and key informant interviews with purposefully recruited participants. Data were analyzed by two researchers using descriptive statistics and thematic analysis. RESULTS: Twenty-two participants from eight provinces participated in key informant interviews and reported on 17 early cancer diagnosis initiatives. Most initiatives (88%) were in early phases of implementation. Two patient-facing and eight provider/organization barriers to implementation (e.g., lack of stakeholder buy-in and limited resources) and five facilitators for implementation and sustainability were identified. Opportunities to improve early cancer diagnosis initiatives included building relationships with stakeholders, co-creating initiatives, developing initiatives for Indigenous and underserved populations, optimizing efficiency and sustainability, and standardizing metrics to evaluate impact. CONCLUSION: Early cancer diagnosis initiatives in Canada are in early implementation phases. Lack of stakeholder buy-in and limited resources pose a challenge to sustainability. We present opportunities for funders and policymakers to optimize the use and potential impact of early cancer diagnosis initiatives.

Exploring the perspectives of patients about their care experience: identifying what patients perceive are important qualities in cancer care.

INTRODUCTION: Delivering person-centered care begins with understanding perspectives of individuals who are recipients of care about their experiences and what constitutes a "positive" experience. METHODS: This project explored views of individuals with cancer regarding their care experiences and identified aspects of care patients thought were important through a qualitative analysis of data from the Ambulatory Oncology Patient Satisfaction Survey (AOPSS). Permission was obtained from seven Canadian provinces to access de-identified written comments to a final open-ended question on the survey: Is there anything else you would like to tell us about your cancer care experience? The descriptive qualitative analysis was guided by two questions: (1) what is the nature of the written comments and (2) what are key ideas expressed about care experiences? Key ideas were collated across provinces to identify significant themes within the national sample. RESULTS: The sample included comments from 6232 individuals. A total of 42.5% comments were positive, 29.7% were negative, and 19.8% were mixed. Four broad themes were identified from the comments: (1) characteristics of a "positive" experience, (2) personal care, (3) interaction with health care providers, and (4) service delivery. Respondents cited being treated as a person with respect and dignity, clear communication, access to relevant and timely information, and care that takes their needs into account as important aspects. Communication, consistency, and ongoing interactions with staff were highlighted as essential elements of a positive experience, yet areas where improvements in care are necessary. CONCLUSION: Patients reported a range of aspects that contribute to positive and negative care experiences which can be used to guide quality improvement initiatives in cancer centers. Results underscore the importance of having data collection systems in place to ensure agencies and providers have timely feedback about patients' experiences and concerns in order to provide responsive and individualized care.