title: Creation of a diagnostic wait times measurement framework based on evidence and consensus.
abstract: OBJECTIVE
  Public reporting of wait times worldwide has to date focused largely on treatment wait times and is limited in its ability to capture earlier parts of the patient journey. The interval between suspicion and diagnosis or ruling out of cancer is a complex phase of the cancer journey. Diagnostic delays and inefficient use of diagnostic imaging procedures can result in poor patient outcomes, both physical and psychosocial. This study was designed to develop a framework that could be adopted for multiple disease sites across different jurisdictions to enable the measurement of diagnostic wait times and diagnostic delay.
  
  
  METHODS
  Diagnostic benchmarks and targets in cancer systems were explored through a targeted literature review and jurisdictional scan. Cancer system leaders and clinicians were interviewed to validate the information found in the jurisdictional scan. An expert panel was assembled to review and, through a modified Delphi consensus process, provide feedback on a diagnostic wait times framework.
  
  
  RESULTS
  The consensus process resulted in agreement on a measurement framework that identified suspicion, referral, diagnosis, and treatment as the main time points for measuring this critical phase of the patient journey.
  
  
  CONCLUSIONS
  This work will help guide initiatives designed to improve patient access to health services by developing an evidence-based approach to standardization of the various waypoints during the diagnostic pathway. The diagnostic wait times measurement framework provides a yardstick to measure the performance of programs that are designed to manage and expedite care processes between referral and diagnosis or ruling out of cancer.
authors: Cancer Care Ontario; University of Toronto; McMaster University; St Joseph's Healthcare; Trillium Health Partners; University Health Network; and Princess Margaret Hospital, Toronto, Ontario, Canada Julie.gilbert@cancercare.on.ca.
authors: Julie E
authors: JE
authors: Gilbert
authors: Cancer Care Ontario; University of Toronto; McMaster University; St Joseph's Healthcare; Trillium Health Partners; University Health Network; and Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Mark J
authors: MJ
authors: Dobrow
authors: Cancer Care Ontario; University of Toronto; McMaster University; St Joseph's Healthcare; Trillium Health Partners; University Health Network; and Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Melissa
authors: M
authors: Kaan
authors: Cancer Care Ontario; University of Toronto; McMaster University; St Joseph's Healthcare; Trillium Health Partners; University Health Network; and Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Julian
authors: J
authors: Dobranowski
authors: Cancer Care Ontario; University of Toronto; McMaster University; St Joseph's Healthcare; Trillium Health Partners; University Health Network; and Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: John R
authors: JR
authors: Srigley
authors: Cancer Care Ontario; University of Toronto; McMaster University; St Joseph's Healthcare; Trillium Health Partners; University Health Network; and Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Audrey
authors: A
authors: Jusko Friedman
authors: Cancer Care Ontario; University of Toronto; McMaster University; St Joseph's Healthcare; Trillium Health Partners; University Health Network; and Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Jonathan C
authors: JC
authors: Irish
mesh_terms: D000465:Algorithms; D019985:Benchmarking; D057210:Delayed Diagnosis; D006297:Health Services Accessibility; D006801:Humans; D007391:International Cooperation; D008495:Medical Oncology / Q000379:methods / Q000592:standards; D017146:Models, Organizational; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D015397:Program Evaluation; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome