Suggestions for accelerated diagnosis of cancer
| Suggestions | Representative quotations |
|---|---|
| System integration | “My main thing is figuring out a way for family docs to get reconnected to the system. What I see happening is [that] medicine is obviously evolving and we’re realizing team-based care is really important. And, what I see is Alberta Health Services and the specialist services really working on that, and getting on top of that, and working in inter-disciplinary teams and that kind of thing. […] And then, family medicine is just kind of on its own. We built this system where we’re like, ’Okay, family docs are out in the community, you’re on your own’. […] Family medicine is an afterthought.” [FP-3] “Specialists get more and more sub-specialized which is a problem because it leads to fragmentation. […] We see that — gastroenterologists who only do hepatology with our liver specialists. They don’t do inflammatory bowel disease or colonoscopy or gastroscopy.” [SP-5] |
| Care pathways | “It would be helpful to have pathways because then, if a family doctor said, ‘Look, I have a pathway in front of me here, this is what they’re asking me to do. I need this within a certain period of time’. And if we’ve set expectations in our discussions with surgeons, diagnostic imaging, family docs, then hopefully we start to get rid of those unnecessary tests that are being done. Because that’s what’s contributing to the wait times, and getting the right tests at the right time for the right patients would actually improve access.” [SP-5] “For [family physicians], if it’s an abnormality on a mammogram, it’s clear where I go. If it’s something on a chest x-ray, it’s clear which way to go. But for the patients where there isn’t a program, they really struggle and they’re calling surgeons, ‘Can you see the patient to do a biopsy?’, calling the oncologist on call, ‘What do I do? They’ve clearly got cancer’. And so, they’re scrambling around calling several different people in the course of a busy day trying to facilitate something that to me [as a specialist], we need a single point of contact so that we can assist with the triage and the appropriate direction of patients for whatever service is required to get them to a diagnosis.” [SP-5] “I think getting the breast health-type clinics for every major type of cancer, and for the “weird and wonderful” that we just don’t know, like ‘I just feel uneasy, I think something is wrong’, the weird stuff […]. I think that would be a great use of resources. It’s confusing because we’re not experts in particularly uncommon cancers, and sometimes it’s just really hard to know what the next step is…” [FP-2] “A potentially dual purpose [...] would be some sort of contact or resource [...]. For the breast health programs in Edmonton and Calgary, they have that. The patient is contacted by the program or vice versa, and there’s a nurse navigator or someone else that the patient can talk to. Because that is a potential issue that we face in that interval between the suspicious imaging diagnosis made and the patient being told the results of the biopsy. Who is supporting that, who is supporting the patient in that interval?” [SP-20] |
| Centralized advice, triage and referral service | “A phone consultation system where you’ve got somebody, just not quite sure the next step to take, and you phone up somebody and get an immediate consult that says, ‘Okay, given that, this is what you should do, go in this direction, do those tests’. So, those are very helpful because that helps us get far enough along that we know there is something there or maybe there isn’t something there.” [FP-6] ”Having access to speak to the appropriate person, and a lot of times maybe that’s not even an oncologist yet. Maybe that’s a nurse that specializes in cancer care […]. So I think there’s this whole notion of having a number you can call.” [FP-2] “What we really need is a central triage place where we say, ‘Here’s the chest mass. Here’s what it looks like. Here’s what it is.’ And then, it would be decided who is going to do what and where, what’s that going to look like.” [SP-19] “If there was a central cancer booking office, for example, referral’s gone in, it’s been triaged by the appropriate specialist and the ball is in the system. And if there’s something like, ‘Oh, the specialist thinks that we should have done something more’, then they can call us and inform us. We’re happy to take that. But I just feel like until you get a proven tissue diagnosis to the “enth” degree, they don’t even want to know. Then by that point, it’s a little bit delayed.” [FP-11] |
Note: FP = family physician, SP = specialist physician.