Defining success factors to describe coordinated care in cancer

Defining success factors to describe coordinated care in cancer Abstract Providing coordinated care remains a challenge for cancer services globally. There is a lack of consensus in the literature about what constitutes successful coordinated care. This study aimed to define and prioritize a set of consensus-driven success factors that can lead to coordinated care. A mixed-methods approach was used that included literature review, a broad call for submissions from relevant stakeholders, and a priority-setting process based on a modified nominal group technique. Thirty articles that related to success factors in coordinated care were identified in the literature. Twenty submissions were received from a broad range of stakeholders. From these sources, a set of 20 success factors was derived. Seventy stakeholders attended a series of workshops across New South Wales, Australia, to review and prioritize these 20 success factors against significance and measurability. Clear consensus was reached on prioritizing two success factors linked to improving coordinated care from first presentation to diagnosis and ensuring that patients are routinely screened for physical and supportive care needs. Other highly ranked factors included the need for a comprehensive care plan and the identification of patients at higher risk for disjointed care. This study defines and prioritizes a set of success factors related to coordinated care in cancer. These success factors will be used to guide the development of interventions that target improving coordinated care as well as supporting the development of new funding models based on performance indicators derived from these factors. Implications Practice: Clinicians and health managers can assess performance across the spectrum of coordinated care in the services they deliver to improve quality. Policy: Success factors to describe coordinated care in cancer can be linked to key performance indicator development to measure and report on coordinated care. Research: Future research should be aimed at validating these success factors in broader populations and reviewing their applicability in indicator development. INTRODUCTION How to best coordinate cancer care remains a key challenge for health services globally [1–3]. Across many types of cancer, there is evidence that care is poorly coordinated resulting in fragmented care, unnecessary stress, and increased morbidity [4]. A variety of interventions have been adopted by health services to improve coordinated care including introduction of cancer care coordinators and patient navigators [5–7], implementation of treatment care pathways and plans [8], screening of patients for physical and psychological distress [9], multidisciplinary cancer care teams [10], and application of electronic communication tools [11]. Despite the wide variety of approaches taken to improve coordinated care, gaps remain in the empirical evidence pertaining to the effectiveness and impact of coordination strategies. One of the greatest challenges is a lack of conceptual clarity for a broadly accepted definition of care coordination [12, 13]. A literature review conducted by McDonald et al. [13] identified more than 40 definitions of care coordination. While the authors of this study propose a common definition for care coordination, the description of an extensive list of available definitions highlights a lack of common understanding for shared discourse and research. This only adds confusion to an already complex process involving multiple players who deliver multimodal interventions typically dispersed across health services. Further consequences include a lack of a common reference for consensus-building processes that seek to better understand components of coordinated cancer care and the development of measures to gauge the impact of these care components. Globally, providers are faced with increasing performance scrutiny, with growing requirements to justify service provision, inclusive of coordination of care interventions. This pressure to demonstrate value has led to considerable interest from multiple stakeholders, such as funders, accreditors, and governing agencies, who seek valid indicators for the measurement of care quality, including care outcomes. The American Society of Clinical Oncology (ASCO) regards the growing number of long-term survivors of cancer to be a success story, but acknowledges that now greater focus is required on transitions in care and coordination with other providers [14]. In a report addressing the state of cancer services in America (2014), ASCO emphasizes the need to engage primary care and advanced practice providers in coordination of care, as well as developing new payment models that reward care coordination services. In the state of New South Wales (NSW), Australia, funding for coordinated care in cancer has been historically directed to supporting care coordinator positions. While cancer care coordinators clearly provide important services [5, 7], there is considerable inequity in the distribution of cancer care coordinators across institutions and tumor streams [5]. The Cancer Institute NSW, a government-funded statewide cancer control agency, has recently changed its funding model from one that focuses on roles to one that links funding to improving performance in key areas across the cancer system. To support this transition, funding for coordinated care is progressively being linked to meeting a set of key performance indicators (KPIs). Such calls exemplify the widespread transitions in services that create the need for reliable measures of care coordination. In addition, there have been a number of indicator development efforts associated with care coordination, including measures not specific to cancer care [15], those focused on a particular tumor stream [3], and others targeted at a specific stage of the cancer journey [16]. To support their iterative KPI development process, the Cancer Institute NSW commissioned the University of Sydney to identify and prioritize a set of key “success factors” to inform a broad set of statements that collectively describe successfully coordinated cancer care from a patient, health professional, and systems perspective. The aim of this project was to document and prioritize success factors for coordinated care based on significance and measurability that can be used to guide the development of a set of coordinated cancer care KPIs. The term success factor is used to describe how successful coordination of care can be described, which is a necessary precursor to the development of formal KPIs. METHODS A systematic process was used to define a set of success factors (Fig. 1). This process included a review of the literature, a broad invitation to stakeholders to submit their own success factors, and a series of workshops to prioritize these success factors against the criteria of significance and measurability. Fig. 1 View largeDownload slide Methodological approach. NSW, New South Wales; KPI, key performance indicator. Fig. 1 View largeDownload slide Methodological approach. NSW, New South Wales; KPI, key performance indicator. Literature review A literature review was undertaken to identify existing success factors for coordinated cancer care. As there is no definitive definition of coordinated care in cancer, a wide variety of search terms were used relating to coordinated care, integrated care, and chronic disease to identify potential success factors. The literature search was conducted using MEDLINE and SCOPUS between 1946 and 2014, which included up to the commencement of the project. The search terms in Table 1 were applied across both databases. Table 1 Search terms  1  [(cancer) OR (neoplasms)] AND [(care coordination) OR (coordination of care)] OR (continuity of care) AND (success factors) OR (quality indicators)]  2  [(cancer) OR (neoplasms)] OR [(chronic illness) OR (chronic disease)] AND [(care coordination) OR (coordination of care) OR (continuity of care) OR (integrated care) OR (care integration) AND (success factors) OR (quality indicators)];  3  [(measurement OR measuring OR measure) OR (evaluation OR evaluate) OR (assessment OR assess) AND “care coordination” AND (cancer)]  Search terms  1  [(cancer) OR (neoplasms)] AND [(care coordination) OR (coordination of care)] OR (continuity of care) AND (success factors) OR (quality indicators)]  2  [(cancer) OR (neoplasms)] OR [(chronic illness) OR (chronic disease)] AND [(care coordination) OR (coordination of care) OR (continuity of care) OR (integrated care) OR (care integration) AND (success factors) OR (quality indicators)];  3  [(measurement OR measuring OR measure) OR (evaluation OR evaluate) OR (assessment OR assess) AND “care coordination” AND (cancer)]  View Large Table 1 Search terms  1  [(cancer) OR (neoplasms)] AND [(care coordination) OR (coordination of care)] OR (continuity of care) AND (success factors) OR (quality indicators)]  2  [(cancer) OR (neoplasms)] OR [(chronic illness) OR (chronic disease)] AND [(care coordination) OR (coordination of care) OR (continuity of care) OR (integrated care) OR (care integration) AND (success factors) OR (quality indicators)];  3  [(measurement OR measuring OR measure) OR (evaluation OR evaluate) OR (assessment OR assess) AND “care coordination” AND (cancer)]  Search terms  1  [(cancer) OR (neoplasms)] AND [(care coordination) OR (coordination of care)] OR (continuity of care) AND (success factors) OR (quality indicators)]  2  [(cancer) OR (neoplasms)] OR [(chronic illness) OR (chronic disease)] AND [(care coordination) OR (coordination of care) OR (continuity of care) OR (integrated care) OR (care integration) AND (success factors) OR (quality indicators)];  3  [(measurement OR measuring OR measure) OR (evaluation OR evaluate) OR (assessment OR assess) AND “care coordination” AND (cancer)]  View Large In addition to the three searches, lists of relevant references were cross-checked for further articles, and the related documents function was utilized within the database. Furthermore, Google Scholar and Google were searched using a combination of the above search terms to identify further research articles or gray literature. The titles and abstracts of articles or executive summaries of gray literature documents were reviewed by two authors (S.Y., A.H.) for relevance. Any discrepancies in inclusion or exclusion of articles were addressed by three authors (S.Y., A.H., T.S.) until a consensus was reached. Articles were included if they made reference to factors or performance indicators of cancer care coordination, achieving best practice for coordinated care in cancer, measuring coordinated care, barriers to coordinated care, or strategies for improving coordinated care. Relevant research articles or gray literature documents were identified and included in the review process (see Fig. 2). Fig. 2 View largeDownload slide Systematic retrieval and exclusion of articles for review. Fig. 2 View largeDownload slide Systematic retrieval and exclusion of articles for review. Developing coordinated care “describing success factors” in cancer While no literature was found that specifically referred to the term “success factors” for coordinated care in cancer, a number of key references and documents were identified that included aspects of successfully coordinated care from a variety of perspectives including the patient, health professional, and organization. Two members of the research team extracted these examples to form a series of succinct statements or “success factors” (S.Y., A.H.). This process was independently reviewed by a third member of the team (T.S.). A matrix of these success factors was developed that linked the factors to the one or more references from which they were drawn. An iterative process of document review and refinement of success factors was undertaken by consensus processes including five authors (S.Y., A.H., T.S., D.M., and N.R.) until saturation of factors in the literature was reached. Inclusion of stakeholder perspectives on successful coordinated care in cancer A list of key stakeholders was identified by the Cancer Institute NSW leadership team and invited by email to electronically submit their perspectives about what they considered to be factors that contributed to improved coordination of care. Key stakeholders included cancer care coordinators, Cancer System Innovation Managers (CSIMs), directors of cancer services, specialist nurses, clinical managers, and consumers (including patients and caregivers). The email provided a background to the project, a set of domains of coordinated care (such as provision of timely information), and examples of potential success factors. A template was included for stakeholders to provide suggestions about what may be regarded as success factors and outcomes of successfully coordinated care, as well as examples of how these might be measured. Success factors and examples of indicators identified through stakeholder submission were merged into the matrix. Where stakeholder suggestions could not be mapped onto success factors drawn from the literature, they were added as standalone items. Refining success factors A consensus driven process was undertaken by the research team and Cancer Institute NSW to refine the list of success factors to reduce duplication, remove factors not clearly linked to coordination of care, and refine the wording of success factors. This process involved two face-to-face meetings attended by the three members of the research team (S.Y., D.M., and T.S.) and two representatives of the Cancer Institute NSW. At these meetings, each success factor was discussed and consensus was reached on its final inclusion. Priority-setting workshops A set of success factors was subjected to a prioritization process previously developed by researchers of Sydney Catalyst in an implementation science program in lung cancer [17, 18]. This priority- setting methodology involves a modified nominal group technique with individual and group ratings of success factors against predetermined criteria. This methodology was well suited to this program of work as it harnesses individual judgments and the interactive discussions of key stakeholders to gain insights and determine the extent of consensus for priority items. Workshop Activity 1—individual ratings Participants were presented with the success factors and provided the opportunity to seek clarification, discuss and debate the factors, and provide suggestions for improvements. A matrix table (see Fig. 3) using a Likert rating scale from 1 to 5 was provided to each participant; they were asked to rate each success factor against two criteria of significance and measurability from 1 (“agree least”) to 5 (“agree most”). Significance was defined as “most likely to impact on patient outcomes” and for measurability, “What indicators set against this could be potentially measured?” During this step, participants were asked to consider and allocate scores based on their individual judgments and were also given the opportunity to provide further comments or suggestion relevant to each success factor. Fig. 3 View largeDownload slide Grid analysis matrix. Fig. 3 View largeDownload slide Grid analysis matrix. Workshop Activity 2—focus group priority-setting activity “significance” Following the completion of the individual matrix, participants broke into one or two groups depending on participant numbers, providing further opportunity for group discussion and debate of the success factors. A “dotmocracy” approach was used to capture the group’s priorities and highlight areas of consensus [19]. Using their individual ratings as a guide, each group member was asked to identify and share what they considered to be their top four success factors, according to significance. Each participant’s priorities were captured with a star placed next to each of their top four identified priorities. If two groups were used, the groups then re-convened and “dotmocracy” charts were compared and combined to determine whole group consensus and priorities for success factors considered to be the most significant. Workshop Activity 3—focus group priority-setting activity “measurability” Participants again broke into one or two groups and repeated Activity 1 for the criteria of measurability. The groups re-convened if needed and charts were combined and compared to determine whole group consensus and priorities considered to be the most measurable in cancer services. Workshop Activity 4—discussion and group consensus Following the priority-setting activities, the charts were combined and reviewed to collectively identify factors that rated highly in terms of both significance and measurability. This provided further opportunity to discuss, debate, and determine whether whole group consensus could be achieved. Evaluation A brief online evaluation survey was disseminated to all workshop participants. The survey consisted of three questions that asked participants to rank on a 1–5 Likert scale: (a) whether they had the opportunity to contribute to discussion during the workshop, (b) whether the success factors were relevant, and (c) whether they found the prioritization process useful. The research team recorded participants’ feedback at each workshop and convened immediately after each workshop to consider how the feedback informed the success factors selected by the participants. RESULTS Scoping literature review Thirty studies and reports were identified and used to develop the success factors for coordinated care. Results included a range of peer reviewed articles, government reports, position statements of cancer control agencies, and clinical and quality of care guidelines [1–3, 8, 12, 15, 16, 20–42]. Inclusion of stakeholder perspectives for successful cancer care coordination A total of 20 submissions were received from stakeholders representing 13 local health districts from across NSW (8 submissions were from metropolitan and 12 from outer metropolitan or rural). Success factors included in the submissions were grouped according to common themes, along with any included examples of indicators. Refining success factors A total of 48 success factors were identified through the review of literature and stakeholder input. This total was refined to the set of 20 success factors. This set of 20 success factors was used in the priority-setting process at each workshop. Priority-setting workshops Quantitative data Seventy key stakeholders from across all NSW local health districts attended one of six priority-setting workshops. Of those in attendance, 25% were from regional, rural, or remote areas. A range of stakeholders attended each workshop dependent on availability. In general, attendees included as a minimum, cancer care coordinators at each site, the CSIM, and a representative of the relevant leadership team. A dedicated workshop was held with eight consumers selected by Cancer Council NSW. Consensus was said to be reached when a success factor was rated as a priority by over one third of all workshop participants for both significance and measurability (this was seen to provide clear value across a heterogeneous stakeholder group). Two success factors stood out as priorities with consensus reached at four of the six priority-setting workshops. These identified success factors were as follows: 1. “Patients receive timely and appropriate care on the pathway from first presentation to diagnosis and to commencement of treatment.” 2. “Patients are routinely screened for physical, psychological, and supportive care needs using validated tools and referred to required services in an appropriate and timely manner.” Two success factors were identified as potential second-tier priorities with consensus reached at three of the six priority-setting workshops. These success factors were as follows: 1. “All patients have a comprehensive care plan that is created jointly by patients, family, and health professionals and that is documented, accessible by relevant care providers and patients, and maintained over the course of their care.” 2. “Patients at elevated risk for disjointed care and poorer outcomes (e.g., Culturally and Linguistically Diverse (CALD), Aboriginal & Torres Strait Islander) are identified and systems are in place to ensure care is appropriately managed and coordinated.” Consensus was not clearly reached on other success factors. Qualitative data Reflection on feedback resulted in the combining of a number of success factors, ultimately leading to refinement of the presented set of 20 success factors to a final set of 14 (see Table 2). Table 2 Final success factors in coordinated cancer care 1  Patients receive timely and appropriate care on the pathway from: • First presentation to diagnosis • Diagnosis to commencement of treatment • From treatment to follow-up care, survivorship, and end of life  2  Patients are screened (routinely and as required) for physical, psychosocial, supportive care, and practical assistance needs using validated tools where available and referred to required services in an appropriate and timely manner.  3  Patients have timely referral and allocation to a key contact person to assist with the coordination of their care.  4  Patients receive best practice care defined by clinical practice guidelines or a clinical pathway for each tumor group  5  Complex presentations and patients at elevated risk for disjointed care and poorer outcomes are identified and systems are in place to ensure care is appropriately managed and coordinated.  6  All patients have comprehensive treatment and follow-up plans that take into account patient and caregiver needs and preferences, and are documented, accessible, and revised over the course of the patient’s care.  7  Transfer of patient information and care between members of the multidisciplinary care team, including allied health, primary, and community care providers, is timely, appropriate, and takes into account patient and caregiver preferences.  8  Patients, families, and caregivers receive timely, relevant, and appropriate information at key points along their care trajectory; this may include information regarding diagnosis, prognosis, intention of treatment (e.g., curative/palliative), and survivorship.  9  Patients are aware of and have access to practical assistance and financial entitlements as appropriate (e.g., transport and accommodation).  10  Patients, caregivers, and families know who to contact for information at different stages during their care trajectory.  11  All patients are considered for discussion at a multidisciplinary team meeting in a timely manner and exclusions are guided by protocols.  12  The roles and responsibilities of each health care professional involved in the patient’s care are understood and communicated to the patient and all members of the multidisciplinary care team.  13  Side effects of disease and treatment are managed in a timely and appropriate manner by the care team to reduce unnecessary visits to ED and hospital admissions.  14  Patients receive timely screening and referral to palliative care services.  1  Patients receive timely and appropriate care on the pathway from: • First presentation to diagnosis • Diagnosis to commencement of treatment • From treatment to follow-up care, survivorship, and end of life  2  Patients are screened (routinely and as required) for physical, psychosocial, supportive care, and practical assistance needs using validated tools where available and referred to required services in an appropriate and timely manner.  3  Patients have timely referral and allocation to a key contact person to assist with the coordination of their care.  4  Patients receive best practice care defined by clinical practice guidelines or a clinical pathway for each tumor group  5  Complex presentations and patients at elevated risk for disjointed care and poorer outcomes are identified and systems are in place to ensure care is appropriately managed and coordinated.  6  All patients have comprehensive treatment and follow-up plans that take into account patient and caregiver needs and preferences, and are documented, accessible, and revised over the course of the patient’s care.  7  Transfer of patient information and care between members of the multidisciplinary care team, including allied health, primary, and community care providers, is timely, appropriate, and takes into account patient and caregiver preferences.  8  Patients, families, and caregivers receive timely, relevant, and appropriate information at key points along their care trajectory; this may include information regarding diagnosis, prognosis, intention of treatment (e.g., curative/palliative), and survivorship.  9  Patients are aware of and have access to practical assistance and financial entitlements as appropriate (e.g., transport and accommodation).  10  Patients, caregivers, and families know who to contact for information at different stages during their care trajectory.  11  All patients are considered for discussion at a multidisciplinary team meeting in a timely manner and exclusions are guided by protocols.  12  The roles and responsibilities of each health care professional involved in the patient’s care are understood and communicated to the patient and all members of the multidisciplinary care team.  13  Side effects of disease and treatment are managed in a timely and appropriate manner by the care team to reduce unnecessary visits to ED and hospital admissions.  14  Patients receive timely screening and referral to palliative care services.  View Large Table 2 Final success factors in coordinated cancer care 1  Patients receive timely and appropriate care on the pathway from: • First presentation to diagnosis • Diagnosis to commencement of treatment • From treatment to follow-up care, survivorship, and end of life  2  Patients are screened (routinely and as required) for physical, psychosocial, supportive care, and practical assistance needs using validated tools where available and referred to required services in an appropriate and timely manner.  3  Patients have timely referral and allocation to a key contact person to assist with the coordination of their care.  4  Patients receive best practice care defined by clinical practice guidelines or a clinical pathway for each tumor group  5  Complex presentations and patients at elevated risk for disjointed care and poorer outcomes are identified and systems are in place to ensure care is appropriately managed and coordinated.  6  All patients have comprehensive treatment and follow-up plans that take into account patient and caregiver needs and preferences, and are documented, accessible, and revised over the course of the patient’s care.  7  Transfer of patient information and care between members of the multidisciplinary care team, including allied health, primary, and community care providers, is timely, appropriate, and takes into account patient and caregiver preferences.  8  Patients, families, and caregivers receive timely, relevant, and appropriate information at key points along their care trajectory; this may include information regarding diagnosis, prognosis, intention of treatment (e.g., curative/palliative), and survivorship.  9  Patients are aware of and have access to practical assistance and financial entitlements as appropriate (e.g., transport and accommodation).  10  Patients, caregivers, and families know who to contact for information at different stages during their care trajectory.  11  All patients are considered for discussion at a multidisciplinary team meeting in a timely manner and exclusions are guided by protocols.  12  The roles and responsibilities of each health care professional involved in the patient’s care are understood and communicated to the patient and all members of the multidisciplinary care team.  13  Side effects of disease and treatment are managed in a timely and appropriate manner by the care team to reduce unnecessary visits to ED and hospital admissions.  14  Patients receive timely screening and referral to palliative care services.  1  Patients receive timely and appropriate care on the pathway from: • First presentation to diagnosis • Diagnosis to commencement of treatment • From treatment to follow-up care, survivorship, and end of life  2  Patients are screened (routinely and as required) for physical, psychosocial, supportive care, and practical assistance needs using validated tools where available and referred to required services in an appropriate and timely manner.  3  Patients have timely referral and allocation to a key contact person to assist with the coordination of their care.  4  Patients receive best practice care defined by clinical practice guidelines or a clinical pathway for each tumor group  5  Complex presentations and patients at elevated risk for disjointed care and poorer outcomes are identified and systems are in place to ensure care is appropriately managed and coordinated.  6  All patients have comprehensive treatment and follow-up plans that take into account patient and caregiver needs and preferences, and are documented, accessible, and revised over the course of the patient’s care.  7  Transfer of patient information and care between members of the multidisciplinary care team, including allied health, primary, and community care providers, is timely, appropriate, and takes into account patient and caregiver preferences.  8  Patients, families, and caregivers receive timely, relevant, and appropriate information at key points along their care trajectory; this may include information regarding diagnosis, prognosis, intention of treatment (e.g., curative/palliative), and survivorship.  9  Patients are aware of and have access to practical assistance and financial entitlements as appropriate (e.g., transport and accommodation).  10  Patients, caregivers, and families know who to contact for information at different stages during their care trajectory.  11  All patients are considered for discussion at a multidisciplinary team meeting in a timely manner and exclusions are guided by protocols.  12  The roles and responsibilities of each health care professional involved in the patient’s care are understood and communicated to the patient and all members of the multidisciplinary care team.  13  Side effects of disease and treatment are managed in a timely and appropriate manner by the care team to reduce unnecessary visits to ED and hospital admissions.  14  Patients receive timely screening and referral to palliative care services.  View Large It was discussed that identifying key time points along the care pathway was vital but particularly challenging in primary care. This led to Success Factor 1 being expanded to include time to diagnosis, time from diagnosis to treatment, and time from diagnosis to supportive care, as described by others [43, 44]. The need for distress and symptom screening being vitally important was highlighted but participants acknowledged that it needs to include both planned and unplanned screening activities. The latter was particularly important in reducing unplanned visits to emergency departments. Success Factor 13 was adjusted accordingly. Treatment and follow-up care plans were considered very important; however, it was recognized that development of a single comprehensive care plan, while ideal, is perhaps unachievable for all patients. Success Factor 6 was modified to indicate that more than one plan could be used along the care trajectory. Much discussion occurred around Success Factor 5 that referred to identifying patients at elevated risk of poorly coordinated care. While this factor was ultimately not prioritized, almost all participants agreed that this factor was central to increasing the efficiency, effectiveness, and equity of access to coordinated care. It was highlighted that what may make a patient at risk of poor coordination covered a wide range of issues, including location, cultural, physical, family, and caregiver related issues. It was discussed at length that every patient needs a key contact at all times during their care journey. However, it was also acknowledged that it is not feasible for all patients to have a coordinator, nor does everyone perhaps need one. It was suggested that appropriate screening of “at risk patients” may alleviate this issue. The role of the general practitioner in the care team was frequently raised. Participants concurred that while there may well be benefits in having general practitioners (GPs) included in multidisciplinary team (MDT) meetings to support coordinated care, logistical issues such as scheduling coordination made it extremely difficult to achieve. Stakeholders referred to just one successful example that involved a GP in a rural location attending an MDT meeting on behalf of other local GPs and reporting back to them. Participants raised concerns around the potential load that may fall on cancer care coordinators and other health professionals in regard to monitoring performance, and they discussed how this load should be kept to a minimum through automation of data collection so it does not distract from clinical care. Care coordinators identified a lack of opportunities to collaborate and recommended establishing a network of coordinators within the state. Participants identified a need for a “universal” electronic/IT system for data collection/reporting and communication/sharing of information between members of the care team, and many felt that a majority of success factors were dependent on the implementation of high-quality health data systems. Evaluation survey A brief online evaluation survey was developed by the research team and disseminated to all workshop participants to evaluate how the workshops were run, how relevant the success factors were, and how useful participants found the prioritization process. Twenty-six of the 51 workshop participants completed the survey (51%). Nearly all (96%) respondents either “strongly agreed” or “agreed” that they had the opportunity to contribute to discussion during the workshop. All respondents either “strongly agreed” (62%) or “agreed” (38%) that the success factors were relevant, and respondents either “strongly agreed” (50%) or “agreed” (46%) that they found the prioritization process useful. Approximately two thirds (62%) of respondents either “strongly agreed” or “agreed” that the workshop provided them a better understanding of the changing funding model for coordinated cancer care suggesting that further information dissemination and stakeholder engagement would be beneficial. DISCUSSION This study presents for the first time success factors for coordinated care in cancer, bringing together the key elements that are reported disparately across a wide body of evidence. We have tested these factors with a diverse group of key stakeholders that includes consumers, clinicians, policymakers, and managers using a validated methodology (the nominal group technique) to prioritize these factors according to significance and measurability. Two success factors in coordinated cancer care were prioritized by study participants. The first was that patients receive timely and appropriate care on the pathway from first presentation to diagnosis, throughout the journey to commencement of treatment, and beyond treatment to follow-up care, survivorship, and end of life. This factor is in line with previous research conducted by Walsh et al. [1] who identified seven key components to care coordination, including access to and navigation through the healthcare system and delivery of services in a complementary and timely manner. Many tumor streams have considerable variation in patient pathways and timeliness of care from first symptom to treatment. This is especially the case in cancers with high morbidity and mortality, such as lung and ovarian cancers where timely treatment needs to occur over a shorter, more rapid timeframe [45]. With regard to the patient journey beyond treatment, the ASCO’s statement on achieving high-quality cancer survivorship care includes acknowledgement of the need for greater coordination of care as the growing population of cancer survivors transition back to primary care [46]. The second prioritized success factor related to patient screening for psychological, physical, and supportive care needs. Again, this is in line with previous research findings that identified needs assessment of each patient’s physical, psychological, and supportive care requirements to be a key element of care coordination [1]. However, while screening for issues such as psychosocial distress is becoming more widespread, and staff are generally positive about screening to help them care for their patients [47], there remains a lack of evidence on the impact of supportive screening and the impact on patient outcomes or the patient experience [48]. Studies have revealed limited use of screening tools, with cancer care professionals expressing reservations about their application in routine practice. There are well-documented challenges with physician time pressures, their comfort with both the clinical and emotional aspects of care, their perception of not having appropriate skills, and finally, poor access to psychological and supportive care services [49]. Concern has also been raised about the potential impact on services, including ensuring adequate psychosocial staff to support a potentially increased need [47]. Issues relating to the systematic identification of patient needs and establishing clear referral pathways need to be addressed if effective psychological, physical, and supportive care is to be provided. The second-tier priority identified in this study—that patients should have a defined care plan along their treatment pathway—is also supported in the literature [20, 27, 33, 34]. Once again this factor presents significant challenges in broad implementation; qualitative data gathered during the prioritization process indicated that treatment plans are infrequently used and are challenging to keep up to date. Further work is needed to define what key elements constitute a treatment plan and when in the treatment pathway plans are best developed and communicated to the patient and GP. The literature review provided a concise overview of the best available evidence relevant to the factors of successful coordination of cancer care. Recent studies, published following commencement of the consensus process, contribute further to the evidence base of relevant consensus studies in cancer care coordination [3, 50, 51] and the impact of care coordination approaches on the quality of care and patient experiences [52]. In this study, patient-reported measures of successful coordination of care were considered in the literature review, and consumers of cancer care were active participants in the consensus process. While others have developed tools for capturing measurements of patient experiences [53], including tools for oncology outpatients [54] and for patients to measure cancer care coordination during the treatment phase of the cancer journey [32], results suggest a need for greater attention on tools aimed at measuring patient experiences of cancer care coordination across the continuum, inclusive of measures of physical and psychosocial care needs. An unexpected outcome of the workshop series was the establishment of a network of care coordinators and exchange of emails across workshops. This reflected the enthusiasm of stakeholders to be able to benchmark different approaches to care coordination across services as well as share experiences. This study prioritizes success factors in the coordination of cancer care to inform future indicator development activities. The results of this study not only inform the Cancer Institute NSW policy concerns, including investments in cancer care services, but also provide valuable insights on priorities that can inform future quality improvement and research activities more broadly. Limitations of this study include the lack of literature available with regard to specifically defining factors relating to successfully coordinated care. The lack of a common definition of coordinated care means that it is more challenging to seek consensus across participants, as participants may attribute different meanings to the term “coordinated care.” The Cancer Institute NSW provided the initial list of stakeholders, and this convenience sample may not represent the views of all oncology health professionals in NSW. For instance, while oncologists were included, it is possible not all specialties were canvassed. In addition, special challenges were faced in obtaining input from certain specialties such as radiation oncology. However, the project team went to considerable lengths to engage a wide variety of participants in the six workshops and ultimately, a wide range of views were represented for the final analysis. In conclusion, this work identifies success factors for coordinated care that are significant in terms of impact on patient outcomes as well as being measurable. These factors lay a strong foundation for the development of KPIs that can be used to link funding with performance. An initial set of KPIs that link to the top two success factors is under development by the Cancer Institute NSW. This project was successful in engaging stakeholders in a priority-setting process that has clear implications for future adoption of KPIs into service delivery. Compliance with Ethical Standards Primary Data: These findings have not been previously published and the manuscript is not being submitted elsewhere. These data have not previously been reported. The authors of this manuscript have full control of all primary data and agree to allow the journal to review the data. Conflict of Interest: There are no actual or potential conflicts of interest Ethical Approval: This is a quality improvement project and no individuals are quoted or identified. No animals were used in this project. Informed Consent: Stakeholders gave informed consent when participating in workshops. The study was completed in compliance with the principles of the Declaration of Helsinki. This is a quality improvement project and no individuals are quoted or identified. Acknowledgments This study was fully funded by the Cancer Institute NSW. References 1. Walsh J, Young JM, Harrison JDet al.   What is important in cancer care coordination? A qualitative investigation. Eur J Cancer Care (Engl) . 2011; 20( 2): 220– 227. Google Scholar CrossRef Search ADS PubMed  2. Walsh J, Harrison JD, Young JM, Butow PN, Solomon MJ, Masya L. What are the current barriers to effective cancer care coordination? A qualitative study. bmc Health Serv Res . 2010; 10: 132. Google Scholar CrossRef Search ADS PubMed  3. Young JM, Masya LM, Solomon MJ, Shepherd HL. Identifying indicators of colorectal cancer care coordination: a Delphi study. Colorectal Dis . 2014; 16( 1): 17– 25. Google Scholar CrossRef Search ADS PubMed  4. Evans SM, Earnest A, Bower W, Senthuren M, McLaughlin P, Stirling R. Timeliness of lung cancer care in Victoria: a retrospective cohort study. Med J Aust . 2016; 204( 2): 75.e1– 75.e9. Google Scholar CrossRef Search ADS   5. Evaluation of the role of cancer care coordinator. 2011; http://www.cancerinstitute.org.au/media/147968/summary%20report%20minus%20es.pdf. Accessed May 3, 2016. 6. Jennings-Sanders A, Anderson ET. Older women with breast cancer: perceptions of the effectiveness of nurse case managers. Nurs Outlook . 2003; 51( 3): 108– 114. Google Scholar CrossRef Search ADS PubMed  7. Yates P. Cancer care coordinators: realizing the potential for improving the patient journey. Cancer Forum . 2004; 28( 3): 128– 132. 8. Department of Health and Ageing GoSA. South Australia lung cancer pathway optimizing outcomes for all South Australians diagnosed with lung cancer. 2013; https://www.sahealth.sa.gov.au. Accessed May 3, 2016. 9. Sellick SM, Edwardson AD. Screening new cancer patients for psychological distress using the hospital anxiety and depression scale. Psychooncology . 2007; 16( 6): 534– 542. Google Scholar CrossRef Search ADS PubMed  10. Freeman RK, Ascioti AJ, Dake M, Mahidhara RS. The Effects of a Multidisciplinary Care Conference on the Quality and Cost of Care for Lung Cancer Patients. Ann Thorac Surg . 2015; 100( 5): 1834– 1838. Google Scholar CrossRef Search ADS PubMed  11. Jefford M, Baravelli C, Dudgeon Pet al.   Tailored chemotherapy information faxed to general practitioners improves confidence in managing adverse effects and satisfaction with shared care: results from a randomized controlled trial. J Clin Oncol . 2008; 26( 14): 2272– 2277. Google Scholar CrossRef Search ADS PubMed  12. Schultz EM, Pineda N, Lonhart J, Davies SM, McDonald KM. A systematic review of the care coordination measurement landscape. bmc Health Serv Res . 2013; 13: 119. Google Scholar CrossRef Search ADS PubMed  13. McDonald KSV, Bravada D, Lewis Ret al.   Care Coordination. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies Technical Review 9 . Shojania K, McDonald K, Wachter R, Owens D, eds 2007, Rockville, MD: Agency for Healthcare Research and Quality: (Prepared by the Stanford University-UCSF Evidence-based Practice Center under contract 290-02-0017); vol. 7; 2007. 14. American Society of Clinical Oncology. The state of cancer care in America, 2014: A report by the American Society of Clinical Oncology. J Oncol Pract . 2014; 10( 2): 119– 142. CrossRef Search ADS PubMed  15. McGuiness C, Sibthorpe B. Development and initial validation of a measure of coordination of health care. Int J Qual Health Care . 2003; 15( 4): 309– 318. Google Scholar CrossRef Search ADS PubMed  16. Seow H, Snyder CF, Mularski RAet al.   A framework for assessing quality indicators for cancer care at the end of life. J Pain Symptom Manage . 2009; 38( 6): 903– 912. Google Scholar CrossRef Search ADS PubMed  17. Rankin NM, McGregor D, Butow PNet al.   Adapting the nominal group technique for priority setting of evidence-practice gaps in implementation science. bmc Med Res Methodol . 2016; 16( 1): 110. Google Scholar CrossRef Search ADS PubMed  18. McGregor D, Rankin N, Butow Pet al.   Closing evidence-practice gaps in lung cancer: results from multi-methods priority setting in the clinical context. Asia Pac J Clin Oncol . 2016. doi: 10.1111/ajco.12499. 19. Public Health Ontario, Health Nexus Canada. Priority setting—four methods for getting to what’s import  ant. Ontario Health Promotion E-Bulletin. 2010, March 5, 2010—OHPE Bulletin 651, Vol. 2010, No. 652. http://www.ohpe.ca/node/11169. Accessed July 26, 2016. 20. COSA. Clinical Oncology Society of Australia: Care coordination workshop report. 2007; https://www.cosa.org.au/media/1063/cosa_report_cancer-care-coordination-workshop_2007.pdf. Accessed April 28, 2016. 21. Services DoHH. Achieving best practice cancer care; a guide for implementing multidisciplinary care. 2007; http://docs.health.vic.gov.au/docs/doc/6675BC2B37531110CA2578E80005F63F/$FILE/multidisciplinarypolicy0702.pdf. Accessed April 28, 2016. 22. COSA. Care coordination outcome measures: building the evidence. 2007; https://www.cosa.org.au/media/185922/COSA-care-coordination-2009-workshop-report-FINAL.pdf. Accessed August 21, 2017. 23. Cancer Council Victoria. Optimal care pathway for people with colorectal cancer. 2014; http://www.cancer.org.au/content/ocp/health/optimal-care-pathway-for-people-with-colorectal-cancer-june-2016.pdf. Accessed August 21, 2017. 24. Division MHaACS. Patient management framework. Breast tumor stream: breast cancer. 2006; www.health.vic.gov.au/cancer. Accessed August 21, 2017. 25. Greenberg A, Angus H, Sullivan T, Brown AD. Development of a set of strategy-based system-level cancer care performance indicators in Ontario, Canada. Int J Qual Health Care . 2005; 17( 2): 107– 114. Google Scholar CrossRef Search ADS PubMed  26. Excellence NIfC. Guidance on cancer services-improving supportive and palliative care for adults with cancer. 2004; http://guidance.nice.org.uk/CSGSP. Accessed August 21, 2017. 27. McDonald KMSE, Albin L, Pineda Net al.   Care Coordination Atlas Version 3 (Prepared by Stanford University under subcontract to Battelle on Contract No. 290-04-0020) . AHRQ Publication No. 11-0023-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2010. 28. Glasgow RE, Wagner EH, Schaefer J, Mahoney LD, Reid RJ, Greene SM. Development and Validation of the Patient Assessment of Chronic Illness Care (PACIC) . Paper presented at: Medical Care; 2005. 29. Ouwens MM, Marres HA, Hermens RRet al.   Quality of integrated care for patients with head and neck cancer: development and measurement of clinical indicators. Head Neck . 2007; 29( 4): 378– 386. Google Scholar CrossRef Search ADS PubMed  30. Peppercorn JM, Weeks JC, Cook EF, Joffe S. Comparison of outcomes in cancer patients treated within and outside clinical trials: conceptual framework and structured review. Lancet . 2004; 363( 9405): 263– 270. Google Scholar CrossRef Search ADS PubMed  31. McDonald KM, Sundaram V, Bravata DMet al.   Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies . Vol. 7: Care Coordination. 2007. 32. Young JM, Walsh J, Butow PN, Solomon MJ, Shaw J. Measuring cancer care coordination: development and validation of a questionnaire for patients. bmc Cancer . 2011; 11: 298. Google Scholar CrossRef Search ADS PubMed  33. NHS Confederation. Coordinated cancer care: better for patients, more efficient. Briefing Issue 203. 2010; http://www.macmillan.org.uk/Documents/AboutUs/Commissioners/CancerCareBriefingJune.pdf. Accessed April 28, 2016. 34. National Quality Forum. Preferred practices and performance measures for measuring and reporting care coordination. 2010; http://www.qualityforum.org/publications/2010/10/Preferred_Practices_and_Performance_Measures_for_Measuring_and_Reporting_care_coordination.aspx. Accessed April 28, 2016. 35. North Eastern Melbourne Integrated Cancer Service. Coordinated Cancer Care Strategy 2012–2013. 2012; http://www.nemics.org.au/icms_docs/177758_NEMICS_coordinated_cancer_care_strategy.pdf Accessed August 21, 2017. 36. Agency for Healthcare Research and Quality. Prospects for Care Coordination Measurement Using Electronic Data Sources. 2014; http://www.ahrq.gov/research/findings/final-reports/prospectscare/index.html. Accessed August 21, 2017. 37. Cancer Institute NSW. Cancer Plan 2011–2015. 2010; https://www.cancerinstitute.org.au/getattachment/2e9328bd-6178-47e8-a6c4-03a7acd8c620/NSW-Cancer-Plan-2011–2015.PDF. Accessed August 23, 2017. 38. Cancer Council Australia. Optimal care pathway for people with lung cancer. 2014; http://www.cancer.org.au/content/ocp/health/optimal-care-pathway-for-people-with-lung- cancer-june-2016.pdf#_ga=2.11026548.1745935410.1503546538-158334493.1502508761. Accessed August 23, 2017. 39. North Eastern Metropolitan Integrated Cancer Services (NEMICS). Enhancing supportive care for people affected by cancer across North East Melbourne. 2010; http://www.nemics.org.au/icms_docs/171576_Supportive_care_strategy.pdf. Accessed August 23, 2017. 40. Cancer Quality Council of Ontario. Strengthening the quality of cancer services in Ontario. 2003; https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=13770. Accessed August 23, 2017. 41. National Breast Cancer Centre. Multidisciplinary meetings for cancer care: a guide for health service providers. 2005; http://www.canceraustralia.gov.au/sites/default/files/publications/mdm-mdc-meeting-for-cancer-care_504af02d7368d.pdf. Accessed August 23, 2017. 42. Cancer Australia. Investigating symptoms of lung cancer: a guide for GPs. 2012; http://canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/investigating-symptoms-lung-cancer-guide-gps. Accessed August 23, 2017. 43. Nekhlyudov L, Latosinsky S. The interface of primary and oncology specialty care: from symptoms to diagnosis. J Natl Cancer Inst Monogr . 2010; 2010( 40): 11– 17. Google Scholar CrossRef Search ADS PubMed  44. Taplin SH, Anhang Price R, Edwards HMet al.   Introduction: understanding and influencing multilevel factors across the cancer care continuum. J Natl Cancer Inst Monogr . 2012; 2012( 44): 2– 10. Google Scholar CrossRef Search ADS PubMed  45. Largey G, Ristevski E, Chambers H, Davis H, Briggs P. Lung cancer interval times from point of referral to the acute health sector to the start of first treatment. Aust Health Rev . 2016; 40( 6): 649– 654. Google Scholar CrossRef Search ADS PubMed  46. McCabe MS, Bhatia S, Oeffinger KCet al.   American society of clinical oncology statement: achieving high-quality cancer survivorship care. J Clin Oncol . 2013; 31( 5): 631– 640. Google Scholar CrossRef Search ADS PubMed  47. Lee SJ, Katona LJ, De Bono SE, Lewis KL. Routine screening for psychological distress on an Australian inpatient haematology and oncology ward: impact on use of psychosocial services. Med J Aust . 2010; 193( Suppl 5): S74– S78. Google Scholar PubMed  48. Grimmer K, Fulton A, Uy J, Dizon J, Pillen H, Gibbs C. Supportive Care Screening Instruments Review . University of South Australia; 2016. 49. Absolom K, Holch P, Pini Set al.  ; NCRI COMPASS Supportive and Palliative Care Research Collaborative. The detection and management of emotional distress in cancer patients: the views of health-care professionals. Psychooncology . 2011; 20( 6): 601– 608. Google Scholar CrossRef Search ADS PubMed  50. Mayer DK, Nekhlyudov L, Snyder CF, Merrill JK, Wollins DS, Shulman LN. American society of clinical oncology clinical expert statement on cancer survivorship care planning. J Oncol Pract . 2014; 10( 6): 345– 351. Google Scholar CrossRef Search ADS PubMed  51. Parry C, Beckjord E, Moser RP, Vieux SN, Padgett LS, Hesse BW. It takes a (virtual) village: crowdsourcing measurement consensus to advance survivorship care planning. Transl Behav Med . 2015; 5( 1): 53– 59. Google Scholar CrossRef Search ADS PubMed  52. Gorin SS, Haggstrom D, Han PKJ, Fairfield KM, Krebs P, Clauser SB. Cancer care coordination: a systematic review and meta-analysis of over 30 years of empirical studies. Ann Behav Med . 2017; 51( 4): 532– 546 Google Scholar CrossRef Search ADS PubMed  53. Jenkinson C, Coulter A, Bruster S. The picker patient experience questionnaire: development and validation using data from in-patient surveys in five countries. Int J Qual Health Care . 2002; 14( 5): 353– 358. Google Scholar CrossRef Search ADS PubMed  54. Harley C, Adams J, Booth L, Selby P, Brown J, Velikova G. Patient experiences of continuity of cancer care: development of a new medical care questionnaire (MCQ) for oncology outpatients. Value Health . 2009; 12( 8): 1180– 1186. Google Scholar CrossRef Search ADS PubMed  © Society of Behavioral Medicine 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 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Defining success factors to describe coordinated care in cancer

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Abstract

Abstract Providing coordinated care remains a challenge for cancer services globally. There is a lack of consensus in the literature about what constitutes successful coordinated care. This study aimed to define and prioritize a set of consensus-driven success factors that can lead to coordinated care. A mixed-methods approach was used that included literature review, a broad call for submissions from relevant stakeholders, and a priority-setting process based on a modified nominal group technique. Thirty articles that related to success factors in coordinated care were identified in the literature. Twenty submissions were received from a broad range of stakeholders. From these sources, a set of 20 success factors was derived. Seventy stakeholders attended a series of workshops across New South Wales, Australia, to review and prioritize these 20 success factors against significance and measurability. Clear consensus was reached on prioritizing two success factors linked to improving coordinated care from first presentation to diagnosis and ensuring that patients are routinely screened for physical and supportive care needs. Other highly ranked factors included the need for a comprehensive care plan and the identification of patients at higher risk for disjointed care. This study defines and prioritizes a set of success factors related to coordinated care in cancer. These success factors will be used to guide the development of interventions that target improving coordinated care as well as supporting the development of new funding models based on performance indicators derived from these factors. Implications Practice: Clinicians and health managers can assess performance across the spectrum of coordinated care in the services they deliver to improve quality. Policy: Success factors to describe coordinated care in cancer can be linked to key performance indicator development to measure and report on coordinated care. Research: Future research should be aimed at validating these success factors in broader populations and reviewing their applicability in indicator development. INTRODUCTION How to best coordinate cancer care remains a key challenge for health services globally [1–3]. Across many types of cancer, there is evidence that care is poorly coordinated resulting in fragmented care, unnecessary stress, and increased morbidity [4]. A variety of interventions have been adopted by health services to improve coordinated care including introduction of cancer care coordinators and patient navigators [5–7], implementation of treatment care pathways and plans [8], screening of patients for physical and psychological distress [9], multidisciplinary cancer care teams [10], and application of electronic communication tools [11]. Despite the wide variety of approaches taken to improve coordinated care, gaps remain in the empirical evidence pertaining to the effectiveness and impact of coordination strategies. One of the greatest challenges is a lack of conceptual clarity for a broadly accepted definition of care coordination [12, 13]. A literature review conducted by McDonald et al. [13] identified more than 40 definitions of care coordination. While the authors of this study propose a common definition for care coordination, the description of an extensive list of available definitions highlights a lack of common understanding for shared discourse and research. This only adds confusion to an already complex process involving multiple players who deliver multimodal interventions typically dispersed across health services. Further consequences include a lack of a common reference for consensus-building processes that seek to better understand components of coordinated cancer care and the development of measures to gauge the impact of these care components. Globally, providers are faced with increasing performance scrutiny, with growing requirements to justify service provision, inclusive of coordination of care interventions. This pressure to demonstrate value has led to considerable interest from multiple stakeholders, such as funders, accreditors, and governing agencies, who seek valid indicators for the measurement of care quality, including care outcomes. The American Society of Clinical Oncology (ASCO) regards the growing number of long-term survivors of cancer to be a success story, but acknowledges that now greater focus is required on transitions in care and coordination with other providers [14]. In a report addressing the state of cancer services in America (2014), ASCO emphasizes the need to engage primary care and advanced practice providers in coordination of care, as well as developing new payment models that reward care coordination services. In the state of New South Wales (NSW), Australia, funding for coordinated care in cancer has been historically directed to supporting care coordinator positions. While cancer care coordinators clearly provide important services [5, 7], there is considerable inequity in the distribution of cancer care coordinators across institutions and tumor streams [5]. The Cancer Institute NSW, a government-funded statewide cancer control agency, has recently changed its funding model from one that focuses on roles to one that links funding to improving performance in key areas across the cancer system. To support this transition, funding for coordinated care is progressively being linked to meeting a set of key performance indicators (KPIs). Such calls exemplify the widespread transitions in services that create the need for reliable measures of care coordination. In addition, there have been a number of indicator development efforts associated with care coordination, including measures not specific to cancer care [15], those focused on a particular tumor stream [3], and others targeted at a specific stage of the cancer journey [16]. To support their iterative KPI development process, the Cancer Institute NSW commissioned the University of Sydney to identify and prioritize a set of key “success factors” to inform a broad set of statements that collectively describe successfully coordinated cancer care from a patient, health professional, and systems perspective. The aim of this project was to document and prioritize success factors for coordinated care based on significance and measurability that can be used to guide the development of a set of coordinated cancer care KPIs. The term success factor is used to describe how successful coordination of care can be described, which is a necessary precursor to the development of formal KPIs. METHODS A systematic process was used to define a set of success factors (Fig. 1). This process included a review of the literature, a broad invitation to stakeholders to submit their own success factors, and a series of workshops to prioritize these success factors against the criteria of significance and measurability. Fig. 1 View largeDownload slide Methodological approach. NSW, New South Wales; KPI, key performance indicator. Fig. 1 View largeDownload slide Methodological approach. NSW, New South Wales; KPI, key performance indicator. Literature review A literature review was undertaken to identify existing success factors for coordinated cancer care. As there is no definitive definition of coordinated care in cancer, a wide variety of search terms were used relating to coordinated care, integrated care, and chronic disease to identify potential success factors. The literature search was conducted using MEDLINE and SCOPUS between 1946 and 2014, which included up to the commencement of the project. The search terms in Table 1 were applied across both databases. Table 1 Search terms  1  [(cancer) OR (neoplasms)] AND [(care coordination) OR (coordination of care)] OR (continuity of care) AND (success factors) OR (quality indicators)]  2  [(cancer) OR (neoplasms)] OR [(chronic illness) OR (chronic disease)] AND [(care coordination) OR (coordination of care) OR (continuity of care) OR (integrated care) OR (care integration) AND (success factors) OR (quality indicators)];  3  [(measurement OR measuring OR measure) OR (evaluation OR evaluate) OR (assessment OR assess) AND “care coordination” AND (cancer)]  Search terms  1  [(cancer) OR (neoplasms)] AND [(care coordination) OR (coordination of care)] OR (continuity of care) AND (success factors) OR (quality indicators)]  2  [(cancer) OR (neoplasms)] OR [(chronic illness) OR (chronic disease)] AND [(care coordination) OR (coordination of care) OR (continuity of care) OR (integrated care) OR (care integration) AND (success factors) OR (quality indicators)];  3  [(measurement OR measuring OR measure) OR (evaluation OR evaluate) OR (assessment OR assess) AND “care coordination” AND (cancer)]  View Large Table 1 Search terms  1  [(cancer) OR (neoplasms)] AND [(care coordination) OR (coordination of care)] OR (continuity of care) AND (success factors) OR (quality indicators)]  2  [(cancer) OR (neoplasms)] OR [(chronic illness) OR (chronic disease)] AND [(care coordination) OR (coordination of care) OR (continuity of care) OR (integrated care) OR (care integration) AND (success factors) OR (quality indicators)];  3  [(measurement OR measuring OR measure) OR (evaluation OR evaluate) OR (assessment OR assess) AND “care coordination” AND (cancer)]  Search terms  1  [(cancer) OR (neoplasms)] AND [(care coordination) OR (coordination of care)] OR (continuity of care) AND (success factors) OR (quality indicators)]  2  [(cancer) OR (neoplasms)] OR [(chronic illness) OR (chronic disease)] AND [(care coordination) OR (coordination of care) OR (continuity of care) OR (integrated care) OR (care integration) AND (success factors) OR (quality indicators)];  3  [(measurement OR measuring OR measure) OR (evaluation OR evaluate) OR (assessment OR assess) AND “care coordination” AND (cancer)]  View Large In addition to the three searches, lists of relevant references were cross-checked for further articles, and the related documents function was utilized within the database. Furthermore, Google Scholar and Google were searched using a combination of the above search terms to identify further research articles or gray literature. The titles and abstracts of articles or executive summaries of gray literature documents were reviewed by two authors (S.Y., A.H.) for relevance. Any discrepancies in inclusion or exclusion of articles were addressed by three authors (S.Y., A.H., T.S.) until a consensus was reached. Articles were included if they made reference to factors or performance indicators of cancer care coordination, achieving best practice for coordinated care in cancer, measuring coordinated care, barriers to coordinated care, or strategies for improving coordinated care. Relevant research articles or gray literature documents were identified and included in the review process (see Fig. 2). Fig. 2 View largeDownload slide Systematic retrieval and exclusion of articles for review. Fig. 2 View largeDownload slide Systematic retrieval and exclusion of articles for review. Developing coordinated care “describing success factors” in cancer While no literature was found that specifically referred to the term “success factors” for coordinated care in cancer, a number of key references and documents were identified that included aspects of successfully coordinated care from a variety of perspectives including the patient, health professional, and organization. Two members of the research team extracted these examples to form a series of succinct statements or “success factors” (S.Y., A.H.). This process was independently reviewed by a third member of the team (T.S.). A matrix of these success factors was developed that linked the factors to the one or more references from which they were drawn. An iterative process of document review and refinement of success factors was undertaken by consensus processes including five authors (S.Y., A.H., T.S., D.M., and N.R.) until saturation of factors in the literature was reached. Inclusion of stakeholder perspectives on successful coordinated care in cancer A list of key stakeholders was identified by the Cancer Institute NSW leadership team and invited by email to electronically submit their perspectives about what they considered to be factors that contributed to improved coordination of care. Key stakeholders included cancer care coordinators, Cancer System Innovation Managers (CSIMs), directors of cancer services, specialist nurses, clinical managers, and consumers (including patients and caregivers). The email provided a background to the project, a set of domains of coordinated care (such as provision of timely information), and examples of potential success factors. A template was included for stakeholders to provide suggestions about what may be regarded as success factors and outcomes of successfully coordinated care, as well as examples of how these might be measured. Success factors and examples of indicators identified through stakeholder submission were merged into the matrix. Where stakeholder suggestions could not be mapped onto success factors drawn from the literature, they were added as standalone items. Refining success factors A consensus driven process was undertaken by the research team and Cancer Institute NSW to refine the list of success factors to reduce duplication, remove factors not clearly linked to coordination of care, and refine the wording of success factors. This process involved two face-to-face meetings attended by the three members of the research team (S.Y., D.M., and T.S.) and two representatives of the Cancer Institute NSW. At these meetings, each success factor was discussed and consensus was reached on its final inclusion. Priority-setting workshops A set of success factors was subjected to a prioritization process previously developed by researchers of Sydney Catalyst in an implementation science program in lung cancer [17, 18]. This priority- setting methodology involves a modified nominal group technique with individual and group ratings of success factors against predetermined criteria. This methodology was well suited to this program of work as it harnesses individual judgments and the interactive discussions of key stakeholders to gain insights and determine the extent of consensus for priority items. Workshop Activity 1—individual ratings Participants were presented with the success factors and provided the opportunity to seek clarification, discuss and debate the factors, and provide suggestions for improvements. A matrix table (see Fig. 3) using a Likert rating scale from 1 to 5 was provided to each participant; they were asked to rate each success factor against two criteria of significance and measurability from 1 (“agree least”) to 5 (“agree most”). Significance was defined as “most likely to impact on patient outcomes” and for measurability, “What indicators set against this could be potentially measured?” During this step, participants were asked to consider and allocate scores based on their individual judgments and were also given the opportunity to provide further comments or suggestion relevant to each success factor. Fig. 3 View largeDownload slide Grid analysis matrix. Fig. 3 View largeDownload slide Grid analysis matrix. Workshop Activity 2—focus group priority-setting activity “significance” Following the completion of the individual matrix, participants broke into one or two groups depending on participant numbers, providing further opportunity for group discussion and debate of the success factors. A “dotmocracy” approach was used to capture the group’s priorities and highlight areas of consensus [19]. Using their individual ratings as a guide, each group member was asked to identify and share what they considered to be their top four success factors, according to significance. Each participant’s priorities were captured with a star placed next to each of their top four identified priorities. If two groups were used, the groups then re-convened and “dotmocracy” charts were compared and combined to determine whole group consensus and priorities for success factors considered to be the most significant. Workshop Activity 3—focus group priority-setting activity “measurability” Participants again broke into one or two groups and repeated Activity 1 for the criteria of measurability. The groups re-convened if needed and charts were combined and compared to determine whole group consensus and priorities considered to be the most measurable in cancer services. Workshop Activity 4—discussion and group consensus Following the priority-setting activities, the charts were combined and reviewed to collectively identify factors that rated highly in terms of both significance and measurability. This provided further opportunity to discuss, debate, and determine whether whole group consensus could be achieved. Evaluation A brief online evaluation survey was disseminated to all workshop participants. The survey consisted of three questions that asked participants to rank on a 1–5 Likert scale: (a) whether they had the opportunity to contribute to discussion during the workshop, (b) whether the success factors were relevant, and (c) whether they found the prioritization process useful. The research team recorded participants’ feedback at each workshop and convened immediately after each workshop to consider how the feedback informed the success factors selected by the participants. RESULTS Scoping literature review Thirty studies and reports were identified and used to develop the success factors for coordinated care. Results included a range of peer reviewed articles, government reports, position statements of cancer control agencies, and clinical and quality of care guidelines [1–3, 8, 12, 15, 16, 20–42]. Inclusion of stakeholder perspectives for successful cancer care coordination A total of 20 submissions were received from stakeholders representing 13 local health districts from across NSW (8 submissions were from metropolitan and 12 from outer metropolitan or rural). Success factors included in the submissions were grouped according to common themes, along with any included examples of indicators. Refining success factors A total of 48 success factors were identified through the review of literature and stakeholder input. This total was refined to the set of 20 success factors. This set of 20 success factors was used in the priority-setting process at each workshop. Priority-setting workshops Quantitative data Seventy key stakeholders from across all NSW local health districts attended one of six priority-setting workshops. Of those in attendance, 25% were from regional, rural, or remote areas. A range of stakeholders attended each workshop dependent on availability. In general, attendees included as a minimum, cancer care coordinators at each site, the CSIM, and a representative of the relevant leadership team. A dedicated workshop was held with eight consumers selected by Cancer Council NSW. Consensus was said to be reached when a success factor was rated as a priority by over one third of all workshop participants for both significance and measurability (this was seen to provide clear value across a heterogeneous stakeholder group). Two success factors stood out as priorities with consensus reached at four of the six priority-setting workshops. These identified success factors were as follows: 1. “Patients receive timely and appropriate care on the pathway from first presentation to diagnosis and to commencement of treatment.” 2. “Patients are routinely screened for physical, psychological, and supportive care needs using validated tools and referred to required services in an appropriate and timely manner.” Two success factors were identified as potential second-tier priorities with consensus reached at three of the six priority-setting workshops. These success factors were as follows: 1. “All patients have a comprehensive care plan that is created jointly by patients, family, and health professionals and that is documented, accessible by relevant care providers and patients, and maintained over the course of their care.” 2. “Patients at elevated risk for disjointed care and poorer outcomes (e.g., Culturally and Linguistically Diverse (CALD), Aboriginal & Torres Strait Islander) are identified and systems are in place to ensure care is appropriately managed and coordinated.” Consensus was not clearly reached on other success factors. Qualitative data Reflection on feedback resulted in the combining of a number of success factors, ultimately leading to refinement of the presented set of 20 success factors to a final set of 14 (see Table 2). Table 2 Final success factors in coordinated cancer care 1  Patients receive timely and appropriate care on the pathway from: • First presentation to diagnosis • Diagnosis to commencement of treatment • From treatment to follow-up care, survivorship, and end of life  2  Patients are screened (routinely and as required) for physical, psychosocial, supportive care, and practical assistance needs using validated tools where available and referred to required services in an appropriate and timely manner.  3  Patients have timely referral and allocation to a key contact person to assist with the coordination of their care.  4  Patients receive best practice care defined by clinical practice guidelines or a clinical pathway for each tumor group  5  Complex presentations and patients at elevated risk for disjointed care and poorer outcomes are identified and systems are in place to ensure care is appropriately managed and coordinated.  6  All patients have comprehensive treatment and follow-up plans that take into account patient and caregiver needs and preferences, and are documented, accessible, and revised over the course of the patient’s care.  7  Transfer of patient information and care between members of the multidisciplinary care team, including allied health, primary, and community care providers, is timely, appropriate, and takes into account patient and caregiver preferences.  8  Patients, families, and caregivers receive timely, relevant, and appropriate information at key points along their care trajectory; this may include information regarding diagnosis, prognosis, intention of treatment (e.g., curative/palliative), and survivorship.  9  Patients are aware of and have access to practical assistance and financial entitlements as appropriate (e.g., transport and accommodation).  10  Patients, caregivers, and families know who to contact for information at different stages during their care trajectory.  11  All patients are considered for discussion at a multidisciplinary team meeting in a timely manner and exclusions are guided by protocols.  12  The roles and responsibilities of each health care professional involved in the patient’s care are understood and communicated to the patient and all members of the multidisciplinary care team.  13  Side effects of disease and treatment are managed in a timely and appropriate manner by the care team to reduce unnecessary visits to ED and hospital admissions.  14  Patients receive timely screening and referral to palliative care services.  1  Patients receive timely and appropriate care on the pathway from: • First presentation to diagnosis • Diagnosis to commencement of treatment • From treatment to follow-up care, survivorship, and end of life  2  Patients are screened (routinely and as required) for physical, psychosocial, supportive care, and practical assistance needs using validated tools where available and referred to required services in an appropriate and timely manner.  3  Patients have timely referral and allocation to a key contact person to assist with the coordination of their care.  4  Patients receive best practice care defined by clinical practice guidelines or a clinical pathway for each tumor group  5  Complex presentations and patients at elevated risk for disjointed care and poorer outcomes are identified and systems are in place to ensure care is appropriately managed and coordinated.  6  All patients have comprehensive treatment and follow-up plans that take into account patient and caregiver needs and preferences, and are documented, accessible, and revised over the course of the patient’s care.  7  Transfer of patient information and care between members of the multidisciplinary care team, including allied health, primary, and community care providers, is timely, appropriate, and takes into account patient and caregiver preferences.  8  Patients, families, and caregivers receive timely, relevant, and appropriate information at key points along their care trajectory; this may include information regarding diagnosis, prognosis, intention of treatment (e.g., curative/palliative), and survivorship.  9  Patients are aware of and have access to practical assistance and financial entitlements as appropriate (e.g., transport and accommodation).  10  Patients, caregivers, and families know who to contact for information at different stages during their care trajectory.  11  All patients are considered for discussion at a multidisciplinary team meeting in a timely manner and exclusions are guided by protocols.  12  The roles and responsibilities of each health care professional involved in the patient’s care are understood and communicated to the patient and all members of the multidisciplinary care team.  13  Side effects of disease and treatment are managed in a timely and appropriate manner by the care team to reduce unnecessary visits to ED and hospital admissions.  14  Patients receive timely screening and referral to palliative care services.  View Large Table 2 Final success factors in coordinated cancer care 1  Patients receive timely and appropriate care on the pathway from: • First presentation to diagnosis • Diagnosis to commencement of treatment • From treatment to follow-up care, survivorship, and end of life  2  Patients are screened (routinely and as required) for physical, psychosocial, supportive care, and practical assistance needs using validated tools where available and referred to required services in an appropriate and timely manner.  3  Patients have timely referral and allocation to a key contact person to assist with the coordination of their care.  4  Patients receive best practice care defined by clinical practice guidelines or a clinical pathway for each tumor group  5  Complex presentations and patients at elevated risk for disjointed care and poorer outcomes are identified and systems are in place to ensure care is appropriately managed and coordinated.  6  All patients have comprehensive treatment and follow-up plans that take into account patient and caregiver needs and preferences, and are documented, accessible, and revised over the course of the patient’s care.  7  Transfer of patient information and care between members of the multidisciplinary care team, including allied health, primary, and community care providers, is timely, appropriate, and takes into account patient and caregiver preferences.  8  Patients, families, and caregivers receive timely, relevant, and appropriate information at key points along their care trajectory; this may include information regarding diagnosis, prognosis, intention of treatment (e.g., curative/palliative), and survivorship.  9  Patients are aware of and have access to practical assistance and financial entitlements as appropriate (e.g., transport and accommodation).  10  Patients, caregivers, and families know who to contact for information at different stages during their care trajectory.  11  All patients are considered for discussion at a multidisciplinary team meeting in a timely manner and exclusions are guided by protocols.  12  The roles and responsibilities of each health care professional involved in the patient’s care are understood and communicated to the patient and all members of the multidisciplinary care team.  13  Side effects of disease and treatment are managed in a timely and appropriate manner by the care team to reduce unnecessary visits to ED and hospital admissions.  14  Patients receive timely screening and referral to palliative care services.  1  Patients receive timely and appropriate care on the pathway from: • First presentation to diagnosis • Diagnosis to commencement of treatment • From treatment to follow-up care, survivorship, and end of life  2  Patients are screened (routinely and as required) for physical, psychosocial, supportive care, and practical assistance needs using validated tools where available and referred to required services in an appropriate and timely manner.  3  Patients have timely referral and allocation to a key contact person to assist with the coordination of their care.  4  Patients receive best practice care defined by clinical practice guidelines or a clinical pathway for each tumor group  5  Complex presentations and patients at elevated risk for disjointed care and poorer outcomes are identified and systems are in place to ensure care is appropriately managed and coordinated.  6  All patients have comprehensive treatment and follow-up plans that take into account patient and caregiver needs and preferences, and are documented, accessible, and revised over the course of the patient’s care.  7  Transfer of patient information and care between members of the multidisciplinary care team, including allied health, primary, and community care providers, is timely, appropriate, and takes into account patient and caregiver preferences.  8  Patients, families, and caregivers receive timely, relevant, and appropriate information at key points along their care trajectory; this may include information regarding diagnosis, prognosis, intention of treatment (e.g., curative/palliative), and survivorship.  9  Patients are aware of and have access to practical assistance and financial entitlements as appropriate (e.g., transport and accommodation).  10  Patients, caregivers, and families know who to contact for information at different stages during their care trajectory.  11  All patients are considered for discussion at a multidisciplinary team meeting in a timely manner and exclusions are guided by protocols.  12  The roles and responsibilities of each health care professional involved in the patient’s care are understood and communicated to the patient and all members of the multidisciplinary care team.  13  Side effects of disease and treatment are managed in a timely and appropriate manner by the care team to reduce unnecessary visits to ED and hospital admissions.  14  Patients receive timely screening and referral to palliative care services.  View Large It was discussed that identifying key time points along the care pathway was vital but particularly challenging in primary care. This led to Success Factor 1 being expanded to include time to diagnosis, time from diagnosis to treatment, and time from diagnosis to supportive care, as described by others [43, 44]. The need for distress and symptom screening being vitally important was highlighted but participants acknowledged that it needs to include both planned and unplanned screening activities. The latter was particularly important in reducing unplanned visits to emergency departments. Success Factor 13 was adjusted accordingly. Treatment and follow-up care plans were considered very important; however, it was recognized that development of a single comprehensive care plan, while ideal, is perhaps unachievable for all patients. Success Factor 6 was modified to indicate that more than one plan could be used along the care trajectory. Much discussion occurred around Success Factor 5 that referred to identifying patients at elevated risk of poorly coordinated care. While this factor was ultimately not prioritized, almost all participants agreed that this factor was central to increasing the efficiency, effectiveness, and equity of access to coordinated care. It was highlighted that what may make a patient at risk of poor coordination covered a wide range of issues, including location, cultural, physical, family, and caregiver related issues. It was discussed at length that every patient needs a key contact at all times during their care journey. However, it was also acknowledged that it is not feasible for all patients to have a coordinator, nor does everyone perhaps need one. It was suggested that appropriate screening of “at risk patients” may alleviate this issue. The role of the general practitioner in the care team was frequently raised. Participants concurred that while there may well be benefits in having general practitioners (GPs) included in multidisciplinary team (MDT) meetings to support coordinated care, logistical issues such as scheduling coordination made it extremely difficult to achieve. Stakeholders referred to just one successful example that involved a GP in a rural location attending an MDT meeting on behalf of other local GPs and reporting back to them. Participants raised concerns around the potential load that may fall on cancer care coordinators and other health professionals in regard to monitoring performance, and they discussed how this load should be kept to a minimum through automation of data collection so it does not distract from clinical care. Care coordinators identified a lack of opportunities to collaborate and recommended establishing a network of coordinators within the state. Participants identified a need for a “universal” electronic/IT system for data collection/reporting and communication/sharing of information between members of the care team, and many felt that a majority of success factors were dependent on the implementation of high-quality health data systems. Evaluation survey A brief online evaluation survey was developed by the research team and disseminated to all workshop participants to evaluate how the workshops were run, how relevant the success factors were, and how useful participants found the prioritization process. Twenty-six of the 51 workshop participants completed the survey (51%). Nearly all (96%) respondents either “strongly agreed” or “agreed” that they had the opportunity to contribute to discussion during the workshop. All respondents either “strongly agreed” (62%) or “agreed” (38%) that the success factors were relevant, and respondents either “strongly agreed” (50%) or “agreed” (46%) that they found the prioritization process useful. Approximately two thirds (62%) of respondents either “strongly agreed” or “agreed” that the workshop provided them a better understanding of the changing funding model for coordinated cancer care suggesting that further information dissemination and stakeholder engagement would be beneficial. DISCUSSION This study presents for the first time success factors for coordinated care in cancer, bringing together the key elements that are reported disparately across a wide body of evidence. We have tested these factors with a diverse group of key stakeholders that includes consumers, clinicians, policymakers, and managers using a validated methodology (the nominal group technique) to prioritize these factors according to significance and measurability. Two success factors in coordinated cancer care were prioritized by study participants. The first was that patients receive timely and appropriate care on the pathway from first presentation to diagnosis, throughout the journey to commencement of treatment, and beyond treatment to follow-up care, survivorship, and end of life. This factor is in line with previous research conducted by Walsh et al. [1] who identified seven key components to care coordination, including access to and navigation through the healthcare system and delivery of services in a complementary and timely manner. Many tumor streams have considerable variation in patient pathways and timeliness of care from first symptom to treatment. This is especially the case in cancers with high morbidity and mortality, such as lung and ovarian cancers where timely treatment needs to occur over a shorter, more rapid timeframe [45]. With regard to the patient journey beyond treatment, the ASCO’s statement on achieving high-quality cancer survivorship care includes acknowledgement of the need for greater coordination of care as the growing population of cancer survivors transition back to primary care [46]. The second prioritized success factor related to patient screening for psychological, physical, and supportive care needs. Again, this is in line with previous research findings that identified needs assessment of each patient’s physical, psychological, and supportive care requirements to be a key element of care coordination [1]. However, while screening for issues such as psychosocial distress is becoming more widespread, and staff are generally positive about screening to help them care for their patients [47], there remains a lack of evidence on the impact of supportive screening and the impact on patient outcomes or the patient experience [48]. Studies have revealed limited use of screening tools, with cancer care professionals expressing reservations about their application in routine practice. There are well-documented challenges with physician time pressures, their comfort with both the clinical and emotional aspects of care, their perception of not having appropriate skills, and finally, poor access to psychological and supportive care services [49]. Concern has also been raised about the potential impact on services, including ensuring adequate psychosocial staff to support a potentially increased need [47]. Issues relating to the systematic identification of patient needs and establishing clear referral pathways need to be addressed if effective psychological, physical, and supportive care is to be provided. The second-tier priority identified in this study—that patients should have a defined care plan along their treatment pathway—is also supported in the literature [20, 27, 33, 34]. Once again this factor presents significant challenges in broad implementation; qualitative data gathered during the prioritization process indicated that treatment plans are infrequently used and are challenging to keep up to date. Further work is needed to define what key elements constitute a treatment plan and when in the treatment pathway plans are best developed and communicated to the patient and GP. The literature review provided a concise overview of the best available evidence relevant to the factors of successful coordination of cancer care. Recent studies, published following commencement of the consensus process, contribute further to the evidence base of relevant consensus studies in cancer care coordination [3, 50, 51] and the impact of care coordination approaches on the quality of care and patient experiences [52]. In this study, patient-reported measures of successful coordination of care were considered in the literature review, and consumers of cancer care were active participants in the consensus process. While others have developed tools for capturing measurements of patient experiences [53], including tools for oncology outpatients [54] and for patients to measure cancer care coordination during the treatment phase of the cancer journey [32], results suggest a need for greater attention on tools aimed at measuring patient experiences of cancer care coordination across the continuum, inclusive of measures of physical and psychosocial care needs. An unexpected outcome of the workshop series was the establishment of a network of care coordinators and exchange of emails across workshops. This reflected the enthusiasm of stakeholders to be able to benchmark different approaches to care coordination across services as well as share experiences. This study prioritizes success factors in the coordination of cancer care to inform future indicator development activities. The results of this study not only inform the Cancer Institute NSW policy concerns, including investments in cancer care services, but also provide valuable insights on priorities that can inform future quality improvement and research activities more broadly. Limitations of this study include the lack of literature available with regard to specifically defining factors relating to successfully coordinated care. The lack of a common definition of coordinated care means that it is more challenging to seek consensus across participants, as participants may attribute different meanings to the term “coordinated care.” The Cancer Institute NSW provided the initial list of stakeholders, and this convenience sample may not represent the views of all oncology health professionals in NSW. For instance, while oncologists were included, it is possible not all specialties were canvassed. In addition, special challenges were faced in obtaining input from certain specialties such as radiation oncology. However, the project team went to considerable lengths to engage a wide variety of participants in the six workshops and ultimately, a wide range of views were represented for the final analysis. In conclusion, this work identifies success factors for coordinated care that are significant in terms of impact on patient outcomes as well as being measurable. These factors lay a strong foundation for the development of KPIs that can be used to link funding with performance. An initial set of KPIs that link to the top two success factors is under development by the Cancer Institute NSW. This project was successful in engaging stakeholders in a priority-setting process that has clear implications for future adoption of KPIs into service delivery. Compliance with Ethical Standards Primary Data: These findings have not been previously published and the manuscript is not being submitted elsewhere. These data have not previously been reported. The authors of this manuscript have full control of all primary data and agree to allow the journal to review the data. Conflict of Interest: There are no actual or potential conflicts of interest Ethical Approval: This is a quality improvement project and no individuals are quoted or identified. No animals were used in this project. Informed Consent: Stakeholders gave informed consent when participating in workshops. The study was completed in compliance with the principles of the Declaration of Helsinki. This is a quality improvement project and no individuals are quoted or identified. Acknowledgments This study was fully funded by the Cancer Institute NSW. References 1. Walsh J, Young JM, Harrison JDet al.   What is important in cancer care coordination? A qualitative investigation. Eur J Cancer Care (Engl) . 2011; 20( 2): 220– 227. Google Scholar CrossRef Search ADS PubMed  2. Walsh J, Harrison JD, Young JM, Butow PN, Solomon MJ, Masya L. What are the current barriers to effective cancer care coordination? A qualitative study. bmc Health Serv Res . 2010; 10: 132. Google Scholar CrossRef Search ADS PubMed  3. Young JM, Masya LM, Solomon MJ, Shepherd HL. Identifying indicators of colorectal cancer care coordination: a Delphi study. Colorectal Dis . 2014; 16( 1): 17– 25. Google Scholar CrossRef Search ADS PubMed  4. Evans SM, Earnest A, Bower W, Senthuren M, McLaughlin P, Stirling R. Timeliness of lung cancer care in Victoria: a retrospective cohort study. Med J Aust . 2016; 204( 2): 75.e1– 75.e9. Google Scholar CrossRef Search ADS   5. Evaluation of the role of cancer care coordinator. 2011; http://www.cancerinstitute.org.au/media/147968/summary%20report%20minus%20es.pdf. Accessed May 3, 2016. 6. Jennings-Sanders A, Anderson ET. Older women with breast cancer: perceptions of the effectiveness of nurse case managers. Nurs Outlook . 2003; 51( 3): 108– 114. Google Scholar CrossRef Search ADS PubMed  7. Yates P. Cancer care coordinators: realizing the potential for improving the patient journey. Cancer Forum . 2004; 28( 3): 128– 132. 8. Department of Health and Ageing GoSA. South Australia lung cancer pathway optimizing outcomes for all South Australians diagnosed with lung cancer. 2013; https://www.sahealth.sa.gov.au. Accessed May 3, 2016. 9. Sellick SM, Edwardson AD. Screening new cancer patients for psychological distress using the hospital anxiety and depression scale. Psychooncology . 2007; 16( 6): 534– 542. Google Scholar CrossRef Search ADS PubMed  10. Freeman RK, Ascioti AJ, Dake M, Mahidhara RS. The Effects of a Multidisciplinary Care Conference on the Quality and Cost of Care for Lung Cancer Patients. Ann Thorac Surg . 2015; 100( 5): 1834– 1838. Google Scholar CrossRef Search ADS PubMed  11. Jefford M, Baravelli C, Dudgeon Pet al.   Tailored chemotherapy information faxed to general practitioners improves confidence in managing adverse effects and satisfaction with shared care: results from a randomized controlled trial. J Clin Oncol . 2008; 26( 14): 2272– 2277. Google Scholar CrossRef Search ADS PubMed  12. Schultz EM, Pineda N, Lonhart J, Davies SM, McDonald KM. A systematic review of the care coordination measurement landscape. bmc Health Serv Res . 2013; 13: 119. Google Scholar CrossRef Search ADS PubMed  13. McDonald KSV, Bravada D, Lewis Ret al.   Care Coordination. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies Technical Review 9 . Shojania K, McDonald K, Wachter R, Owens D, eds 2007, Rockville, MD: Agency for Healthcare Research and Quality: (Prepared by the Stanford University-UCSF Evidence-based Practice Center under contract 290-02-0017); vol. 7; 2007. 14. American Society of Clinical Oncology. The state of cancer care in America, 2014: A report by the American Society of Clinical Oncology. J Oncol Pract . 2014; 10( 2): 119– 142. CrossRef Search ADS PubMed  15. McGuiness C, Sibthorpe B. Development and initial validation of a measure of coordination of health care. Int J Qual Health Care . 2003; 15( 4): 309– 318. Google Scholar CrossRef Search ADS PubMed  16. Seow H, Snyder CF, Mularski RAet al.   A framework for assessing quality indicators for cancer care at the end of life. J Pain Symptom Manage . 2009; 38( 6): 903– 912. Google Scholar CrossRef Search ADS PubMed  17. Rankin NM, McGregor D, Butow PNet al.   Adapting the nominal group technique for priority setting of evidence-practice gaps in implementation science. bmc Med Res Methodol . 2016; 16( 1): 110. Google Scholar CrossRef Search ADS PubMed  18. McGregor D, Rankin N, Butow Pet al.   Closing evidence-practice gaps in lung cancer: results from multi-methods priority setting in the clinical context. Asia Pac J Clin Oncol . 2016. doi: 10.1111/ajco.12499. 19. Public Health Ontario, Health Nexus Canada. Priority setting—four methods for getting to what’s import  ant. Ontario Health Promotion E-Bulletin. 2010, March 5, 2010—OHPE Bulletin 651, Vol. 2010, No. 652. http://www.ohpe.ca/node/11169. Accessed July 26, 2016. 20. COSA. Clinical Oncology Society of Australia: Care coordination workshop report. 2007; https://www.cosa.org.au/media/1063/cosa_report_cancer-care-coordination-workshop_2007.pdf. Accessed April 28, 2016. 21. Services DoHH. Achieving best practice cancer care; a guide for implementing multidisciplinary care. 2007; http://docs.health.vic.gov.au/docs/doc/6675BC2B37531110CA2578E80005F63F/$FILE/multidisciplinarypolicy0702.pdf. Accessed April 28, 2016. 22. COSA. Care coordination outcome measures: building the evidence. 2007; https://www.cosa.org.au/media/185922/COSA-care-coordination-2009-workshop-report-FINAL.pdf. Accessed August 21, 2017. 23. Cancer Council Victoria. Optimal care pathway for people with colorectal cancer. 2014; http://www.cancer.org.au/content/ocp/health/optimal-care-pathway-for-people-with-colorectal-cancer-june-2016.pdf. Accessed August 21, 2017. 24. Division MHaACS. Patient management framework. Breast tumor stream: breast cancer. 2006; www.health.vic.gov.au/cancer. Accessed August 21, 2017. 25. Greenberg A, Angus H, Sullivan T, Brown AD. Development of a set of strategy-based system-level cancer care performance indicators in Ontario, Canada. Int J Qual Health Care . 2005; 17( 2): 107– 114. Google Scholar CrossRef Search ADS PubMed  26. Excellence NIfC. Guidance on cancer services-improving supportive and palliative care for adults with cancer. 2004; http://guidance.nice.org.uk/CSGSP. Accessed August 21, 2017. 27. McDonald KMSE, Albin L, Pineda Net al.   Care Coordination Atlas Version 3 (Prepared by Stanford University under subcontract to Battelle on Contract No. 290-04-0020) . AHRQ Publication No. 11-0023-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2010. 28. Glasgow RE, Wagner EH, Schaefer J, Mahoney LD, Reid RJ, Greene SM. Development and Validation of the Patient Assessment of Chronic Illness Care (PACIC) . Paper presented at: Medical Care; 2005. 29. Ouwens MM, Marres HA, Hermens RRet al.   Quality of integrated care for patients with head and neck cancer: development and measurement of clinical indicators. Head Neck . 2007; 29( 4): 378– 386. Google Scholar CrossRef Search ADS PubMed  30. Peppercorn JM, Weeks JC, Cook EF, Joffe S. Comparison of outcomes in cancer patients treated within and outside clinical trials: conceptual framework and structured review. Lancet . 2004; 363( 9405): 263– 270. Google Scholar CrossRef Search ADS PubMed  31. McDonald KM, Sundaram V, Bravata DMet al.   Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies . Vol. 7: Care Coordination. 2007. 32. Young JM, Walsh J, Butow PN, Solomon MJ, Shaw J. Measuring cancer care coordination: development and validation of a questionnaire for patients. bmc Cancer . 2011; 11: 298. Google Scholar CrossRef Search ADS PubMed  33. NHS Confederation. Coordinated cancer care: better for patients, more efficient. Briefing Issue 203. 2010; http://www.macmillan.org.uk/Documents/AboutUs/Commissioners/CancerCareBriefingJune.pdf. Accessed April 28, 2016. 34. National Quality Forum. Preferred practices and performance measures for measuring and reporting care coordination. 2010; http://www.qualityforum.org/publications/2010/10/Preferred_Practices_and_Performance_Measures_for_Measuring_and_Reporting_care_coordination.aspx. Accessed April 28, 2016. 35. North Eastern Melbourne Integrated Cancer Service. Coordinated Cancer Care Strategy 2012–2013. 2012; http://www.nemics.org.au/icms_docs/177758_NEMICS_coordinated_cancer_care_strategy.pdf Accessed August 21, 2017. 36. Agency for Healthcare Research and Quality. Prospects for Care Coordination Measurement Using Electronic Data Sources. 2014; http://www.ahrq.gov/research/findings/final-reports/prospectscare/index.html. Accessed August 21, 2017. 37. Cancer Institute NSW. Cancer Plan 2011–2015. 2010; https://www.cancerinstitute.org.au/getattachment/2e9328bd-6178-47e8-a6c4-03a7acd8c620/NSW-Cancer-Plan-2011–2015.PDF. Accessed August 23, 2017. 38. Cancer Council Australia. Optimal care pathway for people with lung cancer. 2014; http://www.cancer.org.au/content/ocp/health/optimal-care-pathway-for-people-with-lung- cancer-june-2016.pdf#_ga=2.11026548.1745935410.1503546538-158334493.1502508761. Accessed August 23, 2017. 39. North Eastern Metropolitan Integrated Cancer Services (NEMICS). Enhancing supportive care for people affected by cancer across North East Melbourne. 2010; http://www.nemics.org.au/icms_docs/171576_Supportive_care_strategy.pdf. Accessed August 23, 2017. 40. Cancer Quality Council of Ontario. Strengthening the quality of cancer services in Ontario. 2003; https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=13770. Accessed August 23, 2017. 41. National Breast Cancer Centre. Multidisciplinary meetings for cancer care: a guide for health service providers. 2005; http://www.canceraustralia.gov.au/sites/default/files/publications/mdm-mdc-meeting-for-cancer-care_504af02d7368d.pdf. Accessed August 23, 2017. 42. Cancer Australia. Investigating symptoms of lung cancer: a guide for GPs. 2012; http://canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/investigating-symptoms-lung-cancer-guide-gps. Accessed August 23, 2017. 43. Nekhlyudov L, Latosinsky S. The interface of primary and oncology specialty care: from symptoms to diagnosis. J Natl Cancer Inst Monogr . 2010; 2010( 40): 11– 17. Google Scholar CrossRef Search ADS PubMed  44. Taplin SH, Anhang Price R, Edwards HMet al.   Introduction: understanding and influencing multilevel factors across the cancer care continuum. J Natl Cancer Inst Monogr . 2012; 2012( 44): 2– 10. Google Scholar CrossRef Search ADS PubMed  45. Largey G, Ristevski E, Chambers H, Davis H, Briggs P. Lung cancer interval times from point of referral to the acute health sector to the start of first treatment. Aust Health Rev . 2016; 40( 6): 649– 654. Google Scholar CrossRef Search ADS PubMed  46. McCabe MS, Bhatia S, Oeffinger KCet al.   American society of clinical oncology statement: achieving high-quality cancer survivorship care. J Clin Oncol . 2013; 31( 5): 631– 640. Google Scholar CrossRef Search ADS PubMed  47. Lee SJ, Katona LJ, De Bono SE, Lewis KL. Routine screening for psychological distress on an Australian inpatient haematology and oncology ward: impact on use of psychosocial services. Med J Aust . 2010; 193( Suppl 5): S74– S78. Google Scholar PubMed  48. Grimmer K, Fulton A, Uy J, Dizon J, Pillen H, Gibbs C. Supportive Care Screening Instruments Review . University of South Australia; 2016. 49. Absolom K, Holch P, Pini Set al.  ; NCRI COMPASS Supportive and Palliative Care Research Collaborative. The detection and management of emotional distress in cancer patients: the views of health-care professionals. Psychooncology . 2011; 20( 6): 601– 608. Google Scholar CrossRef Search ADS PubMed  50. Mayer DK, Nekhlyudov L, Snyder CF, Merrill JK, Wollins DS, Shulman LN. American society of clinical oncology clinical expert statement on cancer survivorship care planning. J Oncol Pract . 2014; 10( 6): 345– 351. Google Scholar CrossRef Search ADS PubMed  51. Parry C, Beckjord E, Moser RP, Vieux SN, Padgett LS, Hesse BW. It takes a (virtual) village: crowdsourcing measurement consensus to advance survivorship care planning. Transl Behav Med . 2015; 5( 1): 53– 59. Google Scholar CrossRef Search ADS PubMed  52. Gorin SS, Haggstrom D, Han PKJ, Fairfield KM, Krebs P, Clauser SB. Cancer care coordination: a systematic review and meta-analysis of over 30 years of empirical studies. Ann Behav Med . 2017; 51( 4): 532– 546 Google Scholar CrossRef Search ADS PubMed  53. Jenkinson C, Coulter A, Bruster S. The picker patient experience questionnaire: development and validation using data from in-patient surveys in five countries. Int J Qual Health Care . 2002; 14( 5): 353– 358. Google Scholar CrossRef Search ADS PubMed  54. Harley C, Adams J, Booth L, Selby P, Brown J, Velikova G. Patient experiences of continuity of cancer care: development of a new medical care questionnaire (MCQ) for oncology outpatients. Value Health . 2009; 12( 8): 1180– 1186. Google Scholar CrossRef Search ADS PubMed  © Society of Behavioral Medicine 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 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Translational Behavioral MedicineOxford University Press

Published: May 23, 2018

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