Cancer Outcomes Research Program, Cancer Care Nova Scotia, Halifax, Nova Scotia, Canada.
Implement Sci. 2012 Oct 25;7:102. doi: 10.1186/1748-5908-7-102.
Non-small cell lung cancer, breast cancer, and colorectal cancer are commonly diagnosed cancers in Canada. Patients diagnosed with early-stage non-small cell lung, breast, or colorectal cancer represent potentially curable populations. For these patients, surgery is the primary mode of treatment, with (neo)adjuvant therapies (e.g., chemotherapy, radiotherapy) recommended according to disease stage. Data from our research in Nova Scotia, as well as others', demonstrate that a substantial proportion of non-small cell lung cancer and colorectal cancer patients, for whom practice guidelines recommend (neo)adjuvant therapy, are not referred for an oncologist consultation. Conversely, surveillance data and clinical experience suggest that breast cancer patients have much higher referral rates. Since surgery is the primary treatment, the surgeon plays a major role in referring patients to oncologists. Thus, an improved understanding of how surgeons make decisions related to oncology services is important to developing strategies to optimize referral rates. Few studies have examined decision making for (neo)adjuvant therapy from the perspective of the cancer surgeon. This study will use qualitative methods to examine decision-making processes related to referral to oncology services for individuals diagnosed with potentially curable non-small cell lung, breast, or colorectal cancer.
A qualitative study will be conducted, guided by the principles of grounded theory. The study design is informed by our ongoing research, as well as a model of access to health services. The method of data collection will be in-depth, semi structured interviews. We will attempt to recruit all lung, breast, and/or colorectal cancer surgeons in Nova Scotia (n ≈ 42), with the aim of interviewing a minimum of 34 surgeons. Interviews will be audiotaped and transcribed verbatim. Data will be collected and analyzed concurrently, with two investigators independently coding and analyzing the data. Analysis will involve an inductive, grounded approach using constant comparative analysis.
The primary outcomes will be (1) identification of the patient, surgeon, institutional, and health-system factors that influence surgeons' decisions to refer non-small cell lung, breast, and colorectal cancer patients to oncology services when consideration for (neo)adjuvant therapy is recommended and (2) identification of potential strategies that could optimize referral to oncology for appropriate individuals.
非小细胞肺癌、乳腺癌和结直肠癌是加拿大常见的诊断癌症。诊断为早期非小细胞肺癌、乳腺癌或结直肠癌的患者代表了潜在可治愈的人群。对于这些患者，手术是主要的治疗方式，根据疾病阶段推荐（新）辅助治疗（例如化疗、放疗）。我们在新斯科舍省以及其他地方的研究数据表明，相当一部分非小细胞肺癌和结直肠癌患者，其临床指南建议进行（新）辅助治疗，但并未转诊给肿瘤医生进行咨询。相反，监测数据和临床经验表明，乳腺癌患者的转诊率要高得多。由于手术是主要的治疗方法，因此外科医生在将患者转介给肿瘤医生方面发挥着重要作用。因此，深入了解外科医生如何做出与肿瘤服务相关的决策对于制定优化转诊率的策略非常重要。很少有研究从癌症外科医生的角度研究（新）辅助治疗的决策。本研究将使用定性方法来检查与为诊断为潜在可治愈的非小细胞肺癌、乳腺癌或结直肠癌的个体转介至肿瘤服务相关的决策过程。
一项定性研究将在扎根理论原则的指导下进行。该研究设计是基于我们正在进行的研究以及获得卫生服务的模型。数据收集方法将是深入的半结构化访谈。我们将尝试招募新斯科舍省所有的肺癌、乳腺癌和/或结直肠癌外科医生（n≈42），目标是至少采访 34 名外科医生。访谈将进行录音并逐字转录。数据将同时收集和分析，两名研究人员独立对数据进行编码和分析。分析将采用归纳的、扎根的方法，使用恒定性比较分析。
主要结果将是（1）确定影响外科医生在推荐（新）辅助治疗时决定将非小细胞肺癌、乳腺癌和结直肠癌患者转介至肿瘤服务的患者、外科医生、机构和卫生系统因素，以及（2）确定可优化适当患者向肿瘤学转诊的潜在策略。
