Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.
PROCOME research group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
BMC Health Serv Res. 2019 Aug 16;19(1):577. doi: 10.1186/s12913-019-4413-6.
Many countries have implemented standardized cancer patient pathways (CPPs) to reduce waiting times in cancer care and to ensure timely and quick diagnosis as well as treatment. Yet, no studies have explored the implementation process as perceived by the health care professionals working in the CPPs. The aim of this study is to explore the experiences of health care professionals (HPCs) involved in the CPPs.
A descriptive qualitative design was adopted. Thematic analysis was applied to individual interviews conducted in 2016-2017 with 58 participants working in six different CPPs in Sweden's largest region, covering care for around 2.3 million inhabitants.
In general, the health care professionals had a positive attitude towards the implementation of the CPPs. Our findings showed that the CPPs require close collaboration, both between and within different health care professional groups and units, something that was not always probable due to differences in resource capacity. Better dissemination to all relevant professionals, better conceptualization, and equivalent opportunities in terms of resources were identified by the respondents as being important yet lacking in practice. The analysis showed possible negative effects of the CPP, such as crowding-out on other patient groups.
The CPPs were introduced to address challenges with long waiting times and unequal cancer care. By exploring the experiences of health care professionals involved in the implementation of CPPs, our findings show challenges with multi-level coordination and collaboration, policy dissemination, and resource constraints. The analysis also showed that the implementation of CPPs risk being accompanied by unintended effects such as longer waiting times for other patients and patient groups in need of the same health care resources. The results shed light on and contribute to an understanding of the challenges, opportunities and ways forward.
许多国家已经实施了标准化的癌症患者路径（CPPs），以减少癌症护理中的等待时间，并确保及时和快速的诊断和治疗。然而，尚无研究探讨卫生保健专业人员在 CPP 中所经历的实施过程。本研究旨在探讨参与 CPP 的卫生保健专业人员的经验。
采用描述性定性设计。在 2016-2017 年间，对瑞典最大地区的六个不同 CPP 中的 58 名参与者进行了个人访谈，应用主题分析。这些 CPP 覆盖了约 230 万居民的护理工作。
总的来说，卫生保健专业人员对 CPP 的实施持积极态度。我们的研究结果表明，CPP 需要密切协作，不仅是不同卫生保健专业群体和单位之间，而且是内部之间，由于资源能力的差异，这并不总是可能的。受访者认为，更好地向所有相关专业人员传播信息，更好地概念化以及在资源方面提供平等机会非常重要，但在实践中却缺乏这些。分析表明，CPP 可能会产生负面影响，例如排挤其他患者群体。
CPP 的引入是为了解决长时间等待和不平等的癌症护理的挑战。通过探索参与 CPP 实施的卫生保健专业人员的经验，我们的研究结果表明，在多层次协调与合作、政策传播以及资源限制方面存在挑战。分析还表明，CPP 的实施可能伴随着意想不到的效果，例如其他患者和需要相同卫生保健资源的患者群体的等待时间更长。这些结果揭示了挑战、机遇和前进的方向，并为其提供了理解。
