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Evaluating the organization and delivery of breast cancer services: use of performance measures to identify knowledge gaps

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Abstract

Objectives

This paper identifies gaps in our knowledge about the quality of breast cancer care in Canada to understand where programs and resources are required to enhance health services and research capacity.

Methods

A modified Delphi approach was employed involving a 15-member multidisciplinary panel of health professionals and two rounds of rating followed by deliberation to develop evidence- and consensus-based performance measures. A literature search for Canadian health services research in breast cancer was conducted based on the indicator topics. Eligible articles were identified in indexed databases of medical literature and funded research from 1995 to 2006.

Results

The multidisciplinary panel selected 34 indicators spanning access to services, patient outcomes, diagnosis and staging, surgery, adjuvant therapy, pathology, and follow-up care. A total of 78 articles (66 quantitative; 12 exploratory) on these topics were reviewed. Apart from two aspects of care (communication of treatment options, supportive care), the yield of Canadian breast cancer health services research did not increase subsequent to a review conducted 10 years ago which recommended greater efforts in this area.

Conclusions

Research involving quantitative and qualitative methods is needed to increase our understanding about the organization and delivery of services for breast cancer diagnosis, treatment and follow-up care. Since it is unclear how to balance competing research demands, innovative strategies are required to assemble resources for health services research on breast cancer. This could include the promotion of partnerships between researchers and policy-makers across jurisdictions, and the pooling of resources between organizations, regions or networks.

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Author information

Authors and Affiliations

  1. General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada

    A. Gagliardi, F. C. Wright & M. L. Quan

  2. Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada

    D. McCready

Authors
  1. A. Gagliardi
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  2. F. C. Wright
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  3. M. L. Quan
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  4. D. McCready
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Corresponding author

Correspondence to A. Gagliardi.

Appendices

Appendix 1: Breast cancer surgery quality indicator selection panel

Name

Affiliationa

Role

Jacques Abourbih

Sudbury Regional Hospital, Sudbury (north east)

Surgical oncology

Barry Anderson

Fort Frances Clinic, Fort Frances (north west)

Surgical oncology

Audley Bodurtha

Ottawa Hospital, Ottawa (east)

Surgical oncology

Adalsteinn Brown

University of Toronto, Toronto (central east)

Co-chair, performance measurement

Alexandra Easson

Princess Margaret Hospital, Toronto (central east)

Surgical oncology

Ralph George

Kingston General Hospital, Kingston (south east)

Surgical oncology

Ron Holliday

London Health Sciences Centre, London (south west)

Surgical oncology

Julia Jones

Lakeridge Health, Oshawa (central east)

Surgical oncology

Maria Jones

Grey Bruce Health Services, Owen Sound (central west)

Oncology nursing

Wey Leong

Princess Margaret Hospital, Toronto (central east)

Surgical oncology

David McCready

Princess Margaret Hospital, Toronto (central east)

Co-chair, surgical oncology

Doug Mirsky

Ottawa Hospital, Ottawa (east)

Surgical oncology

Larry Paszat

Sunnybrook & Womens College Health Sciences Centre, Toronto (central east)

Radiation oncology

Carol Sawka

Sunnybrook & Womens College Health Sciences Centre, Toronto (central east)

Medical oncology

Bruce Youngson

Princess Margaret Hospital, Toronto (central east)

Pathology

  1. aAll sites located in Ontario, Canada

Appendix 2: Literature search strategy to identify Canadian breast cancer health services research

1

breast neoplams/

2

surgery/or perioperative care/or intraoperative care/or post-operative care/or preoperative care/

3

diagnosis/or diagnostic errors/or “diagnostic techniques and procedures”/

4

health services accessibility/

5

chemotherapy, adjuvant/

6

radiotherapy, adjuvant/

7

neoadjuvant therapy/

8

follow up.mp.

9

“referral and consultation”/

10

patient participation/

11

interprofessional relations/

12

patient care team/

13

genetic counseling/

14

lymphedema/

15

“Quality of Life”/

16

supportive care.mp.

17

2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16

18

1 and 17

19

18 or breast neoplasms/su

20

exp health services research/

21

physicians practice patterns/or quality of care/or “outcome and process assessment (health care)”/or treatment outcome/or “outcome assessment (health care)”/or “process assessment (health care)”/or program evaluation/or quality assurance, health care/or benchmarking/or quality indicators, health care/or guideline adherence/or diffusion of innovation/

22

20 or 21

23

1 and 22

24

19 or 23

25

exp Canada/

26

canada.mp.

27

25 or 26

28

24 and 27

29

limit 28 to english language

30

limit 29 to (addresses or comment or editorial or interview or lectures or letter or news)

31

29 not 30

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Gagliardi, A., Wright, F.C., Quan, M.L. et al. Evaluating the organization and delivery of breast cancer services: use of performance measures to identify knowledge gaps. Breast Cancer Res Treat 103, 131–148 (2007). https://doi.org/10.1007/s10549-006-9359-9

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