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      Patient experiences of waiting times in standardised cancer patient pathways in Norway – a qualitative interview study

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          Abstract

          Objective

          Standardised cancer patient pathways (CPP) are implemented within cancer care with an aim to ensure standardised waiting times for diagnosis and treatment. This article investigates how patients in Norway experience waiting times within a CPP.

          Methods

          Qualitative semi-structured interviews with 19 patients who had been through CPP for breast cancer, prostate cancer or malignant melanoma in Norway.

          Results

          Few patients knew about the term CPP but trusted that waiting times were standardised to decrease mortality. Their experiences of waiting depended on their expectations as much as the period they waited. Patients generally felt safe about the timing of treatment, but not all expectations of a rapid response from health services were met. Short waiting times were interpreted as a sign of urgency, and a change of pace between urgent action and prolonged periods of waiting were disturbing.

          Conclusions

          Patients are comforted by knowing they are within a structured CPP that ensures rapid diagnosis and start of treatment. CPPs still need to be improved to avoid delays, allow for adaptions to patient needs, and include more information to avoid stress.

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          Most cited references18

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          Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review

          Background: It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. Methods: Systematic review of the literature and narrative synthesis. Results: We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. Conclusions: This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers.
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            A World of Standards but not a Standard World: Toward a Sociology of Standards and Standardization

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              Delay in diagnosis: the experience in Denmark

              Background: Denmark has poorer 5-year survival rates than many other Western European countries, and cancer patients tend to have more advanced stages at diagnosis than those in other Scandinavian countries. Part of this may be due to delay in diagnosis. The aim of this paper is to give an overview of the initiatives currently underway to reduce delays. Methods: Description of Danish actions to reduce delay. Results: Results of surveys of patient-, doctor- and system-related delays are presented and so are the political initiatives to ensure that cancer is seen as an acute disease. Conclusion: In future, fast-track diagnosis and treatment will be provided for suspected cancers and access to general diagnostic investigations will be improved. A large national experiment with cancer seen as an acute disease is currently being implemented, and as yet the results are unknown.
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                Author and article information

                Contributors
                Marit.Solbjor@ntnu.no
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                5 July 2021
                5 July 2021
                2021
                : 21
                : 651
                Affiliations
                [1 ]GRID grid.5947.f, ISNI 0000 0001 1516 2393, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, , Norwegian University of Science and Technology, ; 7491 Trondheim, Norway
                [2 ]GRID grid.4319.f, ISNI 0000 0004 0448 3150, SINTEF, Department of Health Research, ; P.O.Box 4760 Torgården, 7465 Trondheim, Norway
                [3 ]GRID grid.412244.5, ISNI 0000 0004 4689 5540, Department of Oncology, , University Hospital of North Norway, ; Tromsø, Norway
                Author information
                http://orcid.org/0000-0001-8959-4076
                http://orcid.org/0000-0002-8391-2990
                http://orcid.org/0000-0002-9484-2553
                http://orcid.org/0000-0002-4507-0198
                Article
                6679
                10.1186/s12913-021-06679-8
                8256611
                34225705
                69aa11e8-227c-4201-85b7-74d431513a30
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 10 March 2021
                : 24 June 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100005416, Norges Forskningsråd;
                Award ID: 272665
                Award ID: 272665
                Award ID: 272665
                Categories
                Research
                Custom metadata
                © The Author(s) 2021

                Health & Social care
                Health & Social care

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