Are there opportunities to improve care as patients transition through the cancer care continuum? A scoping review

Abstract

Purpose: Patients with cancer experience many Transitions in Care (TiC), occurring when a patient's care transfers between healthcare providers or institutions/settings. Among other patient populations, TiC are associated with medical errors, patient dissatisfaction and elevated healthcare use and expenditure. However, our understanding of TiC among patients with cancer is lacking.

Objective: To map and characterise evidence about TiC among patients with cancer.

Participants: Adult patients with cancer at any stage in the cancer continuum.

Intervention: Evidence sources exploring TiC among patients with cancer were eligible.

Outcome: Evidence sources exploring TiC among patients with cancer using any outcome were eligible.

Setting: Any setting where a patient with cancer received care.

Design: This scoping review included any study describing TiC among patients with cancer with no restrictions on study design, publication type, publication date or language. Evidence sources, identified by searching six databases using search terms for the population and TiC, were included if they described TiC. Two independent reviewers screened titles/abstracts and full texts for eligibility and completed data abstraction. Quantitative data were summarised using descriptive statistics and qualitative data were synthesised using thematic analysis.

Results: This scoping review identified 801 evidence sources examining TiC among patients with cancer. Most evidence sources focused on the TiC between diagnosis and treatment and breast or colorectal cancer. Six themes emerged from the qualitative evidence sources: the transfer of information, emotional impacts of TiC, continuity of care, patient-related factors, healthcare provider-related factors and healthcare system-related factors. Interventions intended to improve TiC among patients with cancer were developed, implemented or reviewed in 163 evidence sources.

Conclusion: While there is a large body of research related to TiC among patients with cancer, there remains a gap in our understanding of several TiC and certain types of cancer, suggesting the need for additional evidence exploring these areas.

Keywords: ONCOLOGY; Organisation of health services; Quality in health care.

Figure 1. The Preferred Reporting Items for Systematic Reviews (PRISMA) flow diagram for the scoping review. The PRISMA diagram details the database searches and selection process applied to the evidence sources during title/abstract screening and full-text screening. The vertical arrows show the flow of the selection process, and the horizontal arrows show the evidence sources that were removed or considered irrelevant. TiC, Transitions in Care.

Figure 2. Pie charts that categorise cancer type (top) and Transitions in Care (TiC) type (bottom) of the included evidence sources. Different colours describe different categories. The total percentage of the categorised cancer type or TiC type is listed below the category (in the pie chart) and beside the side boxes. The thin black lines connected to the coloured boxes denote any cancer or TiC types that were unable to fit within the pie chart. The TiC diagnosis to treatment contains diagnosis to treatment and diagnosis to surgery. Discharge includes any discharge from a healthcare provider, facility or institution. Readmission includes any readmission to a healthcare facility or institution.