Recommendations

Inefficiencies and gaps in optimizing patient entry into diagnosis systems in Canada abound and there are many opportunities for improvement. Action must be taken by policy makers and those working in cancer control in Canada to improve the cancer diagnosis process for all Canadians.

In this section, we present a set of key recommendations to improve the swiftness, accuracy and appropriateness of communication of the diagnosis process in Canada.

Recommendations have been written so that they remain relevant given the uncertain, but potentially major and long-lasting, impacts on the health care system of the COVID-19 pandemic

Our Key Recommendations

Recommendation #1

National convening and coordination of the efforts of various stakeholders in implementing these recommendations are required, with patients and patient representatives providing meaningful leadership in any ongoing multi-stakeholder implementation efforts.

Recommendation #2

Create opportunities to enhance primary care provider knowledge of cancer types, associated symptoms, and established diagnosis pathways.

Catalogue currently available cancer training/education in order to improve upon and better integrate knowledge into relevant post-secondary medical and continuing education programs for practicing providers including knowledge of cancer types, symptoms, and diagnostic pathways.
Work with professional colleges to offer knowledge mobilization and awareness raising opportunities for practicing providers.
Work with provincial cancer systems to ensure awareness and utilization of established standardized diagnostic pathways and guidelines by all providers working in cancer control, including primary care providers and allied health professionals, through a common repository of diagnostic pathways.
Work with provincial cancer systems, researchers, cancer patients, and other stakeholders to develop new standardized diagnostic pathways and guidelines for more types of cancers that are added to the common repository.
Develop electronic decision supports for primary care providers to enable them to assess risk for various types of cancers (e.g., standardized clinical decision support/risk assessment algorithms). Work with key national organizations in Canada to ensure the work is done, standardized, and knowledge is translated and adapted from one province/territory to another (e.g. Health Excellence Canada, Canadian Institute for Health Information, Canada Health Infoway, Canadian Association of Provincial Cancer Agencies).
Work with professional colleges to create opportunities for communication skills acquisition to support excellent patient-provider communication throughout the diagnosis process.

Recommendation #3

Ensure consistently available and accessible seamless care for all cancer types and all jurisdictions throughout the cancer diagnosis process.

Work with provincial and territorial governments, cancer control agencies, provider associations, and other stakeholders to assign system-level accountability to primary care to coordinate the cancer diagnosis process during the early to middle phases. Primary care providers need patient navigation capacity to proactively connect with other parts of the health care system and other systems on behalf of patients. This also requires the establishment of supportive accountability agreements with primary care providers.
Work with cancer control agencies, and other stakeholders to grow and expand patient navigation, multidisciplinary teams, and diagnostic assessment programs (DAPs) within all jurisdictions across Canada to provide a clear point of entry into the cancer care system, assessment within a single location (or at least coordination of assessment), and access to a multidisciplinary team that includes a clinical patient navigator.
Work with provincial and territorial governments, provider associations, cancer control agencies, and other stakeholders to grow and expand physician funding models that support integrated primary care and integrated cancer care and the achievement of patient-defined outcomes in cancer diagnosis.

Recommendation #4

Provide patients the right information at the right time and establish technological mechanisms to facilitate communication throughout the cancer diagnosis process.

Work with professional colleges, provider associations, cancer control agencies, and other relevant stakeholders to ensure the information provided to patients matches the information needed at each phase of the diagnostic process. Specifically, upon entry to the middle phase, provide an overview of the diagnostic pathway. Throughout the middle phase of diagnosis, provide details of what to expect along each step of the diagnosis pathway before it occurs. At the final phase of diagnosis, give the patient an information kit that explains the type of cancer and its treatment(s) and includes a list of reliable sources of information along with a phone number of who or where to call to ask questions (and ideally connecting them with their patient navigator for the treatment phase of their cancer care).
Identify a national body to lead and coordinate the development of technological mechanisms outlined below so that tools that support communication and coordination can be scaled and spread across jurisdictions (e.g. Canada Health Infoway, Health Excellence Canada, possible private-public partnerships).
Support the spread of user-friendly smart-phone applications to enhance provider-provider and patient-provider communication and connection.
Improve on and spread user-friendly online portals that are invoked the moment a patient enters the cancer care system and which can store clinical patient information, make personal health information accessible to patients, and support shared decision-making between patients and providers. Portals must link to existing EMRs and programs in clinics and both patients and providers need to have access to this information as part of a patient’s medical history/file.
Scale virtual communication technology to reduce appointment wait times, increase provider access, and ensure attendance of a support person at appointments during restricted times or otherwise. Establish guidelines around what can be effectively managed virtually and what requires in person consultation. Prepare patients for visits related to the cancer diagnosis process in a virtual environment.
Grow and expand telepathology to make diagnostic care more accessible and faster for people living in rural and Northern Canada.
Remove barriers to digital equity through digital inclusion initiatives to ensure individuals and communities facing barriers achieve access to digital devices, bandwidth and any other mechanisms required, e.g., electricity and freely available Wi-Fi, as well as meaningful adoption that enables underserved people to have the means and knowledge to use technology through easily accessible education and support.

Recommendation #5

Expand availability and accessibility of psychosocial supports for people going through cancer diagnosis and create linkages between cancer care and supportive care.

Work with national bodies such as the Mental Health Commission of Canada, the National Network for Mental Health, the Canadian Mental Health Association, Canadian Association of Psychosocial Oncology and All.Can Canada Hub for Mental Health to grow and expand psychosocial supports for people going through cancer diagnosis across Canada and across cancer types and to create linkages to psychosocial supports as outlined below.
Increase provider awareness of existing psychosocial supports, including those provided by patient groups, regionally and by jurisdiction and create mechanisms for providers (including nurses, patient navigators, technicians, support staff) to easily connect patients with these supports.
Embed psychosocial supports into community-based primary care services, diagnostic facilities, and hospital settings.
Provide funding for travel and other needed diagnostic process supports for people living in rural, remote and Northern Canada.

Recommendation #6

Develop a patient-centred quality framework to measure, benchmark, and improve the efficiency and effectiveness of cancer diagnosis.

Work with key stakeholders (e.g. Canadian Institutes for Health Information, Canadian Partnership Against Cancer, Canadian Cancer Society) to build on the cancer diagnosis quality framework which originated from this research project to establish patient-reported experience measures (PREMs) and other metrics associated with each of the seven outcomes identified in this research, which are common to all cancer types, stage of disease and social determinants of health, to benchmark, compare, and improve across cancer populations and jurisdictions. Once a quality framework is established, develop tools to measure the patient experience in the cancer diagnosis process and use this information for reporting and to guide performance improvement. To this end, create a national dashboard with key metrics and data points of the diagnosis process.
As part of the cancer diagnosis quality framework, continue to establish wait time targets within jurisdictions for various types of cancer with an eye toward establishing national targets.

Led by patient groups and those with lived cancer experience, All.Can Canada is a national platform focused on improving cancer diagnosis. It aims to streamline access to timely, accurate, and appropriately delivered diagnoses. All.Can Canada engages government stakeholders, health authorities, healthcare providers, and patient organizations to share key findings and resources with the diagnosis ecosystem to improve patient outcomes.

Recommendations

In this section, we present a set of key recommendations to improve the swiftness, accuracy and appropriateness of communication of the diagnosis process in Canada.

Our Key Recommendations

Recommendation #1 National convening and coordination of the efforts of various stakeholders in implementing these recommendations are required, with patients and patient representatives providing meaningful leadership in any ongoing multi-stakeholder implementation efforts.

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Recommendation #1

National convening and coordination of the efforts of various stakeholders in implementing these recommendations are required, with patients and patient representatives providing meaningful leadership in any ongoing multi-stakeholder implementation efforts.