title: How can diagnostic assessment programs be implemented to enhance inter-professional collaborative care for cancer?
abstract: BACKGROUND
  Inter-professional collaborative care (ICC) for cancer leads to multiple system, organizational, professional, and patient benefits, but is limited by numerous challenges. Empirical research on interventions that promote or enable ICC is sparse so guidance on how to achieve ICC is lacking. Research shows that ICC for diagnosis could be improved. Diagnostic assessment programs (DAPs) appear to be a promising model for enabling ICC. The purpose of this study was to explore how DAP structure and function enable ICC, and whether that may be associated with organizational and clinical outcomes.
  
  
  METHODS
  A case study approach will be used to explore ICC among eight DAPs that vary by type of cancer (lung, breast), academic status, and geographic region. To describe DAP function and outcomes, and gather information that will enable costing, recommendations expressed in DAP standards and clinical guidelines will be assessed through retrospective observational study. Data will be acquired from databases maintained by participating DAPs and the provincial cancer agency, and confirmed by and supplemented with review of medical records. We will conduct a pilot study to explore the feasibility of estimating the incremental cost-effectiveness ratio using person-level data from medical records and other sources. Interviews will be conducted with health professionals, staff, and referring physicians from each DAP to learn about barriers and facilitators of ICC. Qualitative methods based on a grounded approach will be used to guide sampling, data collection and analysis.
  
  
  CONCLUSIONS
  Findings may reveal opportunities for unique structures, interventions or tools that enable ICC that could be developed, implemented, and evaluated through future research. This information will serve as a formative needs assessment to identify the nature of ongoing or required improvements, which can be directly used by our decision maker collaborators, and as a framework by policy makers, cancer system managers, and DAP managers elsewhere to strategically plan for and implement diagnostic cancer services.
authors.affiliation: Toronto General Research Institute, University Health Network, Toronto, Canada. Anna.gagliardi@uhnresearch.ca.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Gagliardi
authors.forename: Terri
authors.initials: T
authors.lastname: Stuart-McEwan
authors.forename: Julie
authors.initials: J
authors.lastname: Gilbert
authors.forename: Frances C
authors.initials: FC
authors.lastname: Wright
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hoch
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Brouwers
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Dobrow
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Waddell
authors.forename: David R
authors.initials: DR
authors.lastname: McCready
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D003299:Cooperative Behavior; D003365:Costs and Cost Analysis; D019937:Diagnostic Techniques and Procedures; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D012107:Research Design; D018511:Systems Integration